BACKGROUND: HLA-B27 is strongly associated with ankylosing spondylitis (AS), and its subtypes differ in their ethnic distribution. Studies worldwide have shown that B*2701, B*2702, B*2704, B*2705, B*2707, B*2708, B*2714, B*2715, and B*2719 are AS-predisposing subtypes, whereas B*2706 and B*2709 are reported to be negatively associated with AS. The aim of this study was to investigate HLA-B27 polymorphism and clinical features according to subtypes in Korean patients with AS. METHODS: Two hundred thirty samples from patients with impression of AS were analyzed by polymerase chain reaction using a sequence-specific primers (PCR-SSP) method. Pel-Freez SSP Unitray HLA-B*27 kit (Dynal Biotech, USA) including 16 primers was used to define HLA-B27 subtypes from B*2701 to B*2735. RESULTS: Among 230 samples from patients with impression of AS, 171 were HLA-B27 positive, and among 160 patients diagnosed as AS, 154 (96.3%) were HLA-B27 positive, while 17 patients not diagnosed as AS were HLA-B27 positive. Among 154 HLA-B27 positive patients with AS, 142 (92.2%) were typed as B*2705 and 9 (5.8%) were typed as B*2704. Three cases (1.9%) could be interpreted only variously because of their HLA-B27 homogeneous alleles. Between B*2705 and B*2704, no specific HLA-B27 subtype appeared to contribute to AS susceptibility (P=0.60). Difference in clinical features between B*2705 and B*2704 could not be found in this study (P>0.05). CONCLUSIONS: This study verified that HLA-B27 (96.3%) is strongly associated with AS and identified that the major subtypes of HLA-B27 positive patients with AS in Korea are B*2705 (92.2%) and B*2704 (5.8%).
Adult ; Alleles ; Female ; Gene Frequency ; Genotype ; HLA-B27 Antigen/blood/*genetics ; Humans ; Korea/epidemiology ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Reagent Kits, Diagnostic ; Spondylitis, Ankylosing/*diagnosis/epidemiology

OBJECTIVE: We attempted to discover that Ankylosing spondylitis (AS) has a comprehensive relationship with congestive heart failure and death.METHODS: We used a nationwide database managed by the Korean National Health Insurance Service from 2010 to 2014. Twelve thousand nine hundred eighty-eight patients with a diagnosis of AS and 64940 age- and sex- stratified matching subjects without AS were enrolled in the AS and control groups. Incidence probabilities of 6 years congestive heart failure and death in each group were calculated. The Cox proportional hazard regression analysis was used to estimate the hazard ratio. We divided the AS and control groups into subgroups according to sex, age, income, and comorbidities.RESULTS: During the follow-up period, 102 patients (0.79%) in the AS group and 201 patients (0.32%) in the control group developed congestive heart failure (p < ;0.0001). In addition, 211 (1.62%) subjects in the AS group died during the follow-up period compared to 639 (0.98%) subjects in the control group (p < ;0.0001). The adjusted hazard ratio of congestive heart failure and death in the AS group was 2.28 (95% confidence interval [CI], 1.80–2.89) and 1.66 (95% CI, 1.42–1.95), respectively. The hazard ratios of congestive heart failure and death were significantly increased in all of the subgroups.CONCLUSION: The incidence rates of congestive heart failure and death were increased in AS patients.
Cardiovascular Diseases ; Cohort Studies ; Comorbidity ; Diagnosis ; Epidemiology ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Heart Failure ; Humans ; Incidence ; Korea ; National Health Programs ; Spondylitis, Ankylosing

STUDY DESIGN: Retrospective review. PURPOSE: We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. OVERVIEW OF LITERATURE: Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. METHODS: Between January 1, 1998 and March 2011, 30 patients (23 males, 7 females; mean age, 70.43 years; range, 45 to 95 years) with the radiographic diagnosis of AS of the spinal column had 42 fractures. Eight patients presented with significant trauma, 17 after falls, and 5 after minor falls or no recorded trauma. Eleven patients presented with a neurological injury, ranging from mild sensory loss to quadriplegia. RESULTS: There were 16 compression and 10 transverse fractures, two Jefferson's fractures, one type II and two type III odontoid process fractures, and five fractures of the posterior spinal elements (including lamina and/or facet, three spinous process fractures, three transverse process fractures). Twenty-four fractures affected the craniocervical junction and/or cervical vertebrae, 17 were thoracic, and one involved the lumbar spine. The most affected vertebrae were C6 and T10. The mean follow-up was 29.9 months. One patient was lost to follow-up. Eighteen patients were treated conservatively with bed rest and bracing. Twelve patients underwent surgery for spinal stabilization either with an anterior, posterior or combined approach. CONCLUSIONS: Nonsurgical treatment can be considered especially in the elderly patients with AS and spinal trauma but without instability or major neurological deficits. The nonfusion rate in conservatively treated patients is low. When treatment is selected for patients with spinal fractures and AS, the pattern of injury must be considered and the need for individualized treatment is paramount.
Accidental Falls ; Aged ; Bed Rest ; Braces ; Cervical Vertebrae ; Diagnosis ; Epidemiology ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Mortality ; Odontoid Process ; Quadriplegia ; Retrospective Studies ; Spinal Fractures ; Spinal Injuries* ; Spine ; Spondylitis, Ankylosing*

Clustered occurrences of ankylosing spondylitis (AS) in family have been noticed. We evaluated patients with AS confirmed by the modified New York criteria for familial history of AS (one or more first to third degree relatives). The clinical characteristics and the recurrence risks (number of AS patients/number of familial members) of the familial AS compared to sporadic AS were investigated. Out of a total of 204 AS patients, 38 patients (18.6%) reported that they had a familial history of AS. The recurrence risks in the familial AS patients for first, second and third degree family members were 14.5%, 5.2%, and 4.4% respectively. Erythrocyte sedimentation rate (ESR) (22.6+/-22.2 vs 35.4+/-34.4, P=0.029) and C-reactive protein (CRP) (1.24+/-1.7 vs 2.43+/-3.3, P=0.003) at diagnosis, body mass index (21.9+/-2.7 vs 23.7+/-3.3, P=0.002) and frequency of oligoarthritis (13.2% vs 33.7%, P=0.021) were significantly lower in the familial form. The presence of HLA-B27 (97.4% vs 83.1%, P=0.044) was significantly higher in familial AS. In conclusion, Korean familial AS patients show a lower frequency of oligoarthritis, lower BMI, lower ESR and CRP at diagnosis and higher presence of HLA-B27.
Adult ; Age Factors ; Arthritis, Juvenile/diagnosis/epidemiology ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein/analysis ; Demography ; Family ; Female ; HLA-B27 Antigen/metabolism ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Phenotype ; Recurrence ; Republic of Korea ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Spondylitis, Ankylosing/*diagnosis