Spondylitis Syndrome Research Articles

Ankylosing spondylitis syndrome in patients without HLA-B27.

We wish to present in this paper the main clinical, roentgenological and immunogenetic characteristics of our patients with the ankylosing spondylitis syndrome, who do not possess the HLA-B27 antigen. Of 553 patients permanently treated in the Ward for Rheumatic Diseases of the Medical Faculty in Zagreb, 16 patients (7 women and 9 men) have been found who do not have the HLA-B27 antigen. Their average age was 39.6 (men: 46; women: 33; range: 25-66) years. The diagnosis of ankylosing spondylitis had been made on the basis of the Rome criteria (1) and that of sacroiliitis on the criteria of Hart and Robinson (2). HLA antigens were determined on the peripheral blood lymphocytes using the microcytotoxic test according to Terasaki and McClelland (3).

Juvenile-onset chronic arthritis: Clinical and roentgenographic features of a unique HLA-B27 subset

Previous studies of HLA-B27 in children with juvenile-onset chronic arthritis have shown an association in boys with pauciarticular disease which may progress to ankylosing spondylitis. The spectrum of B27-associated disease, however, especially as it relates to arthritis persisting into adulthood, has not been fully clarified. Thus, clinical, roentgenographic, serologic and immunogenetic studies were performed in 54 patients (39 adults and 15 children) with persistent juvenile-onset chronic arthritis. All had had the onset of disease in peripheral or axial joints, and patients with typical febrile Still's disease were excluded. Thirty-five patients (65 percent) were seronegative for both rheumatoid factor and antinuclear antibodies. HLA-B27 (B27) was present in 20 of these 35 seronegative patients (54 percent) (p < 0.005). Four of the 20 (20 percent) had an axial onset and typical ankylosing spondylitis. Peripheral arthritis, however, dominated the course of the remaining 16 patients who had the B27 antigen. Polyarticular disease (nine patients) with “rheumatoid-like” hand deformities (eight patients) occurred primarily in female patients. In addition, sacroiliitis or spondylitis occurred in 14 and acute iritis in five. Cervical apophyseal joint fusion, especially at the level of the C2-C3, a lesion previously ascribed to juvenile rheumatoid disease, was common in seronegative patients and correlated with the presence of B27 (p < 0.01) and sacroiliitis (p < 0.0005). These data suggest that the presence of B27 may mark a group of young women with a dominant peripheral and cervical spondylitic syndrome, often beginning in childhood, which mimics rheumatoid arthritis. Determining the absence or presence of the B27 antigen may be a useful test in the proper diagnosis and classification of such patients.

Observations on Chronic-Ankylosing Inflammation of the Vertebrae and Hip Joints

Ernest Adolph Gustav Gottfried Strümpell of Leipzig (1853–1925) published a 2-volume edition of the Lehrbuch der Speciellen Pathology and Therapie der inneren Krankheiten in 1883–84. He was among the leading internists and pathologists of his generation. The masterpiece went through more than 30 editions, translated into several languages, with the first in English appearing in 1887. The volumes are still valid references in pathology with a wealth of forgotten and rediscovered musculoskeletal material pertinent to contemporary studies. Rather than reprint the description from the original book,* which like all textbooks requires cross references in context, I have reprinted his classic paper of 1897. This more clearly delineates the spondylitic syndrome with which his name is eponymic.

Juvenile ankylosing spondylitis.

SummaryThree cases of ankylosing spondylitis with involvement of the ileosacral joints in infancy are described. In these cases the spondylitis began at the age of 5,8, and 12 years, respectively. In the case where the disease began at the age of 5, the spondylitic syndrome appeared at the outset and was predominant throughout the disease. In the second case the syndrome dominated the beginning of the disease, and in the case where the spondylitic syndrome appeared at the age of 12, syndromes from the peripheral joints had earlier existed for two years. All these cases were boys, and in none of them could any urogenital infection be diagnosed.Next, 9 cases of a cervical spondylitic syndrome during chronic arthritis in infancy are described. In 6 out of these there was dislocation between atlas and epistropheus, in 3 fusion of the posterior vertebral segment with diminishing of intervertebral discs. It is pointed out that cervical spondylitis is a common syndrome in cases of chronic arthritis in children and that, from a therapeutical point of view, it needs constant attention.