The sacroiliac joint in the spondyloarthropathies

Current Opinion in Rheumatology

Volumn 8, Issue 4, 1996, Pages 275-287

  Braun, Jürgen ^a   Sieper, Joachim ^a  

^a FREIE UNIVERSITÄT BERLIN   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

HLA B27 ANTIGEN;

CELL INFILTRATION; CLINICAL FEATURE; HUMAN; MAJOR HISTOCOMPATIBILITY COMPLEX; PATHOGENESIS; PRIORITY JOURNAL; REVIEW; SACROILIAC JOINT; SPONDYLOARTHROPATHY;

EID: 0029759184     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: 10.1097/00002281-199607000-00003     Document Type: Review

References (130)

1. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivierei I, Pasero G, et al.: The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991, 34:1218-1227.
2. Amor B, Dougados M, Mijiyama M: Critére diagnostique des spondylarthropathies [in French]. Rev Rhum Mal Osteoartic 1990, 57:85-90.
3. Amor B, Dougados M, Listrat V, Menkes CJ, Roux H, Benhamou C, Blotman F, Pattin S, Paolaggi JB, Duquesnoy B, et al.: Are classification criteria for spondylarthropathy useful as diagnostic criteria? Rev Rhum Engl Ed 1995, 62:10-15.
4. Boyer GS, Templin DW, Goring WP: Evaluation of the European Spondylarthropathy Study Group preliminary classification criteria in Alaskan Eskimo populations. Arthritis Rheum 1993, 36:534-538.
5. Collantes Estevez E, Cisnal del Mazo A, Munoz Gomariz E: Assessment of 2 systems of spondylarthropathy diagnostic and classification criteria (Amor and ESSG) by a Spanish multicenter study: European Spondylarthropathy Study Group. J Rheumatol 1995, 22:246-251.
6. Boyer GS, Templin DW, Cornoni Huntley JC, Everett DF, Lawrence RC, Heyse SF, Miller MM, Goring WP: Prevalance of spondyloarthropathies in Alaskan Eskimos. J Rheumatol 1994, 21:2292-2297.
7. Underwood MR, Dawes P: Inflammatory back pain in primary care. Br J Rheumatol 1995, 34:1074-1077. In a primary care setting 5.8% of patients with back pain had features of SpA.
8. van der Linden S, Valkenburg H, Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum 1984, 27:361-368.
9. McGuigan LE, Hart HH, Gow PJ, Kidd BL, Grigor RR, Moore TE: The functional significance of sacroiliitis and ankylosing spondylitis in Reiter's syndrome. Clin Exp Rheumatol 1985, 3:311-315.
10. Torre Alonso JC, Rodriguez Perez A, Arribas Castrillo JM, Ballina Garcia J, Riestra Noriega JL, Lopez Larrea C: Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients [see comments]. Br J Rheumatol 1991, 30:245-250.
11. Munch H, Purrmann J, Reis HE, Bertrams J, Zeidler H, Stolze T, Miller B, Korsten S, Cremers J, Strohmeyer G: Clinical features of inflammatory joint and spine manifestations in Crohn's disease. Hepatogastroenterology 1986, 33:123-127.
12. Yli Kerttula T, Tertti R, Toivanen A: Ten-year follow up study of patients from a Yersinia pseudotuberculosis III outbreak. Clin Exp Rheumatol 1995, 13:333-337. Although the initial ReA was only slightly associated with HLA-B27, all HLA-B27-positive patients had chronic symptoms, and two of four developed AS.
13. Suarez Almazor ME, Russell AS: Sacroiliitis in psoriasis: relationship to peripheral arthritis and HLA-B27. J Rheumatol 1990, 17:804-808.
14. Gravallese EM, Kantrowitz FG: Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988, 83:703-709.
15. Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, Deicher H: Clinical features and prognosis of patients with possible ankylosing spondylitis: results of a 10-year followup. J Rheumatol 1988, 15:1109-1114.
16. Calin A: The natural history and prognosis of ankylosing spondylitis. J Rheumatol 1988, 15:1054-1055.
17. Gran JT, Husby G: The epidemiology of ankylosing spondylitis. Semin Arthritis Rheum 1993, 22:319-334.
18. Gran JT, Husby G, Hordvik M: Spinal ankylosing spondylitis: a variant form of ankylosing spondylitis or a distinct disease entity? Ann Rheum Dis 1985, 44:386-371.
19. Khan MA, van der Linden SM, Kushner I, Valkenburg HA, Cats A: Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. Arthritis Rheum 1985, 28:40-43.
20. Reiter's syndrome and reactive arthritis. In Epidemiology of the Rheumatic Diseases. Edited by Silman AJ, Hochberg MC. Oxford: Oxford University Press; 1993: 150-152.
21. Kvien TK, Glennas A, Melby K, Granfors K, Andrup O, Karstensen B, Thoen JE: Reactive arthritis: incidence, triggering agents and clinical presentation. J Rheumatol 1994, 21:115-122.
22. Leirisalo Repo M, Skylv G, Kousa M, Voipio-Pulkki LM, Suoranta H, Nissilä M, Hvidman L, Nielsen ED, Svejgaard A, Tiilikainen A, Laitinen O: Followup study on patients with Reiter's disease and reactive disease with special reference to HLA B27. Arthritis Rheum 1982, 25:249-259.
23. Leirisalo Repo M, Skylv G, Kousa M: Follow-up study of Reiter's disease and reactive arthritis: factors influencing the natural course and the prognosis. Clin Rheumatol 1987, 6(suppl 2):73-82.
24. Leirisalo Repo M, Suoranta H: Ten-year follow-up study of patients with Yersinia arthritis. Arthritis Rheum 1988, 31:533-537.
25. Marks JS, Holt PJ: The natural history of Reiter's disease: 21 years of observations. Q J Med 1986, 60:685-697.
26. Glennas A, Kvien TK, Melby K, Overboo A, Andrup O, Karstensen B, Thoen JE: Reactive arthritis: a favorable 2 year course and outcome, independent of triggering agent and HLA-B27. J Rheumatol 1994, 21:2274-2280.
27. Richens J, McGill PE: The spondyloarthropathies. Baillieres Clin Rheumatol 1995, 9:95-109. Interesting review of data suggesting that bacterial infections and HLA-B27 play an important role in the frequently occurring arthritides in Papua, New Guinea.
28. Bardin T, Lathrop GM: Postveneral Reiter's syndrome in Greenland. Rheum Dis Clin North Am 1992, 18:81-93.
29. Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK: Psoriatic arthritis (PSA): an analysis of 220 patients. Q J Med 1987, 62:127-141.
30. Veale D, Roogers S, Fitzgerald O: Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol 1994, 33:133-138.
31. Salvarani C, Lo Scocco G, Macchioni P, Cremonesi T, Rossi F, Mantovani W, Battistel B, Bisighini G, Portioli I: Prevalance of psoriatic arthritis in Italian psoriatic patients. J Rheumatol 1995, 22:1499-1503.
32. Scarpa R, Oriente P, Pucino A, Vignone L, Cosentini E, Minerva A, Biondi Oriente C: The clinical spectrum of psoriatic spondylitis. Br J Rheumatol 1988, 27:133-137.
33. Hanly JG, Russell ML, Gladman DD: Psoratic spondyloarthropathy: a long term prospective study. Ann Rheum Dis 1988, 47:386-393.
34. Edmunds L, Elswood J, Kennedy LG, Calin A: Primary ankylosing spondylitis, psoriatic and enteropathic spondylarthropathy: a controlled analysis. J Rheumatol 1991, 18:696-698.
35. Morris RI, Metzger AL, Bluestone R, Terasaki PI: HLA B27: a useful discriminator in the arthropathies of inflammatory bowel disease. N Engl J Med 1974, 290:1117-1119.
36. Russell AS, Schlaut J, Percy JS, Dosseter JB: HLA-antigens in ankylosing spondylitis and Crohn's disease. J Rheumatol 1974, 1:203-209.
37. Linssen A, Feltkamp TE: B27 positive diseases versus B27 negative diseases. Ann Rheum Dis 1988, 47:431-439.
38. Paivonsalo Hietanen T, Vaahtoranta Lehtonen H, Tuominen J, Saari KM: Uveitis survey at the University Eye Clinic in Turku. Acta Ophthalmol Copenh 1994, 72:505-512.
39. Zeidler H, Mau W, Khan MA: Undifferentiated spondyloarthropathies. Rheum Dis Clin North Am 1992, 18:187-202.
40. Uppal SS, Pande I, Singh G, Kailash S, Kakker R, Kumar A, Mehra NK, Giri TK, Sekharan NG, Malaviya AN: Profile of HLA-B27-related "unclassifiable" seronegative spondylarthropathy in females and its comparison with the profile in males. Br J Rheumatol 1995, 34:137-140.
41. Hussein A: Die HLA-B27-assoziierten Spondyloarthritiden im Kindesalter [in German]. Monatsschr Kinderheilkd 1987, 135:185-194.
42. Prieur AM, Listrat V, Dougados M, Amor B: Criteres de classification des spondylarthropathies chez les enfants [in French]. Arch Fr Pediatr 1993, 50:379-385.
43. Burgos Vargas R, Vazquez Mellado J: The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. Arthritis Rheum 1995, 38:835-844. Juvenile-onset AS patients had enthesopathy in 88.6% and tarsitis in 85.7% of the cases 1 year after disease onset; this was significantly different from patients with juvenile rheumatoid arthritis. After a mean of 7.3 years, these patients developed definite AS.
44. Olivieri I, Padula A, Pierro A, Favaro A, Oranges GS, Ferri S: Late onset undifferentiated seronegative spondylarthropathy. J Rheumatol 1995, 22:899-903.
45. Joos R, Veys EM, Mielants H, Vandewalle K, de Sutter P, Herman H, Poriau S, de Wilde F, Verbruggen G: Clinical manifestations in HLA-B27-positive patients. Clin Exp Rheumatol 1987, 5(suppl 1):S41-S47.
46. Mattila L, Leirisalo Repo M, Koskimies S, Granfors K, Siitonen A: Reactive arthritis following an outbreak of Salmonella infection in Finland. Br J Rheumatol 1994, 33:1136-1141.
47. Thomson GT, Chiu B, de Rubeis D, Falk J, Inman RD: Immunoepidemiology of post-Salmonella reactive arthritis in a cohort of women. Clin Immunol Immunopathol 1992, 64:227-232.
48. Thomson GT, Derubeis DA, Hodge MA, Rajanayagam C, Inman RD: Post-Salmonella reactive arthritis: late clinical sequelae in a point source cohort Am J Med 1995, 85:13-21. The incidence of ReA after an infection with Salmonella was 6.4%; 22% were HLA-B27 positive. There was a considerable degree of chronicity; after 5 years 65% of the initial 27 patients had continuous joint problems, 37% had obvious pathologic changes, and four patients had radiographic damage.
49. Samuel MP, Zwillich SH, Thomson GTD, Alfa M, Orr KB, Brittain DC, Miller JR, Philips PE: Fast food arthritis: a clinico-pathologic study of post-Salmonella reactive arthritis. J Rheumatol 1995, 22:1947-1952. The incidence of subjective joint symptoms after infection with Salmonella in a fast food restaurant was 14%. Patients with a longer duration of diarrhea were more likely to develop joint symptoms. HLA-B27 correlated with disease severity.
50. Bas S, Griffais R, Kvien TK, Glennas A, Melby K, Vischer TL: Amplification of plasmid and chromosome Chlamydia DNA in synovial fluid of patients with reactive arthritis and undifferentiated seronegative oligoarthropathies. Arthritis Rheum 1995, 38:1005-1013. Excellent study demonstrating the detection of C. trachomatis in 21 joints of 55 patients with ReA and oligoarthritis by polymerase chain reaction technique. The correlation with HLA-B27 was weak.
51. Gladman DD, Anhorn KA, Schachter RK, Mervart H: HLA antigens in psoriatic arthritis. J Rheumatol 1986,13:586-592.
52. Mielants H, Veys EM, Goemaere S, Cuvelier C, De Vos M: A prospective study of patients with spondylarthropathy with special reference to HLA-B27 and to gut histology. J Rheumatol 1993, 20:1353-1358.
53. Mielants H, Veys EM, de Vos M, Cuvelier C, Goemaere S, de Clercq L, Schatteman L, Elewaut D: The evolution of spondylarthropathies in relation to gut histology. I: clinical aspects. J Rheumatol 1995, 22:2266-2272. Prospective study on the clinical evolution of disease in 217 patients with different forms of SpA; 123 patients were reexamined and 94 were contacted by telephone. Fourteen patients had developed AS and seven patients had symptomatic IBD. Forty-three percent were in remission. HLA-B27 was correlated with persistent locomotor inflammation.
54. Mielants H, Veys EM, Cuvelier C, de Vos M, Goemaere S, de Clercq L, Schatteman L, Elewaut D: The evolution of spondylarthropathies in relation to gut histology. II: histologic aspects. J Rheumatol 1995, 22:2273-2278. Of the 123 patients reexamined by ileocolonoscopy, 23% had acute and 45% had chronic gut inflammation, half of them asymptomatic. Thirteen of 14 patients who developed AS had had gut lesions initially. The presence of such lesions also predisposed to the development of symptomatic IBD.
55. Mielants H, Veys EM, Cuuvelier C, de Vos M, Goemaere S, Schatteman L, Gyselbrecht L, Elewaut D, de Clercq L: The evolution of spondylarthropathies in relation to gut histology: III: relation between gut and joint. J Rheumatol 1995, 22:2279-2284. Prospective study with repeated ileocolonoscopies in 49 patients with SpA. Remission was in all 16 cases associated with absence of gut inflammation, and ongoing locomotor inflammation was found in 14 of 33 patients with persistent inflammatory gut lesions.
56. Leirisalo Repo M, Turunen U, Stenman S, Helenius P, Seppala K: High frequency of silent inflammatory bowel disease in spondylarthropathy. Arthritis Rheum 1994, 37:23-31.
57. Altomonte L, Zoli A, Veneziani A, Mirone L, Santacesaria G, Chiarelli C, Federico F, Massi G, Magaro M: Clinically silent inflammatory gut lesions in undifferentiated spondyloarthropathies. Clin Rheumatol 1994, 13:565-570.
58. Banares AA, Jover JA, Fernandez Gutierrez B, Benitez del Castillo JM, Garcia J, Gonzales F, Lopez JA, Hernandez Garcia C: Bowel inflammation in anterior uveitis and spondyloarthropathy. J Rheumatol 1995, 221112-1117. Cross-sectional ileocolonoscopic study in 27 patients with anterior uveitis (46.2% HLA-B27 positive). Signs of chronic gut inflammation were found in 66%. This result was irrespective of a concomitant diagnosis of SpA and was negatively associated with HLA-B27.
59. Schatteman L, Mielants H, Veys EM, Cuvelier C, de Vos M, Gyselbrecht L, Elewaut D, Goemaere S: Gut inflammation in psoriatic arthritis: a prospective ileocolonoscopic study. J Rheumatol 1995, 22:680-683. Important study showing that only 26.3% of the 38 patients with PsA belonging to the subset with SpA-like disease, but not those 26 with symmetric polyarthritis resembling rheumatoid arthritis, had inflammatory gut lesions.
60. Bellamy N, Park W, Rooney PJ: What do we know about the sacroiliac joint? Semin Arthritis Rheum 1983, 12:282-313.
61. Dihlmann W, Lindenfelser R, Selberg W: Sakroilikale Histomorphologie der ankylosierenden Spondylitis als Beitrag zur Therapie [in German]. Dtsch Med Wochenschr 1977, 102:129-132.
62. Francois RJ: Le rachis dans la Spondylarthrite Ankylosante. Brussels: Editions Arscia; 1976.
63. Shichikawa K, Tsujimoto M, Nishioka J, Nishibayshi Y, Matsumoto K: Histopathology of early sacroiliitis and enthesitis in ankylosing spondylitis. In The Spondylarthropathies. Edited by Ziff M, Cohen SB. New York: Raven Press; 1985:15-24.
64. Francois RF, Gardner DL, Bywaters EGL: The sacroiliac joint in ankylosing spondylitis [abstract]. Rheumatol Eur 1995, 24:87.
65. Braun J, Bollow M, Eggens U, Konig H, Distler A, Sieper J: Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 1994, 37:1039-1045.
66. Braun J, Bollow M, Neure L, Seipelt E, Seyrekbasan F, Herbst H, Eggens U, Distler A, Sieper J: Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum 1995, 38:499-505. This study shows that sacroiliac biopsies guided by CT are feasible for local treatment and for obtaining synovial material. In these specimens, inflammatory cellular infiltrates with CD4 and CD8 T cells and CD14 macrophages were found. Tumor necrosis factor-a mRNA was detected in high amounts in patients with severe sacroiliitis. Near areas of ossification, transforming growth factor-β2 mRNA was observed in minor amounts.
67. Braun J, Bollow M, Seyrekbasan F, Häberle HJ, Eggens U, Mertz A, Distler A, Sieper J: Computed tomography corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996, 23:659-664. This open study shows that 80% of patients treated with CT-guided corticosteroid injections in the sacroiliac joints have significantly less back pain symptoms for a mean of 8.9 months; no side effects were observed. The therapeutic success was also documented by dynamic magnetic resonance imaging.
68. Braun J, Grolms M, Sieper J: Three-colour flowcytometric examination of CD4/CD45 subsets reveals no differences in peripheral blood and synovial fluid between patients with reactive arthritis and rheumatoid arthritis. Clin Exp Rheumatol 1994, 12:17-22.
69. Braun J, Bollow M, Wu P, Tuszewski M, Ehlers S, Seyrekbasan F, Häberle HJ, Eggens U, Mertz A, Sieper J: Further examination of sacroiliac biopsies from spondylarthropathy patients: investigation of the cytokine pattern and of bacterial DNA [abstract]. Arthritis Rheum 1995, 38:315. No bacterial DNA was found in eight sacroiliac joints of patients with AS and uSpA. Comparable amounts of interferon gamma and interleukin-4 were detected by polymerase chain reaction.
70. Burmester GR, Daser A, Kamradt T, Krause A, Mitchison NA, Sieper J, Wolf N: Immunology of reactive arthritides. Annu Rev Immunol 1995, 13:229-250. Excellent review on the immunology of ReA and Lyme arthritis.
71. Hammer RE, Maika SD, Richardson JA, Tang JP, Taurog JD: Spontaneous inflammatory disease in transgenic rats expressing HLA-B27 and human beta 2m: an animal model of HLA-B27-associated human disorders. Cell 1990, 63:1099-1112.
72. Kriegsmann J, Franklin BN, Gay RE, Taurog JD, Hammer RE, Gay S: Fusion of vertebral bodies and the sacroiliac joint by cartilaginous tissue in HLA B27 transgenic rats [abstract]. Arthritis Rheum 1995, 38:202. Striking pictures demonstrating fusion of the sacroiliac joints of HLA-B27 transgenic rats.
73. Rynes RI, Volastro PS, Bartholomew LE: Exacerbation of B27 positive spondyloarthropathy by enteric infections. J Rheumatol 1984, 11:96-97.
74. Taurog JD, Richardson JA, Croft JT, Simmons WA, Zhou M, Fernandez Sueiro JL, Balish E, Hammer RE: The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats. J Exp Med 1994, 180:2359-2364.
75. Sieper J, Braun J: Pathogenesis of spondylarthropathies. Arthritis Rheum 1995, 38:1547-1554. Review of the current hypotheses on the pathogenesis of SpA, focusing on bacteria, HLA-B27, and T cells.
76. Nguyen TP, Burk DL Jr: Musculoskeletal case of the day: tuberculous sacroiliitis. AJR Am J Roentgenol 1995, 165:205-206.
77. Rajapakse CN: Bacterial infection: osteoarticular brucellosis. Bailieres Clin Rheumatol 1995, 9:161-177.
78. Relman DA, Schmidt TM, MacDermott RP, Falkow S: Identification of the uncultured bacillus of Whipple's disease. N Engl J Med 1992, 327:293-301.
79. Carlson SA, Jones JS: Pyogenic sacroiliitis. Am J Emerg Med 1994, 12:639-641.
80. Sacks Berg A, Strampfer MJ, Cunha BA: Escherichia coli sacroiliitis: report of a case and review of the literature. Heart Lung 1988, 17:371-373.
81. Schmidt DB, Meier R, Ochsner PE, Zimmerli W, Gyr K: Akute bakterielle Sakroiliitis durch Salmonella cholerae suis [in German]. Dtsch Med Wochenschr 1988, 113:1474-1477.
82. Hermann E, Sucké B, Droste U, Meyer Zum Büschenfelde KH: Klebsiella pneumoniae-reactive T-cells in blood and synovial fluid of patients with ankylosing spondylitis. Arthritis Rheum 1995, 38:1277-1282. This study suggests that the frequency of K. pneumoniae-reactive T cells in peripheral blood is impaired in patients with active AS in comparison with HLA-B27-positive healthy controls. Two CD4 T cell clones from the synovial fluid of a patient with AS recognized K. pneumoniae.
83. Maki Ikola O, Lehtinen K, Nissila M, Granfors K: IgM, IgA and IgG class serum antibodies against Klebsiella pneumoniae and Escherichia coli lipopolysaccharides in patients with ankylosing spondylitis. Br J Rheumatol 1994, 33:1025-1029.
84. Maki Ikola O, Lehtinen K, Toivanen P, Granfors K: Antibodies to Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis in the sera of ankylosing spondylitis patients with/without iritis and enthesitis. Br J Rheumatol 1995,34:418-420.
85. Maki Ikola O, Nissila M, Lehtinen K, Leirisalo Repo M, Toivanen P, Granfors K: Antibodies to Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis in the sera of patients with axial and peripheral form of ankylosing spondylitis. Br J Rheumatol 1995, 34:413-417. Immunoglobulin G and A antibodies to K. pneumoniae, E. coli, and P. mirabilis were elevated in the sera of patients with the axial form of AS, whereas in patients with the peripheral form, mainly IgM and IgA antibodies against K. pneumoniae were increased. Most antibodies were decreased by sulfasalazine therapy.
86. Granfors K, Mäki-Ikola O, Leirisalo-Repo M: Association of gut inflammation with the increased serum Klebsiella pneumoniae-specific antibody levels in patients with the axial type of ankylosing spondylitis [abstract]. Arthritis Rheum 1995, 38:348. Increased serum K. pneumoniae-specific antibody levels in patients with AS are shown to be associated with gut inflammation.
87. Granfors K, Mäki-Ikola O, Hällgren R: Enhanced local production of antibodies against Klebsiella pneumoniae in small intestine of patients with ankylosing spondylitis [abstract]. Arthritis Rheum 1995, 38:348.
88. Nissila M, Lahesmaa R, Leirisalo Repo M, Lehtinen K, Toivanen P, Granfors K: Antibodies to Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis in ankylosing spondylitis: effect of sulfasalazine treatment. J Rheumatol 1994, 21:2082-2087.
89. Feltelius N, Hvatum M, Brandtzaeg P, Knutson L, Hallgren R: Increased jejunal secretory IgA and IgM in ankylosing spondylitis: normalization after treatment with sulfasalazine. J Rheumatol 1994, 21:2076-2081.
90. Sahly H, Podschun R, Sass R, Broker B, Kekow J, Gross WL, Ullmann U: Serum antibodies to Klebsiella capsular polysaccharides in ankylosing spondylitis. Arthritis Rheum 1994, 37:754-759.
91. O'Mahony S, Anderson N, Nuki G, Ferguson A: Systemic and mucosal antibodies to klebsiella in patients with ankylosing spondylitis and Crohn's disease. Ann Rheum Dis 1992, 51:1296-1300.
92. Sprenkels SH, Linssen A, Feltkamp TE: Spondylarthropathy and selective IgA deficiency. Rheumatol Int 1995, 14:261-263. Interesting observation of an SpA patient with IgA deficiency; confirmation of previous reports.
93. Russell AS, Suarez Almazor ME: Ankylosing spondylitis is not caused by Klebsiella. Rheum Dis Clin North Am 1992, 18:95-104.
94. Zink A: Epidemiollogie in der rheumatologischen Versorgung [in German]. Z Rheumatol 199X, 54:184-191.
95. Morris AS, Morris CR: Is the presence of HLA B27 a predisposing factor to poor outcomes in back surgery? [abstract] Arthritis Rheum 1995, 38:251. The presence of HLA-B27 was predictive of a bad outcome of disk surgery in a retrospective study, suggesting that the initial back complaints were of an inflammatory nature.
96. Khan MA: Diagnostic value of HLA B27 testing. Ann Intern Med 1982, 96:70-76.
97. Dougados M: Diagnostic features of ankylosing spondylitis [editorial]. Br J Rheumatol 1995, 34:301-303.
98. van den Hoogen HM, Koes BW, van Eijk JT, Bouter LM: On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice: a criteria-based review of the literature. Spine 1995, 20:318-327. Useful meta-analysis of several variables used for the diagnosis of back disorders, including AS.
99. Blower PW, Griffin AJ: Clinial sacroiliac testing in ankylosing spondylitis and other causes of low back pain: 2 studies. Ann Rheum Dis 1984, 43:192-195.
100. Blackburn WD Jr, Alarcón GS, Ball GV: Evaluation of patients with back pain of suspected inflammatory nature. Am J Med 1988, 85:766-770.
101. Bollow M, Braun J, Hamm B, Eggens U, Schilling A, Konig H, Wolf KJ: Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995, 194:529-536. Basic study confirming and extending the role of dynamic magnetic resonance imaging in the diagnosis of sacroiliitis. Provides excellent image material.
102. Wittram C, Whitehouse GH: Normal variation in the magnetic resonance imaging appearances of the sacroiliac joints: pitfalls in the diagnosis of sacroiliitis. Clin Radiol 1995,50:371-376.
103. Ahlstrom H, Feltelius N, Nyman R, Hallgren R: Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990, 33:1763-1769.
104. Murphey MD, Wetzel LH, Bramble JM, Levine E, Simpson KM, Lindsley HB: Sacroiliitis: MR imaging findings. Radiology 1991, 180:239-244.
105. Hanley JG, Mitchell MJ, Barnes DC, Macmillan L: Early recognition of sacroiliitis by magnetic resonance imaging and single photon emission computed tomography. J Rheumatol 1994, 21:2088-2095.
106. Fam AG, Rubenstein JD, Chin Sang H, Leung FY: Computed tomography in the diagnosis of early ankylosing spondylitis. Arthritis Rheum 1985, 28:930-937.
107. Ryan PJ, Fogelman I: The bone scan: where are we now? Semin Nucl Med 1995, 25:76-91.
108. Vesterskold L, Axelsson B, Jacobsson H: A combined method for quantitative pertechnetate scintigraphy In the diagnosis of sacroiliitis: a controlled study. Scand J Rheumatol 1994, 23:16-21.
109. Batafarano DF, West SG, Rak KM, Fortenbery EJ, Chantelois AE: Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 1993, 23:161-176.
110. Schwarzer AC, Aprill CN, Bogduk N: The sacroiliac joint in chronic low back pain. Spine 1995, 20:31-37.
111. Kahn MF, Kahn MA: The SAPHO syndrome. Baillieres Clin Rheumatol 1994, 8:333-362.
112. Rundback JH, Rosenberg ZS, Solomon G: The radiographic features of rheumatoid arthritis in HLA-B27-positive patients. Skeletal Radiol 1992, 22:263-267.
113. Kohli M, Bennett RM: Sacroiliitis in systemic lupus erythematosus. J Rheumatol 1994, 21:170-171.
114. Nati R, Kirsten D, Galle J, Magnussen H: Bilaterale Sakroileitis als Erstmanifestation einer Sarkoidose [in German]. Pneumologie 1995, 49:431-434.
115. Conaghan PG, Brooks PM: Rheumatic manifestations of malignancy. Curr Opin Rheumatol 1994, 6:105-110.
116. Chamberlain MA, Robertston RJ: A controlled study of sacroiliitis in Behcet's disease. Br J Rheumatol 1993, 32:693-698.
117. Maugars Y, Berthelot JM, Ducloux JM, Prost A: SAPHO syndrome: a followup study of 19 cases with special emphasis on enthesis involvement J Rheumatol 1995, 22:2135-2141. Interesting follow-up study on 19 patients with SAPHO syndrome stating that 43% fulfilled European Spondylarthropathy Study Group criteria for SpA. The hypothesis of the authors that the initial disease target is enthesis remains to be proven. Most patients seemed to have a relatively mild course of disease.
118. Francois RJ, Eulderink F, Bywaters EG: Commented glossary for rheumatic spinal diseases, based on the pathology. Ann Rheum Dis 1995, 54:615-625.
119. Braun J, Siper J: Comment on the glossary of rheumatic diseases. Ann Rheum Dis 1996, 55:76.
120. Amor B, Dougados M, Khan MA: Management of refractory ankylosing spondylitis and related spondyloarthropathies. Rheum Dis Clin North Am 1995, 21:117-128. Informative and stimulating review on treatment of SpA by experienced rheumatologists and SpA experts.
121. Amor B, Santos RS, Nahal R, Listrat V, Dougados M: Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol 1994, 21:1883-1887.
122. Maugars Y, Mathis C, Vilon P, Prost A: Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992, 35:564-568.
123. Nissilä M, Lehtinen K, Leirisalo Repo M, Luukkanien R, Mutru O, Yli Kerttula U: Sulfasalazine in the treatment of ankylosing spondylitis: a twenty-six-week, placebo-controlled clinical trial. Arthritis Rheum 1988, 31:1111-1116.
124. Dougaddos M, van der Linden S, Leirisalo Repo M, Huifeltdt B, Juhlin R, Veys E, Zeidler H, Kvien TK, Olivieri I, Dijkmans B, et al.: Sulfasalazine in the treatment of spondyloarthropathy: a randomized, multicenter, double-blind, placebo-controlled study. Arthritis Rheum 1995, 38:618-627. Multicenter trial with 263 patients treated for 6 months with 3 g of sulfasalazine per day showing that mainly the patients with PsA improved. No significant effects on spinal disease were observed. Significant differences were prevented by high placebo response rates.
125. Kirwan J, Edwards A, Huitfeldt B, Thompson P, Currey H: The course of established ankylosing spondylitis and the effects of sulphasalazine over 3 years. Br J Rheumatol 1993, 32:729-733.
126. Gran JT, Husby G: Ankylosing spondylitis: current drug treatment. Drugs 1992, 44:585-603.
127. Creemers MC, Franssen MJ, van de Putte LB, Gribnau FW, van Riel PL: Methotrexate in severe ankylosing spondylitis: an open study. J Rheumatol 1995, 22:1104-1107. Open study with 11 patients suggesting that methotrexate is beneficial in AS.
128. Creemers MC, van Riel PL, Franssen MJ, van de Putte LB, Gribnau FW: Second-line treatment in seronegative spondylarthropathies. Semin Arthritis Rheum 1994, 24:71-81.
129. van der Linden SM, Boers M: A framework to classify burden of illness measures. J Rheumatol 1995, 22:1185-1187. A guide through the jungle of epidemiologic measurements on patients with rheumatic diseases.
130. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A: A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity index. J Rheumatol 1994, 21:2286-2291.