PMID- 22903740
OWN - NLM
STAT- MEDLINE
DCOM- 20130424
LR  - 20211021
IS  - 1434-9949 (Electronic)
IS  - 0770-3198 (Linking)
VI  - 31
IP  - 11
DP  - 2012 Nov
TI  - Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle 
      East.
PG  - 1633-9
LID - 10.1007/s10067-012-2058-5 [doi]
AB  - Ankylosing spondylitis (AS) is the prototype for spondyloarthritis primarily 
      affecting young men. Geographic and ethnic variations exist in the prevalence and 
      severity of AS and relate to the wide disparity in the frequency of human 
      leukocyte antigen (HLA)-B27, a major genetic risk factor. The strength of the 
      disease association with HLA-B27 is lower in most Arab populations (25-75 %) than 
      in Western European populations (>90 %), and there is no association in 
      sub-Saharan Africa, where the prevalence of HLA-B27 is <1 %. Other epidemiologic 
      differences between European and African populations are the apparent later age 
      at presentation in sub-Saharan Africa, and the high rate of spondyloarthropathies 
      associated with human immunodeficiency virus infection. Diagnosis of AS is often 
      delayed 8-10 years; potential reasons for the delay in Africa and the Middle East 
      include low awareness among physicians and patients, the requirement for 
      radiographic evidence of sacroiliitis for diagnosis, and limited access to 
      magnetic resonance imaging in some countries. Treatment should be initiated early 
      to prevent or reduce skeletal deformity and physical disability. Nonsteroidal 
      anti-inflammatory drugs are effective first-line treatment and anti-tumor 
      necrosis factor-alpha drugs are indicated for patients who have an inadequate 
      response to first-line therapy. In Africa and the Middle East, such treatments 
      may be precluded either by cost or contraindicated because of the high prevalence 
      of latent tuberculosis infection. Research is sorely needed to develop 
      cost-effective tools to diagnose AS early as well as effective, inexpensive, and 
      safe treatments for these developing regions.
FAU - Rachid, Bahiri
AU  - Rachid B
AD  - Rheumatology Department, El Ayachi Hospital, Route de la plage, CHU Rabat, Sale, 
      Morocco. bahirirachid@yahoo.fr
FAU - El Zorkany, Bassel
AU  - El Zorkany B
FAU - Youseif, Ehab
AU  - Youseif E
FAU - Tikly, Mohammed
AU  - Tikly M
LA  - eng
PT  - Journal Article
DEP - 20120819
PL  - Germany
TA  - Clin Rheumatol
JT  - Clinical rheumatology
JID - 8211469
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (HLA-B27 Antigen)
SB  - IM
MH  - Adult
MH  - Africa
MH  - Anti-Inflammatory Agents/pharmacology
MH  - Cost-Benefit Analysis
MH  - Early Diagnosis
MH  - Female
MH  - HLA-B27 Antigen/blood/genetics
MH  - Humans
MH  - Magnetic Resonance Imaging/methods
MH  - Male
MH  - Middle Aged
MH  - Middle East
MH  - Prevalence
MH  - Rheumatology/methods
MH  - Risk Factors
MH  - Spondylitis, Ankylosing/*therapy
MH  - Time Factors
EDAT- 2012/08/21 06:00
MHDA- 2013/04/25 06:00
CRDT- 2012/08/21 06:00
PHST- 2012/05/16 00:00 [received]
PHST- 2012/08/05 00:00 [accepted]
PHST- 2012/07/12 00:00 [revised]
PHST- 2012/08/21 06:00 [entrez]
PHST- 2012/08/21 06:00 [pubmed]
PHST- 2013/04/25 06:00 [medline]
AID - 10.1007/s10067-012-2058-5 [doi]
PST - ppublish
SO  - Clin Rheumatol. 2012 Nov;31(11):1633-9. doi: 10.1007/s10067-012-2058-5. Epub 2012 
      Aug 19.