Undifferentiated Spondyloarthritis Research Articles

Results from Polish Spondyloarthritis Initiative registry (PolSPI) - methodology and data from - the first year of observation.

ObjectivesReport on one-year results from the Polish Spondyloarthritis Initiative registry (PolSPI), containing the cross-sectional analysis of clinical and imaging data as well as database methodology.Material and methodsThe PolSPI registry includes patients with axial (axSpA) and peripheral (perSpA) spondyloarthritis according to ASAS classification criteria, and/or patients with ankylosing spondylitis according to modified New York criteria, psoriatic arthritis according to CASPAR criteria, arthropathy in inflammatory bowel disease, reactive arthritis, juvenile spondyloarthritis or undifferentiated spondyloarthritis. Epidemiologic data and history of signs, symptoms and treatment of spondyloarthritis are collected and assessment of disease activity is performed. Radiographic images of sacroiliac joint, cervical and lumbar spine, and results of bone densitometry are collected. Every 6 months blood samples for inflammatory markers, and for long-term storage are taken.ResultsDuring a one-year period from September 2015 to August 2016, 63 patients were registered on an electronic database; 44 (69.8%) of patients were classified as axial spondyloarthritis (axSpA) and 19 (30.2%) as peripheral spondyloarthritis (perSpA) according to ASAS criteria. Statistically significant differences between axSpA and perSpA were discovered in the percentage of HLA-B27 antigen occurrence (92.6% and 50%, respectively), BASDAI (2.8% and 4.1%, respectively), DAS 28 (2.66% and 4.03%, respectively), percentage of peripheral arthritis (20% and 88.8%, respectively), enthesitis (26.7% and 70.6%, respectively), dactylitis (6.7% and 88.9%, respectively), as well as extra-articular symptoms: acute anterior uveitis (26.7% and 5.6%, respectively) and psoriasis (6.9% and 55.6%, respectively). Patients with axSpA had significantly higher mean grade of sacroiliac involvement according to New York criteria, higher mSASSS score, and lower T-score in femoral neck in bone densitometry.ConclusionsAt the early stage of the disease patients with axSpA compared to those with perSpA, have more advanced structural damage of sacroiliac joints and spine, and lower bone mineral density in the femoral neck. In the upcoming years the PolSPI registry will prospectively follow-up patients with SpA, recording response to treatment and carrying out research on interaction of inflammation and bone remodelling.

Higher Levels of Secretory IgA Are Associated with Low Disease Activity Index in Patients with Reactive Arthritis and Undifferentiated Spondyloarthritis.

Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student's t-test, Kruskal-Wallis test, and U Mann-Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = -0.42, p = 0.0046), ASDAS-CRP (r = -0.37, p = 0.014), and ASDAS-ESR (r = -0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = -0.70, p = 0.0009, ASDAS-CRP r = -0.58, p = 0.0093, and ASDAS-ESR r = -0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.

IL-17 and IFN-γ producing NK and γδ-T cells are preferentially expanded in synovial fluid of patients with reactive arthritis and undifferentiated spondyloarthritis

The IL-17/1L-23 axis is important in the pathogenesis of spondyloarthropathy. Innate cells produce IL-17 in addition to Th17 cells. We studied the frequencies of natural killer (NK) (total, CD56bright, CD56dim, perforin+ and granzyme+), NK-T, γδ-T, and IFN-γ+, IL-17+ NK and γδ-T cells in peripheral blood (PB) and synovial fluid (SF) of ReA/uSpA patients. PB from 45 patients and paired SF from 39 patients were studied, together with PB from 18 healthy controls (HC). The frequency of γδ-T cells was decreased (p<0.05) while IL-17 producing NK and γδ-T cells were increased (p<0.05) in PB of patients as compared to HC. In SF, CD56bright NK cells were increased (p<0.001) but had reduced expression of perforin and granzyme (p<0.0001) as compared to PB. Frequency of IL-17+, IFN-γ+ NK and γδ-T cells was higher in SF as compared to PB (p<0.05). We suggest that innate cells by producing pro-inflammatory cytokines may contribute to pathogenesis.

Progression rate of ankylosing spondylitis in patients with undifferentiated spondyloarthritis: A systematic review and meta-analysis.

The idea that undifferentiated spondyloarthritis (uSpA) represents the early undifferentiated stage of ankylosing spondylitis (AS) and other well-defined SpA subtypes is well known. The gist of this study is to assess the rate estimate of patients with uSpA evolved to AS during long-term follow-up. A systematic search was implemented to identify pertinent articles. The primary outcome was the rate estimate that patients with uSpA fulfilling the diagnosis of AS according to the modified New York criteria during follow-up. The rate estimate and corresponding 95% confidence interval (95%CI) were pooled by the random-effects model in STATA 11.0 software. Meta-regression analyses were adopted to explore the sources of heterogeneity. The quality assessment was conducted by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Begg test and the Egger test were applied to assess publication bias. Sixteen papers were finally included in this study after screening 1299 citations. The pooled rate of patients with uSpA progression to AS synthesized from the 16 papers was 0.323 (95%CI 0.257-0.389). Subgroup analysis based on the length of follow-up showed that the rate at the time-point of 5, 8, and 10 years follow-up was 0.220 (95%CI 0.110-0.330), 0.291 (95%CI 0.257-0.325), and 0.399 (95%CI 0.190-0.608), respectively; while the rate in Asia, Europe, and Latin America was 0.367 (95%CI 0.282-0.452), 0.228 (95%CI 0.066-0.390), and 0.269 (95%CI 0.209-0.329), respectively. Meta-regression analysis indicated that the length of follow-up alone accounts for 45.23% of the total heterogeneity. Nearly half of the papers scored fair quality and none publication bias was identified based on the Begg test and the Egger test. Further, line chart describes an obviously increased trend for the patients with uSpA fulfilling the diagnosis of AS over time. The progression rate of patients with uSpA evolved into AS was variable in different time-point, this variation can mostly be explained by the length of follow-up. Thus, more studies with similar time point of follow-up are needed to clarify the full spectrum of uSpA.

Impact of HLA -B*27 subtypes with increased susceptibility to seronegative spondyloarthropathies in Vojvodina population

The aim of this study is to investigate which subtype of HLA-B*27 was associated with susceptibility of seronegative spondyloarthropathies (SpA) in Vojvodina patients. The dataset of the current study is composed of 172 SpA patients, among which there were 72 HLA-B*27+ (positive) and 100 HLA-B*27? (negative) patients. HLA-B*27 allele genotyping was carried out by Polymerase Chain Reaction-Sequence Specific Primer (PCR-SSP) method and low and high resolution tests, respectively. The association of HLA-B*27 subtypes with SpA was determined by the calculation of Relative Risk (RR) and Etiological Fraction (EF), while the allelic distribution between two group of patients was assessed by chi-square test. In HLA-B*27+ patients with SpA, the most common were patients with Reactive Arthritis (ReA) (41/72 or 56,94%) and Ankylosing Spondylitis (AS) (17/72 or 23,61%). Statistically significant difference was found in HLA-B*27+ and HLA-B*27? patients among SpA subgroups studied: Arthritis Psoriatica (PsA), Ankylosing Spondylitis (AS), Undifferentiated Spondyloarthritis (uSpA), Inflamatory Bowel Disease (IBD), Juvenilis Idiopathic Arthritis (JIA) and Reactive Arthritis (ReA). Two HLA-B*27 allele subtypes were found in SpA patients in Vojvodina: B*27:02 and B*27:05. Both HLA-B*27:02 and HLA-B*27:05 alleles have shown positive association with Ankylosing Spondylitis (RR=9.458 for B*27:02 and RR=6.585 for B*27:05), but significant Etiological Fraction (EF) or population attributive risk with value of 0.281 was found only for HLA-B*27:05 subtype. In this study we have showed, for the first time in Vojvodina population, that HLA-B*27:05 subtype have strong positive or susceptible association with Ankylosing Spondylitis. &lt;br&gt;&lt;br&gt;&lt;font color="red"&gt;&lt;b&gt; This article has been corrected. Link to the correction &lt;u&gt;&lt;a href="http://dx.doi.org/10.2298/GENSR1801357V"&gt;10.2298/GENSR1801357V&lt;/a&gt;&lt;u&gt;&lt;/b&gt;&lt;/font&gt;

Association of human leukocyte A, B, and DR antigens in Colombian patients with diagnosis of spondyloarthritis.

There is substantial evidence that non-B27 major histocompatibility complex (MHC) genes are associated with spondyloarthritis (SpA). Studies in Mexican and Tunisian populations demonstrated the association of SpA and human leukocyte antigen (HLA) B15. The purpose of this study was to evaluate the association of HLA-A, B, and DR antigens in a group of Colombian patients with a diagnosis of SpA. A total of 189 patients and 100 healthy subjects were included in the present study. All subjects underwent a complete characterization of HLA alleles A, B, and DR. Of the 189 studied patients, 35 were reactive arthritis (ReA), 87 were ankylosing spondylitis (AS), and 67 undifferentiated SpA (uSpA). According to the Assessment of Spondyloarthritis International Society (ASAS) criteria, 167 were axial SpA (axSpA) and 171 were peripheral SpA (pSpA). 63.8% were men, with a mean age of 35.9±12.7years. 40.7% (77/189) of patients were HLA-B27 positive of which 52.9% had AS and 42.5% axSpA. 23.2% (44/189) of patients were HLA-B15 positive: 23.8% were uSpA, 12.57% were axSpA, and 11.7% were pSpA. In addition, HLA-DRB1*01 was associated with AS (58.6%) and axSpA (42.5%). Also, HLA-DRB1*04 was present in 62 patients with AS (71.2%) and in 26 with axSpA (15.5%). In this population, we found a strong association between the presence of HLA-B27 and the diagnosis of axSpA and AS, but the HLA-B15 is also significantly associated with all subtypes of the disease, predominantly with pSpA. Additionally, HLA-DR1 and DR4 were associated in a cohort of patients with SpA from Colombia.

Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura

IntroductionSeronegative spondyloarthritis (SpA) is a group of chronic potentially disabling diseases that affect mainly axial joints in addition to extra-articular manifestations such as enthesitis, dactylitis and uveitis. Aim of the workTo assess the demographic features, clinical manifestations and radiological findings of SpA in Egyptian patients. Patients and methodsFifty-three SpA patients were recruited from the Rheumatology and Immunology Unit of Mansoura University Hospital. Demographic, clinical and therapeutic data were collected. Skin was carefully assessed for psoriasis. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. All patients were evaluated by conventional radiographs of hands, knees, ankles, sacroiliac joints (SIJ) and lumbosacral spines in addition to magnetic resonance imaging (MRI) of the SIJs. ResultsAnkylosing spondylitis (AS) was the most prevalent (55%) followed by psoriatic arthritis (PsA) (38%) and 2 patients had enteropathic arthritis, one had reactive arthritis and another had undifferentiated SpA. The mean age of the patients was 39±10.8years; disease duration was 10±3.5years with a male predominance (58%). Inflammatory low back pain was present in all the patients and 77.4% had both axial and peripheral arthritis. Extra-articular manifestations as enthesitis, bursitis and dactylitis were detected in only 9.4% of patients. Sacroiliitis was detected in 81.1% of patients using conventional radiographs. MRI detected bone marrow edema in 9.4%, narrowing in 11.3%, sclerosis in 17% and ankylosis in 52.8%. ConclusionThe demographic, clinical and radiological characteristics of Egyptian SpA patients are comparable to those from other countries except for the lower prevalence of extra-articular manifestations.

Efficacy of an acquainted drug in the treatment of inflammatory low back pain: sulfasalazine under investigation.

In the current study, the overall prevalence and the main underlying etiologies of inflammatory low back pain (ILBP) were determined, and the effectiveness of treatment with sulfasalazine was investigated in patients with inflammatory versus mechanical low back pain (LBP). In a prospective study conducted from July 2013 until August 2015, 1,779 consecutive patients within the age range of 18–50 years with a primary complaint of LBP referring to the rheumatology clinics were included. The patients were classified into two distinct groups: those suffering from ILBP (n=118) and those having mechanical LBP (n=1,661). Patients were followed-up for assessing the response rate to sulfasalazine with a mean follow-up time of 16 months. Results showed that among the total number of participants, 6.6% suffered from ILBP. The main underlying diagnoses of ILBP were undifferentiated spondyloarthropathy (USpA) (61.0%) and ankylosing spondylitis (24.6%). During the follow-up period, 3.4% of the participants had an appropriate response to only nonsteroidal anti-inflammatory drugs, 57.6% to sulfasalazine, 26.3% to addition of methotrexate to the previous regimen, and 12.7% to biological agents. Multiple logistic regression results showed that the underlying disease had a significant effect on the sulfasalazine response. The odds for response to treatment was 3.53 times higher in USpA patients compared to other patients (odds ratio =3.53, 95% confidence interval: 1.63–7.68, P=0.001). In 69.4% of the participants, the highest response to sulfasalazine was found, which was related to the underlying USpA. This study found that an adequate response to nonsteroidal anti-inflammatory drugs in patients with ILBP was potentially increased by adding sulfasalazine. Thus, the observed response rate was dependent on the nature of underlying spondyloarthropathy.

Spondyloarthritis: Pathogenesis, Clinical Manifestations, Diagnosis and Management

The term spondyloarthritis (SpA) is used to describe a heterogeneous group of diseases sharing certain characteristics. Traditionally, patients with SpA have been classified in five subgroups: ankylosing spondylitis (AS), psoriatic arthritis, arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, and undifferentiated SpA. The pathogenesis of SpA is still not entirely clear; it is considered to be multifactorial, the result of interaction between genetic risk factors and environmental triggers that lead to activation of autoinflammation and autoimmunity. This group of diseases is characterised by a chronic inflammation in entheses and other anatomical structures, leading to their main clinical features: sacroilitis, enthesitis, and peripheral arthritis. An association with extra-articular manifestations such as psoriasis, uveitis, and IBD is also a distinctive feature of SpA. Several diagnostic and classification criteria have been proposed over time. However, all of these criteria have a main limitation, which is the difficulty to identify patients at an early stage of the disease. The Assessment of Spondyloarthritis International Society (ASAS) proposed the ASAS classification criteria that introduced two major changes: first, the classification of patients with SpA based on the predominant symptoms (axial or peripheral); second, the introduction of magnetic resonance imaging, which allows detection of sacroiliitis at the early stages of the disease. Nowadays, the ASAS criteria classify SpA in two groups: axial SpA, including classical AS and non-radiographic axial SpA, and peripheral SpA. The therapy for SpA has evolved dramatically over time. The introduction of biological therapy in recent years, which has continuously progressed, has improved the functional and clinical prognosis of SpA patients.

Global Prevalence of Spondyloarthritis: A Systematic Review and Meta-Regression Analysis.

To summarize the prevalence of spondyloarthritis (SpA) and its subtypes in the general population, and to identify demographic and methodologic characteristics that might explain heterogeneity in prevalence estimates. A systematic literature search was performed to identify relevant articles. Risk of bias was assessed and data were extracted. Pooled prevalences were calculated. Potential sources of heterogeneity were explored by subgroup analysis and meta-regression analysis. The prevalence of SpA ranged from 0.20% (95% confidence interval [95% CI] 0.00-0.66) in South-East Asia to 1.61% (95% CI 1.27-2.00) in Northern Arctic communities; the prevalence of ankylosing spondylitis (AS) from 0.02% (95% CI 0.00-0.21) in Sub-Saharan Africa to 0.35% (95% CI 0.24-0.48) in Northern Arctic communities; and the prevalence of psoriatic arthritis (PsA) from 0.01% (95% CI 0.00-0.17) in the Middle East to 0.19% (95% CI 0.16-0.32) in Europe. The following characteristics were significantly associated with variation in prevalence of SpA, AS, and/or PsA: proportion of females, mean age of the sample, geographic area and setting (demographic characteristics), year of data collection, case finding, and case ascertainment (methodologic characteristics). For the other SpA subgroups, too few studies were available to conduct a meta-analysis, but prevalence estimates of reactive arthritis (range 0.0-0.2%), SpA related to inflammatory bowel disease (range 0.0-0.1%), and undifferentiated SpA (range 0.0-0.7%) were generally low. SpA is a common disease, but with large variation in reported prevalence estimates, which can partly be explained by differences in demographic and methodologic characteristics. Particularly, geographic area as well as case finding account for a substantial part of the heterogeneity.

Safety, efficacy and immunogenicity of switching from innovator to biosimilar infliximab in patients with spondyloarthritis: a 6-month real-life observational study.

Biosimilar infliximab (INX) was recently approved by the European Medicine Agency for the treatment of rheumatoid arthritis, ankylosing spondylitis (AS), Crohn's disease, ulcerative colitis, psoriatic arthritis (PsA), and psoriasis on the grounds that its pharmacokinetics, safety, and efficacy were comparable to those of innovator INX. The aim of this study was to investigate the real-life efficacy, safety, and immunogenicity of switching from innovator to biosimilar INX in patients with spondyloarthritis (SpA). Forty-one patients attending three Italian rheumatology centres with a previous diagnosis of SpA and clinically inactive or moderate disease activity (ASDAS-CRP<2.1; 22 with AS, five with enteropathic arthritis, 10 with PsA, and four with undifferentiated SpA), who had been treated for more than 6months with innovator INX in accordance with the ASAS/EULAR guidelines, were switched to biosimilar INX for pharmaco-economic reasons (Tuscany Law No. 450 of 7 April 2015) and followed up for 6months. A record was kept of their BASDAI, BASFI, ASDAS-CRP, DAS28-CRP (in the presence of peripheral disease), MASES, VAS pain scores, the duration of morning stiffness, and adverse events (AEs). At the time of the switch, the patients had a median age of 50.9years (range 23-80), a median disease duration of 124.5months (range 14-372), and a median duration of treatment with innovator INX of 73.7months (range 6-144). After 6months of biosimilar INX therapy, there were no statistical differences in their median BASDAI (2.73±1.5 vs. 2.6±1.3, p=.27), BASFI (2.34±1.3 vs. 2.17±1.2, p=0.051), ASDAS-CRP (1.35±0.3 vs. 1.28±0.2, p=0.24), DAS28-CRP (2.66±0.67 vs. 2.67±0.35, p=0.92), MASES (0.35±0.7 vs. 0.17±0.4, p=0.08), or VAS pain scores (18±14.7 vs. 16.7±11.3, p=0.55), whereas the median duration of morning stiffness had significantly decreased (7.2±6.9 vs. 5.8±6, p=0.02). Furthermore, there was no change in circulating INX (4.22±2.89 vs 4.84±2.86μg/mL, p=0.80) or anti-INX antibody levels (27.76±17.13 vs 27.27±17.28ng/mL, p=0.98). The switch from innovator to biosimilar INX in this Italian multicentre SpA cohort was not associated with any statistically significance differences in efficacy, adverse events or anti-drug antibody level.

Recombinant Salmonella typhimurium outer membrane protein A is recognized by synovial fluid CD8 cells and stimulates synovial fluid mononuclear cells to produce interleukin (IL)-17/IL-23 in patients with reactive arthritis and undifferentiated spondyloarthropathy.

In developing countries, one-third of patients with reactive arthritis (ReA) and undifferentiated spondyloarthropathy (uSpA) are triggered by Salmonella typhimurium. Synovial fluid mononuclear cells (SFMCs) of patients with ReA and uSpA proliferate to low molecular weight fractions (lmwf) of outer membrane proteins (Omp) of S. typhimurium. To characterize further the immunity of Omp of Salmonella, cellular immune response to two recombinant proteins of lmwf, OmpA and OmpD of S. typhimurium (rOmpA/D-sal) was assessed in 30 patients with ReA/uSpA. Using flow cytometry, 17 of 30 patients' SF CD8(+) T cells showed significant intracellular interferon (IFN)-γ to Omp crude lysate of S. typhimurium. Of these 17, 11 showed significantly more CD8(+) CD69(+) IFN-γ T cells to rOmpA-sal, whereas only four showed reactivity to rOmpD-sal. The mean stimulation index was significantly greater in rOmpA-sal than rOmpD-sal [3·0 (1·5-6·5) versus 1·5 (1·0-2·75), P < 0·005]. Similarly, using enzyme-linked immunospot (ELISPOT) in these 17 patients, the mean spots of IFN-γ-producing SFMCs were significantly greater in rOmpA-sal than rOmpD-sal [44·9 (3·5-130·7) versus 19·25 (6-41), P < 0·05]. SFMCs stimulated by rOmpA-sal produced significantly more proinflammatory cytokines than rOmpD-sal: IFN-γ [1·44 (0·39-20·42) versus 0·72 (0·048-9·15) ng/ml, P < 0·05], interleukin (IL)-17 [28·60 (6·15-510·86) versus 11·84 (6·83-252·62) pg/ml, P < 0·05], IL-23 [70·19 (15-1161·16) versus 28·25 (> 15-241·52) pg/ml, P < 0·05] and IL-6 [59·78 (2·03-273·36) versus 10·17 (0·004-190·19) ng/ml, P < 0·05]. The rOmpA-sal-specific CD8(+) T cell response correlated with duration of current synovitis (r = 0·53, P < 0·05). Thus, OmpA of S. typhimurium is a target of SF CD8(+) T cells and drives SFMC to produce increased cytokines of the IL-17/IL-23 axis which contribute to the pathogenesis of Salmonella-triggered ReA.

Is there a correlation between Chlamydia trachomatis detection and development of disease in reactive arthritis/ undifferentiated spondyloarthropathy patients

Is there a correlation between Chlamydia trachomatis detection and development of disease in reactive arthritis/ undifferentiated spondyloarthropathy patients

Causality of Chlamydiae in Arthritis and Spondyloarthritis: a Plea for Increased Translational Research.

Current molecular genetic understanding of the metabolically active persistent infection state of Chlamydia trachomatis and Chlamydia pneumoniae in the synovium in patients with arthritis and spondyloarthritis favors a causal relationship. Here, we examine how adequately the accepted criteria for that etiologic relationship are fulfilled, emphasizing the situation in which these microorganisms cannot be cultivated by standard or other means. We suggest that this unusual situation of causality by chlamydiae in rheumatic disease requires establishment of a consensus regarding microorganism-specific terminology as well as the development of new diagnostic and classification criteria. Recent studies demonstrate the value of molecular testing for diagnosis of reactive arthritis, undifferentiated spondyloarthritis, and undifferentiated arthritis caused by C. trachomatis and C. pneumoniae in clinical practice. Data regarding combination antibiotic therapy is consistent with the causative role of chlamydiae for these diseases. Observations of multiple intra-articular coinfections require more research to understand the implications and to respond to them.

THE PREVALENCE AND CLINICAL FEATURES OF GOUT AND CALCIUM PYROPHOSPHATE DEPOSITION DISEASE IN PATIENTS WITH ACUTE ARTHRITIS

Objective: to study the rate of gout and calcium pyrophosphate deposition disease (CPDD) and to provide their clinical characteristics in patients with acute arthritis. Subjects and methods . The investigation enrolled 150 patients (97 men and 53 women) with acute mono- or oligoarthritis of no more than 2 weeks’ duration who had visited the Outpatient Department of V.A. Nasonova Research Institute of Rheumatology. Their mean age was 60.2±12.0 years (range, 28–76 years). All the patients underwent inflamed joint puncture and synovial fluid (SF) crystal identification by polarized microscopy using an Olympus CX31-P compensator.The diagnosis of CPDD was established in compliance with the criteria elaborated by D. McCarty. Gout was diagnosed only when sodium monourate (SMU) crystals were found in SF. Results and discussion. The investigation revealed gout in 51 (34%) patients, CPDD in 45 (30%), coincidence of gout and CPDD in 15 (14%), and 39 (26%) patients had other diseases: 15 (10%) – osteoarthritis, 6 (4%) – rheumatoid arthritis, 5 (3%) – septic arthritis, 5 (3%) – psoriatic arthritis, 2 (1%) – ankylosing spondyloarthritis, 4 (3%) – injury, and 5 (3%) – undifferentiated spondyloarthritis. There were 40 men and 11 women among the patients with gout and 13 men and 32 women among those with CPDD. The patients with gout were younger than those with CPDD (35.5±8.9 and 58.4±12.8 years, respectively; p < 0.05). In the patients with CPDD, knee, ankle, and first metatarsophalangeal joint arthritis was present in 34 (76.3%), 17 (30.3%), and 4 (9%) cases, respectively. Arthritis developed within a few hours in 90% of the patients with gout and in 33.3% of those with CPDD (p < 0.001). Monoarthritis was significantly more common in gout whereas oligoarthritis – in CPDD (p < 0.05). Visual analog scale pain intensity averaged 78.4±12.5 mm and 54.32±22.02 mm (p < 0.05), duration of arthritis – 10.3±3.8 days and 3.4±2.1 days (p < 0.05) in gout and CPDD respectively. Conclusion. CPDD is the most common (60%) cause of acute arthritis in women and the second most frequent (13%) cause in men (following gout). Acute arthritis develops more slowly and persists for a longer period of time in patients with CPDD than in those with gout.

Validity of magnetic resonance image and HLA-B27 in early detection of sacroiliitis in Egyptian spondyloarthropathic patients

The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P= 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis

A Survey on the Frequency of HLA-B27 in Patients Engaged With Seronegative Spondyloarthropathies in Kashan, Iran

Background: Seronegative Spondyloarthropathies (SNSAs) are referred to a group of diseases with same clinical and genetic features. Objectives: Due to lack of data about HLA-B27 prevalence in patient with SNSA in Kashan this study was conducted to determine the status of HLA-B27 in these patients. Patients and Methods: This cross sectional study was conducted on 294 patients suffered from SNSA. Presence or absence of HLA-B27 was checked by serological method using Greener kit. Results were analyzed with SPSS-16 software using t-test and χ 2 test. Results: Of all 26.5% of subjects were HLA-B27 positive. HLA-B27 was significantly more frequent in male patients (34.1% vs. 16.5%, P < 0.001). Prevalence of HLA-B27 was 69% in ankylosing spondylitis, 31.5% in psoriatic arthritis, 18.2% in entropathic arthropathy, 17.9% in undifferentiated spondyloarthropathies, 16.1% in reactive arthritis and 12.5% in juvenile rheumatoid arthritis (P < 0.001). Conclusions: HLA-B27 has highest prevalence in ankylosing spondylitis and least prevalence in juvenile rheumatoid arthritis. HLA-B27 prevalence was in relation with gender, type of disease, family history, peripheral, and axial joints engagement.

Undifferentiated spondyloarthritis is more frequently seen in women than in men

Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS). This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI. In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8–377) months for AS and 74.23 ± 60.7 (median 55.5, range 0–238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1. SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better results than applying them in the advanced stages.

Recombinant Salmonella typhimurium outer membrane protein A and D reactive T cells are expanded in synovial fluid of patients with reactive arthritis and undifferentiated spondyloarthropathy (HUM6P.251)

Abstract Introduction: Low molecular weight fractions of outer membrane protein (OMP) of S. typhimurium have been shown to stimulate synovial fluid mononuclear cells (SFMCs) of patients in reactive arthritis (ReA) and undifferentiated spondyloarthropathy (uSpA). By proteomic analysis the stimulatory fractions predicted to consists of 10 proteins including OMPA and OMPD. We studied the frequency of recombinant OMPA and OMPD reactive T cells in the synovial fluid (SF) of patients with ReA/uSpA. Methods: Recombinant OMPA and D were synthesized and SFMCs of 20 patients with ReA/uSpA and 8 patients with rheumatoid arthritis (RA) were cultured with rOMPA/D. IFN-γ and IL17 production by SF T cells was assessed by Flow cytometry and in culture supernatant by ELISA. Antigen specific IFN-γ producing T cells were also enumerated by ELISPOT. A positive response was taken if % cells or Mean spots/well with antigen/Control ≥ 3 Results: Frequency of IFN-γ producing CD8 T cells was increased to crude OMP in 13/20, rOMPA in 9/20 and to rOMPD in 4/20 patients. Frequency of IFN-γ producing CD4 T cells was increased to crude OMP in 6/15, rOMPA in 4/15 and to rOMPD in 2/15 patients. By ELISPOT, 13, 7 and 3 patients showed increased IFN-γ producing SF T cells to crude OMP, rOMPA and rOMPD respectively. IFN-γ and IL17 levels were found to be significantly increased in culture supernatant of cells treated with rOMPA. Conclusion: OMPA is a major antigenic target in patients with Salmonella triggered ReA/uSpA.

CLINICAL HETEROGENEITY OF EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF CLINICAL AND RADIOLOGICAL FINDINGS IN CRIMEA’S PATIENTS

Ankylosing spondylitis (AS) is characterized by considerable variation in the rate of development of structural changes in the vertebral column and joints. As of now, the clinical and laboratory predictors of progression of undifferentiated axial spondyloarthritis (SpA) to AS have not been adequately explored. Objective: to study the clinical features of early axial SpA in view of radiographic changes in the sacroiliac and hip joints and spinal column. Subject s and methods. The rate of different clinical syndromes of axial SpA was analyzed in 162 patients. The study included less than 35-year-old patients with a 2-to-5-year history of axial SpA that was first diagnosed according to the 2009 ASAS criteria, by excluding psoriatic and reactive arthritis and inflammatory bowel diseaserelated arthritis. Result s and discussion. The examinees were diagnosed with undifferentiated SpA (52.5%), advanced AS (43.2%), and late AS (in the presence of syndesmophytes) (4.3%). 38.3% of patients had peripheral arthritis (PA), 8.6% – dactylitis, 28.4% – enthesitis , and 4.9% – uveitis. The patients with advanced AS had higher C-reactive protein (CRP) levels (38.7 [22.3; 45.8]) and lower rates of PA (27%) than those with undifferentiated axial SpA (14.4 [4.2; 18.6] mg/l and 48%, respectively; p < 0.05). The patients with late AS had more commonly enthesitis (71.4%) and HLA-B27 (100%) than those with undifferentiated axial SpA (31.4 and 78.8%) and those with advanced AS (22.3 and 81.4%, respectively; p < 0.05). Radiographic narrowing of the hip joint space was accompanied by increases in the rate of enthesitis up to 56.2% and HLA-B27 up to 93.7% (the remaining patients exhibited 24.6 and 79.5% increases, respectively (p < 0.05). Conclusion. High CRP levels, presence of enthesitis and HLA-B27 may be regarded as predictors for rapid progression of structural changes in patients with early axial SpA. DOI: http://dx.doi.org/10.14412/1995-4484-2015-139-142