Spondyloarthropathies

Ankylosing spondylitis (AS) is a chronic, inflammatory, and progressive rheumatic disease that is a member of a family of disease referred to as spondyloarthritis. Although the prevalence estimates of AS vary from 0.25% up to 4.5% in living human populations , the frequency of the disease in the past has not yet been determined. Some suspected AS cases have been reported only based on the vertebral ankyloses or fusions of sacroiliac joints dating from the Neolithic period to the Middle Ages among ancient Anatolian populations, but the AS diagnosis has not been definitively revealed in these cases. In this study, we aimed to identify an AS case that has AS-originated pathological changes on a relatively well-preserved middle-aged male skeleton, recovered from the archaeological excavation of Kılıçlı Church, Sinope, Northern Turkey and dated to the 18-9th centuries. In addition, we made a differential diagnosis with other pathologies such as diffuse idiopathic skeletal hyperostosis, reactive arthritis, and psoriatic arthritis. In the specimen, there are four macroscopic features that are diagnostic of AS: (a) both sacroiliac joints were symmetrically obliterated, (b) spinal fusion was observed without skipping any vertebrae, (c) the spine has "bamboo spine" appearance, and (d) the vertebral syndesmophytes caused squaring of the vertebral bodies. We conclude that the Kılıçlı skeleton, one of the few archaeological specimens showing all symptoms of AS disease, is the first convincing case in Anatolia.

Introduction
Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS).
Patients and methods
This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI.
Results
In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8–377) months for AS and 74.23 ± 60.7 (median 55.5, range 0–238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1.
Conclusion
SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better results than applying them in the advanced stages.

Bone ankylosis is a pathological feature that may occur in many chronic diseases involving joints. In paleopathology, it is therefore challenging to attribute such a change to a specific condition. Here, we illustrate the differential diagnosis by discussing the lesions observed on an incomplete skeleton from the Roman period, recovered from the catacomb of Saints Peter and Marcellinus (Rome, Italy). The skeleton exhibits several bone changes, including ankylosis on both feet and the left hand. The right tarsal fusion is accompanied by soft tissue ossifications involving the plantar aponeurosis and the tendinous structures connecting the great toe's proximal phalanx and sesamoid bones. The lesions recorded suggest that a spondyloarthropathy is the most likely cause of these extensive fusions.

Les maladies app artenant au groupe des spondylarthropathies inflammatoires ont en commun, outre des facteurs génétiques et certaines caractéristiques cliniques, une cible pathologique particulière : l’enthèse. Les données médicales récentes tendent à prouver que les enthésopathies des spondylarthropathies inflammatoires divergeraient de celles causées par les processus dégénératifs en se caractérisant par des lésions érosives aboutissant secondairement à une ossification. Afin d’évaluer la validité de cette hyp othèse sur le matériel ostéologique, une étude comparative entre les lésions des enthèses fibrocartilagineuses app endiculaires de six individus atteints de spondylarthropathies et d’individus non affectés par la maladie provenant d’un même échantillon a été réalisée, en tenant compte de l’influence du vieillissement sur les signes osseux d’enthésopathies. Les résultats indiquent que des ostéolyses, associées ou non à une production osseuse cicatricielle, sont les remodelages majoritairement observés pour certaines insertions des individus malades, alors que cet aspect est plus rare dans le reste de la population. Ces résultats concordent avec les données de la littérature médicale et permettent de discuter des spécificités du remodelage des enthèses fibrocartilagineuses dans les spondylarthropathies inflammatoires diagnostiquées sur du matériel osseux.

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The spondyloarthropathies are a group of related conditions which have in common genetic factors, clinical features and a specific pathological target: the enthesis. Recent medical data point out the enthesopathies in spondyloarthropathies would differ from those caused by degenerative processes, being characterized by erosive lesions leading secondarily to an ossification. In order to evaluate the validity of these assumptions on the osteological material, a comparative study between the appendicular fibrocartilaginous entheses lesions of six individuals showing signs of spondyloarthropathies and those of “healthy” individuals coming from the same sample was realized. The influence of ageing on the osseous signs of enthesopathies was also considered. The results indicate that osteolysis, sometimes associated with a cicatricial osseous production, is the mainly observed remodelling aspect for some insertions of the six cases, whereas this feature is rare in the remainder of the population. These results agree with the medical literature data and make it possible to propose a first characterization of the remodelling process of entheses in spondyloarthropathies diagnosed on osteological material.

Objective: Seronegative spondyloarthritis (SpA) is characterized by chronic inflammation affecting the axial skeleton, entheses and occasionally peripheral joints. The involvement of the sacroiliac joints, sacroiliitis, is considered as a pathognomonic radiographic finding. Magnetic resonance imaging (MRI) is the method of choice for its early detection. Bone scintigraphy (BS) is characterized by high sensitivity in the diagnosis of bone and articular diseases. Limited value of BS in the diagnosis of sacroiliitis may be attributed to the use of planar imaging. In the present study, we aimed to investigate the role of SPECT in SpA, compared to MRI. Methods: Forty-three patients suffering from inflammatory back pain underwent MRI evaluation of the sacroiliac joints and BS, combined with SPECT in the same region, for the assessment of sacroiliitis. Results: Bone SPECT revealed no findings of sacroiliitis in 11 patients, with total agreement with MRI. Findings of chronic lesions were demonstrated from both modalities in 2 patients. Bone SPECT and MRI findings were in concordance regarding the investigation of active sacroiliitis, with the exception of one patient with mild SPECT findings and negative MRI examination; the diagnosis of AS however, was established one year later, after a positive follow-up MRI. The evaluation of the planar imaging of the whole skeleton and SPECT imaging, revealed additional lesions. Conclusions: Bone SPECT is a reliable imaging method in the diagnosis of active sacroiliitis. Its application on planar BS, an economic and widely available diagnostic technique, appears to be a valuable aid for the clinician. Öz Amaç: Seronegatif spondiloartrir (SpA) aksiyal iskelet, entezler ve nadiren perifer eklemlerin kronik enflamasyonu ile karakterizedir. Sakroiliak eklem tutulumu, sakroiliit, patognomonik bir radyografik bulgu olarak kabul edilir. Manyetik rezonans görüntüleme (MRG) erken tanı için tercih edilen yöntemdir. Kemik sintigrafisi (KS) kemik ve eklem hastalığının tanısında yüksek duyarlılığa sahiptir. KS'nin sakroiliit tanısındaki kısıtlı değeri planar görüntüleme kullanılmasına bağlı olabilir. Bu çalışmada SpA'da SPECT'in rolünün MRG ile karşılaştırılması amaçlandı.

ABSTRACT In palaeopathology, the diagnosis of spondyloarthropathies traditionally relies on the association of three types of skeletal lesions: erosive and proliferative modifications of the sacroiliac joint, formation of vertebral syndesmophytes and erosive and proliferative changes in peripheral joints. These conditions can therefore be recognised only in well-preserved skeletons that exhibit the most typical pattern of lesions. In order to develop additional criteria for the diagnosis of spondyloarthropathies, a literature survey was conducted as a preliminary step by comparing biomedical data with the palaeopathological literature. We point out musculoskeletal changes and localisations rarely, if ever, used for identification of spondyloarthropathies in skeletal material. Whereas a specific focus has been put on entheseal changes encountered in spondyloarthropathies, the results highlight skeletal changes that may contribute to the diagnosis of the spondyloarthropathies from osseous remains such as erosive lesions of the temporomandibular joint and erosive changes of entheses in the pectoral girdle. Recording of these lesions in future studies of archaeological samples would contribute to discussions of their diagnostic relevance.


Palaeopathological diagnosis of spondyloarthropathies: Insights from the biomedical literature. Available from: https://www.researchgate.net/publication/265209974_Palaeopathological_diagnosis_of_spondyloarthropathies_Insights_from_the_biomedical_literature [accessed Mar 30, 2015].

Military personnel are often subjected to physical exertion, sleep deprivation, deficient diets, overcrowding, and stress. All of these influences are capable of compromising the immune system’s ability to ward off disease-causing bacteria, thus explaining why the historical narrative of war is frequently accompanied by reports of death and suffering due to epidemics of infectious diseases. Historically some of the most common infections included: diarrhoea, dysentery, typhoid fever, gonorrhoea, and streptococcal tonsillitis. The bacteria which cause these diseases are also capable of triggering arthritis. When an arthritic condition is triggered by an infectious microbe it can broadly be referred to as “reactive arthropathy,” of which the spondyloarthritides (SpAs) are of great interest. Since the bacteria associated with these arthritic conditions are responsible for the epidemics which have plagued combatants for centuries, it is reasonable to assume that reactive arthropathy was present in past military populations. This assertion can be tested through a prevalence study of military related skeletal assemblages. To test the methodology and gain preliminary results for this research project, a pilot study was carried out using remains from the 1461 Battle of Towton. The methodology was deemed to be sound and the statistical results, while not significant, were promising.