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Ankylosing spondylitis.

Ankylosing spondylitis occurs chiefly in young men and affects principally the sacroiliac, apophyseal, and costovertebral joints. Physical findings may be minimal, and special tests may be necessary to find objective evidence of the disease. HLA-B27 histocompatibility antigen is present in 90% to 95% of patients. The feature of highest diagnostic significance is the roentgenographic finding of syndesmophytes. The natural course of the disease is characterized by spontaneous remissions and exacerbations and by possible arrest at any stage. In general, the prognosis is good for maintenance of functional ability despite the development of severe back deformities. In management, emphasis must be given to maintaining normal posture and body habitus and to encouraging the patient to cope with individual needs and problems. If basic measures, including salicylate therapy, do not control the disease, additional drug therapy must be initiated. Surgical intervention is a last resort.

Adolescent

The clinical spectrum of ankylosing spondylitis.

Ankylosing spondylitis is more common in young men than in young women and is insidious in onset. Typically, patients complain of pain and stiffness around the sacroiliac region. At the disease progresses, pain is often felt in the mid-lumbar, thoracic and cervical regions resulting in a significant reduction in the range of motion of the entire spine. About one fourth of the patients display involvement of proximal synovial joints. Acute anterior uveitis may precede AS or can occur when the disease is otherwise in apparent remission. Each patient with established disease should be carefully evaluated for cardiovascular, pulmonary, and neurologic complications. Early detection of AS is important, since proper management may well prevent the severe fixed deformities of the spine and root joints that is liable to occur in these patients.

Adult

Ankylosing spondylitis and inflammatory bowel disease. II. Prevalence of peripheral arthritis, sacroiliitis, and ankylosing spondylitis in patients suffering from inflammatory bowel disease.

To establish the prevalence of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis in patients with inflammatory bowel disease, 58 consecutive patients suffering from ulcerative colitis (UC) and 51 with Crohn's disease (CD) underwent a detailed rheumatological examination. In addition, all patients were screened for the presence of the antigen HLA B27. Peripheral arthritis was found in 14 (8 UC, 6 CD) patients (12.8%); radiographic sacroiliitis was diagnosed in 11 (5 UC, 6 CD) (10.1%), of whom 10 were asymptomatic; and ankylosing spondylitis was diagnosed in 2 UC and 2 CD patients (3.7%). 18.9% of the UC and 3.9% of the CD patients were HLA B27 positive. One of the 11 patients with radiographic sacroiliitis and 2 of the 4 with ankylosing spondylitis had the HLA B27 antigen. Peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis are apparently frequent manifestations in patients suffering from inflammatory bowel disease. Asymptomatic radiographic sacroiliitis in these patients appears to differ from idiopathic ankylosing spondylitis, both clinically and genetically. Evaluation of subjective rheumatological complaints, necessary for a confident diagnosis of ankylosing spondylitis, according to the New York criteria is difficult during a flare-up of the inflammatory bowel process, as was shown in 4 CD cases with marked limitation of lumbovertebral function and chest expansion, but no radiological abnormalities of the SI joints.

Adult

Spinal fractures complicating ankylosing spondylitis.

The ankylosed osteoporotic spines of patients with long-standing ankylosing spondylitis are prone to fracture. The spinal trauma is of a trivial nature in many patients and the diagnosis may be overlooked, unless neurologic damage occurs. The fractures most commonly occur in the cervical region and may be multiple. Because of spinal osteoporosis and deformity, radiographic visualization of the fracture site may be difficult. Tomography may be helpful in some patients. Management may be conservative or surgical and is complicated by increased instability of the fracture site, spinal osteoporosis, and deformity. Conservative management of cervical fractures is probably best accomplished by halo traction and body cast. Progression of the neurologic deficit is an indication for surgical intervention.

Adult

[Ankylosing spondylitis (Bechterew) and tissue antigen HLA-B27. III, Heredity of ankylosing spondylitis (Bechterew)].

A family with known accumulation of ankylosing spondylitis (AS) was examined clinically, radiologically and by HLA tissue typing. Among 17 individuals of three generations there were four carriers of classical AS, all HLA-B27-positive. Five carriers of HLA-B27 were clinically and radiologically healthy, but three of them were below the age of 30, thus still being at risk of developing AS. The numerical relation between first degree relatives with and without HLA-B27 was 10:7. Genotype reconstruction of the great grandparents lead to the conclusion, that they were carriers of two different haplotype combinations, HLA-1/HLA-B27 and HLA-2/HLA-B27. Both haplotype combinations proved to be associated with AS. Among the offsprings of these great grandparents the combination of HLA-2 with HLA-B27 occurred in 3 of the 4 ankylosing spondylitics and in four of the six healthy HLA-B27-carriers. The question whether a haplotype combination of HLA-2 and HLA-B27 leads to an increased risk for AS cannot be decided without further systematic genotype determinations.

HLA Antigens

Ankylosing spondylitis and inflammatory bowel disease. I. Prevalence of inflammatory bowel disease in patients suffering from ankylosing spondylitis.

To establish the prevalence of inflammatory bowel disease in ankylosing spondylitis (AS), 79 AS patients underwent detailed medical screening, including sigmoidoscopic and roentgenological examination, 48 had gastrointestinal symptoms and the others did not. In 3 patients a diagnosis of Crohn's disease was made which was previously established. In all other patients inflammatory bowel disease could be excluded. The prevalence of inflammatory bowel disease in this series of patients with AS therefore was 3.8%.

Enteritis

[Ankylosing spondylitis (Bechterew) and tissue antigen HLA-B 27. II. HLA-B 27 negativity in classical clinical ankylosing spondylitis: no independent nosological entity].

The question, whether HLA-B27-negative patients with classical ankylosing spondylitis (AS) belong to a separate nosological entity, was studied by a standardized analysis of 12 clinical, 8 radiological and 6 laboratory criteria in 95 cases, including 7 with HLA-B27-negativity, who reinforced international criteria for classical AS. The results showed neither definite clinical nor radiological, or laboratory differences between the HLA-B27 negative and positive group. We conclude, that existence or absence of the tissue antigen HLA-B27 has no influence on inflammatory activity of skeletal or soft tissue manifestations of the disease. The group of HLA-B27-negative patients who fulfill the criteria of classical AS does therefore not seem to form a separate nosological entity.

HLA Antigens

Ankylosing spondylitis and inflammatory bowel disease. III. Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease.

A study was made, in co-operation with several gastroenterology and rheumatology centres, of the clinical and genetic characteristics (HLA B27) of 50 patients suffering from both inflammatory bowel disease (38 Crohn's disease (CD), 12 ulcerated colitis (UC)) and ankylosing spondylitis (AS), the latter diagnosis being established according to the New York criteria. 20 CD (52.6%) and 8 UC (66.7%) patients were HLA B27 positive. The presence of HLA B27 was studied in relation to clinical parameters, such as first occurrence of symptoms of AS or inflammatory bowel disease (IBD), a history of peripheral arthritis, iridocyclitis, and a positive history of AS or IBD. Our patients were found to have heterogeneous clinical features: on one side of the spectrum a group of cases was distingiushed with the typical characteristics of idiopathic AS, often being HLA B27 positive. On the other side a smaller group of HLA B27 negative patients was observed, with severe intestinal inflammatory pathology, lacking most of the typical clinical features of idiopathic AS ('secondary' form of AS). Finally, between these two extremes a group of patients was found with less pronounced clinical or genetic characteristics. These different clinical and histocompatibility patterns suggest a mixed aetiopathogenesis of AS in IBD patients. Such a 'syndrome' of AS might harbour both idiopathic AS and forms of AS 'secondary' to the intestinal inflammatory pathology.

Adult

Association of renal papillary necrosis and ankylosing spondylitis.

Three patients with ankylosing spondylitis developed renal papillary necrosis. All had received prostaglandin synthetase inhibitors including phenylbutazone, indomethacin, or ibuprofen. One patient had sickle trait. These drugs are not commonly associated with papillary necrosis in man, but may adversely effect renal medullary blood flow. An underlying renal vascular abnormality related to ankylosing spondylitis is also considered. Patients with ankylosing spondylitis who are taking prostaglandin synthetase inhibitors should be routinely screened for hematuria.

Adult

Ankylosing spondylitis of childhood onset.

Ankylosing spondylitis begins in childhood in a significant number of patients. The disease may begin in one of two ways: with early hip girdle and low back complaints, or with peripheral arthritis affecting a few large joints. Ankylosing spondylitis should be suspected in seronegative boys over the age of 8 years who have pauciarticular arthritis, particularly if there is associated hip girdle involvement. Early recognition of ankylosing spondylitis may be helpful in appropriate therapy and followup of patients.

Adolescent

Clinical and radiographic "reankylosis" following hip surgery in ankylosing spondylitis.

Eleven patients with ankylosing spondylitis underwent reconstructive hip surgery (21 hips). In 10 of these hips multiple surgical procedures had been performed. The final procedure included total hip arthroplasties (16 hips), femoral cup arthroplasties (four hips) and an Austin-Moore prosthetic replacement (one hip). A clinical and radiographic evaluation in the postoperative period revealed a high incidence of decreased joint motion and heterotopic ossification. Clinically moderate to severe restriction of motion was noted in 12 hips, and in six of these "reankylosis" was present. Radiographically moderate to severe new bone formation was seen in 11 hips, and in nine of these "reankylosis" was suggested. An association of excessive ossification and multiple surgical procedures was evident. It would appear that when the prime indication for hip surgery in patients with ankylosing spondylitis is restricted motion, the operation may not be beneficial.

Adult

Hip involvement in ankylosing spondylitis.

Hip involvement in ankylosing spondylitis (AS) is a common and disabling problem. The clinical and x-ray records of 87 patients with definite AS (Rome criteria) were examined to define and characterize their hip disease. Clinical hip disease was present in 33 cases (38%), was usually bilateral (91%), and tended to begin early in the disease course; it was the cause of 50% of the Class III and IV disability in the entire study group. Typical findings included regional pain, limitation of motion, muscle atrophy, and flexion contractures. Radiologic hip abnormalities occurred in 42 cases (48%). The radiographic pattern was distinctive when compared to that in two control groups and included axial migration of the femoral head (63%), concentric joint space narrowing (50%), rufflike femoral osteophytosis (36%), and protrusio acetabuli (30%). Eight patients required bilateral hip surgery. Para-articular ossification occurred in 8 of 16 replaced hips; in 5 of 8 hips it caused clinical immobility. This potentially serious complication may limit the usefulness of hip arthroplasty in some AS patients.

Adult

Alclofenac in ankylosing spondylitis.

Eighteen patients with definite ankylosing spondylitis were treated with 3 to 4 g. alclofenac daily for up to 8 months in an open trial against previous therapy. Therapeutic efficacy was greater than or equivalent to previous therapy in 10 of 18 patients after 1 month and 8 patients remain on alclofenac. There was a significant increase in symptoms, particularly morning stiffness after 1 month, but they tended to improve with time. Measurement of spinal movements was not found useful. Side-effects were commoner than expected but not serious. Alclofenac may prove a useful alternative drug in the management of ankylosing spondylitis and further trials are indicated.

Adult

A Bibliometric Analysis of Systematic Reviews in the Field of Ankylosing Spondylitis from 2007 to 2025.

BACKGROUND: Ankylosing spondylitis (AS) is an inflammatory autoimmune disease and the most common clinical form of spinal arthritis. Over the past decades, tremendous progress has been made in systematic reviews on AS. This study aimed to conduct a bibliometric analysis of AS-related meta-analyses to visualize the hotspots and trends in the field. METHODS: A comprehensive search was conducted for publications of AS meta-analysis from 2007 to 2025 using the Web of Science Core Collection database. Bibliometric analysis was performed using the Bibliometrix software package, VOSviewer, and CiteSpace. RESULTS: In total, 1073 articles were identified, and the number of relevant publications showed annual growth. China, the USA, and England were the most productive countries. Annals of the Rheumatic Diseases was the most productive journal (54, 10.65%), Pan Faming was the most productive author (23, 4.54%), and Anhui Medical University (45, 8.88%) was the most productive institution. High-frequency keywords were mainly grouped into five themes: complications, biologics, physical therapy exercises, gut microbiota, and analytical methods. DISCUSSION: This first bibliometric analysis of AS-related EBM research showed a 20-year upward trend in AS meta-analyses, consistent with prior studies. CiteSpace revealed that China (top since 2014) and the USA led in publications (53 countries) but had limited collaboration. Pan Faming (23 articles) was the most active author, and Annals of the Rheumatic Diseases published the most articles. Keyword analysis identified five themes (e.g., AS complications, biologics) and research frontiers: pre-2012 genome-AS links, post-2012 multi-center RCTs, and the recent focus on AS patients' HRQoL. Limitations included database and English-language bias; future meta-analyses should adopt standardized outcomes. CONCLUSION: In recent years, there has been a remarkable surge in the number of meta-analyses on AS. This significant increase underscores the importance of this research area. Studies in this field have mainly focused on several key aspects: risk factors, network meta-analysis, and quality- of-life studies. These findings are highly valuable for understanding advancements in ASrelated research and can also encourage researchers and clinicians to focus on both effective medical treatments and the well-being of AS patients.

Spondylitis, Ankylosing

HLA B27 and the genetics of ankylosing spondylitis.

One hundred and twenty-eight of 145 patients with ankylosing spondylitis (AS) were found to be HLA B27 positive. Five patients had evidence of a sero-negative peripheral arthritis resembling peripheral psoriatic arthritis and 3 of these were B27 negative. One further B27 negative patients had a sister with ankylosing spondylitis and ulcerative colitis and a mother with ulcerative colitis. There was evidence of a somewhat later age of onset of symptoms in B27 negative patients. These findings are interpreted as suggesting some degree of clinical and genetic heterogeneity in ankylosing spondylitis with genes for psoriasis and inflammatory bowel disease being important in some individuals, particularly those who are B27 negative. Twenty-five first-degree relatives with ankylosing spondylitis were all B27 positive. The only instance of disassociation of B27 and spondylitis in a family was where the proband had ulcerative colitis as well as spondylitis. Of 13 B27 positive fathers 3 could be diagnosed as having definite ankylosing spondylitis (23%). These findings are thought to provide evidence against the concept that the gene for ankylosing spondylitis is not B27 but a closely linked gene and favour the occurrence of an environmental event affecting approximately one-fifth of B27 positive males to result in disease.

Adolescent

Comparison of clinical features in HLA-B27 positive and negative patients with ankylosing spondylitis.

The clinical features of ankylosing spondylitis (AS) were compared in 63 HLA-B 27 positive (+) and 15 B27 negative (-) individuals with this disease. There were no differences in age at onset, functional class, degree of deformity, pain, severity of X-ray changes, or frequency of peripheral joint involvement or of reconstructive orthopedic surgery. These data demonstrated that skeletal manifestations of AS were essentially the same in B27(+) and (-) patients, and provide no evidence for the speculation that AS in B27(-) patients is milder or is a different disease from that occurring in B27(+) patients. On the other hand, acute anterior uveitis was found to be significantly more common in B27(+) patients, a fact suggesting that the "uveitis of AS" may in fact be an independent condition occurring in B27(+) individuals, rather than a manifestation of AS per se.

Black People

HLA B27 in regional enteritis with and without ankylosing spondylitis or sacroiliitis.

The incidence of B27 in patients with ankylosing spondylitis associated with regional enteritis was significantly lower than in ankylosing spondylitis without inflammatory bowel disease. It was significantly higher, however, than in a control group of blood donors. The incidence of B27 was found to be nil in patients with regional entertitis without ankylosing spondylitis, as well as in patients with regional enteritis and asymptomatic radiographic sacroilitis. Conversely, all patients with regional enteritis, positive for B27, developed ankylosing spondylitis.

Arthritis