IntroductionBoth reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood.ObjectiveTo evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects.MethodsThis was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05.ResultsIn all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time.ConclusionElevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.

No abstract

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes. 99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P < 0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P < 0.005; OR = 3.4; 95% CI = 1.5-7.4). It is concluded that (a) abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

No abstract

BackgroundThe human Major Histocompatibility Complex (MHC) encompasses a group of genes located in chromosome 6 (6p21.3); it encodes proteins expressed on the cell surface. The HLA-B27 is a MHC class I molecule associated with spondyloarthritis (SpA); many theories related to its natural function have been postulated to explain its pathogenic role.(1–2) Relevance of HLA-B27 molecule in the mucosal immune system, the gut mucosa inflammation, and secretory IgA (SIgA) production remains unresolved.ObjectivesThe purpose of this study was to evaluate the correlation between serum SIgA levels and disease clinical activity in a cohort of HLA B27 positive and negative SpA patients with ReA and USpA, in a clinical center in Bogota Colombia.MethodsThe concentration of SIgA in serum was measured by an enzyme linked immunosorbent assay and the HLA-B27 was assessed by flow cytometry, followed by Polymerase Chain Reaction with sequence specific primers, in 46 patients with USpA and ReA. Clinical gastrointestinal manifestations and activity indices (BASDAI, ASDAS x CRP and ASDAS x ESR) were collected from each patient. Statistical analysis was performed using Stata 11.2 ® software for Windows; Pearson correlation was used to measure the degree of relationship between SIgA and clinical activity depending on the HLA B27 status. The study was approved by local hospital's ethics committee.Results46 SpA patients completed the study with mean age of 34,8 ±12,3 years; 78,2% were men, 52,17% were HLA B27 positive, 60.9% of patients reported gastrointestinal symptoms such as diarrhea, abdominal pain, abdominal swelling and hematochezia. 63,6%, 88,6% and 100% of patients had disease activity evaluated by BASDAI, ASDAS-CRP and ASDAS-ESR scores, respectively, and 71,7% of patients had SIgA concentration above the upper normal range. The SIgA concentration was correlated with disease activity measures: BASDAI, ASDAS-CRP and ASDAS-ESR (-42% (0.0046), -37% (0.014) and -45% (0.0021) respectively); the negative coefficient correlation between SIgA and BASDAI, ASDAS-CRP and ASDAS-ESR was higher in HLA-B27 + patients -70% (0.0009), -58% (0.0093) and -57% (0.0083) than in HLA-B27 – patients.CorrelationHLA-B27 positiveHLA-B27 negativePearson CoefficientP valuePearson CoefficientP valueSIgA vs BASDAI−70%0.0009−21%0.3397SIgA vs ASDAS-CRP−58%0.0093−20%0.3579SIgA vs ASDAS-ERS−57%0.0083−35%0.0992ConclusionsThese results suggest that SIgA levels in patients with ReA and USpA might be a correlate of disease activity measures based upon HLA-B27 status and might reflect an immunomodulatory role in these pathologies.ReferencesBowness P. HLA-B27. Annu Rev Immunol. 2015; 33:29–48.Chatzikyriakidou A, Voulgari PV, Drosos AA. What is the role of HLA-B27 in spondyloarthropathies? Autoimmun Rev. 2011 Jun; 10(8):464–8.Disclosure of InterestNone declared