Humans ; Spondylarthritis/drug therapy* ; Spondylitis, Ankylosing/drug therapy* ; China

Humans ; Uric Acid ; Cross-Sectional Studies ; Spondylarthritis/diagnostic imaging* ; C-Reactive Protein ; Spondylitis, Ankylosing

No abstract available.
Spondylarthropathies* ; Spondylitis, Ankylosing*

BACKGROUND: The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. METHODS: Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. RESULTS: In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. CONCLUSIONS Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
Humans ; Arthritis, Psoriatic/drug therapy* ; East Asian People ; Enthesopathy/complications* ; Registries ; Severity of Illness Index ; Spondylarthritis/epidemiology*

BACKGROUND: HLA-B27 is associated with an increased incidence of specific spondyloarthropathies(SpA), most notably ankylosing spondylitis(AS). I evaluated the cases referred for HLA-B27 antigen using flowcytometry (FCM) to find the clinical characteristics of the patients and the diagnostic utilities of median fluorescence intensity (MFI) in HLA-B27 program. METHODS: I evaluated 443 subjects of HLA-B27 cases using FACScan flowcytometry, consisted with software for automated calibration and analysis, calibration beads, and the anti-HLA- B27 fluorescein isothiocyanate (FITC)/anti-CD3 phycoerythrin (PE) monoclonal antibodies (all from Becton Dickinson, San Jose, CA). RESULTS: Of the total 443 cases, the positive rate in male cases was 44% (132/300) and it was higher than that of female cases (22.4%, 32/143). The gating procedure was failed in one sample of 443 (0.23%). The positive rates in each diagnostic criteria were as follows; AS 61.6%, gout 20.0%, herniated intervertebral disc 20%, lower back pain 25.6%, polyarthritis 16.0%, psoriatic arthritis 20.0%, rheumatoid arthritis 28.3%, reactive arthritis 26.9%, SpA, undifferentiated 31.8% and uveitis/iritis 23.8%. In AS group, 89 cases (95.7%) showed MFI values higher than 150. CONCLUSION: About 62% of AS group showed HLA-B27 positivity using FCM and the positive rates of other diseases group in SpA categories were around 20-30%. If we considered MFI value 150 as differential value, about 95% of HLA-B27 positive AS cases might not need further confirmatory study to differentiate HLA-B7.
Antibodies, Monoclonal ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Reactive ; Arthritis, Rheumatoid ; Calibration ; Female ; Fluorescein ; Fluorescence ; Gout ; HLA-B27 Antigen* ; HLA-B7 Antigen ; Humans ; Incidence ; Intervertebral Disc ; Low Back Pain ; Male ; Phycoerythrin ; Spondylarthropathies ; Spondylitis, Ankylosing

OBJECTIVE: This study examined the all-cause and sex-specific standardized mortality ratios (SMRs) in patients with spondyloarthropathy. METHODS: Studies examining the all-cause and/or cause-specific SMRs in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) compared to the general population were surveyed using MEDLINE, EMBASE, and Cochrane databases and manual searches. A meta-analysis of the all-cause and sex-specific SMRs in patients with rheumatic diseases was then performed. RESULTS: In total, 7 comparisons (5 PsA and 2 AS) from 6 reports met the inclusion criteria. Disease-specific meta-analysis showed that the pooled SMR was 1.299 (95% confidence interval [CI] 1.092–1.605, p=0.015) for PsA and 1.784 (95% CI 1.576–2.020, p < 0.001) for AS. Meta-analysis showed that the SMRs of PsA and AS were significantly higher (1.299 to 1.784 times) than those in the general population. The age- and sex-adjusted SMR was highest for AS (1.784), followed by PsA (1.299). Moreover, sex-specific meta-analysis showed that the all-cause SMRs were increased in female and male patients with PsA. On the other hand, mortality increased in male patients with AS (SMR 1.834), whereas there was no significant increase in female patients with AS. CONCLUSION: All-cause mortality is higher in patients with PsA and AS compared to the general population. On the other hand, the mortality was higher in males with AS but not in females.
Arthritis, Psoriatic* ; Female ; Hand ; Humans ; Male ; Mortality* ; Rheumatic Diseases ; Spondylarthropathies ; Spondylitis, Ankylosing*

The spondyloarthropathies are a group of inflammatory rheumatic diseases including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthropathy. It usually begins in young or middle aged adults, but sometimes presents with atypical symptoms in the older patients. Late onset spondyloarthropathies are characterized by severe disease, marked elevation of laboratory parameters of inflammation, oligoarthritis involving the lower limbs with edema of the extremities. We described a 66-year-old patient who presented with asymmetric polyarthritis mainly involving lower extremities with fever, marked elevation of laboratory inflammatory markers, and was successfully treated with mini-pulse corticosteroids with disease modifying antirheumatic drugs.
Adrenal Cortex Hormones ; Adult ; Aged ; Antirheumatic Agents ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Reactive ; Edema ; Extremities ; Fever ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Lower Extremity ; Middle Aged ; Rheumatic Diseases ; Spondylarthropathies* ; Spondylitis, Ankylosing

We present the first case of enthesitis in the lumbar spine in a woman with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Enthesopathy is defined as pathological alterations at the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. In particular, enthesitis is the universal hallmark of seronegative spondyloarthropathies (SpA), including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and spondyloarthropathies associated with inflammatory bowel diseases. A 36-year-old female SLE patient with a history of lupus nephritis and thrombosis from APS presented with low back pain that had been gradually worsening for several months. She reported no previous episodes of trauma. Plain radiography indicated sclerosis at the anterior superior bodies of L3 and L5. Magnetic resonance imaging (MRI) showed low-intensity lesions on T1-weighted images and high-intensity lesions on T2-weighted images at the anterior superior bodies of L3, L4, and L5, consistent with osteitis or enthesitis. A nonsteroidal antiinflammatory drug (NSAID) was used as the first-line therapy in this patient, which improved her symptoms. This is the first report of enthesitis in the context of SLE. Although the possibility of coincidental occurrence of SpA and SLE cannot be excluded, the observations in this case suggest that enthesitis may be one of the manifestations of SLE.
Adult ; Antiphospholipid Syndrome ; Arthritis, Psoriatic ; Arthritis, Reactive ; Collodion ; Fascia ; Female ; Humans ; Inflammatory Bowel Diseases ; Joint Capsule ; Ligaments ; Low Back Pain ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Magnetic Resonance Imaging ; Osteitis ; Rheumatic Diseases ; Sclerosis ; Spine ; Spondylarthropathies ; Spondylitis, Ankylosing ; Tendons ; Thrombosis

The hallmark of ankylosing spondylitis (AS) is acute and chronic spinal inflammation initiating in the sacroiliac joints, often coupled with enthesitis, presenting as chronic inflammation at the sites of ligamentous and tendinous insertions into bone. Peripheral joint synovitis can be a prominent feature as well. Reactive arthritis (ReA) is a sterile synovitis arising after enteric or urogential tract infections. A great progression has been recently achieved in revealing the causes, and making plans for the treatments for AS and other types of spondyloarthropathy. The human leukocyte antigen (HLA)-B27 has been well known to be associated with disease susceptibility in AS and ReA. But the pathogenesis of AS and ReA is still not well defined. Although the clinical manifestations of AS and ReA may differ, in this review we discuss the two diseases together and focus on recent developments on the pathogenesis of both diseases.
Arthritis, Reactive ; Disease Susceptibility ; HLA-B27 Antigen ; Humans ; Inflammation ; Joints ; Leukocytes ; Ligaments ; Sacroiliac Joint ; Spondylarthropathies ; Spondylitis, Ankylosing* ; Synovitis

Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks tumor necrosis factor-alpha (TNF-alpha) and has been successfully used in the treatment of immune-mediated diseases. In particular, its efficacy has been proven in the treatment of rheumatoid arthritis, spondylarthritis, lymphoproliferative diseases and inflammatory bowel disease. Its use has also been studied for the treatment of psoriasis and yet, paradoxically, cases of new onset or exacerbation of psoriasis continue to increase in patients undergoing treatment with anti TNF-alpha agents. A 51-year-old woman had arthritis for a year and was diagnosed with psoriatic arthritis. After she had received adalimumab for psoriatic arthritis five times during one year, erythematous eruptions were found on her entire body. She then stopped adalimumab therapy for two months, although her skin lesions did not resolve. The patient was diagnosed with psoriasis through biopsy and began using cyclosporine, a topical steroid used for treatment of psoriasis.
Antibodies, Monoclonal, Humanized ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Biopsy ; Cyclosporine ; Female ; Humans ; Immunoglobulin G ; Inflammatory Bowel Diseases ; Middle Aged ; Psoriasis ; Skin ; Spondylarthritis ; Tumor Necrosis Factor-alpha ; Adalimumab