Ankylosing spondylitis; a review of 184 cases

A new and spontaneous animal model for ankylosing spondylitis is found in cynomolgus monkeys

BACKGROUND

Ankylosing spondylitis is a progressive, disabling joint disease that affects millions worldwide. Given its unclear etiology, studies of ankylosing spondylitis relied heavily on drug-induced or transgenic rodent models which retain only partial clinical features. There is obviously a lack of a useful disease model to conduct comprehensive mechanistic studies.

METHODS

We followed a group of cynomolgus monkeys having joint lesions reported of spinal stiffness for 2 years by conducting hematological testing, radiographic examination, family aggregation analysis, pathological analysis, and genetic testing.

RESULTS

The results confirmed that these diseased animals suffered from spontaneous ankylosing spondylitis with clinical features recapitulating human ankylosing spondylitis disease progression, manifested by pathological changes and biochemical indicators similar to that of ankylosing spondylitis patients.

CONCLUSION

The study offers a promising non-human primate model for spontaneous ankylosing spondylitis which may serve as an excellent substitute for its pre-clinical research.

Ankylosing spondylitis and peripheral joint disease

We reviewed 13 patients with Ankylosing Spondylitis and radiologically demonstrated peripheral arthritis. Due to seriousness and extensiveness, we could distinguish three subgroups.

Subacute bacterial endocarditis in a patient with ankylosing spondylitis

A 57 year old white man with aortic insufficiency and previously undiagnosed ankylosing spondylitis, who developed subacute bacterial endocarditis (SBE), is described. Emergency aortic valve replacement was necessary, and the aortic valve pathology showed diffusely fibrosed and thickened valve leaflets with bacterial vegetations. This is the first recorded case of SBE in ankylosing spondylitis.

New criteria for the diagnosis of ankylosing spondylitis

Criteria for ankylosing spondylitis are useful for two main purposes. First, to provide unity of diagnosis in population surveys; secondly, in the field of therapeutic assessment. This paper is concerned with criteria used largely in the former role, i.e. as an epidemiological tool. Critical formulation and subsequent evaluation of criteria is important if a realistic measure of disease prevalence is to be obtained. The New York criteria have provided the general currency for diagnosis epidemiologically in recent years, but their value, in their originally published form, has been questioned for various reasons. Attempts have been made to improve these criteria or to suggest alternatives. Although increased sophistication of the original New York criteria has doubtless been achieved, the position regarding the diagnosis of ankylosing spondylitis continues to represent a challenge. The main concern is that the present "index of truth" for the disease, radiological sacroiliitis, is all too often a delayed feature, presenting only after pain has been present for some time. A second problem is the difficulty in diagnosing with confidence the early changes of sacroiliac sclerosis and erosion, and the degree of intra- and inter-observer error arising from these changes. Newer techniques such as radioisotope scintigraphy and computerised tomography (CT) are unlikely to replace the traditional pelvic radiograph. The way forward is more likely to be in the direction of how existing data are processed rather than what is used to obtain them. In this vein, suitable mathematical/biological models coupled with computer technology could provide realistic tools through a system of probability weighting of existing criteria.

Acute anterior uveitis, ankylosing spondylitis, back pain, and HLA-B27

One hundred and sixty-nine patients with acute anterior uveitis were studied for the presence of HLA-B27 tissue type, radiological evidence of ankylosing spondylitis, and a history of back pain. 60% were male; 45% were HLA-B27+. The male:female ratio in the HLA-B27+ group was the same as in the whole group. 24% had radiological evidence of ankylosing spondylitis, and, of these, 83% were HLA-B27+ while 17% were HLA-B27-. There was a definite correlation between the severity of the ankylosing spondylitis and preponderance of males in the HLA-B27+ group of patients. Significant back pain occurred in 60% of HLA-B27+ patients but in only 14% of HLA-B27- patients. The importance of the selection of patients and of consistency in the use of diagnostic criteria in studies relating to ankylosing spondylitis and acute anterior uveitis is stressed.

The natural disease course of ankylosing spondylitis

One hundred fifty war veterans with ankylosing spondylitis were entered into a prospective study in 1947. In 1957, 142 were traced, and they have been reviewed periodically. Eighty-one of these patients were still alive in 1980. Information was obtained from 67 (83%) of the survivors and 51 were reexamined. This report is based on the clinical findings in these 51 patients, who have a mean disease duration of 38 years. Forty-seven (92%) were functioning well. The disease in 21 (41%) had progressed to cause severe spinal restriction. Of those, 12 had peripheral joint involvement early in their course and 9 had iritis. Seventy-four percent of the patients who had mild spinal restriction after 10 years did not progress to having more severe restriction. Eighty-one percent of the patients who had severe spinal restriction in 1980 were severely restricted within the first 10 years. Hips that were normal after 10 years of disease did not become diseased subsequently. This study suggests that a predictable pattern of ankylosing spondylitis emerges within the first 10 years of the disease.

76 patients with ankylosing spondylitis seen after 30 years of disease

Seventy-six patients treated for ankylosing spondylitis at the Rheumatism Foundation Hospital during the 1950s were re-examined. The mean duration of the disease was 30.5 years. The main interest was in the clinical and radiological progression of the disease, functional and working ability and the number of complications and their severity. The results seem to show that the long-term prognosis for AS is good, on average. A detailed description of the results is presented.

Ankylosing spondylitis of juvenile onset: comparison with adult onset disease

Although less frequently, ankylosing spondylitis (AS) may also occur during childhood. The present report describes the clinical features in 24 patients with AS of juvenile onset and its comparison with those found in 71 patients with adult onset AS. A slightly increased prevalence of female patients was found in the juvenile onset group. Peripheral joint involvement as a mono- or oligoarticular arthritis was significantly more frequent in juvenile onset patients, not only as a mode of onset but also during the course of the disease. 5.4 years after onset all these patients had developed axial involvement. Extra-articular manifestations occurred with similar frequency in juvenile and adult onset patients. One juvenile patient had associated multiple sclerosis; one juvenile and one adult onset patient developed amyloidosis. Impairment of functional capacity was more severe in the juvenile onset group; hip joint involvement was closely related to a poorer prognosis.

A syndrome of seronegative enthesopathy and arthropathy in children

Thirty-nine children with a syndrome of seronegative enthesopathy and arthropathy were evaluated. The group included 25 patients with no apparent underlying primary disease and 13 with either ankylosing spondylitis, inflammatory bowel disease, reactive arthritis, or Reiter's syndrome. Significant distinguishing characteristics of the group included male predominance, late age at onset, positive family histories of arthritis, oligoarthropathy, axial skeleton involvement, and the presence of the B27 histocompatibility antigen. This syndrome is distinguishable from other childhood rheumatic disorders, including juvenile rheumatoid arthritis. Its recognition may reliably identify children with the prodromal manifestations of seronegative spondylarthropathies.

Frequency of faecal Klebsiella aerogenes in patients with ankylosing spondylitis and controls with respect to individual features of the disease

A study of 59 patients with definite ankylosing spondylitis and 41 comparable hospital outpatients with fractures has been undertaken to determine if the presence of faecal Klebsiella aerogenes is related to clinical activity of the spinal disease and its extraspinal features. The frequencies of fecal K. aerogenes were similar in both patients and controls and were not significantly related to spinal disease activity. Careful inquiry about antibiotic treatment, dietary habits, and hospitalisation did not significantly influence the results. A significant association was found between the presence of faecal K. aerogenes and both acute non-granulomatous anterior uveitis (P less than 0.01) and peripheral synovitis in HLA B27 positive patients (P less than 0.05). These results suggest that K. aerogenes may have an aetiological role in the development of non-granulomatous anterior uveitis and peripheral arthritis in patients with ankylosing spondylitis but do not lend support to this organism having such a role in the spinal disease itself.

Pain threshold and arthritis

Pain threshold was measured in 106 patients with rheumatoid arthritis, 50 with ankylosing spondylitis, and 50 normal controls using Keele's algometer. In rheumatoid arthritis patients with a low pain threshold had more severe pain for a greater part of the day and required more tablets for pain relief. In ankylosing spondylitis the pain threshold was higher and was not related to pain or analgesic requirements. There was no evidence that pain threshold affected the course or outcome of rheumatoid arthritis in any way.

ANKYLOSING SPONDYLITIS IN CHILDREN AND ADOLESCENTS

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Prostatitis and Ankylosing Spondylitis

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Ankylosing spondylitis

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