Explore chapters and articles related to this topic
Unexplained Fever Associated With Hypersensitivity and Auto-Immune Diseases
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
This is a chronic inflammatory disease, of unknown etiology with a predominance in males (90%), which involves prominently sarcoiliac joints, spinal articulations, and paravertebral soft tissues. It is strikingly associated with HLA-B27 antigen.
Rheumatology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Clarissa Pilkington, Kiran Nistala, Helen Lachman, Paul Brogan
Spinal and sacroiliac involvement (ankylosing spondylitis) is uncommon in childhood but may occur in later life (Fig. 17.13). Arthritis may progress to involve hip joints in adolescence and be very destructive. A family history of HLA-B27 associated disorders is common.
Immunotherapy of Uveitis
Published in George S. Eisenbarth, Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Roberto de Bara, Alan G. Palestine, Robert B. Nussenblatt
Anterior uveitis or iritis refers to inflammation within the anterior chamber of the eye. Patients usually present with a red eye and complain of decreased vision, photophobia, increased lacrimation, and pain. This is the most common form of uveitis encountered by the general ophthalmologist and can occur as an isolated, self-limited event or in conjunction with systemic disease. Individuals with the HLA-B27 phenotype are at an increased risk for developing anterior uveitis.2 Patients suffering from ankylosing spondylitis3 and Reiter’s syndrome,4 where there is a high correlation with the HLA-B27 phenotype, can often present with anterior chamber inflammation. Anterior uveitis responds well to treatment with topical steroids and in severe cases may require the use of periocular steroid injections.
The Risk of overdiagnosis and overtreatment in spondyloarthritis
Published in Scandinavian Journal of Rheumatology, 2022
A Ortolan, M Lorenzin, A Doria, R Ramonda
This patient developed, in January 2021, pain and stiffness of the shoulder and hip girdle and increased inflammation indices (C-reactive protein 23 mg/L and erythrocyte sedimentation rate 79 mm/h). Since cervical stiffness was noted upon clinical examination, X-rays of the spine and pelvis were also performed. An ossification of the posterior longitudinal ligament (PLL) between C6 and C7 (Figure 1A) and a slight monolateral sclerosis of the sacroiliac joint (SIJ) (Figure 1D) were highlighted. Therefore, human leucocyte antigen (HLA)-B27 was assessed and it was found to be positive. Based on these findings, AS was the first diagnosis and the patient was treated with non-steroidal anti-inflammatory drugs, with only partial effect. Then, a 2 month course of medium-dose glucocorticoids was initiated (prednisone 25 mg daily, tapered to 7.5 mg in 4 weeks, then continued at a dose of 5 mg daily), with a brilliant response, including normalization of inflammatory indices. Thereafter, the patient was referred to our tertiary referral centre (Spondyloarthritis Clinic, Rheumatology Unit, Padova University) to initiate biological treatment.
‘Can you touch your toes?’ spondyloarthropathies and acute anterior uveitis for primary eyecare practitioners
Published in Clinical and Experimental Optometry, 2022
SpAs, and AS in particular, are polygenic but the most significant association is with the Major Histocompatibility Complex (MHC),9,10 in particular the Class I Human Leukocyte Antigen molecule HLA-B27. MHC and HLA are key elements of the immune defence of the body against infection. Inappropriate activation of an HLA receptor may explain auto-immune reactions, of which AS and AAU are examples. The link between AS and HLA-B27 was first identified in 1973.11 HLA-B27 positivity was soon shown to be related to reactive arthritis, psoriatic arthritis and enteropathic arthropathy (inflammatory bowel diseases) as well. AAU similarly is strongly associated with HLA-B2710,12 and the mutual association between AAU and the SpAs remains a very active area of immunological research for uveitis specialists.
Osteitis condensans ilii in a patient with ulcerative colitis: a mimic of ankylosing spondylitis or non-radiographic axial spondyloarthritis
Published in Modern Rheumatology Case Reports, 2021
Kotaro Otomo, Tsutomu Takeuchi
Laboratory tests revealed normal concentrations of C-reactive protein (CRP, 0.04 mg/dl), Erythrocyte Sedimentation Rate (ESR, 9 mm/h) or matrix metalloproteinase 3 (MMP-3, 19.4 ng/ml). Total serum calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) levels were within normal ranges. Anti-nuclear antibodies were positive at 1: 40 (homogenous pattern) and anti-dsDNA antibody was negative. No other specific autoantibodies were detected. Total serum IgG, IgA and IgM, and complements (C3, C4 and CH50) levels were all within each normal range. Rheumatoid factor [10 IU/ml (normal range <15)] and anti CCP antibodies (<0.5 U/ml) were negative. Human leukocyte antigen (HLA)-B27 was negative. The interferon gamma assays (IGRA) for tuberculosis (T-SPOT® TB) and 1,3 b-D-glucan were also negative.