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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.01.001 Byline: John D. Reveille, Frank C. Arnett Abstract: A great deal of progress has occurred in the past few years in elucidating the causes and designing new treatments for ankylosing spondylitis and other types of spondyloarthritis. In addition to the human leukocyte antigen (HLA)-B27 and other major histocompatibility complex (MHC) genes, chromosomal regions and genes elsewhere in the genome are being implicated both in disease susceptibility and severity. The various ways HLA-B27 may function in causing spondyloarthritis now are better understood to encompass not only antigen presentation but also other mechanisms, possibly all being operative in pathogenesis (misfolding of the HLA-B27 molecule, impaired intracellular killing of bacteria, and HLA-B27 itself serving as an autoantigen). Specific enteric and sexually acquired infections can trigger reactive arthritis, though no specific microbe has been identified in other forms of spondyloarthritis. Intestinal inflammation with impairment of the gut:blood barrier may be operative in driving ankylosing spondylitis and enteropathic arthritis. A number of treatments have been tried in spondyloarthritis, including older agents such as methotrexate and sulfasalazine but also newer drugs such as pamindronate. The recent introduction of tumor necrosis factor (TNF) blockers in the treatment of spondyloarthritis has offered the most hope in not only relieving symptoms and signs of both peripheral arthritis and enthesitis but also spinal disease, which often has been refractory to other agents. Their high cost and considerable side effect profile, however, have necessitated the establishment of guidelines for their use in these diseases in order to target the patient in whom they are likely to have the most benefit. Author Affiliation: Division of Rheumatology, Department of Internal Medicine, The University of Texas-Houston Health Science Center

Low back pain in athletic teenagers may indicate lumbar spondylolysis. This condition is a small fracture or region of bone degradation in the spine, usually from a fall or other trauma. Back pain in teenagers is often initially diagnosed as a strain, although 47% of low back pain may be spondylolysis. The bony defect is often not visible by conventional X-ray, but apparent on a bone scan or by SPECT imaging. Early detection of spondylolysis can be treated with strict activity restriction and pain medication, which may prevent progression of the condition.

Care, treatment and diagnosis of spondylarthropathies, types of inflammatory arthropies, are discussed. Common features distinguish them from rheumatoid arthritis and they can be placed in a group called seronegative polyarthropathies, but it is more useful to see them as subtly ineterrelated arthropathies with some features in common, including high frequency of the histocompatibility antigen HLA-B27 and a family history for the problem, among other things.

The spondyloarthropathies are a cluster of overlapping forms of inflammatory arthritis that are distinct from rheumatoid arthritis and characteristically affect the spine and entheses (insertions of tendons and ligaments). The [...]

Drugs or monoclonal antibodies that block the activity of tumor necrosis factor alpha may be the first effective treatment for arthritic diseases of the spine. However, long-term studies are needed to determine potential side effects and smaller doses may be less expensive.

Abstract Objective--To determine which inflammatory cell types are present in entheses from patients with spondyloarthropathy (SPA) compared with patients with rheumatoid arthritis (RA) or osteoarthritis (OA). Methods--Enthesis specimens were obtained [...]

Ankylosing spondylitis, a prototype of spondyloarthropathy, is a rare disease with a few treatment options. An attempt is made to create an algorithm approach in the early detection of this disease.

ARTICLE CONSULTANTS LUIS R. ESFINOZA, MD, is Professor of Medicine and Chief, Section of Rheumatology, Louisiana State University School of Medicine, New Orleans. MUHAMMAD ASIM KHAN, MD, is Professor of [...]