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| Year : 1980 | Volume
: 26
| Issue : 3 | Page : 153-4 |
Seronegative spondarthritis.
Soman RN, Tilve GH, Jayakar VV
How to cite this article:
Soman R N, Tilve G H, Jayakar V V. Seronegative spondarthritis. J Postgrad Med 1980;26:153 |
The entire concept of seronegative spondarthritis has only emerged in recent years [3], [5], [6] Reiter's disease, ankylosing spondylitis, Behcet's syndrome psoriatic arthritis and arthritis associated with inflammatory bowel disease have become distinct entities, not merely variants of rheumatoid arthritis. Nevertheless there is a common thread running through many of these syndromes which is the presence of the histocompatibility antigen HLA-B27. The discovery of this antigen has been one of the most exciting recent advances in the field of rheumatology.
The earliest suspicion that the diseases included in this group are distinct from rheumatoid arthritis, was derived from the proclavity of these patients to be seronegative for IgM rheumatoid factor. Bilateral sacroiliitis, indistinguishable from that observed in uncomplicated ankylosing spondylitis has been seen in patients with these diseases. Seronegative spondarthritis has clinical overlap in that skin lesions, bowel ulceration, thrombophlebitis, buccal and genitourinary inflammation are found in combination. Still's disease represents an interesting entity and is perhaps a mixture of separate diseases; some are true juvenile rheumatoid arthritis, others represent patients who are developing ankylosing spondylitis in early life.
Familial aggregation has been found in each group which could be related to genetic or environmental factors. Lack of comparable population controls and of uniform diagnostic criteria present enormous difficulties in drawing firm conclusions. The answer to this intriguing familial aggregation and clinical overlap is provided by the increased prevalence of HLA-B27 in the members of this group.[1], [4] This suggests a genetic and immunologic mechanism in the pathogenesis of these diseases. Over 90% of patients with ankylosing spondylitis possess this tissue type. The prevalence of HLA-B27 drops to 65% in Reiter's disease, Yersinia arthritis and inflammatory bowel disease. The varying clinical picture and lower prevalence of HLA-B27 when other diseases are present suggest that several genes are involved in the production of these diseases. The B27 antigen may be linked to an immune response gene that governs the environmental-host interaction leading to chronic granulomatous inflammation. A lot of progress will have been made if a susceptible host identified by the HLA antigen can be observed to develop the disease due to a specific infectious agent.
For the clinician, histocompatibility testing in seronegative arthropathies is a discriminatory tool in cases of doubtful diagnosis. It is of equal importance for the clinician to avoid inducing iatrogenic "HL-A itis" in normal people with backache, as over 80% of people with HLA-B27 do not have any disease.
The awareness of this syndrome of seronegative spondarthritis will help in the correct diagnosis of many patients with back pain of ill-defined etiolgy. This group of patients also respond better to phenylbutazone and indomethacin rather than to aspirin and gold .[2]
It is hoped that such striking developments in the understanding of the pathogenesis of ankylosing spondylitis are followed closely by advances in therapy for this crippling disease.
| 1. | Brewerton, D. A., Caffrey, M., Hart, F. D., James, D. C. O., Nicholls, A., and Sturrock, R. D.: Ankylosing spondylitis and HL-A 27, Lancet, 1: 904-907, 1.73.  |
| 2. | Malaviya, A. N., Mehra, N. K., Adhar, G. C., Jindal, K., Bhargava, S., Batta, R. K., Vaidya, M. C. and Sankaran, B.: The clinical spectrum of HLA-B27 related rheumatic diseases in India. J. Ass. Phys. India, 27: 487-492, 1979. |
| 3. | Moll, J. M. H., Haslock, J., Macrae, I. F. and Wright, V.: Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies and Behcet's syndrome. Medicine, 53: 343-369, 1974. |
| 4. | Schlosstein, L., Terasaki. P. l.. Blue stone and Pearson, C. M.: High association of an HL-A antigen W27 with ankylosing spondylitis. New Eng. J. Med., 288: 704-705, 1973. |
| 5. | Wright, V . , Sturrock, R. D. and Carson, D. W.: "Seronegative spondarthritides". In, "Recent advances in Rheumatology." Vol. 1, Part 11, Chapter 7, page 193-215 Churchill Livingstone, 1976. |
| 6. | Wright, V.: "Seronegative spondarthritis". In, "Progress in Clinical Medicine." Chapter 17, page 409-414, Edited by Horler, A. R. and Forster, J. B.: Seventh Edition, Churchill Livingstone, 1977. |
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