Læknablaðið : fylgirit - 01.05.1978, Page 105

Ossi Laitinen, Marjatta Leirisalo and Anja
Tiilikaninen
Second Department of Medicine, Helsinki
University Central Hospital, and Finnish Red
Cross Blood Transfusion Service, Helsinki,
Finland
Introduction:
One of the most important recent findings in
rheumatoiogy has without doubt been the extra-
ordinary association between the histocompa-
tibility antigen HLA-B27 and certain rheumato-
logical diseases such as ankylosing spondylitis,
Reiter’s disease, spondylitis with inflammatory
bowel disease, psoriatic spondylarthritis, and
some forms of reactive arthritis, such as yersinia
arthritis, salmonella arthritis and dysenteria
arthritis (1, 2). In this contribution we shall
present some aspects of yersinia arthritis and
B27 leukocyte antigen and to some extent of the
association of B27 and other reactive forms of
arthritis. By choosing yersinia arthritis for a
model for our study on B27 positive rheumatic
disease it was possible to compare the B27
positive and negative patients on one hand, and
female and male patients with "B27 positive
rheumatic disease" on the other. This has not
been possible in studies on ankylosing spondylitis
because of the small number of B27 negative
cases and the male predominance in spondyl-
arthritis ancylopoetica. The purpose of our study
was to obtain more detailed information on the
influence of B27 on the clinicai picture of yersinia
arthritis.
R e s u 11 s :
During the past 7 years we have investigated
48 patients with yersinia arthritis at Helsinki
ON THE HLA-B27 POSITIVE
RHEUMATIC DISEASE; ACUTE
YERSINIA ARTHRITJS IN
PATIENTS WITH ANKYLOSING
SPONDYLITIS AND REITER"S
DISEASE
University Central Hospital (Table 1). Twenty six
were female and 22 male. Thirty one of the
patients were B27 positive and 17 were B27 nega-
tive (Table 2). Out of the male yersinia arthri-
tis patients 3/4 (77%) were B27 positive, whereas
only about half (54%) of the females carried the
antigen. Most of the patients were young, the
mean age being 32 and 35 years in B27 negative
and B27 positive groups, respectively. The mean
yersinia enterocolitica agglutinin titre (highest
values) was about 3 times higher in the B27 posi-
tive group than in the B27 negative group (Table
3). Even if the difference between the values is
not significant because of the great scatter of the
individuals titres, the findings may be of interest
because of the fact that the Ir genes, which are
responsible for immunologic response in certain
infections, have a definite correlation with B27.
Table 4 shows some details of joint involvement
in the B27 negative and positive yersinia arthritis
patients. The frequency of affected joints was
similar in both groups: knees, ankles, toes,
fingers and wrists were affected most often, and
there were no statistical differences between the
groups regarding the number of affected joints
or which joints were involved. By contrast,
there was a significant difference in the duration
of the joint symptoms: 18 out of 31 B27 positive
patients had signs of acute synovitis longer than
3 months compared with only 2 out of 17 cases
without B27 tissue antigen (X2=7.87; p<0.01; X2
test with Yates' correction).
Table 1. Number, sex and age of patients with yersinia
arthritis.
No. of patients 48
Female/male ratio 26/22
Age
Mean 33.3
Range 15-64
103