The patient with inflammatory spine disease

Abstract

The syndrome described in Table 1 is caused by a group of inflammatory diseases which are thought to result from a derangement of the immune mechanism of the body. These so-called sero-negative spondylarthropathies share a variety of clinical, radiographic and genetic features (Kohler and Vaughan, 1982; Moll, 1974; Brewerton et al. 1973; Jayson, 1986). Although, both inflammatory arthritis and spondylitis are major components of each of these diseases, they are not to be thought of as variations of rheumatoid arthritis. This clinical distinction is important since complications, response to therapy and progress are quite different. Inflammatory spinal disease, extra-articular foci, particularly eye disease, and a tendency for onset in young, mainly male, adults are uniting features linking this group of diseases together. Additionally, three of the five subgroups in this category have a very high incidence of the histocompatibility antigen HLA-B27 among those afflicted with the spinal component of the disease, and an even greater proportion are HLA-B27 positive if they manifest both the eye and spinal components (Table 2). The five sub-groups to be considered are: (1) ankylosing spondylitis; (2) “reactive arthritis”; (3) Reiter’s syndrome; (4) inflammatory bowel disease; and (5) psoriasis (Table 3). In the inflammatory bowel disease and psoriasis the HLA-B27 antigen is not a factor unless there is spinal involvement and then not nearly in as great a proportion as in the other three groups (Mills et al., 1975).