Ankylosing spondylitis and inflammatory bowel disease. III. Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease.

Abstract

SUMMARY A study was made, in co-operation with several gastroenterology and rheumatology centres, of the clinical and genetic characteristics (HLA B27) of 50 patients suffering from both inflammatory bowel disease (38 Crohn's disease (CD), 12 ulcerated colitis (UC)) and ankylosing spondylitis (AS), the latter diagnosis being established according to the New York criteria. 20 CD (52 -6 %O) and 8 UC (66 * 7 %) patients were HLA B27 positive. The presence of HLA B27 was studied in relation to clinical parameters, such as first occurrence of symptoms of AS or inflammatory bowel disease (IBD), a history of peripheral arthritis, iridocyclitis, and a positive history of AS or IBD.Our patients were found to have heterogeneous clinical features: on one side of the spectrum a group of cases was distinguished with the typical characteristics of idiopathic AS, often being HLA B27 positive. On the other side a smaller group of HLA B27 negative patients was observed, with severe intestinal inflammatory pathology, lacking most of the typical clinical features of idiopathic AS ('secondary' form of AS). Finally, between these two extremes a group of patients was found with less pronounced clinical or genetic characteristics. These different clinical and histocompatibility patterns suggest a mixed aetiopathogenesis of AS in IBD patients. Such a 'syndrome' of AS might harbour both idiopathic AS and forms of AS 'secondary' to the intestinal inflammatory pathology.

Genetics of Inflammatory Bowel Disease: A Reappraisal

“…This is perhaps best illustrated by the recent studies on arthritis in IBD. Despite similarities to other HLA-B27 related diseases no HLA association had been demonstrated with peripheral arthritis in IBD [23,52]. However clinical analysis of the patterns of disease led to the subdivision of arthritis into Type 1 (a large joint acute arthritis) and Type 2 (a small joint chronic polyarthritis) [53].…”

Inflammatory bowel disease and spondylarthropathy

“…The intestinal disease-arthritis association is particularly strong in patients with IBD. Early work showed that 10-18% of patients with classic IBD develop sacroiliitis (8), with features that differ from those of idiopathic AS only in that the prevalence of HLA-B27, while still high in IBD-associated sacroiliitis, is significantly lower than in idiopathic AS (9). These HLA-B27 associations are thought to be very important.…”

Enteropathische Spondarthritiden bei chronisch entzündlichen Darmerkrankungen: Prävalenz, Befallsmuster und HLA-Assoziation

“…So leiden HLA-B27-positive Patienten mit chronisch entzª Darmerkrankungen zu 50 bis 90% an einem Befall des Achsenskeletts [21]. 2) den mit HLA-Klasse-I-Antigenen sind fª periphere Arthritiden mit dem HLA-B17 [18], fª klinisch blande Verltiufe mit dem HLA-B62 [16] und in einer grol3en deutschen Studie mit dem HLA-B44 [20] beschrieben. Weitete Assoziationen von enteropathischen Spondarthriti-colopr(x:to[ogy 19 (1997), 59~,6 (Nr.…”