ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article examines some fundamental features of the histopathology of ankylosing spondylitis (AS) such as inflammation in the entheses and syndesmophyte formation. This may be linked to the generation of transforming growth factor in inflammation, which can stimulate bone formation, and to the molecular composition of entheses where molecules are present, such as the proteoglycan aggrecan, that are normally found in cartilage. Immunity to these molecules is observed in patients with AS and in experimental immunity to aggrecan, or the G1 domain only, which can cause spondylitis. Involvement of other tissues (the eye and arterial vessels) may be due to crossreactive immunity.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The spondyloarthropathies are a group of inflammatory arthritic conditions characterized by the absence of rheumatoid factor, and the presence of spondylitis, sacroiliitis, and an asymmetric peripheral arthritis. Familial aggregation and the presence of enthesitis, skin and mucous membrane lesions, bowel complaints, eye involvement, and aortic root dilatation are also features of these conditions. An association with HLA-B27 has been documented in the diseases constituting the spondyloarthropathies, including ankylosing spondylitis, Reiter's disease/reactive arthritis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Although there are similarities among the entities included in this group, each of these conditions have specific characteristics that help distinguish them. Differences in response to medications and in prognosis are such that it is important to make the correct diagnosis in the individual patient.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In the 25 years since the initial reports of the association of HLA-B27 with ankylosing spondylitis (AS) and subsequently with Reiter's syndrome, psoriatic spondylitis, and the spondylitis of inflammatory bowel disease, the association of HLA-B27 with the seronegative spondyloarthropathies has remained one of the best examples of a disease association with a hereditary marker. HLA-B27 has been recognized as representative of a spectrum of diseases, ranging from the majority of HLA-B27-positive individuals who have no disease at all, through those with isolated eye or skin involvement, to those with critical eye, heart, and peripheral joint compromise of full-blown AS. Yet HLA polymorphism has evolved in response to environmental stresses, and even the presence of HLA-B27 itself appears to confer advantages in certain infectious diseases, such as acquired immune deficiency syndrome (AIDS). This article will review what is currently known about HLA-B27 and disease, especially in the seronegative spondyloarthropathies. The structure-function relationship of HLA-B27 will be presented, including differences between the B27 subtypes both in their ethnic variation and possible disease implications. The disease spectrum conferred by the presence of HLA-B27 will also be discussed, and the theories of how HLA-B27 contributes to the pathogenesis of the spondyloarthropathies will be considered.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This review focuses on investigations of rats and mice transgenic for HLA-B27; these animals have been investigated for several years as potential models for the human spondyloarthropathies. Spontaneous multi-system disease occurs in rats with high expression of B27 and human β2-microglobulin (hβ2m). The disease is T-cell-dependent and is sensitive to both environmental and genetic manipulation. A spontaneous arthritis and enthesopathy has been observed by some investigators in nontransgenic mice which seems to be more prevalent in B27 transgenic mice. Peripheral arthritis has also been reported in B27 transgenic mice that lack mouse β2m. Potential insights from these animals into the pathogenesis of B27-related disease are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The way in which a host accommodates invasive facultative intracellular bacteria must be the key to the development of reactive arthritis. Investigators have analyzed the bacterial events at several levels: invasion into host cells, intracellular survival, translocation from the sites of infection to the joints, residence in the joints, and evasion of host defense. Because HLA-B27 is present in higher incidence in patients with reactive arthritis and is an essential gene in the related ankylosing spondylitis, the role of HLA-B27 in host defense is also assumed to be important in the development of reactive arthritis. This review summarizes the various studies in this field.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Reactive arthritis was originally defined as a sterile joint inflammation after infection elsewhere in the body, but this view has been challenged in the past decade since different antigens and DNA and RNA of various triggering microbes have been shown to exist at the sites of inflammation in the joints. It has been suggested that microbial antigens, or intact pathogens, are important for the pathogenesis of reactive arthritis, at least in the early phase of the disease, but the exact mechanism of how the pathogens contribute to the development of this usually self-limiting polyarthritis has not been discovered. This article reviews the theories on the role of infectious agents as triggers of reactive arthritis.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Psoriasis and its related arthritis are chronic inflammatory disorders affecting predominantly the skin and synovium. Although their etiology remains to be established, multiple factors seem to play important roles in their pathogenesis. These environmental (eg, infectious agents and trauma), genetic, and immunologic factors are reviewed in this article.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Because of increasing reports of multiple-antibiotic-resistant strains ofStreptococcus pneumoniaeand associated clinical failures, this study was performed to determine the prevalence of multiresistance among strains from nine Louisiana medical centers. Using a National Committee for Laboratory Standards broth microdilution method. 481 strains were tested. Of these, 70% were penicillin-susceptible (PS), 23% had intermediate minimum inhibitory concentration values to penicillin (I), and 7% were fully resistant to penicillin (PR). The isolation rates (15% to 40% for I strains and 0% to 33% for PR strains) at the various medical centers varied appreciably. The prevalence of penicillin resistance was highest among upper respiratory isolates, while cross-resistance to other antimicrobials varied. The least cross-resistance was noted among PS strains. However, strains with reduced penicillin susceptibility had high levels of cross-resistance. Among I strains, the prevalence of cross-resistance (%) was noted for amoxicillin/clavulanate (6%), cefuroxime (71%), cefaclor (91%), ceftriaxone (13%), cefotaxime (34%), erythromycin (67%), azithromycin (32%), and clarithromycin (32%). For PR strains, the prevalence of cross-resistance was 97% for amoxicillin/clavulanate, cefuroxime, and cefaclor; 67% for ceftriaxone and erythromycin; 89% for cefotaxime; and 69% for azithromycin and clarithromycin. These data emphasize the high prevalence of multiple-antimicrobial-resistance among strains ofS pneumoniaewith reduced penicillin susceptibility in this geographic area.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Human papilloma viruses (HPVs) are known to infect the genitourinary tract, the skin, the anal canal, and the upper respiratory tract. Esophageal papillomas and especially HPV-induced squamous papillomas of the esophagus are rare. The authors report a case of extensive HPV-induced esophageal polyposis, which was probably sexually transmitted. The 53-year-old female patient presented with chronic diarrhea and had occult blood in the stool. She underwent esophagogastroduodenoscopy, at which time multiple esophageal polyps were observed and biopsy specimens obtained. Histologic evaluation was consistent with benign papillomas. Polymerase chain reaction and DNA hybridization of the biopsied tissue specimens confirmed the diagnosis of HPV infection. Because of our observation and because of HPV's relationship to cervical and esophageal cancer, further evaluation of HPV as the cause of esophageal papillomatosis and as a risk factor for esophageal cancer is warranted.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID