MODERN VIEW ON THE PROBLEM OF OSTEOPOROSIS IN ANKYLOSING SPONDYLITIS

2020 ◽  
Vol 5 (4) ◽  
pp. 19-28
Author(s):  
Tat'yana Raskina ◽  
O. Malyshenko ◽  
M. Pirigova ◽  
M. Letaeva ◽  
Yu. Averkieva
Keyword(s):  
Ankylosing Spondylitis ◽  
Early Detection ◽  
Axial Skeleton ◽  
Diagnostic Techniques ◽  
Control Group ◽  
Hla B27 ◽  
Functional Disorders ◽  
Healthy Men ◽  
X Ray ◽  
Reliable Diagnosis

The study included 72 men with a reliable diagnosis of AS, mean age – 43,2±9,1 years. X-ray examination of the axial skeleton and peripheral joints was carried out, HLA-B27 was determined. Disease activity was assessed using the index ВАSDАI, functional disorders with the help of the BASFI index. BMD was determined by two-energy x-ray absorptiometry. The control group consisted of 74 healthy men, mean age – 46,7±0,9 years. Given the chronic nature and asymptomatic course of osteoporosis, the task of doctors working with this group of patients is an active search for osteoporosis using all available diagnostic techniques for the early detection of this condition and subsequent correction of the drug treatment.

scholarly journals The pathogenesis of ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E3 ◽  
Author(s):  
Mohammed F. Shamji ◽  
Mohammed Bafaquh ◽  
Eve Tsai
Keyword(s):  
Ankylosing Spondylitis ◽  
Molecular Mimicry ◽  
Human Leukocyte ◽  
Axial Skeleton ◽  
Chronic Inflammatory Disease ◽  
The Body ◽  
Hla B27 ◽  
Leukocyte Antigen ◽  
Molecular Events ◽  
Microbial Tolerance

✓ Ankylosing spondylitis (AS) is a chronic inflammatory disease that can cause significant functional complications by affecting the sacroiliac joints and axial skeleton. Despite a longstanding knowledge about the familial associations of this disease, particularly among patients positive for human leukocyte antigen (HLA)–B27, the fundamental pathogenetic mechanism by which this disease arises in genetically susceptible individuals remains ill defined. Furthermore, the molecular predilection for characteristic articular site involvement remains under ongoing investigation. Current theories about the HLA-B27 association range from the presentation of novel arthritogenic peptides, to abnormal autoimmune stimulation, to anomalous microbial tolerance. The immune effectors of this damage include CD4+, CD8+, and natural killer cells, with marked heterogeneity at different sites. Biomechanical stresses may trigger this disease by exposing the body to previously immune-sequestered autoantigens or by providing a route for bacterial seeding. Environmental triggers such as infection have not been definitively established but may represent a primary pathogenic step in a molecular-mimicry process. In this article, the authors review the current literature on the origin and pathophysiology of AS, focusing on genetic and molecular associations, consequent pathomechanisms, and associated triggers. An improved understanding of the sequence of molecular events that predispose and initiate the onset of this disease will allow for more specific and targeted therapy and better avoidance of the significant side effects of systemic immunomodulation.

scholarly journals A review of the pathogenesis of ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E2 ◽  
Author(s):  
Elias Dakwar ◽  
Jaypal Reddy ◽  
Fernando L. Vale ◽  
Juan S. Uribe
Keyword(s):  
Ankylosing Spondylitis ◽  
Strong Association ◽  
Critical Role ◽  
Axial Skeleton ◽  
Causative Role ◽  
Hla B27 ◽  
Pathogenic Role ◽  
The Past ◽  
New Findings

✓ Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease involving primarily the sacroiliac joints and the axial skeleton. The main clinical features are back pain and progressive stiffness of the spine. Oligoarthritis of the hips and shoulders, enthesopathy, and anterior uveitis are common, and involvement of the heart and lungs is rare. The current understanding of the pathogenesis of this disorder is limited. Despite the strong association between human leukocyte antigen B27 (HLA-B27) and susceptibility to AS reported over the past 30 years, the exact pathogenic role of HLA-B27 in AS and other spondyloarthropathies has yet to be determined. The authors present a review of the literature pertaining to the pathogenesis of AS over the past several decades. Ankylosing spondylitis is a polygenic disorder, with HLA-B27 playing a critical causative role in its pathogenesis. Animal studies of the immunobiology of HLA-B27 have provided significant insight into the pathogenic role of HLA-B27. The search for the antigenic peptide to support the “arthritogenic peptide” hypothesis has been disappointing. Over the past decade there has been increasing interest in the critical role of the misfolding and unfolded protein response of the heavy chain HLA-B27 in the modulation of the inflammatory response. Although there have been significant new findings in the understanding of the pathogenesis of AS, the exact mechanisms have yet to be identified. There is considerable optimism that additional susceptibility genes, predisposing factors, and regulators of the inflammatory process will be identified that will provide avenues for future treatment.

scholarly journals Association of ankylosing spondylitis activity indicators in a Russian population of patients with STAT4 rs7574865 gene polymorphism

2019 ◽  
Vol 13 (2) ◽  
pp. 55-60
Author(s):  
M. Yu. Krylov ◽  
A. S. Starkova ◽  
E. Yu. Samarkina ◽  
T. V. Dubinina ◽  
Sh. F. Erdes
Keyword(s):  
Ankylosing Spondylitis ◽  
Gene Polymorphism ◽  
Autoimmune Diseases ◽  
Disease Activity ◽  
Topoisomerase I ◽  
Association Studies ◽  
Russian Population ◽  
Control Group ◽  
Genome Wide Association Studies ◽  
Hla B27

Family and twin studies have shown that ankylosing spondylitis (AS) has a hereditary nature that is based on a strong association with the leukocyte antigen HLA-B27. However, only 1–5% of HLA-B27 carriers develop AS, which indicates that there are other genetic markers involved in the formation of a predisposition to this disease. A number of genome-wide association studies have convincingly confirmed the role of the STAT4 gene. This gene encodes the protein – the signal transducer and activator of transcription (STAT) protein, which is a predisposing factor for the development of many autoimmune diseases. There are not so many studies of the relationship of STAT4 polymorphisms to the predisposition to AS, and there are no these studies regarding the Russian population.Objective: to study whether there is a possible association of STAT4 rs7574865 gene polymorphism with the predisposition to AS and to assess the activity of this disease using BASDAI and ASDAS scores in the Russian patient population.Patients and methods. A cohort of 203 individuals, including 100 patients (79 men and 21 women) with AS, and 103 healthy volunteers (a control group) was surveyed. Age, gender, duration, and specific features of AS onset, ESR, and CRP levels were assessed. BASDAI and ASDAS scores were calculated to evaluate disease activity.Results and discussion. There was a significant relationship between STAT4 polymorphism and C-reactive protein (CRP) levels and BASDAI and ASDAS-CRP scores. The TT genotype carriers had significantly higher mean activity indices compared to the GG (p=0.001) and GT (p=0.005) genotype carriers for CRP, BASDAI (p=0.0001 and p=0.009, respectively) and ASDAS-CRP (p=0.009 and p=0.001, respectively). High disease activity (BASDAI >4 and ASDAS-CRP >3.5) was also associated with the high frequency of the T allele (p=0.046 and p=0.004, respectively). The value of STAT4 rs7574865 gene polymorphism in the pathogenesis of autoimmune diseases is confirmed by a study in which the T allele in STAT4 rs7574865 enhances mRNA transcription and protein expression. Italian authors have shown that there is a relationship between the minor T allele of rs7574865 and the high risk of arthritis. We have previously established a relationship between the T allele and the predisposition to diffuse systemic scleroderma, interstitial lung damage, and elevated anti-topoisomerase I antibody levels.Conclusion. The present study has shown for the first time a significant association of STAT4 rs7574865 polymorphism with the main AS activity indicators: CRP levels, BASDAI and ASDAS-CRP scores. The studied polymorphism may be a new genetic marker for predicting the severity of AS. 

scholarly journals Ankylosing Spondylitis

2021 ◽  
Author(s):  
Nazanin Ebrahimiadib ◽  
Sahar Berijani ◽  
Mohammadreza Ghahari ◽  
Fatemeh Golsoorat Pahlaviani
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Diseases ◽  
Strong Association ◽  
Joint Destruction ◽  
Human Leukocyte ◽  
Axial Skeleton ◽  
Term Treatment ◽  
Joint Involvement ◽  
Hla B27 ◽  
Short Term Treatment

The seronegative spondyloarthropathies are a group of autoimmune inflammatory diseases lacking rheumatoid factor or antinuclear antibody in their serum. They include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, spondylitis associated with Crohn’s disease and ulcerative colitis, and undifferentiated spondyloarthropathies. Inflammation mostly affects the axial joints, entheses, and extra-articular structures such as uveal tract, gastrointestinal tract, mucocutaneous tissue, and heart. Uveitis is the most common extra-articular manifestation. Spondyloarthropathies, especially AS, have a strong association with the presence of Human Leukocyte Antigen (HLA)-B27 gene. AS happens earlier in HLA-B27 patients and men are more prone to the disease. Uveitis, typically unilateral nongranulomatous acute anterior uveitis, occurs in up to 50% of the patients with AS. HLA-B27 positivity correlates with more frequent flare-ups. Conjunctivitis and scleritis are rare ocular manifestations of AS. To establish the diagnosis of AS, at least one clinical and one radiologic parameter are required for definitive diagnosis. Magnetic resonance imaging (MRI) or bone scan can help early detection of the axial skeleton inflammation. The course of eye and joint involvement are not correlated. Short-term treatment with topical corticosteroids and cycloplegic agents control the uveitis attack. In resistant cases, local or systemic therapy with corticosteroids are recommended. NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), methotrexate, azathioprine, anti-IL-17A monoclonal antibodies, and TNF- α antagonists are effective treatments for ocular and systemic manifestations of AS. If not treated adequately, uveitis may become recalcitrant and extend posteriorly. Functional impairment due to joint destruction can also occur as a result of undertreatment.

scholarly journals IgA nephropathy associated acute kidney injury with ankylosing spondylitis and HLA-B27 positive: a case report

2019 ◽  
Vol 8 (1) ◽  
pp. 39-43
Author(s):  
Mahmud Javed Hasan ◽  
ASM Ruhul Quddus ◽  
Nitai Chandra Ray
Keyword(s):  
Acute Kidney Injury ◽  
Ankylosing Spondylitis ◽  
Iga Nephropathy ◽  
Rare Case ◽  
Morning Stiffness ◽  
Kidney Injury ◽  
Creatinine Ratio ◽  
Hla B27 ◽  
Sacroiliac Joints ◽  
X Ray

We are reporting a rare case with ankylosing spondylitis (AS), renal impairment with IgA nephropathy. Here, we discuss the course of diagnosis. A 32 year-old man with bilateral pain of the sacroiliac joints for 5 years and leg swelling for 10 days.  A Diagnosis of AS by HLA-B27 and pelvic X-ray tests, pathological diagnosis and IgA nephropathy based on renal biopsy. We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD for a month. The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin creatinine ratio decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved. Although the causal relationship between AS and IgA nephropathy in this patient still needs to be established. In clinical practice, patients with AS need to be screened for renal complications. CBMJ 2019 January: vol. 08 no. 01 P: 39-43

scholarly journals Arthritis Associated with Crohn's Disease

1990 ◽  
Vol 4 (8) ◽  
pp. 497-502 ◽  
Author(s):  
JM Gilvarry ◽  
F Keeling ◽  
O Fitzgerald ◽  
JF Fielding
Keyword(s):  
Crohn’S Disease ◽  
Ankylosing Spondylitis ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Disease Onset ◽  
Close Correlation ◽  
Control Group ◽  
Hypertrophic Osteoarthropathy ◽  
Hla B27 ◽  
Peripheral Arthritis

A controlled prospective study was undertaken to determine the incidence and characteristic features of peripheral arthritis, sacroiliitis, ankylosing spondylitis and hypertrophic osteoarthropathy in a group of patients with Crohn's disease, and to define the relationship of such arthritides with disease site, duration and activity. Peripheral arthritis occurred in 14.5% of the patients; it was not seen in the control group. This arthritis, which tended to be pauciarticular, was more common in females with large bowel disease and post dated the bowel symptoms in all but one patient. There was close correlation with disease activity. Radiographic sacroiliitis occurred in 12.7% of the patients and ankylosing spondylitis in 7.3%; neither of these were seen in the control group. Sacroiliitis was more common in females and showed no correlation with either disease activity or human lymphocyte antigen (HLA) B27. Ankylosing spondylitis was seen equally in males and females and showed close correlation with both disease activity and HLA B27. Hypertrophic osteoarthropathy occurred in 9.1% of patients. It was not seen in the control group. All patients were asymptomatic. It showed no correlation with disease activity, finger clubbing, age of disease onset, or HLA B27.

Kinesiotherapy in patients with ankylosing spondylitis

2020 ◽  
Vol 96 (2) ◽  
pp. 18-23
Author(s):  
R.R. Ahunova ◽  
R.A. Bodrova
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Axial Skeleton ◽  
Poor Quality ◽  
Chronic Inflammatory Disease ◽  
Functional Disorders ◽  
Regular Group ◽  
Permanent Disability ◽  
Positive Effect

Ankylosing spondylitis is a chronic inflammatory disease from the group of spondylarthritis, characterized by damage to the predominantly axial skeleton, gradual formation of functional disorders of the spine and joints, leading to temporary or permanent disability and poor quality of life for patients, mostly young. In recent years, much attention has been paid to the study of the effectiveness of kinesitherapy in patients with ankylosing spondylitis. Studies have been conducted that confirmed the positive effect on the function of the spine and joints of regular exercises performed at home, regular group exercise and their combination with physiotherapy methods. However, due to the imperfect methodology of conducting these studies and the lack of a standardized approach in evaluating the effectiveness of therapy in these patients, further detailed researches are needed to select the required amount of kinesitherapy for patients with ankylosing spondylitis and develop a standardized assessment of its effectiveness.

Ankylosing spondylitis

2013 ◽  
Author(s):  
Joachim Sieper
Keyword(s):  
Ankylosing Spondylitis ◽  
Axial Skeleton ◽  
Chronic Inflammatory Disease ◽  
Hla B27 ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Male Predominance ◽  
Inflammatory Drugs ◽  
Active Inflammation

Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2 and 0.8% and is strongly dependent on the prevalence of HLA B27 in a given population. For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axial spondyloarthritis (SpA) have been developed by the Assessement of Spondylo-Arthritis international Society (ASAS) which cover AS but also the earlier form of non-radiographic axial SpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.

scholarly journals Unusual Placement of an EBV Epitope into the Groove of the Ankylosing Spondylitis-Associated HLA-B27 Allele Allows CD8+ T Cell Activation

Cells ◽  
2019 ◽  
Vol 8 (6) ◽  
pp. 572 ◽  
Author(s):  
Valentina Tedeschi ◽  
Josephine Alba ◽  
Fabiana Paladini ◽  
Marino Paroli ◽  
Alberto Cauli ◽  
...  
Keyword(s):  
T Cells ◽  
Ankylosing Spondylitis ◽  
T Cell ◽  
T Cell Activation ◽  
Cd8 T Cells ◽  
Cell Activation ◽  
Molecular Mechanisms ◽  
Axial Skeleton ◽  
Binding Motif ◽  
Hla B27

The human leukocyte antigen HLA-B27 is a strong risk factor for Ankylosing Spondylitis (AS), an immune-mediated disorder affecting axial skeleton and sacroiliac joints. Additionally, evidence exists sustaining a strong protective role for HLA-B27 in viral infections. These two aspects could stem from common molecular mechanisms. Recently, we have found that the HLA-B*2705 presents an EBV epitope (pEBNA3A-RPPIFIRRL), lacking the canonical B27 binding motif but known as immunodominant in the HLA-B7 context of presentation. Notably, 69% of B*2705 carriers, mostly patients with AS, possess B*2705-restricted, pEBNA3A-specific CD8+ T cells. Contrarily, the non-AS-associated B*2709 allele, distinguished from the B*2705 by the single His116Asp polymorphism, is unable to display this peptide and, accordingly, B*2709 healthy subjects do not unleash specific T cell responses. Herein, we investigated whether the reactivity towards pEBNA3A could be a side effect of the recognition of the natural longer peptide (pKEBNA3A) having the classical B27 consensus (KRPPIFIRRL). The stimulation of PBMC from B*2705 positive patients with AS in parallel with both pEBNA3A and pKEBNA3A did not allow to reach an unambiguous conclusion since the differences in the magnitude of the response measured as percentage of IFNγ-producing CD8+ T cells were not statistically significant. Interestingly, computational analysis suggested a structural shift of pEBNA3A as well as of pKEBNA3A into the B27 grooves, leaving the A pocket partially unfilled. To our knowledge this is the first report of a viral peptide: HLA-B27 complex recognized by TCRs in spite of a partially empty groove. This implies a rethinking of the actual B27 immunopeptidome crucial for viral immune-surveillance and autoimmunity.

scholarly journals Gait Characteristics In patients With Ankylosing Spondylitis – a Systematic Review (Preprint)

2019 ◽  
Author(s):  
Julie Soulard ◽  
Jacques Vaillant ◽  
Clara-Thémis Agier ◽  
Nicolas Vuillerme
Keyword(s):  
Ankylosing Spondylitis ◽  
Sagittal Plane ◽  
Axial Skeleton ◽  
Gait Pattern ◽  
Lower Limbs ◽  
Spinal Mobility ◽  
Control Group ◽  
Published Data ◽  
Gait Characteristics ◽  
Study Characteristics

BACKGROUND Ankylosing spondylitis (AS) is a chronic rheumatic disease which affects the axial skeleton and sacro-iliac joints. By impacting spinal mobility and physical functions, AS could also potentially impair gait. However, while published data are rather sparse, it appears that discrepancies exist regarding AS consequences on gait characteristics, tasks and analysis techniques used to assess gait ability of patients with AS. OBJECTIVE The review questions are twofold: (1) What are the consequences of AS on gait? and (2) How is gait assessed in patients with AS? METHODS Databases were systematically searched to identify studies satisfying the search criteria, using the synonyms of ankylosing spondylitis and gait. Two reviewers extracted from the articles study characteristics, sample descriptions, methods and main results in relation to gait. RESULTS 168 titles were extracted from databases and 17 studies were included in the review. 13 studies (76%) used clinical gait measurements, and 4 (23%) used laboratory gait measurements. Only 6 involved a healthy control group. Gait pattern of patients with AS was more cautious, associated to a decreased pelvic tilt and lower limbs angles in the sagittal plane. Studies used diverse protocols, instructions and parameters when assessing gait in AS patients. CONCLUSIONS Only few studies have assessed gait characteristics in patients with AS. Published data evidence that no consensus exists regarding gait analysis methods for patients with AS. However, published studies are encouraging as they provide us the opportunity to propose guidelines to improve the design and methodology for future studies on gait and AS. CLINICALTRIAL PROSPERO: CRD42018102540 and JMIR Res Protoc doi:10.2196/12470

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