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The spondyloarthropathies

J Richens1, P E McGill

  • 1Academic Department of Genitourinary Medicine, University College London Medical School, UK.

Bailliere'S Clinical Rheumatology
|February 1, 1995
PubMed
Summary

Spondyloarthropathies vary globally, with HLA B27 subtypes potentially influencing ankylosing spondylitis frequency. Reactive arthritis, strongly linked to HLA B27, is common in tropics, possibly increasing with HIV in Africa.

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Area of Science:

  • Rheumatology
  • Immunogenetics
  • Tropical Medicine

Background:

  • Spondyloarthropathies present with variable frequency in tropical regions.
  • Ankylosing spondylitis is reportedly rare in tropical Africa, potentially due to low HLA B27 gene frequency.
  • Conversely, Melanesian populations in Papua New Guinea have high HLA B27 frequency but low ankylosing spondylosis incidence, suggesting complex genetic interactions.

Purpose of the Study:

  • To explore the diverse occurrences of spondyloarthropathies in tropical regions.
  • To investigate the role of HLA B27 gene subtypes in the varying prevalence of ankylosing spondylitis.
  • To highlight the significance and associations of reactive arthritis in tropical settings.

Main Methods:

  • Review of epidemiological data on spondyloarthropathies in tropical regions.
  • Analysis of HLA B27 gene frequencies and subtypes in different populations.
  • Correlation of reactive arthritis prevalence with factors like HIV infection and specific genetic markers.

Main Results:

  • Observations suggest that HLA B27 subtypes, not just the gene's presence, may explain differing ankylosing spondylitis rates.
  • Reactive arthritis is a significant acute arthritis form in the tropics, strongly associated with HLA B27 in Papua New Guinea.
  • An increasing prevalence of reactive arthritis in Africa may be linked to the spread of HIV infection.

Conclusions:

  • Variations in HLA B27 subtypes could reconcile the disparate frequencies of ankylosing spondylitis observed globally.
  • Reactive arthritis is a key spondyloarthropathy in tropical areas, with potential links to HIV.
  • Extra-articular manifestations like balanitis and enthesitis aid diagnosis, while infections like gonorrhea and TB must be ruled out. Treatment involves anti-inflammatories, with specific options for chlamydia-triggered or chronic cases.

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