Seronegative Spondylarthropathies Research Articles

Ankylosing spondylitis in Senegal: epidemiological, diagnostic, therapeutic and evolutionary features at the Hospital Center University Aristide Le Dantec, Dakar

Introductionla spondylarthrite ankylosante (SA) est une maladie évolutive, pouvant s'aggraver par une invalidité. Le but de notre étude est de décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la SA dans le service de rhumatologie du Centre Hospitalier Universitaire Aristide LeDantec à Dakar.Méthodesil s´agissait d´une étude transversale descriptive et analytique, avec un recueil de données à la fois prospectif et rétrospectif sur une période de 8 ans, entre janvier 2012 et décembre 2020, sur des patients atteints de SA de diagnostic établi en accord avec les critères diagnostiques d´Amor, de l´ESSG (European Seronegative Spondylarthropathy Group), d´ASAS (Assessment of Spondyloarthritis International Society) et les critères de New York modifié pour la SA. Les données ont été recueillies par le biais d'un questionnaire structuré et analysées à l´aide du logiciel SPSS25 (Statistical Package for the Social Sciences).Résultatssix cent quarante-sept (647) patients ont répondu aux critères d´inclusions; 414 femmes et 233 hommes soit un sex ratio de 1,77F/1H. Différentes formes symptomatiques étaient obtenues: les formes axiales (55,65%), les formes mixtes (44,35%) et les formes systémiques avec manifestation extra-articulaires: uvéites (12,21%), insuffisance aortique (5,71%) et maladie fibrobulleuse des poumons (3,86%). Soixante pourcent (60%) des patients étaient sous antiinflammatoires non stéroïdiens (AINS), 47% sous méthotrexate et 0,92% sous biothérapie. Les indices d´activité de la maladie, les indices fonctionnels et les indices de la qualité de vie ont permis le suivi de la maladie.Conclusionnos résultats ont montré une prédominance féminine. Les formes axiales étaient les plus représentées. Plus de la moitié de nos patients étaient sous antiinflammatoires, 47% sous méthotrexate et 0,92% sous biothérapie. Cette étude a permis de comprendre le poids de la SA dans les spondyloarthrites et son évolution dans le temps.

Assessment of the safety, tolerability and effectiveness of first Russian generic aceclofenac in patients with undifferentiated peripheral inflammatory arthritis

To evaluate the effectiveness and tolerability of the drug in patients with undifferentiated peripheral inflammatory arthritis (UPIA). We observed 60 patients (39 women and 21 men) met G. Hazlewood et al., UPIA criteria, 2011. Patients were divided into 3 groups: with monoarthritis, oligoarthritis and polyarthritis. They took aceclofenac 100 mg twice day for 3 weeks. We noted significant decreasing in pain level according to visual analogue scale: in patients with monoarthritis by 69.3 mm (p0.001); in oligoarthritis group by 47.5 mm (p0.001), in patients with polyarthritis by 30 mm (p0.001). The life quality by the EQ-5D-5L index was improved too in all groups from 0.616 to 0.829 (p0.001). The satisfaction with the therapy was: in monoarthritis patients (80% of patients and 93% of doctors noted good results), in oligoarthritis group (53% and 39% accordingly) and polyarthritis (74% and 64% respectively). We suppose the difference was due to the fact that mono- and oligoarthritis patients suffered from initial forms of seronegative spondylarthropathy, in which the effectiveness of NSAIDs is traditionally higher; polyarthritis patients probably had debut of rheumatoid arthritis. Adverse events of therapy were mild. We noted gastrointestinal tract symptoms (dyspepsia) and increased ALT in 10 patients and increased blood pressure in 1 patient. The symptoms did not require discontinuation of therapy. Сonclusion. Post-registration observational study of first Russian generic aceclofenac (Alental, Vertex, Russia) was conducted. In UPIA patients aceclofenac therapy was most effective in mono- and oligoarthritis patients. The first Russian generic aceclofenac (Alental, Vertex, Russia) has good efficacy, tolerability and safety and can be recommended for arthritis treatment.

SAPHO syndrome the therapeutical challenge

Introduction: Sapho syndrome is a syndrome characterizing with osteoarticular end dermatologic symptoms. Acronym 'SAPHO' means: S-Sinovitis, A-Acne, H-Hyperostosis, O-Osteytis. SAPHO syndrome has a 50 different names in existing literature. For now, etiology remains unclear, but it belongs to group of seronegative spondylarthropathies. Therapy of SAPHO includes NSAIL, glucocorticosteroids, disease modifying anthireumatic drugs (DMARD), antibiotics, bifosfonatos, and anti TNF - alfa drugs with variable success. Case outline: Patient P.Z, 47 age, female, comes in the hospital, because of pain in anterior chest, with propagation in right arm, end morning stiffness in sacral part, which passes short after. Also, with recidivant pustules on the palms, bilaterally, which precedes itch. Bone scintigraphy was performed: There is a clear increasing binding of radiopharmacs in projection of strenoclavicular joint, and slightly in both shoulders and both knees. HP: Pustulosis palmoplantaris. We introduced in therapy azithromycin in the dose of 500 mg, two times weekly, for 16 weeks. Patient, one year after, is without relapses of arthritis and skin lesions. Conclusion: This report has goal, to get more knowledge about this rare disease, and to be easier for recognition. Also we want to introduce other physicians, of varying specialities, like orthopaedics, and other surgeries, with this disease, not only rheumatologists, dermatologists, and pediatrics.

Skeletal indicators of reactive arthritis: A case study comparison to other skeletal conditions, such as rheumatoid arthritis, ankylosing spondylitis, ankylosing sero-negative SpA, and DISH

In this case study we report a unique modern case of severe reactive arthritis (Reiter's Syndrome) observed on an elderly Cypriot female from the St. Nicholas cemetery in Limassol, Cyprus and the successful differential diagnosis of the condition. The individual exhibited lesions specific to fusion of the thoracic and lumbar spinal column, primarily along the posterior aspect of the spine with sacroiliac fusion, fusion of the left femoral head within the acetabulum, no intervertebral fusion, and severe Launois’s deformity with no corresponding fusion or arthritis mutilans of the hands. Diagnosis of reactive arthritis is much more compatible than other common HLA-B27 related seronegative spondylarthropathies such as ankylosing spondylitis, psoriatic arthropathy, or enteropathic arthropathy given the suite of conditions present. We conclude with the confirmation of reactive arthritis and stress the importance of having a broad literature base when making differential diagnoses.

Immune cell transcript modules reveal leukocyte heterogeneity in synovial biopsies of seronegative spondylarthropathy patients.

BackgroundThe objective of this study was to identify leukocyte cell types found within the synovia of patients with seronegative spondylarthropathies (SpA), such as ankylosing spondylitis (AS), using transcription based analyses.MethodsLeukocyte transcriptional profiles obtained from the NCBI’s gene expression omnibus and prediction analysis of microarrays (PAM) was used to identify 25-gene leukocyte metagenes. Subsequently, transcriptional profiles from murine and clinical models of AS and SpA were interrogated to characterize the local infiltration of leukocytes in SpA synovia.ResultsAnalysis of a proteoglycan-induced murine model of AS reveals infiltration of dendritic cells, CD4+ T cells, monocytes, and natural killer cells to the spine. In human SpA and AS patients, transcriptional analysis of synovial biopsies revealed local infiltration of dendritic cells and CD4+ T cells.ConclusionsWe identified leukocyte cell types that infiltrated the synovial of SpA patients. Our results imply a role for dendritic cells and CD4+ T cells in the local inflammation that underlies pathogenesis in patients with SpA.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-446) contains supplementary material, which is available to authorized users.

Application of 18F-FDG PET or PET/CT in the diagnosis and treatment monitoring of rheumatic disease

18F-FDG PET or PET/CT plays an important role in the differential diagnosis of rheumatic disease.By imaging evaluation of glucose metabolism,18F-FDG PET or PET/CT can identify disease activity and distribution.It can also evaluate treatment response of rheumatic disease based on the change of glucose metabolism between baseline and follow-up studies.This article reviews the clinical application of 18F-FDG PET or PET/CT in rheumatoid arthritis (RA),seronegative spondylarthropathy (SpA),large vessel vasculitis (LVV),polymyalgia rheumatica (PMR) and adult onset Still's disease (AOSD). Key words: Rheumatic diseases; Tomography, emission-computed; Tomography, X-ray computed ; Deoxyglucose; Trends

Bamboo spine – X-ray findings of ankylosing spondylitis revisited

Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions), florid diskitis (Andersson lesions), early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures. Typical radiological abnormalities are pointed out on conventional X-rays and reviewed for early diagnosis and prompt treatment of patients at risk.

Bamboo spine – X-ray findings of ankylosing spondylitis revisited

Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions), florid diskitis (Andersson lesions), early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures. Typical radiological abnormalities are pointed out on conventional X-rays and reviewed for early diagnosis and prompt treatment of patients at risk.

Periodontal Disease as a Risk Factor for Rheumatoid Arthritis: A Systematic Review.

Types of participants This review will consider for inclusion, studies that include patients with diagnosed rheumatoid arthritis with or without a clinical diagnosis of chronic periodontitis. Participants will be at least 45 years of age and both genders will be considered. The lower age limit was selected in order to be as inclusive as possible, however, studies specifically focussing aggressive forms of periodontitis will not be included as the aetiology is likely to be different. Studies were the focus is patients with co-morbidities that may impact on periodontal disease and/or rheumatoid arthritis will not be considered as they are outside the scope of this review. Diagnosis of periodontal disease should be based on the clinical and radiographic criteria described by the 1999 Consensus Classification of Periodontal Diseases. 19 Focus of the review The focus of this systematic review is the epidemiological association between periodontal disease and rheumatoid arthritis. Types of outcomes This review will consider studies that aim to establish periodontal disease as a risk factor for rheumatoid arthritis. Outcomes measures considered will include, but are not limited to: Primary Outcomes Studies that include either or both clinical and laboratory measurements that describe rheumatoid arthritis using criteria by the American College of Rheumatology 3 will be considered for inclusion. Outcomes measures such as DAS-28, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), citrullinated proteins (CCP) and rheumatoid factor (RF) will be considered. Secondary Outcomes A secondary outcome of interest in the tooth loss in rheumatoid arthritis sufferers as a result of periodontal disease.

Psoriatic arthritis in two patients with an inadequate response to treatment with tocilizumab

Psoriatic arthritis (PsA) is considered as one of the seronegative spondylarthropathies. Like rheumatoid arthritis (RA), the increased production of interleukin (IL)-6 suggests a pathogenic role of IL-6 in PsA. However, whether humanized anti-IL-6 receptor antibody such as tocilizumab (TCZ) might be effective for PsA as well as RA has yet to be determined. We report herein two cases of PsA treated using TCZ. Although, TCZ treatment resulted in disappearance of serum CRP in both patients, arthritis and skin lesions were not improved despite 6-month administration of TCZ. In contrast, tumor necrosis factor (TNF) inhibitor proved effective against arthritis and skin lesions in these patients. Collectively, these findings not only indicate that IL-6 has distinct pathological roles in RA and PsA, but also suggest that TNF inhibitor therapy (but not TCZ) is effective for arthritis and skin lesions of PsA.

Recurrent new-onset uveitis in a patient with rheumatoid arthritis during anti-TNFα treatment

Inflammation involving the uveal tract of the eye, termed uveitis, is frequently associated with various rheumatic disease, including seronegative spondylarthropathies, juvenile rheumatoid arthritis, Crohn's disease and Behçet's disease. Scleritis and keratitis may be associated with rheumatoid arthritis and systemic vasculitides such as Wegener's granulomatosis. Immune-mediated uveitis can have a chronic relapsing course and produce numerous possible complications, many of which can result in permanent vision loss. Treatment typically includes topical or systemic corticosteroids with cycloplegic-mydriatic drugs and/or noncorticosteroid immunosuppressants, but often there is an insufficient clinical effectiveness. Anti-TNFalpha therapy is promising in the treatment of sight threatening uveitis, particularly in patients with Behçet's disease. However, there have been also reports of new-onset uveitis during treatment of joint disease with TNFalpha inhibitors. We describe a case of new-onset uveitis in a patient with rheumatoid arthritis during therapy with etanercept at first and infliximab at last. Although we cannot exclude uveitis as linked to rheumatoid arthritis, it is unlike that the uveitis arises when the joint disease is well controlled. The hypothetical paradoxical effect of anti-TNF is here discussed.

Recurrence of severe low back pain due to myeloproliferative disorder in a patient affected by seronegative spondyloarthropathy

Sir, A 62-year-old Italian woman was diagnosed with seronegative spondyloarthropathy in 1999; the diagnosis was based on inflammatory lumbar pain and severe bilateral hip arthritis. The patient was successfully treated with methotrexate and NSAIDs for a long time. An IgG/K M component was known since 1997 with fewer than 10% plasma cells in the bone marrow, no amounts of M-protein in the urine, and absence of hypercalcaemia and renal insufficiency. In 2009, in spite of therapy, the patient complained recurrence of severe low back pain. The opportunity to start an anti-TNF inhibitor drug was considered, but a CT scan of lumbar spine showed multiple osteolytic lesions (Fig. 1). Laboratory evaluation demonstrated for the first time polyglobulia (haemoglobin level 15.6 g/dl, haematocrit 54.1%) and showed the stability of the M component; WBC and platelet counts were normal as well as serum calcium and creatinine levels. Histological evaluation of a CT scan-driven vertebral biopsy showed a markedly hypercellular bone marrow with trilinear hyperplasia, along with a slightly delayed maturation of all lineages and some atypia of megakaryocytes (Fig. 2; magnification 4009; haematoxylin and eosin staining). The morphological picture was deemed consistent with the diagnosis of myeloproliferative disorder. The plasma cell component was also increased, in agreement with the concomitant presence of monoclonal gammopathy of undetermined significance. The V617F/Jak2 mutation was found, as known Jak2 mutation is present in nearly all patients suffering from polycythemia vera and in roughly every second patient suffering from essential thrombocythemia and primary myelofibrosis. The final diagnosis was low back pain due to polycythemia vera in patient affected by seronegative spondyloarthropathy and monoclonal gammopathy of undetermined significance. Patients affected by seronegative spondylarthropathies may present low back pain due to other causes like

Psoriatic arthritis

Psoriatic arthritis (PSA) is an entity of inflammatory joint disease associated with psoriasis. PSA belongs to the heterogeneous group of seronegative spondylarthropathies. Both peripheral joints and axial skeleton can be affected in a characteristic pattern. In addition to that, enthesitis and dactylitis are important extracutaneous manifestations. Uveitis anterior is temporarily seen in about one quarter of PSA patients. There is a closer relationship of nail and joint disease. This review provides data on drug and physical treatment options. In particular DMARDS and inhibitors of tumor necrosis factor alpha are established therapies with importance for quality of life and long term outcome. New drugs are tested in various trials.

Rheumatology in Iran

Rheumatology in Iran started in the 1960s by a group of eight rheumatologists trained in France and Switzerland. The Iranian Rheumatology Society was founded in 1973. Academic rheumatology started in the city of Teheran (capital of Iran), by the Tehran University and by the National University in the '60s. Later, Shiraz University and Mashhad University followed. After the creation of the subspecialty Board of Rheumatology in 1985, other universities gradually created their rheumatology sections with the help of newly trained rheumatologists. The first subspecialty rheumatology outpatient clinic was created in 1970, in Tehran. In 1973, rheumatology was recognized as an internal medicine subspecialty for the training of medical students. Thus, one-eighth of internal medicine training was allocated to rheumatology. The subspecialty Rheumatology National Board was created in 1985. Four medical universities were approved for the training of rheumatology fellows. They were Tehran University, Beheshti University, Iran University, and Shiraz University of Medical Sciences. From 1985 to 2008, more than 150 rheumatologists got their Board of Rheumatology subspecialty. Thirty-seven medical universities in Iran have a rheumatology section. The prevalence of musculoskeletal complaints in people aged 15 years and over, is 41.9% in urban areas and 66.6% in rural areas (P < 0.001). Two major ethnicities live in Iran; Caucasians (71.4%) and Turks (23.1%). Musculoskeletal complaints are more frequent in Turks than in Caucasians (46%vs.40.8%, P < 0.001). Men complained less than women in urban areas: 34.1% versus 50.2% (P < 0.001). The same was seen in rural areas: 51.6% versus 72.4% (P < 0.001). The most frequent complaints were (urban vs. rural): knee (25.5%vs. 39.2%), dorsolumbar spine (21.7%vs. 41.9%), shoulder (14.5%vs. 22.7%), and cervical spine (13.4%vs. 17.9%). The distribution of mechanical diseases was: low back pain (15.4%vs. 23.4%), osteoarthritis (16.6%vs. 20.5%), and soft tissue rheumatism (4.6%vs. 2.2%). The distribution of inflammatory diseases was: rheumatoid arthritis (0.33%vs. 0.19%), seronegative spondylarthropathies (0.23%vs. 1.1%), and systemic lupus erythematosus (0.04%vs. 0.06).

Recurrent anterior uveitis in Henoch Schonlein’s vasculitis

Uveitis is an important component of many rheumatic diseases. The main causes of recurrent uveitis are seronegative spondylarthropathies and Behçet's disease. We describe a rare case of Henoch Schönlein vasculitis (HSV) along with multiple recurrences of acute anterior uveitis. In cases of skin rash and recurrent anterior uveitis, HSV should be considered in the differential diagnosis.

Imaging of the sacroiliac joint involvement in seronegative spondylarthropathies

Involvement of the sacroiliac joints is the first predominant finding of all seronegative spondylarthropathies (SpA) subsets, such as ankylosing spondylitis, psoriatic arthritis, and undifferentiated SpA. Although conventional radiography is indicated in the initial evaluation of sacroiliac joints diseases, it is often insensitive for demonstrating the early changes of sacroiliitis, so other imaging techniques typically are often necessary to clarify the pathology and for establishing the early diagnosis of seronegative SpA. Other imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and bone scintigraphy have improved visualization of inflammatory changes at the sacroiliac joints (SIJ). CT scans are indicated for disease processes in which bony destruction or ossification may occur. MRI has been proposed as an imaging method to detect sacroiliitis earlier. MRI can identify both inflammation and structural changes caused by inflammation, while radiographs show only structural changes. MRI may be particularly useful in making a diagnosis of SpA. Musculoskeletal US has an increasing and relevant role in the evaluation of SpA mainly for its ability to assess joint and periarticular soft tissue involvement and in particular for its capacity to detect enthesitis. US assessment in general is safe, noninvasive, and comparably cheap, showing itself as a complimentary tool to clinical evaluation in SpA; nevertheless, it is very user dependent. Bone scintigraphy is at most of limited diagnostic value for the diagnosis of established AS, including the early diagnosis of probable/suspected sacroiliitis. The main aim of this study is to introduce the clinical and radiological aspects of the SIJ involvement in SpA, particularly the contribution of the different imaging techniques.

Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is one of the rheumatoid diseases, however its clinical features are different. The diagnosis of AS and clinical features are shown, especially the diagnosis is very important. The new modified criteria for diagnosis is detailed here. In addition, the differential diagnosis is exhibited which is significantly useful for the diagnosis of AS. Recently As has been included in the group of seronegative spondylarthropathy (SPA). Now AS is thought to be the central position among SPA which has a lot of similar symptoms. The characteristic symptoms of SPA or AS are spinal, eye, skin, sytemic lesions and enthesopathy. These clinical features are also critical in the diagnosis of AS as well. Finally, what is the most important factor in AS? The answer is an early treatment by a correct diagnosis.

Serum levels of tissue inhibitor of metalloproteinase-1 and periarticular bone loss in early rheumatoid arthritis

We investigated the relationship between disease activity, serum biological mediators of joint damage, and periarticular bone loss in inflammatory arthritis. Patients with early inflammatory arthritis were recruited from a dedicated early arthritis clinic. At the time of recruitment, all had clinical evidence of synovitis. Patients were assessed at baseline and at 1-year follow-up. Periarticular and axial bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum levels of matrix metalloproteinase 1 and tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by enzyme-linked immunosorbent assay. A total 38 patients were included in the study. Twenty had rheumatoid arthritis (RA) and 18 had a seronegative spondylarthropathy (SpA). At baseline, periarticular hand BMD measurements were similar in RA and SpA. At 1 year, the mean periarticular hand BMD was significantly lower in RA (p < 0.05). Significant inverse correlations between both the Ritchie articular index and C-reactive protein levels and the change in periarticular hand BMD at 1 year were observed in RA (r = -0.792, p < 0.001 and r = -0.478, p = 0.045, respectively). Baseline TIMP-1 levels correlated with the change in periarticular hand BMD at 1 year in RA (r = 0.519, p = 0.02). At 1 year, radiographic measures of joint damage were highest in RA. Inverse correlations between the change in periarticular hand BMD and the changes in erosion score (r = -0.90, p = 0.04) were observed in patients demonstrating significant periarticular bone loss. Persistent disease activity was associated with increased periarticular bone loss in the hands in patients with RA, consistent with synovitis-mediated periarticular bone loss. The correlation between baseline TIMP-1 levels and periarticular bone loss over 1 year suggests that TIMP-1 may have utility as a biomarker of periarticular bone loss in early RA.

Nicht infektiöse Entzündungen der Wirbelsäule

Non-infective inflammations of the vertebral spine can be caused by seronegative spondylarthropathies or rheumatoid arthritis, respectively. Seronegative spondylarthropathies include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases and undifferentiated arthritis. This review discusses etiology and pathogenesis, epidemiology, clinical features, diagnosis and differential diagnoses of these chronic inflammatory diseases with a special focus on vertebral involvement.

Immune-cell–cartilage interactions in arthritis

Arthritis is demonstrated in association with autoimmunity to cartilage tissue. This review discusses interaction between autoantigens from cartilage tissue and the immune cells in specific responses to these molecules in arthritis. The autoantigens from cartilage tissue play different roles in the pathogenesis of arthritis dependent on their different sources. Fibroblastic synovial cells and chondrocytes can also present antigens to antigen-specific T cells as well as synovial macrophages, dendritic cells and B cells. CD4+ T cells play crucial roles in rheumatoid arthritis whereas CD8+ T cells play dominant roles in seronegative spondylarthropathies. The Th1/Th2 and Th-/T-regulatory cell imbalance is associated with initiation and maintenance of the diseases. Recent research has revealed that B cells contribute to cartilage destruction by means of specific antigen presentation, adjustment of T-cell activity, proinflammatory-cytokine secretion and autoantibody production. The interaction between cartilage and immune cells plays pivotal roles in arthritis. Autoantigens from cartilage tissue, antigen-presenting cells, T cells and B cells are major players in cartilage destruction. Recovery of the balance of Th1/Th2 and Th-/T-regulatory cells as well as depletion of B cells may be new topics of therapy for arthritis.