Association of homocysteine with ankylosing spondylitis: a systematic review and meta-analysis

Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.(AU)

Espondilite anquilosante e uveíte: revisão / Ankylosing spondylitis and uveitis: overview

O presente trabalho propõe uma revisão de epidemiologia, patogênese, quadro clínico, diagnóstico e tratamento da espondilite anquilosante e sua associação com alteração ocular com a devida condução da doença e suas manifestações. Os autores utilizaram em sua pesquisa os bancos de dados PubMed (MEDLINE), LILACS e Biblioteca do Centro de Estudos de Oftalmologia. A espondilite anquilosante é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial, podendo evoluir com rigidez e limitação funcional progressiva. Seu início costuma ocorrer por volta da segunda à terceira década de vida, preferencialmente em indivíduos do gênero masculino, caucasianos e HLA-B27-positivos. Sua etiologia e patogênese não são completamente elucidadas, e seu diagnóstico costuma ser tardio. O controle clínico e o tratamento são frequentemente satisfatórios.A uveíte anterior aguda é a manifestação extra-articular mais comum, ocorrendo em cerca de 20%-30% dos pacientes com espondilite anquilosante. Aproximadamente metade dos casos de uveíte anterior aguda está associada à presença do antígeno HLA-B27, podendo ser a primeira manifestação de uma doença reumatológica não diagnosticada, geralmente com boa resposta terapêutica e bom prognóstico. Concluímos que, para melhor avaliação e tratamento dos pacientes com uveíte, é importante maior integração entre oftalmologistas e reumatologistas.

The present article reviews the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of ankylosing spondylitis and its association with ocular changes. The authors used the PubMed (MEDLINE), LILACS, and Ophthalmology Library databases. Ankylosing spondylitis is a chronic inflammatory disease that usually affects the axial skeleton and can progress to stiffness and progressive functional limitation. Ankylosing spondylitis usually begins around the second to third decade of life, preferentially in HLA-B27-positive white males. Its etiology and pathogenesis are not completely understood, and its diagnosis is diffi cult. Clinical control and treatment are frequently satisfactory. Acute anterior uveíte is the most common extra-articular manifestation, occurring in 20%-30% of the patients with ankylosing spondylitis. Approximately half of the acute anterior uveíte cases are associated with the presence of the HLA-B27 antigen. It can be the first manifestation of an undiagnosed rheumatic disease, usually having a good prognosis and appropriate response to treatment. In conclusion, for better assessment and treatment of patients with uveitis, ophthalmologists and rheumatologists should work together.

Possible role of streptokinase-induced delayed hypersensitivity and eosinophilia in pathogenesis of ankylosing spondylitis.

Present study relates to the results of investigations on 16 patients with Ankylosing spondylitis (AS). Age of the patients ranged from 16 to 44 (median 25) years. Male female ratio was 4.3:1. Sacroileitis was detected in all the patients. Seven patients each had stage 1 and 2 disease. Two other patients had stage 3 disease. Lower mean Hb per cent was detected among patients as compared to control groups. Twelve of 16 (75 per cent) patients had eosinophilia. HLA-B27 antigen was detected in 10 of 16 (62.5 per cent) patients. Streptokinase-induced delayed sensitivity was detected in 10 of 16 (62.5 per cent) patients. Anti-streptolysin 'O' antibodies were detected in 2 of 16 patients' sera. Moderate negative correlation was found between the size of induration of skin test and haemoglobin concentration (P < 0.05). Possibly, delayed hypersensitivity might induce both eosinophilia as well as anaemia among AS patients.

Diagnóstico falso-positivo de tumor intra-ocular; relato de caso / False-positive diagnosis of intra-ocular tumor; report a case

Os autores relatam um caso com diagnóstico ultrassonográfico de tumor intra-ocular, num paciente portador de espondilite anquilosante com uveíte crônica e visäo zero no olho esquerdo, em que, após enucleaçäo, constatou-se a presença do cristalino luxado no vítreo

Inmunogenética del HLA-B27 / Immunogenetics of the HLA-B27

En los últimos cinco (5) años el avance de la biología molecular ha podido clarificar los subtipos del B27 y así poder estudiar su ontogenia. Esta revisión tiene el propósito de analizar la estructura y función de las moléculas de clase I, como una unidad funcional en la respuesta inmunitaria y su interacción con el agente en la expresión de la enfermedad. Hemos querido analizar desde la ontogenia y filogenia del B27 en el timo con las teorías de la selección positiva y negativa y del superantígeno para explicar la pérdida de la tolerancia inmunológica y poder asociarlo con las alteraciones relacionadas con los defectos relacionados con la presentación antígenos y la disfunción del B27 y explicar las diferentes hipótesis implicadas en la patogenesis de la espondilitis anquilosante. En esta misma revisión se analizan los factores inmunogenéticos (diferentes subtipos del B27), algunos agentes microbianos y los experimentos utilizando modelos de ratones transgénicos para explicar la patogenesis y la expresión en la clínica de los diferentes subgrupos de espondilitis anquilosante

A study of the gram-negative bacterial flora in patients with ankylosing spondylitis

Twenty-eight patients with active definite primary ankylosing spondylitis and fifty-four healthy control subjects were studied. The HLA-B27 antigen was found in 75% of patients and 3.7% of control. Fecal samples from these subjects were cultured for gram-negative enteric bacteria on two occasions within one month. Positive cultures for Klebsiella sp were found in 32.1% of patients and in 22.2% of healthy controls, but this difference was not statistically significant. All obther microorganisms detected were qualitatively and quantitatively similar in both groups. Significantly increased mean values of serum IgA levels were found in the patient group when compared with the control group (P<0.01). The mean serum IgG and IgM levels did not differ statistically between the two groups. There was no correlation between any laboratory or clinical parameter and presence of Klebsiella sp carriage in ankylosing spondylitis patients. These data are consistent with the view that a long time elapses between exposure to a trigger facter and clinical manifestations of the disease

Espondilite anquilosante / Ankylosing spondylitis

Define-se, descreve-se e faz-se consideraçöes quanto ao quadro clínico e tratamento da espondilite anquilosante