Vertebral ankylosing hyperostosis (forestier's disease) and hla antigens in pima indians

Abstract

Vertebral ankylosing hyperostosis is a common skeletal disorder among Pima Indians. Prevalence rates of approximately 50% have been reported in Pima Indian males aged 55 or older. The HLA-B27 antigen is also found more commonly in Pima Indians than in Caucasians (18% versus 6%). Because of the increased prevalence of both vertebral ankylosing hyperostosis and HLA-B27 in Pima Indians, a possible association between the two was thought to exist. Therefore, histocompatibility testing was done on 44 adult male Pima Indians age 55 or older with classic vertebral ankylosing hyperostosis and 33 agematched controls. No significant association between any histocompatibility antigen phenotype or haplotype and vertebral ankylosing hyperostosis was found. This disease, therefore, cannot be classified with the HLA-B27 associa ted spondylarthropathies. Vertebral ankylosing hyperostosis (Forestier's disease) is a disease of the spine characterized radiographically by the formation of large osseous spurs or bridges connecting adjacent vertebrae. Also seen radiographically are ligamentous ossification, paraarticular osteophytes, and fluffy periostitis at the sites of ligament and tendon insertions (1,2). Originally described in the nineteenth century, the disease was rediscovered in 1950 by Forestier and Rot&-Querol who renamed it "senile ankylosing hyperostosis of the spine" (3). Later, the term "senile" was omitted since cases were reported in young adults (4).The bony bridges in vertebral ankylosing hyperostosis are usually found in the lower dorsal spine, but involvement of the cervical and lumbar spine is not uncommon ( 13). The bony bridges are most marked on the anterolateral surfaces of the vertebral bodies and differ radiographically and morphologically from the bony bridges (syndesmophytes) seen in ankylosing spondylitis.Julkunen et ul. (6) described a prevalence rate in Finland for vertebral ankylosing hyperostosis of 3.8% in men and 2.6% in women aged 40 years and over. Vernon-Roberts et al. (7) reported a 6% autopsy prevalence. However, Henrard and Bennett (5) have described overall prevalence rates of this disease of 25% in Pima Indian men and 4.7% in Pima Indian women aged 15 and over living in Arizona. In male Pima Indians aged 55 and older the prevalence rate was 48%, and in Pima women of similar age the prevalence rate was 12%.

Diffuse Idiopathic Skeletal Hyperostosis in Psoriatic Arthritis

“…In a study conducted in Budapest, the prevalence in those over age 50 years was 4.9% in men and 1.4% in women 3 . Pima Indians in Arizona, USA, have a particularly high prevalence of DISH, 48% in men and 12% in women over the age of 55 years 4 .…”

“…DISH is more common in men than women and the incidence varies by population and increases with age, rarely being diagnosed before the age of 40 years 2,3,4 . Frequent clinical manifestations of DISH include dorsolumbar stiffness and pain, peripheral bone pain, and enthesitis.…”

DISH and the monastic way of life

“…The crude prevalence rate in those over 40 years of age is estimated to be 3.8% in males and 2.6% in women (Mata et al, 1997). The prevalence is greater in whites than in blacks, and seems to be relatively low in Asians and Native Americans, suggesting that genetic factors may be involved in the aetiology of the condition (Spagnola et al, 1978;Cassim et al, 1990;Weinfeld et al, 1997). disease (Morales et al, 1993;Marcelli et al, 1995) and multiple myeloma (Scutellari et al, 1995).…”

Thoracic Vertebral Body Fracture After Total Hip Replacement in Diffuse Idiopathic Skeletal Hyperostosis

“…Excessive osteoblast proliferation caused by an unknown genetic disposition and various external factors, such as environmental, dietary (obesity), and metabolic (diabetes mellitus), are thought to be responsible for this pathological condition. [20][21][22][23][24] In addition to the noted changes of the peripheral skeleton, diffuse idiopathic skeletal hyperostosis is often asymptomatic or clinically associated with morning stiffness and mild dorsolumbar pain. 2 The prevalence of ankylosing disorders has been reported to be between 0.1% and 1.4% for ankylosing spondylitis 25 and between 2.9% and 25% for diffuse idiopathic skeletal hyperostosis, with Europeanborn Caucasians more likely to be affected.…”