ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Studies from around the world have confirmed the association between HLA-B27 and human spondyloarthropathies. The onset of many HLA-B27-linked arthritides follows an infection with enterobacteria. How bacteria interact with HLA-B27 and modify the immune system to give rise to the clinical disease is currently unclear. The roles of other genetic factors, including major histocompatibility complex class II genes and other genes located within this region (Tap/Lmp), have been postulated in certain spondyloarthropathies. We are using transgenic and knockout mice to answer some of these unsolved issues. This review discusses recent findings from our laboratories.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ankylosing spondylitis (AS) almost invariably starts before the age of 50, and clinical features suggestive of AS in older age should lead to consideration of other rheumatic disorders. Clinical manifestations of extraskeletal tissue such as renal amyloidosis and lung disease may occur. However, the detection of amyloidosis may not invariably infer poor prognosis, and associated lung disease may include apical fibrosis and also interstitial lung disease. Although the clinical significance and pathogenesis of osteoporosis in AS remain unclear, reduced bone mass may be found in a significant number of patients. Population surveys on AS have shown a correlation between the population frequency of HLA B27 and prevalence of AS. However, neither B27 subgroup distribution nor low frequency of B27 can explain the rarity of AS among certain African regions. Also representing an area of future research is the detection of both disease-related variables and sociomedical factors influencing the final outcome of this disease.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent population-based studies have examined the incidence, prevalence, and survival rates of patients with psoriatic arthritis (PsA). Although there are still no completely satisfactory diagnostic criteria for PsA, Moll and Wright's criteria although not a true classification/diagnostic scheme-are the most used. The sensitivity of these criteria is low (61%), as are the sensitivities of the European Spondyloarthropathy Study Group and Amor classification criteria for the whole spectrum of spondyloarthropathy. In some patients, PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis or dactylitis. These patients may represent a subset of PsA that is not defined by the Moll and Wright or European Spondyloarthropathy Study Group criteria and is, therefore, poorly recognized as such. Recent studies have analyzed the expression of adhesion molecules, cytokines, and chemokines in the synovial fluid and synovial membrane of patients with PsA. The therapeutic approach to PsA must be multidisciplinary, involving dermatologists and rheumatologists. Currently the most widely used second-line drugs are methotrexate, sulfasalazine, and cyclosporine. Used in combination, these drugs will probably become a well-established therapy for PsA.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The termsundifferentiated arthritisandundifferentiatedcharacterize arthritides that do not fit into well-known clinical disease categories (eg, seronegative rheumatoid arthritis and reactive arthritis) and that are an early stage or forme fruste of a definite rheumatic disease, an overlap syndrome between such diseases, or an unknown, etiologically undefined disease that remains to be differentiated from other types of arthritis or spondylarthritis. Undifferentiated arthritis and undifferentiated spondylarthritis share some clinical features with reactive arthritides. Recent data suggest that, at least in Chlamydiainduced reactive arthritis, the triggering bacteria persist in affected joints for some time during the course of the disease in a viable but nonreplicative state, providing an antigenic stimulus for a bacteria-specific immune reaction in the joint. The clinical manifestations of reactive arthritis include not only Reiter's syndrome or clinically suspected postinfectious arthritis but also undifferentiated oligoarthritis and spondylarthritis. The optimal treatment remains to be defined, but there is increasing data that antibiotic therapy is not as effective in cases of well-established reactive arthritis as has been suggested.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Acute anterior uveitis (AAU) is characterized by sudden-onset, mostly unilateral exacerbations of an inflammation of the iris and ciliary body. The duration of illness is short if the patient is treated with corticosteroids. Half of all patients with any type of anterior uveitis are HLA-B27-positive, and more than half of the B27-positive patients have spondyloarthropathy. Ophthalmologists should therefore refer all patients with AAU who are HLA-B27-positive to a rheumatologist. Because attacks of AAU are extremely painful and frightening, most spondyloarthropathy patients with AAU will seek out an ophthalmologist on their own. The anterior chamber of the eye and the joints are mesenchymal cavities that are cleaned by macrophages. Anterior chamber-associated immune deviation is the mechanism by which specific regulatory T cells normally produce sufficient transforming growth factor-β to impair inflammatory reactions that might hamper vision. Another mechanism of immune privilege is Fas-ligand induced apoptosis. Because the cells of the anterior eye express Fas-ligand, infiltrating cells are apoptotically killed. Comparable mechanisms may occur at a lower level in joints. The cause of AAU and spondyloarthropathy is unknown. B27 is probably only responsible for one quarter of the pathogenesis, other non- 627 genetic factors for another quarter, and unknown exogenous factors for the remaining half. It is possible that Gramnegative bacteria such asKlebsiellaorYersiniaare involved in the pathogenesis in a yet unknown way.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Whereas it is clear that HLA-B27 is increased in many North American natives, the prevalence varies a great deal. There is still a paucity of data on a large number of tribes. There is, however, a suggestion that HLA-B27 positive prevalence follows cultural/linguistic groupings. Reactive arthritis, sacroiliitis, and ankylosing spondylitis also appear to be increased in these people, but their relationship to HLA-B27 and possibly additional genetic predisposing factors is far from clear. Given these data and the known association of infectious agents, more extensive studies are warranted, especially in those tribes with a large enough population to achieve statistical significance.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID