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HLA-B27 and spondyloarthropathy: value for early diagnosis?

1995; BMJ; Volume: 32; Issue: 7 Linguagem: Inglês

10.1136/jmg.32.7.497

1468-6244

Jan Tore Gran, Gunnar Husby,

Rheumatoid Arthritis Research and Therapies

The seronegative spondyloarthropathy complexThe seronegative spondyloarthropathy com- plex embraces a group of inflammatory rheum- atic disorders linked together by certain clinical, laboratory, and radiological manifestations.Clinically, the disorders are characterised by asymmetrical peripheral oligoarthritis and in- volvement of the sacroiliac joints (table 1).Manifestations in the eyes, mucocutaneous membranes, and genitourinary system not in- frequently accompany the often predominant arthritis.The patients lack detectable rheum- atoid factors in serum, hence the term "sero- negative".Other serum autoantibodies, often found in inflammatory rheumatic diseases, are notably absent in the spondyloarthropathies.Unlike in rheumatoid arthritis, radiological examinations of peripheral joints rarely show destructive changes.However, radiological sacroiliitis is essential for the diagnosis of many of these diseases. ANKYLOSING SPONDYLITISAnkylosing spondylitis (AS) is regarded as the prototype of the seronegative spondyloarthropathies (table 1).In its classic but quite rare form, complete ankylosis of the whole spine develops within a few years.More often, however, the clinical picture is dominated by pain and stiffness of the back with radiological examination showing sacroiliitis and varying degrees of spinal inflammation.'Table 1 The seronegative spondyloarthropathy complex: disorders, common disease manifestations, and frequencies of HLA-B27 Disorders % Ankylosing spondylitis 90-95 Reiter's disease 70-85 Reactive arthritis 36-100 Psoriatic arthritis 54 Arthritis in inflammatory bowel diseases 50 Manifestations Seronegativity for rheumatoid factors Absence of antinuclear antibodies Absence of rheumatic nodules Peripheral arthritis Genitourinary (urethritis, vaginitis, balanitis) Mucocutaneous (stomatitis, dermatitis) Intestinal (enteric infections or chronic inflammation)