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Gastroenterology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Peak incidence is between the ages of 20 to 40 years. Two disorders cause chronic inflammation and although there is overlap they have distinct features: Crohn’s disease.Ulcerative Colitis (UC). Both conditions are associated with HLA-B27 and ankylosing spondylitis. In addition, there is an increased risk of colorectal cancer (more for UC than Crohn’s).
The Musculoskeletal System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
No laboratory tests are specific for ankylosing spondylitis. The sedimentation rate, alkaline phosphatase, and the genotype HLA-B27 are used for a possible association. Treatment is with a vigorous exercise program and cautious use of nonsteroidal antiinflammatory agents (NSAlDs).
The Interaction Between Genetic Factors and Microorganisms in Ankylosing Spondylitis
Published in Irun R. Cohen, Perspectives on Autoimmunity, 2020
L. E. McGuigan, A. F. Geczy, J. K. Prendergast, L. I. Upfold
Ankylosing spondylitis (AS) is a relatively uncommon rheumatological disease occurring principally in men in the early part of their adult lives. Although it may only cause mild symptomatology, in its worst form AS causes crippling deformities of the back and neck and destruction of the large joints of the hips, knees, and shoulders.1 Some early genetic studies on AS demonstrated a tendency for familial aggregation,2 but research on possible pathogenetic mechanisms involved in the development of AS did not really commence until 1973, when Brewerton et al.3 and Schlosstein et al.4 found the very close association between AS and HLA-B27. This discovery greatly increased the interest in the relationship between HLA and disease predisposition, as never before had such a close association been demonstrated for any other condition. Moreover, this remarkable finding of HLA-B27 in over 90% of AS patients has been echoed in all other similar studies except those conducted in populations where HLA-B27 is an uncommon allele.5 However, in those populations where HLA-B27 is uncommon, so too is the incidence of AS.6
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.