Page 799 - Clinical Immunology_ Principles and Practice ( PDFDrive )

770 Part six Systemic Immune Diseases

TABLE 57.1 Current Classification Criteria for spondyloarthritis
a. European spondyloarthropathy study Group (EssG) (a) Inflammatory low back pain
Criteria for spondyloarthritis (b) Arthritis
1. Inflammatory back pain or synovitis (asymmetrical, lower extremity) (c) Enthesitis
plus one of the following: (d) Dactylitis
(a) Alternating buttock pain (e) Psoriasis
(b) Sacroiliitis (f) Crohn disease or ulcerative colitis
(c) Heel pain (enthesitis) (g) Good response to nonsteroidal antiinflammatory agents
(d) Positive family history (h) Positive family history of SpA
(e) Psoriasis (i) Presence of human leukocyte antigen (HLA)-B27
(f) Crohn disease, ulcerative colitis (j) Elevated cross-reactive protein
(g) Urethritis or cervicitis or acute diarrhea in the preceding 4 weeks
E. asas Criteria for Peripheral spondyloarthritis—arthritis or
B. the Modified New York Criteria for Enthesitis or Dactylitis With at Least One of:
ankylosing spondylitis 4 a. Uveitis
1. Clinical criteria: b. Psoriasis
(a) Low-back pain and stiffness for more than 3 months which c. Crohn disease or ulcerative colitis
improves with exercise, but is not relieved by rest d. Previous infection
(b) Limitation of motion of the lumbar spine in both the sagittal and e. Presence of HLA-B27
frontal planes f. Sacroiliitis on imaging
(c) Limitation of chest expansion relative to normal values correlated OR
for age and gender with at least two of:
2. Radiological criterion: a. Inflammatory low back pain
(a) Sacroiliitis grade 2 bilaterally or grade 3–4 unilaterally b. Arthritis
(b) Definite ankylosing spondylitis if the radiological criterion is c. Enthesitis
associated with at least one clinical criterion d. Dactylitis
e. Positive family history of SpA
C. the Classification Criteria for Psoriatic arthritis (CasPar)
Criteria for Psoriatic arthritis F. the international League against rheumatism (iLar)
1. Inflammatory joint disease plus at least three points from the following Juvenile idiopathic arthritis Classification Criteria for
Enthesitis-related arthritis (Era)
features:
(a) Current psoriasis (assigned a score of 2; all others assigned a score Arthritis and enthesitis
of 1) OR
(b) History of psoriasis Arthritis or enthesitis with at least two of:
(c) Family history of psoriasis 1. Sacroiliac joint tenderness and/or inflammatory spinal pain
(d) Dactylitis 2. Presence of HLA-B27
(e) Juxtaarticular new bone formation 3. Family history in at least one first- or second-degree relative of
(f) Rheumatoid factor seronegativity medically confirmed HLA-B27-associated disease
(g) Nail dystrophy 4. Anterior uveitis that is usually associated with pain, redness, or
photophobia
D. asas Criteria for axial spondyloarthritis in Patients With 5. Onset of arthritis in a boy after 8 years of age
Chronic Low Back Pain for at Least 3 Months Exclusions
1. Sacroiliitis on imaging (either MRI findings of inflammatory disease in • Psoriasis confirmed by a dermatologist in at least one first- or
the sacroiliac joints or sacroiliitis on standard pelvic X-rays by New York second-degree relative
criteria) plus ONE of the following OR HLA-B27 positivity plus TWO of • Presence of systemic arthritis
the following:

KEY CONCEPts estimating disease heritability to exceed 90%. The concordance
11
The Genetic Basis of Spondyloarthritis rate for AS in identical twins has been reported to be as high as
11
63% compared with 23% in nonidentical twins. The concurrence
• Human leukocyte antigen (HLA)-B27 comprises nearly 80% of the
overall genetic susceptibility to ankylosing spondylitis (AS) and con- rate for psoriasis in monozygotic twins is 70 versus 15–30% in
tributes heavily to susceptibility to reactive arthritis, psoriatic arthritis, dizygotic twins. Recurrence risk for parents and sibs of patients
and enteropathic spondylitis. with CD is 4.8% and 7%, respectively, and for UC 0.9 and 1.2%,
• Additional influences seem to come from other major histocompatibility respectively. 11
complex (MHC) genes, including HLA-A*02, B*40 for AS and C*0602
for psoriasis, whose identification has been confounded by linkage HLA-B27 and Spondyloarthritis
to HLA-B27.
• Genome-wide association studies (GWAS) utilizing dense single HLA-B27, which is encoded in the MHC class I region (Chapter
nucleotide polymorphism (SNP) mapping have located at least 70 5), confers the greatest known risk for AS and is found in up to
genes or genetic regions in AS susceptibility. 90% of AS patients of European ancestry 11-13 (Table 57.3), as
• Over 60 genes have been identified thus far in psoriasis opposed to 6–8% of healthy Caucasians. 12,14 The estimated
pathogenesis. prevalence of HLA-B27 in the United States is 6.1% overall, is
• GWAS utilizing dense SNP mapping will likely locate many of the highest in younger individuals (7.5% before age 50 years), and
remaining genes in AS susceptibility. 14
falls rapidly over age 50 years (3.3%).