Ankylosing spondylitis in african blacks

Chalmers, Ian

doi:10.1002/art.1780231206

Cited by 37 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chalmers et al [2] reported a series of eight AS patients seen over 4 years at a large South African teaching hospital, noting that only one was HLA-B27 positive and that “the patients reported in this study appeared to have disease of unusual severity,” although admitting that selection bias may have influenced this. Ouédraogo et al [7] observed 13 cases of AS in 2 years of rheumatologic practice among 1439 patients (0.9%) from Burkina Faso, finding a 55% frequency of HLA-B27.…”

Section: Discussionmentioning

confidence: 91%

“…In part, this has been attributed to the lower frequency of HLA-B27 in Blacks both in the US and in most but not all African ethnic groups [3, 5, 6] and, in Latinos, in the US [6], although the only study to examine the frequency of AxSpA in Mexican-Americans residing in the US showed similar frequency as Whites (1.5%) [4]. However, an early study of Black AS patients from the US and another from Burkina Faso showed the frequency of HLA-B27 in AS to range between 50 and 60% [5, 7], and other studies in Africa found even lower frequencies [2] compared to up to 90% of White patients [8]. Furthermore, in Whites, HLA-B27 positivity was associated with earlier age at disease onset, higher rates of anterior uveitis, a shorter delay to diagnosis from first symptoms, and an increased familial incidence of AS in Black and white patients [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups

et al. 2017

View full text Add to dashboard Cite

The purpose of this study is to compare disease severity in ankylosing spondylitis (AS) in three ethnic groups. We assessed 925 AS patients (57 Blacks, 805 Whites, 63 Latinos) enrolled in the longitudinal Prospective Study of Outcomes in AS (PSOAS) for functional impairment, disease activity, and radiographic severity. Comparisons of clinical characteristics and HLA-B27 frequency for each group were performed, in two multivariable regression models, we compared the baseline Bath Ankylosing Spondylitis Radiographic Index (BASRI) and modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) by ethnicity, adjusting for covariates. Blacks had greater functional impairment (Bath Ankylosing Spondylitis Functional Index) (median 62.5 vs. 27.8 in Whites and 38.1 in Latinos; p < 0.0001); higher disease activity (Bath Ankylosing Spondylitis Disease Activity Index), (median 5.9 vs. 3.5 in Whites and 4.5 in Latinos; p < 0.0001), erythrocyte sedimentation rate (median 27.0 in Blacks vs. 10.0 in Whites and 17.0; p < 0.0001), and C-reactive protein levels (median 1.2 vs. 0.4 mg/dL in Whites and 0.9 in Latinos; p < 0.0001). Baseline BASRI and mSASSS were higher in Blacks (mean 9.5 and median 38.2, respectively) compared to Whites (7.3 and 6.4) and Latinos (7.3 and 8.1), (p = 0.004, 0.007), respectively, more significant as disease duration increased. HLA-B27 occurred in 62.5% of Blacks, 85.3% of Whites, and 86.7% of Latinos (p < 0.0001). On multivariable analysis, higher BASRI and mSASSS were associated with Black ethnicity, after adjusting for disease duration and gender as well as TNF inhibitor (TNFi) usage, smoking status, or education level. Blacks with AS have more severe disease compared to either Whites or Latinos.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups

et al. 2017

View full text Add to dashboard Cite

show abstract

“…None had iritis or a positive family history. The HLA-B27 antigen was found in only one patient 16. Another study, done in Gambia, found that the risk of developing AS is small, even in HLA-B27 positive Gambians, compared to those of HLA-B27 positive Caucasians, suggesting that there may be a non-B27 protective factor reducing the prevalence of AS in this (sub) population 17…”

Section: Epidemiologymentioning

confidence: 88%

Ankylosing spondylitis in sub-Saharan Africa

Belachew

Sandu

Schaller

et al. 2009

Postgraduate Medical Journal

View full text Add to dashboard Cite

Ankylosing spondylitis (AS) represents a chronic inflammatory bone disease of the axial skeleton that manifests as chronic back pain and progressive stiffness of the spine. It characteristically affects young adults with a peak age of onset between 20-30 years. In contrast to Western Europe and North America, the disease is rare in Sub-Saharan Africa where the majority of the population is HLA-B27 negative. Even in some African populations where HLA-B27 is prevalent (for example, in Gambia and Senegal, where 3-6% of the general population has HLA-B27), the disease is also said to be rare. However, some other genetic markers may be involved in the causation of AS in the HLA-B27 negative population, and when it occurs in this subgroup of patients it has a similar manifestation with HLA-B27 negative white patients and these patients rarely develop anterior uveitis. The clinical presentation of the disease in Africa is generally milder; most affected individuals do not have a family history of AS, the patients are older at onset of the disease, and the majority of them lack extra-articular manifestations such as anterior uveitis compared with the situation in Western Europe and North America. In conclusion, AS in sub-Saharan Africa seems to represent a subgroup of the disease, which may open the window to a greater understanding of the pathophysiology of the condition.

show abstract

“…Older studies from Africa reported AS to be rare, with a very low frequency of HLA-B27 in patients with AS 6 7. This was attributed, as least in part, to a ‘protective’ West African B27 subtype ( B*27:03 ),7 although subsequent studies reported an association of this subtype with AS in Africans 8.…”

Section: Role Of Hla-b27mentioning

confidence: 99%

The genetic basis of spondyloarthritis

Reveille

2011

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

Modern technological innovations have advanced our understanding of the genetic basis of spondyloarthritis. In ankylosing spondylitis (AS), where the major histocompatibility complex (MHC) accounts for nearly half of the predisposition, most comes from HLA-B27, for which 65 subtypes are now recognised, although other genes are also at work including HLA-B60 (B*40:01). Other genes have been identified, including those involved in peptide editing for loading onto class I MHC molecules (ERAP1) and cytokine genes such as interleukin 1A (IL-1A) and those involved in the Th17 network (IL-23R, an association seen primarily in Caucasians) and others. In acute anterior uveitis, these associations are also seen as well as a region on chromosome 9p and genes whose confirmation is under way. Psoriasis and psoriatic arthritis fall into this disease spectrum, with the largest region of susceptibility coming from the MHC (most likely HLA-C, ie, C*06:02 although additional influences are also being implicated), and most of the other genetic susceptibility coming from genes involved in cytokine production, specifically genes in the Th17 pathway (IL-12B, IL-23A and IL-23R, the latter, like in AS, not seen in Asians), genes in the nuclear factor κB pathway (TNFAIP3 and TNIP1) and genes in the Th2 pathway (IL-4 and IL-13). Given that more than half of patients with AS have evidence on colonoscopy of at least occult inflammatory bowel disease (IBD), it is not surprising that shared genetic influences are operative. In IBD, genes important in the innate immune response (NOD2), autophagy (ATG6L1) and regulation of the IL-23 pathway (IL-23R) play a role in disease susceptibility.

show abstract

Ankylosing spondylitis in african blacks

Cited by 37 publications

References 15 publications

Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups

Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups

Ankylosing spondylitis in sub-Saharan Africa

The genetic basis of spondyloarthritis

Contact Info

Product

Resources

About