Seronegative Spondyloarthropathies Research Articles

Ocular manifestations of various spondyloarthropathies

Eye inflammation has been described as a crucial prominent feature of several rheumatic diseases. Uveitis, conjunctivitis, and episcleritis have been reported in patients with known spondyloarthropathies or may be significant symptoms for the diagnosis of previously undiagnosed spondyloarthropathy. A hospital-based, cross-sectional, observational study was conducted over twenty-one months, from January 2021 to September 2022. Patients aged more than 18 years with a definitive diagnosis of Spondyloarthropathy, attending the Department of Orthopedics outpatient clinics, SGMH, Rewa, were screened for presence of eye disorders. A total of 100 cases were recruited in the study. The mean age of the study group was 34.58 years (female 33.5 years and male 35.6 years) with a majority of cases (72%) in the study group aged between 20 and 39 years. Ankylosing spondyloarthropathy was the most common diagnosis in the study, with 49% cases being diagnosed with it. Patients with Psoriatic arthropathy were also found to have a significant association with foreign body sensation and diminution of vision while ciliary congestion was significantly associated with ankylosing spondylitis. In addition, uveitis was observed to have a statistically significant association with incidence of ankylosing spondylitis. The various manifestations of seronegative spondyloarthropathies include uveitis, which is a potentially blinding complication was noted in 19% of the patients, that needs to be identified early and treated right away to avoid irreparable vision loss.

Added Advantages of DWI MR Imaging and ADC Mapping in the Diagnosis of Active Sacroiliitis of Axial Seronegative SpA

Aim: To evaluate the effectiveness of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping in diagnosing active sacroiliitis in patients with axial seronegative spondyloarthropathy (SpA). Material and Methods: This prospective study comprised 26 patients with MR imaging detected active sacroiliitis categorised as a case group, and compared them with healthy controls. ADC value measurements were obtained from the sacral and iliac sides of the bilateral S.I. joints in each case and control group. Independent samples t-test, Chi-square test, and ROC curve analysis were used. Result: Twenty-six patients had active sacroiliitis in 45 S.I. joints, unilateral active sacroiliitis was observed in seven patients (26.9%), bilateral symmetrical in three patients (11.5%) and bilateral asymmetrical in 16 patients (61.5%). The mean ADC value was 1.447 ± 0.528 [SD] × 10–3 mm 2 /s in the right S.I. joint and 1.630 ± 0.441 [SD] × 10–3 mm 2 /s in the left S.I. joint in active sacroiliitis (case group). The mean ADC value of the right S.I. joint was 0.965 ± 0.123 [SD] × 10–3 mm 2 /s and the left S.I. joint was 0.967 ± 0.96 [SD] × 10–3 mm 2 /s in inactive sacroiliitis (control group). A significant difference was observed statistically between the active sacroiliitis and the inactive sacroiliitis with a P < .0005. A cut-off mean ADC value of 1.034 ×10–3 mm 2 /s was obtained for differentiating active sacroiliitis from inactive sacroiliitis with a sensitivity of 84.6% and specificity of 84.6% from the ROC curve analysis. Conclusion: Diffusion-weighted MRI imaging with ADC value mapping acts as a sensitive diagnostic technique in the detection of active sacroiliitis in axial seronegative spondyloarthropathies and also helps in assessing the treatment response.

Renal AA Amyloidosis in Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease of seronegative spondyloarthropathies (SpA). Secondary amyloid A amyloidosis (Amyloidosis AA) is an uncommon complication of ankylosing spondylitis (AS). Amyloidosis AA is a systemic disease characterized by amyloid deposition in many organs including kidneys. An amyloid fibril formation starts with inappropriate folding of amyloidogenic precursor proteins. The amyloid fibrils have a typical appearance on light microscope that could be easily identified. The classification of secondary amyloidosis is based on the precursor proteins that form amyloid fibrils along with systemic and local distribution of amyloid deposition. Renal involvement is most frequent in systemic amyloidosis. The clinical manifestation of renal amyloidosis differs depending on the type of amyloid protein with the location and amount of amyloid deposition. The treatment of amyloidosis should be focused on managing symptoms and stabilizing amyloid protein.

OA15 A case series of idiopathic granulomatous mastitis patients and their immunosuppressive management

Abstract Background/Aims Rheumatologists are experts in managing immunosuppression and are asked to supervise immunosuppression for non-rheumatic conditions. Thus, it is important to be aware of these conditions and the regimes required. Idiopathic granulomatosis mastitis (IGM) is a rare inflammatory breast condition which can have systemic manifestations including arthritis. Methods Our index case presented with peripheral ankle synovitis/tenosynovitis, struggling to weight bear, whilst being investigated for a breast mass. Breast US, mammogram and biopsy (acute and chronic inflammatory cells including multi-nucleated giant cells) were completed and there was little response to 3 courses of antibiotics. No mycobacteria were seen on microscopy, ZN stain negative, CXR normal, T spot negative and serum ACE normal. There was no rash and no conditions associated with a seronegative spondyloarthropathy. RF, anti-CCP and ANA were negative. A moderate course of prednisolone immediately resolved the peripheral arthritis, but high-dose steroids were required to reduce the breast mass. The mass recurred upon weaning prednisolone requiring the addition of azathioprine as a steroid-sparing agent. Results Our case series includes the immunosuppressive management of 3 other IGM patients: 1) 43-year-old referred after an 8 year history of alternating breast ‘abscesses’ and sinuses treated with courses of antibiotics to little avail. High dose prednisolone and methotrexate resolved the breast mass within a month. 2) 37-year-old referred with a 14 year history of breast masses and fistulae previously treated with surgery and antibiotics. Currently asymptomatic so commenced on methotrexate. 3) 39-year-old referred with a 3 year history of recurrent sterile breast abscesses previously managed with antibiotics, incision and drainage. Recent small masses had settled with NSAIDs. Conclusion IGM is a rare benign inflammatory breast disease of unknown aetiology, commonest in Middle Eastern populations, median age 30s. The most common presentation is a unilateral painful mass, which can ulcerate, fistulate and form abscesses. Management of IGM varies from expectant/topical steroids/NSAIDs to high dose steroids and DMARDs. A literature review shows that the usual starting dose of prednisolone is 40-60mg; the addition of methotrexate and azathioprine increases likelihood of successful treatment and allows for faster steroid tapering. Surgery for specific types of IGM can also be useful; for example, where there is duct granuloma, surgical excision can be curative. IGM can associate with arthritis, erythema nodosum, and episcleritis. One case series found that 14% of patients with IGM had concomitant arthritis. Key points: In our local experience we have had four patients with IGM, all previously treated with antibiotics or surgical methods but subsequently diagnosed with IGM and referred for immunosuppressive therapy. Being a rare condition, we feel it’s important for clinicians to be aware of IGM and its link with inflammatory arthritis. Disclosure S. Islam: None. P. Stonelake: None. H. John: None.

P004 Empowering the reproductive choices of patients with rheumatic disease: using the BSR 2022 pregnancy guidelines audit tool to evaluate pre-conception medication advice

Abstract Background/Aims For ideal pregnancy outcomes, patients with inflammatory rheumatic disease require targeted disease control with pregnancy compatible medications. A proactive approach is required given that people often won’t disclose plans for a pregnancy with healthcare professionals unless directly asked, and 45% of UK pregnancies are unplanned. The BSR 2022 guidelines on prescribing drugs in pregnancy and breastfeeding makes various recommendations on pre-pregnancy counselling for people with rheumatic disease with referral to specialists with relevant expertise as appropriate. Therefore, we used the linked BSR audit tool to evaluate documentation of pre-pregnancy counselling in rheumatology clinics lacking obstetric input at our hospital. Methods Inclusion criteria were all females, aged 15-45 years, attending a doctor-led Rheumatology clinic without obstetric input between 24/4/23 - 30/4/23 at University College London Hospital. Exclusion criteria were infertility and those seen as one-off clinic appointments and not commenced on medications. Clinic notes from all Rheumatology reviews over the preceding one year were assessed using the audit tool in the 2022 BSR pregnancy guidelines. People currently pregnant were audited for the year prior to the date of conception of their pregnancy. Results Among 50 clinics reviewed, 42 female subjects were eligible across 19 clinics, 64% of whom were aged 36-45 years and 36% were aged 21-35 years. Six subjects were pregnant. Diagnoses included: 24% systemic lupus erythematosus; 19.5% rheumatoid arthritis; 17% seronegative axial spondyloarthropathy; and the remaining 39% consisted of fibromyalgia, hypermobility, and other inflammatory arthritidies. 70% of people were screened for antibodies that could adversely impact pregnancy (i.e. anti-Ro or anti-phospholipid). Only 26% of subjects had documentation of being asked if they wished to conceive. In subjects who did not express a wish to conceive, only 21% were asked if they were using contraception. A total of 17% of the 42 subjects were referred to a specialist Obstetric-Rheumatology clinic for pre-pregnancy counselling during the study period. Of 35 subjects taking medications, only 22.8% had documentation of appropriate pre-pregnancy drug counselling within the last year. Of patients without documented pre-pregnancy advice, 46% were taking medications considered unsafe in pregnancy. Furthermore, no patients were signposted to sources of further information on drug therapy and/or rheumatic disease in pregnancy. Conclusion This audit highlights a lack of regular documented discussions around family planning and medication counselling in female subjects of childbearing age attending rheumatology clinics lacking obstetric input. Regular discussions are important for those who do and don’t wish to conceive, to appropriately counsel regarding pre-pregnancy measures or contraception. This audit using the BSR audit tool will be used as the baseline for a quality improvement project to support colleagues in providing regular, accurate reproductive health advice, supported by trusted online resources and referral to a specialist obstetric-rheumatology service as required. Disclosure A. Shirazi: None. B. Goulden: Grants/research support; Undertaking a PhD supported by Versus Arthritis (ref. 22975). I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma.

Role of endoplasmic reticulum aminopeptidase-1 gene polymorphism (rs13167972) in occurrence susceptibility of ankylosing spondylitis in a sample of Iraqi male patients.

Ankylosing spondylitis (AS) is a chronic and systemic seronegative inflammatory spondyloarthropathy, an autoimmune disease that has been associated with impaired Endoplasmic Reticulum Aminopeptidase (ERAP)-1 activity, which is involved in priming antigenic peptides. The purpose of this study is to investigate the association of 3-UTR of ERAP1 gene polymorphism (rs13167972) with the AS occurrence susceptibility in a sample of Iraqi male patients. The AS patients were diagnosed clinically and by magnetic resonance imaging (MRI) and other clinical and laboratory criteria like symptoms, increased C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The blood grouping and Body Mass Index (BMI) were also investigated to be associated with AS occurrence. The genotyping of the 3-UTR region of the ERAP1 gene (rs13167972) was done by Sanger sequencing. The results revealed that the AS occurred significantly in the age group of 20-35years (p = 0.013). The BMI shows that the AS patients were overweighted males (p = 0.013) and the most predominant blood group in AS patients was O- (p = 0.002). The ESR and serum level of CRP were significantly raised in AS patient sera (< 0.001). The results of the receiver-operating characteristics curve analysis (ROC) revealed that the CRP (AUC: 0.995, cut-off: 2.48mg/L, had 95% %sensitivity, 100% specificity, p < 0.001) is more discriminative than BMI (AUC: 0.300, cut-off: 46.91kg, had 0% sensitivity, 100% specificity, p = 0.001), and ESR (AUC: 0.808, cut-off: 7.50mm/hr, had 60% sensitivity, 88% specificity, p < 0.001) in distinguishing between AS patients and control group. The genotyping of the 3-UTR region of ERAP1 gene (rs13167972) result shows that the AG and GG genotypes are significantly occurring in AS patients (70%, OR: 2.33, 95%CI: 1.02-5.36, p = 0.04). The G allele is significantly occurring in AS patients (47%, OR: 2.07, 95CI%: 1.15-3.71, p = 0.01). The AS occurred in young overweight males with blood group O-. The AG and GG genotypes are risk factors for AS development while the G allele is a risk factor that increases the chances for disease incidence.

Effect of integrated Ayurvedic approach for management of ankylosing spondylitis: A case report

Abstract Ankylosing spondylitis (AS) is a seronegative spondyloarthropathy that mainly affects the spine and further involves various sacroiliac joints and articular structures. Human leukocyte antigen-B27 and tumor necrosis factor are said to be contributing factors. In this context, the etiology of the disease might be unknown or unclear. To date, conventional medicine has not provided a satisfactory treatment for this condition, but integrated Ayurveda regimens, such as oral medications, Panchakarma therapies, Yoga, and diet, could be beneficial for these manifestations and aimed at enhancing an individual’s quality of life. Ayurveda regimen, such as oral medications, Panchakarma therapies, Yoga, and diet, could benefit in this symptomatic presentation. A 27-year-old female presented with complaints of progressive neck pain and sacroiliac pain along with stiffness of the spine and hip for 6 years, associated with restricted movement of the spine. The condition was diagnosed as AS and treated for 6 months with Ayurveda treatment, Yoga, and diet. This therapeutic protocol was directed toward alleviating symptoms, reducing severe disability, and improving quality of life. The patient’s condition was assessed for symptoms of Asthimajjagata Vata, Ankylosing Spondylitis Quality of Life Scale score, and AS Disease Activity Score showed substantial improvement. After a 1-year follow-up in September 2022, C-reactive protein and erythrocyte sedimentation rate levels were within the normal range, and no subjective or objective symptoms were observed. This case study shows that cases of AS can be successfully managed with Ayurveda treatment.

The impact of anti-tumor necrosis factor alpha drugs on lipid profile of patients with rheumatoid arthritis or seronegative spondyloarthropathy

Background: Inflammatory arthritis is associated with abnormal levels of lipoprotein. The cause is considered to be inflammation. Recently, the use of biologic drugs in the treatment of inflammatory arthritis, especially rheumatoid arthritis (RA) and seronegative spondyloarthropathy, has increased. There are different results of the effect of these drugs on fat profile. Evaluate the impact of anti-tumor necrosis factor (TNF) alpha drugs on lipid profile of patients with RA or seronegative spondyloarthritis. Methods: In this cross-sectional descriptive study, 50 patients with rheumatoid arthritis or seronegative spondyloarthritis, who were candidates for TNF alpha treatment, were included in the study. After obtaining written consent, a checklist was completed for all patients including demographic information such as age, sex, height, weight, place of residence, level of education, type of disease, and lipid profile test results including total cholesterol, triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were recorded. Then the patients were treated and evaluated for fat profile after 3, 6, 9 months after receiving the relevant treatment regimen. The test results were recorded in checklists. After completing the study, the data were entered into the statistical package for the social sciences (SPSS) 24 software and analyzed. Results: The mean age of patients was 46.38±14.33 years. 54% of patients were female. 54% of patients had rheumatoid arthritis. 62% of patients were treated with Sinora. The results of this study showed that serum triglyceride levels increased during the study period and this increase was statistically significant but the trend of changes in serum cholesterol, HDL and LDL levels was not statistically significant. However, serum LDL levels measured in the ninth month increased significantly compared to the initial measurement. Conclusions: Results showed that there was a significant relationship between lipid profile changes and anti-TNF alpha consumption. Although decreased inflammation appears but other mechanisms may be involved in dyslipidemia.

Dynamic thiol-disulfide homeostasis as an oxidative stress marker in ankylosing spondylitis and undifferentiated spondyloarthropathy.

Seronegative spondyloarthropathies (SpA) are a group of chronic diseases characterized by axial inflammation, oligoarthritis, and enthesitis. Oxidative stress may contribute to a wide range of rheumatologic diseases, including SpA. This prospective case-control study was designed to compare thiol-disulfide levels as a marker of oxidative stress between SpA patients and healthy controls. A total of 144 patients diagnosed with undifferentiated spondyloarthropathy (USpA, n = 97) or ankylosing spondylitis (AS, n = 47) were included along with 80 healthy controls. Serum native thiol (NT), total thiol (TT), and disulfide (D) levels were measured using the fully automated Erel method. The ratios NT/TT, D/TT, and D/NT were calculated. Thiol-disulfide levels were compared between the SpA groups and the healthy controls. The NT and NT/TT ratios were found to be significantly lower in the SpA group (p < 0.001). The disulfide, D/NT, and D/TT ratios were found to be significantly higher in the SpA group (p < 0.001). In pairwise comparisons between the SpA subgroups, the NT and TT levels were lower in the USpA group than in the AS group (p = 0.021), but serum disulfide levels were higher in the USpA group than in the AS group (p = 0.004). Among the patients with SpA, the group taking antitumor necrosis factor (anti-TNF) had lower TT measurements compared to the group taking conventional disease modifying antirheumatic drugs (DMARD) (p = 0.039). The thiol-disulfide balance is disturbed in favor of disulfide in SpA patients compared to healthy volunteers. Native and total thiol measurements correlate with acute phase reactants and might be used to monitor disease activity. Anti-TNF therapy might control the oxidative degenerative process better than the conventional DMARD in SpA patients.

The adult with low back pain: causes, diagnosis, imaging features and management.

Low back pain is the leading cause of disability worldwide. This article highlights the importance of succinct history taking and a thorough clinical examination when managing a patient with lower back pain in hospital. Furthermore, it encourages the clinician to consider the pertinent causes of low back pain such as age-related degeneration, malignancy, trauma, infection and seronegative inflammatory spondyloarthropathies, and looks at the diagnosis, imaging features and key management options which are available in secondary care.

Multidisciplinary non-pharmacological treatments with effects on pain modulation and functioning in spondyloarthropathies – a systematic review

Abstract: Treatment for chronic rheumatic diseases, included various modalities for pain management and for functioning modulation, has the main gole to increase the quality of life and to improve also the activities of daily living. Seronegative spondyloarthropathies (SpA) are a group of rheumatologic disorders that include ankylosing spondylitis, psoriatic arthritis, entheropatic SpA, reactive arthritis and undifferentiated SpA. Treatment methods include clasically pharmacological modalities. Physical therapy should also be highlighted as being part of the treatment. Balneotherapy and spa therapy are increasingly taken into account in evidence-based treatment guidelines for multiple rheumatic diseases, for specific effects on functional parameters and also for the involvement in cartilage regeneration. Balneotherapy is universally defined as the treatment method which uses bathing in thermal and mineral waters. Other balneological treatments include peloidotherapy, balneological gases and therapeutic waters in various forms of bathing, inhalation or drinking. Spa therapy comprises complementary and alternative treatment modalities including balneotherapy, hydrotherapy, exercises, and massage therapy. This systematic literature review aims to highlight the effects of balneotherapy in spondylarthropathies. The review is based on the internationally accepted method, the “PRISMA” methodology- “Preferred Reporting Items for Systematic Reviews and Meta-Analysis”.

The “Dagger Sign”: A classic sign in abdominal radiology

Ankylosing Spondylitis (AS) is one of the seronegative spondyloarthropathies, a group of inflammatory spine conditions that are characterized

Seronegative spondyloarthropathy-associated inflammatory bowel disease.

Seronegative spondyloarthropathy (SpA) usually starts in the third decade of life with negative rheumatoid factor, human leukocyte antigen-B27 genetic marker and clinical features of spinal and peripheral arthritis, dactylitis, enthesitis and extra-articular manifestations (EAMs). Cases can be classified as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, or juvenile-onset spondyloarthritis. Joint and gut inflammation is intricately linked in SpA and inflammatory bowel disease (IBD), with shared genetic and immunopathogenic mechanisms. IBD is a common EAM in SpA patients, while extraintestinal manifestations in IBD patients mostly affect the joints. Although individual protocols are available for the management of each disease, the standard therapeutic guidelines of SpA-associated IBD patients remain to be established. Nonsteroidal anti-inflammatory drugs are recommended as initial therapy of peripheral and axial SpA, whereas their use is controversial in IBD due to associated disease flares. Conventional disease-modifying anti-rheumatic drugs are beneficial for peripheral arthritis but ineffective for axial SpA or IBD therapy. Anti-tumor necrosis factor monoclonal antibodies are effective medications with indicated use in SpA and IBD, and a drug of choice for treating SpA-associated IBD. Janus kinase inhibitors, approved for treating SpA and ulcerative colitis, are promising therapeutics in SpA coexistent with ulcerative colitis. A tight collaboration between gastroenterologists and rheumatologists with mutual referral from early accurate diagnosis to appropriately prompt therapy is required in this complex clinical scenario.

Pattern of Uveitis in a Tertiary Hospital in North Jordan and the Impact of Behcet's Disease.

The purpose of this study is to assess the prevalence of autoimmune-mediated uveitis in relation to other diseases and to describe the clinical patterns of uveitis in a single tertiary hospital in north Jordan. A cross-sectional retrospective review was performed. We included all patients diagnosed with uveitis in King Abdullah University Hospital (KAUH) ophthalmology clinic and/or patients referred to KAUH rheumatology clinics for evaluation of suspected autoimmune mediated uveitis or for difficult to treat uveitis. This included patients from January 2015 to January 2019. Data collected about patients' age, sex, anatomical location of the disease, etiology, treatment, complications, and outcomes on vision loss were analyzed. A total of 221 patients were included in our study. The mean (±SD) age was 36 (±16) years. A total of 111 patients were female and 110 were male with a ratio of 1 : 1. Noninfectious uveitis was found to be more common than infectious uveitis (95% vs. 5% respectively). Autoimmune-mediated uveitis accounted for 40% of the total cases. The most common causes of autoimmune-mediated uveitis included Behcet's disease (n = 41, 19%) and seronegative spondyloarthropathy (n = 29, 13%). The majority of patients (n = 207, 94%) were treated with ophthalmic eye drops, cDMARDs (n = 101, 46%), biologics (n = 33, 15%), and colchicine (n = 30, 14%). Autoimmune-mediated uveitis, most commonly associated with Behcet's disease and seronegative spondyloarthropathy, represents a high percentage of uveitis in our area. This implies the need for a high index of suspicion at the time of evaluation.

Spondyloarthropathies That Mimic Ankylosing Spondylitis: A Narrative Review.

Ankylosing spondylitis is the most common type of seronegative inflammatory spondyloarthropathy often presenting with low back or neck pain, stiffness, kyphosis and fractures that are initially missed on presentation; however, there are other spondyloarthropathies that may present similarly making it a challenge to establish the correct diagnosis. Here, we will highlight the similarities and unique features of the epidemiology, pathophysiology, presentation, radiographic findings, and management of seronegative inflammatory and metabolic spondyloarthropathies as they affect the axial skeleton and mimic ankylosing spondylitis. Seronegative inflammatory spondyloarthropathies such as psoriatic arthritis, reactive arthritis, noninflammatory spondyloarthropathies such as diffuse idiopathic skeletal hyperostosis, and ochronotic arthritis resulting from alkaptonuria can affect the axial skeleton and present with symptoms similar those of ankylosing spondylitis. These similarities can create a challenge for providers as they attempt to identify a patient's condition. However, there are characteristic radiographic findings and laboratory tests that may help in the differential diagnosis. Axial presentations of seronegative inflammatory, non-inflammatory, and metabolic spondyloarthropathies occur more often than previously thought. Identification of their associated symptoms and radiographic findings are imperative to effectively diagnose and properly manage patients with these diseases.

Внекишечные проявления воспалительных заболеваний кишечника у детей: фокус на опорно-двигательный аппарат

The duration of inflammatory bowel disease (IBD) in children has an important effect on the condition of children's musculoskeletal system. The manifestations are different: from peripheral and axial spondiarthropathies to musculoskeletal deficiency in form of osteopenia and sarcopenia, nutritional deficiency and growth retardation. The article describes the modern foundations of the pathogenesis, duration, diagnosis and therapy of seronegative spondyloarthropathies in IBD in children. The ASAS, Garmisch-Partenkirchen criteria, ACR pedi or JADAS criteria used to verify spondyloarthritis and help specialist to assess the joint syndrome in children with IBD and monitoring the effect of therapy. Multidisciplinary management of children with IBD and joint syndrome by gastroenterologist and rheumatologist allows to choose the most successful individual treatment line for patients, many drugs (sulfasalazine, methothotrexate, biological therapy (a-TNF-α, a-IL 12/23, Janus kinase inhibitors) have common pathogenetic effects in IBD and joint syndrome. Therapy of peripheral arthropathies associated with IBD activity is aimed to controlling the main disease. We initiate early the treatment with вiological therapy (TNF-a) in children with axial spondyloarthritis and persistent peripheral duration. Musculoskeletal deficiency, nutritional insufficiency and growth retardation also largely determine the condition of children with IBD, correlating with the activity of disease at the manifestation of illness. However, in many patients, researchers have founded a persistent deficiency in bone and muscle health, even with good control of IBD. Therefore, today the priority of studies are aimed to the prevention of disorders and early correction of nutritional status, a quick return to a healthy lifestyle for children with IBD, which promises to significantly improve the prognosis of the condition of musculoskeletal system. Key words: Crohn's disease, extraintestinal manifestations, inflammatory bowel disease, children, musculoskeletal deficiencyt, spondyloarthropathy, ulcerative colitis

Uveitis in spondyloarthropathies

Background: Uveitis is associated with several systemic disorders. It may be the initial presentation or manifestation of a systemic disease. It is the most common ocular complication and is sometimes the earliest manifestation of spondyloarthropathies. This study aimed to review the current literature on spondyloarthropathies and associated uveitis.&#x0D; Methods: A narrative review was performed using various combinations of the keywords spondyloarthropathies, seronegative spondylarthritis-related uveitis, and human leukocyte antigen-associated uveitis using PubMed/MEDLINE and Google Scholar from January 1, 2000, to September 30, 2022. We describe the disease mechanisms, genetics, and classification of spondyloarthropathies, the clinical patterns of their related ocular diseases, and the current modalities for the management of their ocular or systemic manifestations.&#x0D; Results: Seronegative spondyloarthropathies are a group of rheumatic disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-related spondyloarthropathy, juvenile-onset spondyloarthritis, and undifferentiated spondyloarthritis. These are characterized by enthesitis in the absence of serum rheumatoid factor and have a strong association with human leukocyte antigen B27. The clinical courses and features of spondyloarthropathies are remarkably diverse. Ocular inflammation is common in spondyloarthropathies, often precedes the onset or diagnosis of systemic disease, and responds well to topical therapy. Timely diagnosis of systemic diseases may improve quality of life and help avoid ocular and skeletal complications. Recurrence of ocular inflammation is frequent; on occasion, it may be associated with etanercept administration.&#x0D; Conclusions: Eye care professionals should be able to recognize spondyloarthropathies, manage ocular disease, and collaborate with related specialties for modification of systemic treatment if associated with ocular complications. Timely referral and early management could attenuate or prevent ocular or systemic morbidities associated with spondyloarthropathies.

T1w MRI vs STIR MRI vs Conventional Radiography in Evaluation of Seronegative Spondyloarthropathies

Ankylosing spondylitis and other seronegative arthropathies are conventionally diagnosed using clinical criteria and xrays of SI joints and spine. The introduction of MRI particularly the STIR sequence has revolutionised the diagnosis and assessment of activity of the diseease. But as inferred from this study MRI is not infallible and xrays maybe superior to MRI to identify the structural changes and low dose CT maybe a good alternative to even MRI to establish the Diagnosis.

Frequency and Predictors of Opioid Use in Rheumatoid Arthritis and Seronegative Spondyloarthropathy Patients.

Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients. This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05. About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval. Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Systemic Lupus in males – clinical-laboratory, immunological and histological characteristics.

Systemic lupus erythematosus is a chronic, systemic, non-organ-specific autoimmune disease that affects all organs and systems of the human body and is characterized by the production of autoantibodies against nuclear antigens. Its prevalence in Europe reaches 1:2500. It affects mostly women (female : male ratio=9 : 1) in fertile age group (15-45 years). The clinical course of lupus in males is characterized by more aggressive clinical course and the development of serious complications, such as vasculitis, central nervous system involvement, antiphospholipid syndrome, etc. For the period of 7 years (2012-2019) we observed overall 18 male patients with systemic lupus, 11 with biopsy-proven renal involvement and 7 without clinically significant renal disease (proteinuria &lt; 0.5 g/24 h., no erythrocyturia/cylindruria, normal renal function), mean age at the diagnosis 39.6 +/- 12.3 years. All patients received pathogenetic treatment (corticosteroids + cytotoxic agents). Three had secondary antiphospholipid syndrome, 1 – inflammatory bowel disease, 1 – seronegative spondyloarthropathy. Three had type 2 diabetes. The authors discuss the clinical, immunological and histological characteristics and the therapeutic approach in males with systemic lupus.