Key words: ankylosing spondylitis, Reiter's syndrome, reactive arthritis, acute anterior uveitis Many authors regard psoriatic arthritis, also, as a B27 negative*
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B27 positive diseases versus B27 negative diseases - Annals of the
Key words: ankylosing spondylitis, Reiter's syndrome, reactive arthritis, acute anterior uveitis Many authors regard psoriatic arthritis, also, as a B27 negative*
HLA B27 and the genetics of ankylosing spondylitis - Annals of the
resembling peripheral psoriatic arthritis and 3 of these were B27 negative ankylosing spondylitis with genes for psoriasis and inflammatory bowel disease
Seronegative Rheumatoid Arthritis - JAMA Network
shown to be closely associated with HLA-B27 This syndromic discrimination has raised question as to the validity of RF negative RA (ie, seronegative RA)
Managing seronegative spondarthritides - Oxford Academic Journals
Rheumatoid arthritis, juvenile Still's disease, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome 1 The term seronegative arthritis still survives and
Seronegative Arthritis - Oxford Academic Journals
5 had ankylosing spondylitis, 3 had psoaritic arthritis Mean disease duration: 6 1 tified as the triggering organism in all cases ) and 3 psoriatic arthritis A repeated (16 7 ) HLA-B27 positive patients and 1/67 (1 5 ) HLA-B27 negative pa-
[PDF] Ankylosing spondylitis, Psoriatic Arthritis And the others
Prevalence 0 2-1 4 • M:F 2:1 • 90-95 HLA-B27 positive • Onset 2nd to 3rd decade • Back pain, arthritis, enthesitis, extra-articular features – uveitis in up to
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ALINSSENANDT EWFELTKAMP
AcccptedforpublicationIOctober1987.CorrespondencetoDrALinssen,NetherlandsOphthalmicRescarchInstitute,POBox12141,1100AC,Amsterdam,TheNetherlands.indicatedgenesotherthanB27.t"'12NordidanyoftheB27subtypesshowaparticularassociationwithAS.1 8StrongevidenceforB27asthemajorgeneticsusceptibilityfactorisfoundindetailedpopulationandfamilystudies,inwhichnostrongerassociationhasbeenobservedotherthanthatbetweenB27andAS.AstrongerB27associationhasbeenfoundinCaucasianswithspondylitisthanintheirAmericanblackcounterparts.'9Inadditiontogeneticfactors,infectiousagentshavebeenregardedasalikelycauseofprimaryAS.SeveralstudiesbyEbringeretalstronglysuggestedKlebsiellapneumoniaeinthisrespect,2tbutotherauthorscouldnotconfirmtheirresults.2'Inreactivearthritisclearcutevidenceforcausativeinfectiousorganismsofurinaryandentericoriginhavebeendemonstrated.InthecaseswhereHLA-B27isconsideredtoplayapartinthepathogenesisofB27associateddis-eases,B27-AS,B27-RS,B27-ReA,andB27-AAUareprobablythesamediseases,butdevelopingalongdifferentlines.WehaveattemptedtosolvethisproblembycomparingtheclinicalpicturesofB27+AS,B27+RS,B27+ReA,andB27+AAUwiththoseoftheirB27-counterparts.Areviewoftheliteratureisgiventogetherwiththeobservationsmadebyourowngroup.
B27+ASversusB27-AS(Table1)
431 on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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Table1DifferencesbetweenB27+ASandB27-AS
*AAU=acuteanterioruveitis.Theydidnotfindanydifferenceofageatonset,functionalclass,degreeofdeformity,xrayabnor-malities,ortheprevalenceofperipheralarthritis.TheonlydifferencewasanincreasedprevalenceofahistoryofAAUinB27+ASpatientscomparedwithB27-ASpatients.ThisstudywasconfirmedbyNahirandScharf,whofoundAAUinB27+ASpatientsonly.2526VanderLindenetaldiscoverednoclinicaldifferencesatall.27TheyfoundAAUinbothB27+andB27-patients.AllthepatientswithASwhohadafamilyhistoryofASwereB27'.27Gerberetalobservedarthritisoftheshouldersandlowerextremitiesandthedevelopmentofa'bamboospine'slightlymoreofteninB27+ASthaninB27-ASpatients.2Ontheotherhand,thedataofDekker-Saeys,29WoodrowandEastmond,31'M0lleretal,8andWagenereta131didshowclinicaldifferences.InB27-diseasetheyfoundalateronsetofAS,milderinitscourseinrespectofthedevelopmentofabamboospine,andthuslessaggressiveinappear-anceandsubsequentlywithabetterprognosis.Theyobservedmorepsoriasisandinflammatoryboweldisease(IBD)inB27-ASandmoreperipheralarthritisandacuteanterioruveitisinB27+AS.FamilyaggregationwasseeninB27+ASonly.273()ConstantfindingsbynearlyallauthorswerethepositivefamilyhistoryofASandthedevelopmentofAAU,mostlyinB27+ASpatients.Thediscrepanciesofthevariousstudiesarecertainlyduetopatientselection.InthosestudiesinwhichnoclinicaldifferenceswereobservedbetweenB27+ASandB27-AStheselectionwasmadefromwelldefinedclassicalASwithoutassociateddis-eases.InthestudiesofDekker-Saeys,29M0lleretal,8andWageneretal31ASassociatedwithpsoriasisandIBDwerenotexcluded.WoodrowandEastmonddidexcludepsoriasisandIBDassociatedwithAS.3t)Theyfoundfivepatientswithperipheralarthritisresemblingpsoriaticarthritis.ThreeofthesewereB27-.OneotherB27-patienthadasisterwithulcerativecolitisandASandamotherwithulcerativecolitis.FromthesestudiesonemayconcludethatB27+ASandB27-AS-apartfromAAU-arealmostidenticaldiseases,butthatdifferencesintheclinicalpicturearecausedbythepresenceofpsoriasisorIBD.InB27-ASpatientsgenesotherthanB27mayprovidesusceptibilitytothedevelopmentofAS.PossiblecandidatesforsucharolearetheB7-CREGantigens32-36andtheantigensassociatedwithpsoriasis3738andinflammatoryboweldisease.39ASmaydevelopinB27-patientscarryinggenesassociatedwithpsoriasisorinflammatoryboweldiseasewithoutshowingclinicalexpressionoftheskinorboweldisease,aswasmentionedearlierbyWoodrow38andKhanetal.33Nofirmassociationbetweensuchnon-B27BlocusantigensandAShasbeenfounduntilrecently,however.4'}42TwodifferentclinicalpicturesofASemanatefromtheabove-mentionedstudies,ashasalreadybeensuggestedbyDekker-Saeysin1976.29(a)PrimaryoridiopathicAS,developingearlyingeneticallypredisposedpersons,triggeredbyun-knownendogenousorexogenousfactors,probablyinfectiveinorigin.ThesepatientsaremostlyB27+.(b)SecondaryAS,triggeredbyaprimarydisease,forinstanceagenitalorgutinfection,inflammatoryboweldisease,orpsoriasis.InthisgroupB27ismostlynegative.Finally,ithastobekeptinmindthatpsor-iasiS25W!46andIBD54748itself,evenwhenaccom-paniedbyperipheralarthritis,arenotassociated on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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B27+ReAversusB27-ReA
responseswerenotperformed.TheydidnotMen5349512524Duration<1month514313667Duration<1month5231151741Duration<1month534982540Duration>2months51435160Duration>3months5231591712Duration>3months5349452524Monarthritis514314650Monarthritis523161718Monarthritis534942510Polyarthritis5349532528Bilateralsacroiliitis51431660Bilateralsacroiliitis523110170Sacroiliitis(acutestage)547023166Sacroiliitis(followup)544520138Backpain54105343915Chronicbackpain54105473914Urologicalmanifestations523135176Urologicalmanifestations534927254Urethritis5410531393Reiter'ssyndrome534912250Reiter'ssyndrome5410537390AAU51431860Iritis523116170Iritisorconjunctivitis534920250Ocularmanifestations5410518390Carditis523116170Erythemanodosum534922532Erythemanodosum5410523921Yersiniatitre5349980(titre)25490(titre) on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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ritis. wereB27-,showedmildersymptomsandalowerTable4DifferencesbetweenB27+RSandB27-RS*
*RS=Reiter'ssyndrome. on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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*AAU=acuteanterioruveitis.675059604943(years)43(years)39385079441888001060322330151343503058(weeks)1227538100141013908 on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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B27+AAUversusB27-AAU(Table5)
Discussion
ThisreviewshowsthatthestronginterrelationshipofAS,RS,ReA,andAAU,especiallyinthepresenceofB27,isremarkable.In1974MollandWrightsuggestedcallingthisgroupofstronglyinterrelateddiseases'theseronegativespondarth-ritides'.7>81Itisevident,however,thatthisnamehasnoreferencetoAAU,exceptwhenAAUisanextra-articularmanifestationofAS.SomeauthorsevenconsideredB27+AAUtobeamonosympto-maticmanifestationor'formefruste'ofAS.7118283AAUmaybefoundinallseronegativespondyloarth-ropathies,withorwithoutsacroiliacjointchanges,especiallyinthepresenceofB27.2956798084-86RadiologicalsacroiliitisisanecessaryconditionforthediagnosisofAS,878whichiswhyMollandWrightchoseradiologicalsacroiliitisasthepivotalpointoftheseronegativespondarthritides.Radio-logicalsignsofsacroiliitismayexist,however,withoutotherclinicalsymptomsofAS.29X2Ankylosisofthespineisnotcontractedbyallpatients,85899)andspinalsyndesmophytesmayexistwithoutradio-logicalsacroiliitisinB27+patients,ashasbeenpostulatedbysomeauthors.7980Moreover,sacroili-itismaybefoundinalldiseasesassociatedwithAS,especiallyinthepresenceofB27.79Therefore,AAUandsacroiliitismaybeconsideredastwoclinicalfeaturesfromavastnumberofoverlappingsymptomsoccurringinASanditsrelateddiseases,especiallyinthepresenceofB27.Itmaybebettertospeakofasyndromeinsteadofadisease.TheclinicalfeaturesofthissyndromehavebeendescribedbyMollandWright.798'ThesefeaturesarecommontoalldiseasesassociatedwithAS.Absenceoftherheumatoidfactorandsubcutaneousnoduleshasbeennoted.Peripheralarthritisattack-ingthejointsofthelowerextremitiesandentheso-pathyoftheAchillestendonoftenoccurduringthecourseofthedisease. on July 2, 2023 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/ard.47.5.431 on 1 May 1988. Do
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