Ankylosing Spondylitis

Abstract

The seronegative spondyloarthropathies are a group of autoimmune inflammatory diseases lacking rheumatoid factor or antinuclear antibody in their serum. They include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, spondylitis associated with Crohn’s disease and ulcerative colitis, and undifferentiated spondyloarthropathies. Inflammation mostly affects the axial joints, entheses, and extra-articular structures such as uveal tract, gastrointestinal tract, mucocutaneous tissue, and heart. Uveitis is the most common extra-articular manifestation. Spondyloarthropathies, especially AS, have a strong association with the presence of Human Leukocyte Antigen (HLA)-B27 gene. AS happens earlier in HLA-B27 patients and men are more prone to the disease. Uveitis, typically unilateral nongranulomatous acute anterior uveitis, occurs in up to 50% of the patients with AS. HLA-B27 positivity correlates with more frequent flare-ups. Conjunctivitis and scleritis are rare ocular manifestations of AS. To establish the diagnosis of AS, at least one clinical and one radiologic parameter are required for definitive diagnosis. Magnetic resonance imaging (MRI) or bone scan can help early detection of the axial skeleton inflammation. The course of eye and joint involvement are not correlated. Short-term treatment with topical corticosteroids and cycloplegic agents control the uveitis attack. In resistant cases, local or systemic therapy with corticosteroids are recommended. NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), methotrexate, azathioprine, anti-IL-17A monoclonal antibodies, and TNF- α antagonists are effective treatments for ocular and systemic manifestations of AS. If not treated adequately, uveitis may become recalcitrant and extend posteriorly. Functional impairment due to joint destruction can also occur as a result of undertreatment.

Human Leukocyte Antigens in Pregnancy and Preeclampsia

“…Increased SLE susceptibility has been linked to HLA-DRB1*15 alleles across multiple ethnic populations ( Selvaraja et al, 2022 ). Ankylosing spondylitis, a disease whose susceptibility is strongly linked to HLA-B*27 ( Ebrahimiadib et al, 2021 ) has similarly been associated with poor pregnancy outcomes ( Jakobsson et al, 2016 ). Other autoimmune diseases such as type 1 diabetes mellitus and rheumatoid arthritis also have increased risks conferred by HLA class II haplotypes ( Ebrahimiadib et al, 2021 ; Enczmann et al, 2021 ).…”

“…Ankylosing spondylitis, a disease whose susceptibility is strongly linked to HLA-B*27 ( Ebrahimiadib et al, 2021 ) has similarly been associated with poor pregnancy outcomes ( Jakobsson et al, 2016 ). Other autoimmune diseases such as type 1 diabetes mellitus and rheumatoid arthritis also have increased risks conferred by HLA class II haplotypes ( Ebrahimiadib et al, 2021 ; Enczmann et al, 2021 ). Nevertheless, as HLA-B and class II HLA molecules are not normally expressed by placental trophoblasts, the mechanism by which maternal autoimmune diseases lead to poor pregnancy outcomes like preeclampsia and preterm birth needs to be further elucidated.…”

MALT1 positively relates to Th17 cells, inflammation/activity degree, and its decrement along with treatment reflects TNF inhibitor response in ankylosing spondylitis patients

“…Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the spine, sacroiliac joints, and leads to bone erosion as well as joint deformation; these pathological changes can result in disability and vastly affect the patients’ quality of life 1,2 . Currently, therapies for AS mainly include physiotherapy, non‐steroidal anti‐inflammatory drugs (NSAIDs), glucocorticoids, and biological agents 2,3 . Typically, the utilization of TNF inhibitors, including adalimumab, infliximab, and golimumab, has largely improved the management of AS patients 4,5 .…”

“…1,2 Currently, therapies for AS mainly include physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and biological agents. 2,3 Typically, the utilization of TNF inhibitors, including adalimumab, infliximab, and golimumab, has largely improved the management of AS patients. 4,5 Whereas a certain part of the patients cannot well respond to TNF inhibitor treatment, thus it is of importance to explore more indicators to forecast the treatment efficacy of TNF inhibitors and therefore realize better supervision for AS patients.…”

HLA-B27 may modulate the interaction between ERAP1 polymorphisms and smoking in ankylosing spondylitis patients

“…Ankylosing spondylitis (AS) is an inflammatory autoimmune disease that is part of the group of spondyloarthropathies (SpAs), which share clinical, genetic and radiographic characteristics. Seronegative SpAs are those that lack rheumatoid factor or anti-nuclear antibodies in serum, including AS, psoriatic arthritis, reactive arthritis and spondylitis associated with nonspecific inflammatory bowel diseases [ 1 – 3 ]. AS is characterized by inflammation of the peripheral and sacroiliac joints of the axial skeleton, and in some cases, it can cause enthesitis, pain in the area where a tendon, muscle or ligament inserts into bone.…”