Presence Of HLA-B27 Antigen Research Articles

Reactive arthritis in coinfection with Chlamydia trachomatis and Chlamydia pneumoniae

The below case of the development of reactive arthritis against the background of coinfection of Chlamydia trachomatis and Chlamydia pneumoniae is interesting by the features of the clinical picture, the duration of the course, the complexity of diagnosis, laboratory observation, and a comprehensive approach to therapy.
 Reactive arthritis belongs to the group of seronegative spondyloarthritis, has a variety of symptoms with damage to various organs and systems. All patients have pathology of peripheral joints and/or axial skeleton. The disease is immuno-inflammatory in nature, may follow an infection of the genitourinary or digestive tract. A special role in the development of urogenic reactive arthritis is assigned to Chlamydia trachomatis. Less often, reactive arthritis is caused by C. pneumoniae. In the case of persistent infection, non-simultaneous development or low expression of symptoms, the diagnosis of reactive arthritis is difficult, and in about one case out of five, the disease becomes chronic. Predisposition to severe course of reactive arthritis may cause the presence of HLA-B27 antigen in the patient. It can be assumed that coinfection of two varieties of chlamydia (C. pneumoniae and C. trachomatis) can act synergistically, increasing the risk of developing reactive arthritis.
 The available data on the effectiveness of the complex of antibacterial anti-chlamydia drugs, own experience of the lymphotropic method of administration, has been successfully used in the complex treatment of the patient.

P022 Genetic background predicts the extra-articular involvement in patients with enthesitis related arthritis

Abstract Background Enthesitis-related arthritis (ERA) represents 20% of all juvenile idiopathic arthritis subtype. Among the genetic risk factors for the development of ERA, HLA-B27 has been implicated as a major contributor. The frequency of HLA-B27 varies among population. HLA-B 27 status in ERA may influence the clinical phenotype and prognosis of the disease. The main objective of this study is to determine whether genetic background including HLA B27 and familial history of spondylarthritits (SpA) may influence the clinical features of ERA patients. Methods We conducted a retrospective study including patients with ERA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria. For all patients, we collected the following data: Age, family history of rheumatic inflammatory diseases, inflammatory bowel diseases (IBD), the presence of HLA-B27 antigen, the inflammatory biomarkers: Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP), the disease activity assessed by morning stiffness, night awakenings, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the current treatment. We assessed, as well, the functional impact using the Bath Ankylosing Spondylitis Functional Index (BASFI) the Lequesne index. The population was divided into two groups: a group including patients positive to HLA-B27 antigen and/or with family history of rheumatic inflammatory diseases, psoriasis or inflammatorybowel diseases. The second group was defined as control group with patients negative to HLA-B27 antigen and without any family history of the diseases above. Results We included 40 ERA patients, mean age of onset 12,43 ± 3,003 years (6–16). The majority of them were male (n = 34). Twenty-eight patients had a genetic background. Among them, 7,5% of patients had a positive family history, 42,5% were positive to HLA-B27 antigen and 20% of them met both criteria. As shown in table 1, clinical manifestations were similar between the 2 groups. Enthesitis was more frequent in patients with HLAB27 without a significant difference. Regarding the disease activity, the number of night awakenings and the morning stiffness duration were comparable in the two groups. Six patients had a BASDAI score > 4 with no difference between the two groups. Extra-articular manifestations were present in 15 patients. Among them 14 had a genetic background, reaching the significance threshold with P = 0,013. We counted 8 cases of uveitis, one case of IBD, 5 cases of lung disease and 1 case of cardiac involvement. Inflammatory markers were higher in the group with familial history of SpA and/or positive HLAB27. Indeed, the mean ESR value was 42,73 vs 29.9, P = 0,01. There were no correlations between BASFI score and a positive genetic background (P = 0,283). Only one patient was put on biologics. He has no family history and is negative to HLA-B27 antigen. Conclusion The frequency of HLAB27 was in line with the literature data. The genetic background did not influence the disease activity or the functional impairment in our population. However, a positive correlation was found between a positive familial history of SpA, HLAB27, and the presence of extra-articular manifestations as well as with a higher ESR value.

REASONS FOR DIAGNOSTIC DELAYS OF AXIAL SPONDYLOARTHRITIS

Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases' activity has a comparable impact on the patients' quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists. Material and methods: We performed a retrospective analysis of the records of 82 patients' with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older. Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) - group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t. Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists' help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only "imaging biomarker". The presence of extra-axial symptoms does not improve the diagnostic sensitivity.

ETANERCEPT TREATMENT RESULTS IN CHILDREN WITH NON-SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: REMISSION, RECRUDESCENCE, AND ADVERSE EVENTS. RETROSPECTIVE COHORT STUDY

Background.Etanercept is a biological drug most commonly used in patients with juvenile idiopathic arthritis (JIA). The results of its use are showed in local studies.Objective.Our aim was to evaluate the efficacy and safety of the use of etanercept in children with non-systemic JIA, to determine the predictors of remission and the risk factors for the development of exacerbations.Methods.In a retrospective cohort study, the results of etanercept treatment (remission, exacerbations, adverse events) in children with non-systemic JIA were analyzed. The minimum follow-up period was 6 months.Results.The period of remission within 6–36 months occurred in 77/131 (58.8%), exacerbations developed in 18/129 (14.0%) patients. Predictors of achieving remission were the age of JIA onset < 8 years [relative risk (RR) 2.05; 95% confidence interval (CI) 1.27–3.23], the age of prescribing etanercept ≤ 10 years (RR 1.7, 95% CI 1.22–2.38), the time of the disease prior to etanercept prescription < 2.5 years (RR 2.4, 95% CI 1.4–4.4), the presence of HLA-B27 antigen (RR 2.15, 95% CI 0.98–4.75; p = 0.06). The risk of exacerbations was higher in children with polyarticular JIA (RR 2.7, 95% CI 0.9–8.2; p = 0.08), whereas methotrexate therapy reduced the risk of exacerbations (RR 0.32, 95% CI 0.1–1.15; p = 0.05). Etanercept was discontinued due to primary (improvement by the ACRpedi criteria after 3 months of therapy <30%) or secondary (loss of previously achieved ≥ 30% improvement) failure in 14/152 (9.2%) patients; de novo uveitis developed in 8/152 (5.3%) patients; reactions at the injection site — in 6/152 (4.0%) patients.Conclusion.Therapy involving etanercept is more likely to induce remission in younger patients with JIA onset at the age of 8 years and a history of less than 2.5 years. A high risk of exacerbations was noted in patients with polyarticular JIA, and low one — in those receiving methotrexate as a part of combined therapy.

CLINICAL COURSE OF JUVENILE IDIOPATHIC ARTHRITIS IN HLA-B27-POSITIVE PATIENTS IN ADULTHOOD

Relevance. The existence of associations between histocompatibility antigens and JIA variants has been proved. There is no consensus that the JIAs associated with HLA-B27 antigen are transformed in adulthood into other diseases for which it is necessary to revise the diagnosis, according to the adult classification of rheumatic diseases. Is this one process that began in childhood and continues into adulthood, and whether these two processes that begin in childhood and adulthood have common signs and differences? There is few data about the hallmarks of the disease and outcome in adulthood. 
 Objective. – To investigate the frequency of HLA-B27 detection in adult patients with a history of JIA and to evaluate the clinical features of the course of arthritis in adulthood and the long-term articular and extra-articular consequences of JIA.
 Materials and methods. A survey of 132 young adult patients with different variants of JIA in the history (70 women, 62 males), aged – 24,3±8,3 years; disease duration – 13,6±9,3 years. We evaluated body mass index, anamnestic data, visual analogue scale, C-reactive protein quantitatively, HLA-B27, rheumatoid factor (RF), IgG-antibody to cyclic citrulline peptide (anti-CCP) and antinuclear antibody (АNА). Long-term effects JIA assessed by joint indices (JADI-A) and extraarticular (JADI-E) damage. Disease activity in childhood and adulthood was assessed on a scale JADAS (Juvenile Arthritis Disease Activity Score) and DAS 28. For statistic analises we use the Statistica 6.0 software packages Copyright © StatSoft, Inc. 1984-2001.
 Results. HLA-B27 was found in 38 patients with JIA (28,8 %), including 95 % of patients with enthesitis-related arthritis, 28,1 % – with persistent oligooarthritis and 36,8 % of patients with extended oligoarthritis, 8,3 % – with RF-positive JIA and 10,5 % – with the systemic onset JIA. According adult classification 61,5 % of patients with positive HLA-B27 antigen in adulthood developed ankylosing spondilitis or undifferentiated spondiloarthritis, in 22,7 % – undifferentiated arthritis, 100 % – psoriatic arthritis and 31,8 % – remission of the disease. In the childhood in HLA-B27 (+) patients, symmetrical joint damage (20,5 %, p<0,0001), enthesitis (20,5 %, p<0,05), lesion of the joints of the hands (26,4 %, p<0,05), defeat of more than 3 peripheral joints (36,8 %, p <0,05) and longer morning stiffness (Ме 40 [20; 60] min, p<0,001) were observed more often, compared with adult age. In adulthood, pain in the spine was significantly more frequent (27,5 %, p<0,01), as well as sacroilitis (15,0 %, p<0,05) and oligoarthritis (45 %, p<0,01). Only 21 % HLA-B27-positive patients received NSAIDs, 26,3 % had one DMARD and NSAIDs, 31,6 % had more than one DMARDs, and 21,1 % had a combination of different DMARDs and biological therapy (BTs). In childhood 58,3 % of patients received glucocorticoids and in adulthood only 22,2 % of patients but this difference was not significant. 42,1 % of adults needed intensification of therapy, 26,3 % of patients required BT. The most significant joint damages (JADI-A) in adulthood were found in the anti-CCP/RF-positive patients (3,04±4,90), whereas HLA-B27- positive patients had the lowest rates of this index, that shows the development of less remote negative consequences. Extra-articular damages (JADI-E) were most pronounced in АNА-positive patients (1,31±1,49), compared with a more favorable course in the groups anti-CCP/RF- (0,38±0,70; p <0,05) and HLA-B27-positive (0,50±1,06; p <0,05) patients.
 Conclusion. Clinical manifestations of articular syndrome have certain age-related pecularities in HLA-B27-positive patients with JIA: symmetrical joint damage, enthesitis, lesion of the joints of the hands, affections of more than 3 peripheral joints, and more prolonged morning stiffness are observed in childhood but in adulthood, pain in the spine, sacroilitis and oligoarticular lesion are more common. The presence of HLA-B27 antigen in patients with JIA is associated with the development of a smaller number of long-range articular damage (JADI-A), compared to the anti-CCP/RF-positive group (p <0,05) and less of the remote extra-articular effects (JADI- E) compared with the group of ANA-positive patients (p <0,05) in an adulthood.

Cutaneous manifestation of reactive arthritis: Case report

Abstract Introduction Reactive arthritis (ReA) is one of the forms of seronegative spondyloarthropathies. The difficulties in the diagnosis of reactive arthritis, despite a complex clinical picture, result from the lack of unequivocal diagnostic criteria, especially in the initial period. Diverse clinical manifestation of ReA may require the cooperation of many specialists. Aim The case of a 59-year-old man with reactive arthritis caused by an acute Yersinia enterocolitica infection 3 weeks before was described. Case study A 59-year-old patient, so far healthy, was admitted due to fever for a few days, pain and swelling of crurotalar joints, pain in the left part of the lumbosacral region, escalating at night, and additional complaints impeding urinating. Joint involvement was accompanied by numerous cutaneous and mucosal lesions. Results and discussion In this case the presence of characteristic cutaneous symptoms as keratoderma blenorrhagicum and balanitis circinata allowed to identify the disease quickly, despite a short course of the disease. The presence of antibodies of Y. enterocolitica IgA was noticed, without the presence of IgG and IgM. The presence of HLA B27 antigen was positive. In this case, the occurrence of many characteristic cutaneous lesions enabled a quick identification of the disease, despite the difficulties with determining the etiological factor. Conclusions The diagnosis of ReA is clinical, based on the history and physical examination findings. A high index of suspicion is required because no laboratory tests, markers or imaging finding allow diagnosing of ReA. The most important is proper cooperation between a rheumatologist and a dermatologist.

AB0917 Clinical, biological and radiological particularities of destructive hip arthritis in ankylosing spondylitis

BackgroundThe hip involvement in patients with ankylosing spondylitis (AS) has been recognized as a common and disabling problem. Many radiological pattern of hip arthritis were recognized and seems to have...

AB0889 Low percentage of MRI changes in clinically suspected axial spondyloarthritis

BackgroundThe prevalence of Ankylosing Spondylitis (AS) reaches about 0.9%, starts at a relatively young age and the burden of the disease is considerable. A diagnostic algorithm was developed in order...

Elevated levels of anti‐endotoxin antibodies in patients with bilateral idiopathic acute anterior uveitis

Endotoxins have been proved to be responsible for acute anterior uveitis (AAU) in animals in a well-established experimental model of endotoxin-induced uveitis (EIU). The purpose of our study was the detection of antibodies against endotoxins of selected enterobacteria in the serum of patients with idiopathic AAU and searching for correlations between the levels of these antibodies and the presence of HLA-B27 antigen as well as characteristic signs of EIU such as bilaterality and the absence of spontaneous recurrences of the disease. Reactions of serum IgG antibodies with lipopolysaccharides (LPSs) of Escherichia coli O1, E. coli O10, E. coli O111, E. coli J5, and Klebsiella pneumoniae O3 were determined for 60 patients with idiopathic AAU and 40 healthy volunteers. The presence of HLA-B27 antigen in patients was determined. Documentation of the frequency of recurrences of AAU during a follow-up period of 8 years was collected. We have observed that the sera of patients with a first attack of AAU reacted stronger with the LPS of K. pneumoniae O3 than the sera of patients with relapse of the disease. Patients with bilateral AAU had markedly higher levels of antibodies against four of the five used LPSs than patients with one eye involved. A multiply comparison showed higher levels of IgG reacting with LPS of E. coli O111 in patients with bilateral eye inflammation admitted with the first attack of AAU comparing to controls. The incidence of recurrent form of AAU was significantly increased in HLA-B27-positive patients compared to HLA-B27-negative patients. However, we found in HLA-B27 carriers that those with the bilateral form of AAU had over three times smaller risk of recurrence and showed stronger immunization by endotoxins than patients with unilateral inflammation. Our results suggest a potential role of endotoxins in the aetiology of the nonrecurrent bilateral form of AAU. We suggest that not only HLA-B27 status but also determination of number of involved eyes may be useful to assess the risk of recurrence of the idiopathic AAU.

Arthrite réactionnelle après infection par Clostridium difficile chez deux enfants

In adults, reactive arthritis (ReA) following Clostridium difficile-enterocolitis has been documented. In children, only one case of Clostridium difficile (C. difficile) associated ReA in a child has been reported. We now describe 2 other cases of ReA associated with C. difficile in children. The characteristics of ReA due to C. difficile appear to be similar in adults and children. Both children showed poly-arthritis after an episode of diarrhoea with positive stool cultures for C. difficile. Arthritis was asymmetrical with a self-limiting course. Nonsteroidal anti-inflammatory drug (NSAID) therapy was sufficient. One case is remarkable because of its prolonged course of ReA despite NSAID therapy, and its association with the presence of HLA B27 antigen.

Clostridium difficile-associated reactive arthritis in two children

In adults, reactive arthritis (ReA) following Clostridium difficile-enterocolitis has been documented. In children, only one case of C. difficile-associated ReA has been reported. We now describe two other cases of ReA associated with C. difficile in children. The characteristics of ReA due to C. difficile appear to be similar in adults and children. Both children show polyarthritis after an episode of diarrhoea with positive stool cultures for C. difficile. Arthritis is asymmetrical with a self-limiting course. Nonsteroidal antiinflammatory drug (NSAID) therapy is sufficient. One case is remarkable because of its prolonged course of ReA despite NSAID therapy, and its association with the presence of HLA-B27 antigen.

Lower level of synovial fluid interferon-gamma in HLA-B27-positive than in HLA-B27-negative patients with Chlamydia trachomatis reactive arthritis

To compare the synovial fluid (SF) concentrations of various cytokines in rheumatoid arthritis (RA) and in reactive arthritis, and to look for a correlation between cytokine levels and the presence of HLA-B27 antigen in reactive arthritis patients. Concentrations of interleukin (IL) 10, IL-12, IL-18, interferon gamma (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were determined by commercially available enzyme-linked immunosorbent assays (ELISA) in the SF from 48 patients with reactive arthritis, 33 with RA and 13 with osteoarthritis (non-inflammatory controls). The SF concentrations of IL-10 were significantly lower in patients with reactive arthritis (median 2.3 pg/ml) than in RA patients (median 14.6 pg/ml). The SF levels of IFN-gamma were not significantly different but the ratios of IFN-gamma to IL-10 were significantly higher in patients with reactive arthritis (median 9.2) than in RA patients (median 0.83). When the subset of patients with Chlamydia trachomatis reactive arthritis was considered, the SF concentration of IFN-gamma was significantly lower in HLA-B27-positive (median 2.9 pg/ml) than in HLA-B27-negative patients (median 42.4 pg/ml). After 2 yr of follow-up, two HLA-B27-positive patients, who had low SF levels of IFN-gamma, had a chronic course of arthritis, whereas after 1 yr all HLA-B27-negative patients had complete resolution of arthritis. The lower IFN-gamma concentrations in HLA-B27-positive patients with C. trachomatis reactive arthritis could be related to the tendency of these patients to have more severe or chronic arthritis.

Tropical arthritis in Papua New Guinea: a reactive arthritis

An idiopathic, asymmetrical oligoarthritis affecting young adults is prevalent in the tropical regions of Africa, Asia and Melanesia. A serological study was undertaken in 23 consecutive patients with polyarthritis. Each patient was assigned two paired control subjects. A standardized history, physical examination and investigations were performed. Acute and convalescent sera were examined for evidence of recent infection. The presence of HLA-B27 was determined. Twelve (52%) of the 23 patients had more than one of the clinical features of a reactive arthritis. No serological evidence was found of acute infection with viruses (arboviruses, enteroviruses, mumps, rubella, adenoviruses, Epstein-Barr virus and hepatitis B), Chlamydia, Mycoplasma, Yersinia or syphilis. HLA-B27 was found in 14 (61%) of the 23 patients in contrast with in seven (17%) of the 41 control subjects (P less than 0.001). In two patients with HLA-B27, diagnostic titres of antibodies to Campylobacter jejuni-Campylobacter coli indicated recent infection. The presence of HLA-B27 antigen was significantly (P less than 0.05) associated with the presence of the clinical features of reactive arthritis. This study suggests that "tropical arthritis" commonly is a reactive arthritis that is associated with the presence of HLA-B27.

Aortic Insufficiency With Mild Ankylosing Spondylitis in Black Men

Two black male patients with aortic insufficiency were later found to have mild, asymptomatic ankylosing spondylitis, evident from roentgenograms and from the presence of HLA-B27 antigen. The two cases emphasize the even "subclinical" ankylosing spondylitis may have aortic insufficiency, and that the uncommon occurrence of ankylosing spondylitis in black patients may also be associated with this extra-articular manifestation.