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Seronegative Arthritis in South Asia: An Up-to-date Review

  • SPONDYLOARTHRITIS (MA KHAN, SECTION EDITOR)
  • Published:
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Abstract

This article summarises the available information on seronegative arthritides from South Asian countries, namely India, Pakistan, Bangladesh, Sri Lanka, Nepal, and Bhutan. The diseases described are spondyloarthritides (SpA), including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), inflammatory bowel disease-related arthritis (IBDa), enthesitis-related arthritis (ERA) of the paediatric age group, and undifferentiated spondyloarthritis (uSpA). Relevant information on SpA from South Asia is scarce. However, the available publications indicate that these are commonly seen conditions. HLA-B27 is present in approximately 6–8 % of the normal population in the Indian subcontinent. In the SpA group, HLA-B27 has the highest frequency in AS patients (>90 %) and the lowest in PsA patients. Clinical features are similar to those reported in standard textbooks, but with a few exceptions: e.g., in South Asian countries ERA is the most common subset of juvenile idiopathic arthritis (JIA), whereas in the West the most common subset of JIA is oligoarthritis. Poverty is a major challenge in treating these diseases in South Asia; with poor health insurance coverage, only a few patients are able to afford biological treatment. Therefore, rheumatologists have attempted novel treatment strategies for those with an unsatisfactory response to standard non-steroidal anti-inflammatory drugs (NSAIDs) or coxibs.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Moll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies, and Behçet’s syndrome. Medicine (Baltimore). 1974;53:343–64.

    Article  CAS  Google Scholar 

  2. Wright V, Moll JMH, editors. Seronegative polyarthritis. Amsterdam: North Holland Publishing; 1976.

    Google Scholar 

  3. Ruben Burgos-Vargas. The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: a critical appraisal for the pediatric rheumatologist. Pediatr Rheumatol. 2012;10:14-on line. Important review on the origin and current state of the assessment of the SpondyloArthritis International Society (ASAS) criteria for the classification of axial and peripheral spondyloarthritis (SpA) and the possible implications in the paediatric population.

  4. Rudwaleit M, van der Heijde D, Landew R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.

    Article  CAS  PubMed  Google Scholar 

  5. Rudwaleit M, van der Heijde D, Landew R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70:25–31. Highly recommended for routine use in research, clinical trials, and routine clinical work.

    Article  CAS  PubMed  Google Scholar 

  6. Jariwala M, Aggarwal M, Sawhney S. Diagnostic Value of the Assessment of Spondyloarthropathy International Society (ASAS) Criteria for Children with Enthesitis Related Arthritis (ERA): A Single Center Study of 124 Patients. Arthritis Rheum. 2012;64:S718. An important paper emphasising that ERA is the commonest subset of JIA in India (and possibly in this part of the world).

    Article  Google Scholar 

  7. Chopra A, Patil J, Billempelly V, et al. Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD study. J Assoc Physicians India. 2001;49:240–6.

    CAS  PubMed  Google Scholar 

  8. Joshi VL, Chopra A. Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. J Rheumatol. 2009;36:614–22.

    Article  PubMed  Google Scholar 

  9. Chandrasekaran AN, Porkodi R, Achutan K, Madhavan R, Parthiban M. Spectrum of clinical and immunological features of systemic rheumatic disorders in a referral hospital in south India: Primary ankylosing spondylitis. J Ind Rheumatol Assoc. 1994;2–4:149–52.

    Google Scholar 

  10. Malaviya AN, Mehra NK, Adhar GC, Jindal K, Bhargava S, Batta RK, et al. The clinical spectrum of HLA B27 related rheumatic diseases in India. J Assoc Physicians India. 1979;27:487–92.

    CAS  PubMed  Google Scholar 

  11. Madhavan R, Chandrasekaran AN, Parthiban M, Achutan K, Porkodi R, Rajendran CP. HLA profile of seronegative spondyloarthropathies in a referral hospital in South India. J Ind Rheumatol Assoc. 1996;4–3:91–5.

    Google Scholar 

  12. Aggarwal A, Misra R, Chandrasekara S, Prasad KN, Dayal R, Ayyagiri A. Is undifferentiated seronegative s spondyloarthripathy a forme frusta of reactive arthritis? Br J Rheumatol. 1997;36:1001–4.

    Article  CAS  PubMed  Google Scholar 

  13. Hameed K, Gibson T. A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan. Br J Rheumatol. 1997;36:781–5.

    Article  CAS  PubMed  Google Scholar 

  14. Farooqi A, Gibson T. Prevalence of the major rheumatic disorders in the adult population of north Pakistan. Br J Rheumatol. 1998;37:491–5.

    Article  CAS  PubMed  Google Scholar 

  15. Haq SA, Darmawan J, Islam MN, et al. Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol. 2005;32:348–53.

    PubMed  Google Scholar 

  16. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol. 1995;61:202–5.

    CAS  PubMed  Google Scholar 

  17. Helliwell PS, Porter G, Taylor WJ, CASPAR Study Group. Polyarticular psoriatic arthritis is more like oligoarticular psoriatic arthritis, than rheumatoid arthritis. Ann Rheum Dis. 2007;66:113–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Mithun CB, Antony PT, Mariaselvam CM, Negi VS. Clinical and immunogenetic characteristics of psoriatic arthritis: a single-center experience from South India. Internet J Rheumatol Clin Immunol 2013;1(no.1)OA1. An important paper on immunogenetic and clinical features of psoriatic arthritis from southern India.

  19. Rajendran CP, Ledge SG, Rani KP, Radha Madhavan R. Psoriatic arthritis. J Assoc Physicians India. 2003;51:1065–8.

    CAS  PubMed  Google Scholar 

  20. Singh YN, Verma KK, Kumar A, Malaviya AN. Methotrexate in psoriatic arthritis. J Assoc Physicians India. 1994;42:860–2.

    CAS  PubMed  Google Scholar 

  21. Malaviya AN, Dasgupta B, Tiwari SC, Khan KM, Pasricha JS, Mehra NK. Psoriatic arthritis: a clinical and immunological study in 20 cases from India. J Assoc Physicians India. 1984;32:403–5.

    CAS  PubMed  Google Scholar 

  22. Sawhney S. Spectrum of Juvenile idiopathic arthritis in a tertiary level centre in India. Indian J Rheumatol. 2006;14:3–6.

    Google Scholar 

  23. Agarwal M, Jariwala M, Prakash R, Sawhney S. 110 Patients with enthesitis related arthritis: a demographic and clinical study from a tertiary level Pediatric Rheumatology Centre In India. Ann Rheum Dis. 2012;71(Suppl3):264. Major study on ERA from this part of the world.

    Google Scholar 

  24. Siddiq AB, Hasan SA, Abdullah AM, Azad SA, Khan EH, Khasru MR. Juvenile onset ankylosing spondylitis with ankylosing tarsitis: a rare combination. Mymensingh Med J. 2012;21:179–83.

    CAS  PubMed  Google Scholar 

  25. Espinosa M, Gottlieb BS. Juvenile idiopathic arthritis. Pediatr Rev. 2012;33:303–13. Excellent review on JIA and its subtypes.

    Article  PubMed  Google Scholar 

  26. Kunjir V, Venugopalan A, Chopra A. Profile of Indian patients with juvenile onset chronic inflammatory joint disease using the ILAR classification criteria for JIA: a community-based cohort study. J Rheumatol. 2010;37:1756–62.

    Article  PubMed  Google Scholar 

  27. Sawhney S. Spectrum of juvenile idiopathic arthritis in a tertiary care centre in northern India. Indian J Rheumatol. 2006;14:3–6.

    Google Scholar 

  28. Seth V, Kabra SK, Semwal OP, Jain Y. Clinico-immunological profile in juvenile rheumatoid arthritis–an Indian experience. Indian J Pediatr. 1996;63:293–300.

    Article  CAS  PubMed  Google Scholar 

  29. Singh S, Salaria M, Kumar L, Minz R, Datta U, Sehgal S. Clinico-immunological profile of juvenile rheumatoid arthritis at Chandigarh. Indian Pediatr. 1999;36:449–54.

    CAS  PubMed  Google Scholar 

  30. Sengupta S, Sehgal S, Aikat BK, Deodhar SD. HLA B27 in ankylosing spondylitis in India. Lancet. 1997;309:1209–10.

    Article  Google Scholar 

  31. Malaviya AN, Mehra NK, Adhar GC, Jindal K, Bhargava S, Batta RK, et al. HLA B27 in patients with seronegative spondarthritis. J Rheumatol. 1979;6:413–6.

    CAS  PubMed  Google Scholar 

  32. Prakash S, Mehra NK, Bhargava S, Vaidya MC, Malaviya AN. Ankylosing spondylitis in India. Ann Rheum Dis. 1984;43:381–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. López-Larrea C, Sujirachato K, Mehra NK, Chiewsilp P, Isarangkura D, Kanga U, et al. HLA-B27 subtypes in Asian patients with ankylosing spondylitis. Evidence for new associations. Tissue Antigens. 1995;45:169–7635.

    Article  PubMed  Google Scholar 

  34. Kanga U, Mehra NK, Larrea CL, Lardy NM, Kumar A, Feltkamp TE. Seronegative spondyloarthropathies and HLA-B27 subtypes: a study in Asian Indians. Clin Rheumatol. 1996;15 Suppl 1:13–8.

    Article  PubMed  Google Scholar 

  35. Shankarkumar U. HLA-B27 allele diversity in Indians: impact of ethnic origin and the caste system. Br J Biomed Sci. 2003;60:223–637.

    CAS  PubMed  Google Scholar 

  36. Chhaya SU. HLA-B27 polymorphism in Mumbai, Western India. Tissue Antigens. 2005;66:48–50.

    Article  CAS  PubMed  Google Scholar 

  37. Thomas R, Philip J, Banerjee M. Association of an extended haplotype of HLA class I alleles and their flanking microsatellites with spondyloarthropathies in South Indian patients. Hum Immunol. 2006;67(4–5):318–23.

    Article  CAS  PubMed  Google Scholar 

  38. Zafar N, Khan S, Qadir A, Raza Y, Naqvi A, Rizvi A. HLA frequencies in Pakistani population groups. J Pak Med Assoc. 1996;46:12.

    CAS  PubMed  Google Scholar 

  39. Khan MA. Ankylosing Spondylitis: The Facts Publisher Oxford University Press; 2000. p. 119

  40. Khan MA. Ankylosing spondylitis and HLA?B27 in Punjabis. Lancet. 1977;2(8036):504.

    Article  CAS  PubMed  Google Scholar 

  41. Prakash S, Mehra NK, Bhargava S, Malaviya AN. HLA B27 related 'unclassifiable' seronegative spondyloarthropathies. Ann Rheum Dis. 1983;42:640–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Mehra NK, Kanga U. Molecular diversity of the HLA-B27 gene and its association with disease. Mod Rheumatol. 2001;11:275–85.

    Article  CAS  PubMed  Google Scholar 

  43. Chavan H, Samant R, Deshpande A, Mankeshwar R. Correlation of HLA B27 subtypes with clinical features of ankylosing spondylitis. Int J Rheum Dis. 2011;14:369–74. Excellent paper from the western part of India describing clinical subtypes of HLA B27 with clinical features of AS.

    Article  PubMed  Google Scholar 

  44. Ghosh K, Shankarkumar U, Shetty S, Mohanty D. Chronic synovitis and HLA-B27 in patients with severe haemophilia. Lancet. 2003;361:933–4.

    Article  CAS  PubMed  Google Scholar 

  45. Akkoc N, Khan MA. HLA B27 and ankylosing spondylitis. APLAR J Rheumatol. 2005;8:146–53.

    Article  Google Scholar 

  46. Khan MA. Polymorphism of HLA-B27: 105 subtypes currently known. Curr Rheumatol Rep. 2013;15:362. Excellent paper describing the large number of currently known subtypes of HLA B27.

    Article  PubMed  Google Scholar 

  47. Mehra NK, Taneja V, Jhingan B, Malaviya AN. Evidence to show MHC-linked factors other than HLA-B27 governing susceptibility to spondylo-arthropathies in Asian Indians. Asian Pac J Allergy Immunol. 1985;3:143–6.

    CAS  PubMed  Google Scholar 

  48. Martinez-Borra J, Gonzalez S, López-Vazquez A, Gelaz MA, Armas JB, Kanga U, et al. HLA-B27 alone rather than B27-related class I haplotypes contributes to ankylosing spondylitis susceptibility. Hum Immunol. 2000;61:131–9.

    Article  CAS  PubMed  Google Scholar 

  49. Dhurandhar PS, Shankarkumar U. HLA association in seronegative spondyloarthritis patients from Mumbai, India. Int J Hum Genet. 2007;7(3):235–9.

    Google Scholar 

  50. Mehra NK, Khan MA, Vaidya MC, Malaviya AN, Batta RK. HLA antigens in acute anterior uveitis and spondylarthropathies in Asian Indians and their comparision to American Whites and Blacks. J Rheumatol. 1983;10:981–4.

    CAS  PubMed  Google Scholar 

  51. Mishra MN, Bharucha KM. HLA-B27 Association with uveitis in an Asian Indian Population. Iran J Immunol. 2011;8:85–9. A large study on the association of HLA B27 and uveitis in this part of the world.

    CAS  PubMed  Google Scholar 

  52. Sen Gupta S, Jain IS, Jain GC, Deodhar SD. HLA antigens in acute anterior uveitis in North Indians. Indian J Ophthalmol. 1978;26:26–9.

    Google Scholar 

  53. Vaidya B, Nakarmi S, Batajoo P. Clinical profile of Spondarthritis in females as compared to male patients with reference to HLAB27: a single center study from Nepal. J Adv Intern Med. 2013;2:3–5. Large study, the only one from Nepal describing spondyloarthritis and its association with HLA B27.

    Article  Google Scholar 

  54. Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, et al. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2012;71:50–5.

    Article  PubMed  Google Scholar 

  55. Queiro R, Torre JC, González S, López-Larrea C, Tinturé T, López-Lagunas I. HLA- antigens may influence the age of onset of psoriasis and psoriatic arthritis. J Rheumatol. 2003;30:505–7.

    PubMed  Google Scholar 

  56. Dalbeth N, Dockerty JL, Williamson L. Influence of HLA-B27 on the Clinical Presentation of Psoriatic Arthritis. J Rheumatol. 2003;30:2511–2.

    PubMed  Google Scholar 

  57. Liao HT, Lin KC, Chang YT, Chen CH, Liang TH, Chen WS, et al. Human leukocyte antigen and clinical and demographic characteristics in psoriatic arthritis and psoriasis in Chinese patients. J Rheumatol. 2008;35:891–5.

    PubMed  Google Scholar 

  58. Chandran V, Tolusso DC, Cook RJ, Gladman DD. Risk Factors for Axial Inflammatory Arthritis in Patients with Psoriatic Arthritis. J Rheumatol. 2010;37:809–15.

    Article  PubMed  Google Scholar 

  59. Queiro R, Sarasqueta C, Belzunegui J, Gonzalez C, Figueroa M, Torre-Alonso JC. Psoriatic spondyloarthropathy: a comparative study between HLA-B27 positive and HLA-B27 negative disease. Semin Arthritis Rheum. 2002;31:413–8.

    Article  PubMed  Google Scholar 

  60. Bonfiglioli R, Conde RA, Sampaio-Barros PD, Louzada-Junior P, Donadi EA, Bertolo MB. Frequency of HLA-B27 alleles in Brazilian patients with psoriatic arthritis. Clin Rheumatol. 2008;27:709–12.

    Article  PubMed  Google Scholar 

  61. Brown MA. Genetics of ankylosing spondylitis. Curr Opin Rheumatol. 2010;22:126–32.

    Article  CAS  PubMed  Google Scholar 

  62. Zachariae H, Overgaard Peterson H, Kissmeyer Nielson F, Lamm L. HLA- antigens in pustular psoriasis. Dermatologica. 1977;154:73–7.

    Article  CAS  PubMed  Google Scholar 

  63. Sonkar GK, Usha, Singh S. Is HLA-B27 a useful test in the diagnosis of juvenile spondyloarthropathies? Singap Med J. 2008;49:795–9.

    CAS  Google Scholar 

  64. Shankarkumar U, Ghosh K, Mohanty D. HLA B27 polymorphism in Western India. Tissue Antigens. 2002;60:98–101.

    Article  CAS  PubMed  Google Scholar 

  65. Agrawal S, Srivastava R, Sharma B, Pandya S, Misra R, Aggarwal A. IL1RN*2 allele of IL-1receptor antagonist VNTR polymorphism is associated with susceptibility to ankylosing [corrected] spondylitis in Indian patients. Clin Rheumatol. 2008;27:573–6.

    Article  PubMed  Google Scholar 

  66. Madhavan R, Porkodi R, Rajendran CP, Chandrasekaran AN, Umadevi KR, Alamelu R. IgM, IgG, and IgA response to enterobacteria in patients with ankylosing spondylitis in Southern India. Ann N Y Acad Sci. 2002;958:408–11.

    Article  CAS  PubMed  Google Scholar 

  67. Rodrigues JJ, Joshi VR. Bacterial DNA Detection in Spondyloarthropathies Proc International Symp Recent Advan Mol Biol, Allerg & Immunol 3–5th Sept., 2000, Baroda, India.

  68. Singh AK, Aggarwal A, Chaurasia S, Misra R. Identification of immunogenic HLA-B*27:05 binding peptides of salmonella outer membrane protein in patients with reactive arthritis and undifferentiated spondyloarthropathy. J Rheumatol. 2013;40:173–85. Evidence is presented of the involvement of salmonella outer membrane protein in the pathogenesis of uSpA and ReA.

    Article  CAS  PubMed  Google Scholar 

  69. Saxena N, Aggarwal A, Misra RN. Is the enthesitis-related arthritis subtype of juvenile idiopathic arthritis a form of chronic reactive arthritis? Rheumatology. 2006;45:1129–32.

    Article  CAS  PubMed  Google Scholar 

  70. Myles A, Tuteja A, Aggarwal A. Synovial fluid mononuclear cell gene expression profiling suggests dysregulation of innate immune genes in enthesitis-related arthritis patients. Rheumatology (Oxford). 2012;51:1785–9. Proves the important function of dysregulated innate immune system in ERA.

    Article  CAS  Google Scholar 

  71. Rahman MT, Myles A, Gaur P, Misra R, Aggarwal A. TLR4 endogenous ligand MRP8/14 level in enthesitis-related arthritis and its association with disease activity and TLR4 expression. Rheumatology (Oxford). 2013 Nov 14. Further proof of abnormalities in the innate immune system in ERA.

  72. Myles A, Aggarwal A. Lack of association of single nucleotide polymorphisms in toll-like receptors 2 and 4 with enthesitis-related arthritis category of juvenile idiopathic arthritis in Indian population. Rheumatol Int. 2013;33:417–21.

    Article  CAS  PubMed  Google Scholar 

  73. Myles A, Rahman MT, Aggarwal A. Membrane-bound toll-like receptors are overexpressed in peripheral blood and synovial fluid mononuclear cells of enthesitis-related arthritis category of juvenile idiopathic arthritis (JIA–ERA) patients and lead to secretion of inflammatory mediators. J Clin Immunol. 2012;32:488–96. More proof of abnormalities in the innate immune system in ERA.

    Article  CAS  PubMed  Google Scholar 

  74. Agarwal S, Misra R, Aggarwal A. TLR ligands induce metalloproteinases expression in human fibroblast like synoviocytes from patients with juvenile idiopathic arthritis. Indian J Med Res. 2010;131:771–9.

    CAS  PubMed  Google Scholar 

  75. Mahendra A, Misra RN, Aggarwal A. Th1 and th17 predominance in the enthesitis-related arthritis form of juvenile idiopathic arthritis. J Rheumatol. 2009;36:1730–6.

    Article  CAS  PubMed  Google Scholar 

  76. Amor B, Dougados M, Mijiyawa M. Criteres de classification des spondylarthropathies. Rev Rhum. 1990;57:85–9.

    CAS  PubMed  Google Scholar 

  77. Dougados M, van Der LS, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34:1218–27.

    Article  CAS  PubMed  Google Scholar 

  78. Borges NE, Desai HR, Joshi AD, Siqueira RD, Mangat G, Joshi VR. Unclassifiable seronegative spondyloarthritides. J Assoc Physicians India. 1986;34:387, Correspondence.

    CAS  PubMed  Google Scholar 

  79. Kellgren JH, Jeffrey MR, Ball J, editors. The Epidemiology of Chronic Rheumatism. 1st ed. Oxford: Blackwell; 1963. p. 326. Rome criteria.

    Google Scholar 

  80. Mathew CM, Bhandarkar P, Siqueria RD, Boerges NE, Joshi VR. Ankylosing spondylitis in females – similarities and differences from male spondylitics. J Assoc Physicians India. 1989;37:334–6.

    CAS  PubMed  Google Scholar 

  81. Achuthan K, Porkodi R, Ramakrishnan S, Krishnamurthy V, Madhavan R, Parthiban M, et al. Pattern of rheumatic diseases in south India. V. Ankylosing spondylitis. A clinical and radiological study. J Assoc Physicians India. 1990;38:774–6.

    CAS  PubMed  Google Scholar 

  82. Uppal SS, Abraham M, Chowdhury RI, Kumari R, Pathan EM, Al Rashed A. Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians. Clin Rheumatol. 2006;25:219–24.

    Article  CAS  PubMed  Google Scholar 

  83. Aggarwal R, Malaviya AN. Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol. 2009;28:1199–205.

    Article  PubMed  Google Scholar 

  84. Aggarwal R, Malaviya AN. Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes–an Indian perspective. Clin Rheumatol. 2009;28:327–31.

    Article  PubMed  Google Scholar 

  85. Van der Linden SM, Valkenburg HA, Cats A. Evaluation of the diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.

    Article  PubMed  Google Scholar 

  86. Al Hasan S, Siddiq MAB, Hassan MU, Hossain MS. Clinical presentation of Spondyloarthropathy: a study of 61 patients. J Chittagong Med Coll Teachers' Assoc (JCMCTA). 2007;18:7–10.

    Google Scholar 

  87. Calin A, Fries JF. Striking prevalence of ankylosing spondylitis in ‘healthy’ W27 positive males and females: a controlled study. N Engl J Med. 1975;293:835–9.

    Article  CAS  PubMed  Google Scholar 

  88. Manoj EM, Ragunathan MK. Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report. J Med Case Rep. 2012;6:60. http://www.jmedicalcasereports.com/content/6/1/60.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Shah NM, Mangat G, Balakrishnan C, Joshi VR. Psoriatic arthritis - A study of 102 patients. J Indian Rheumatol Assoc. 1995;3:133–6.

    Google Scholar 

  90. Saeed M, Zaman T, Tariq Rashid T, Jahangir M. Evaluation of joint involvement in patients of psoriasis: an observational study. J Pak Assoc Dermatol. 2008;18:6–8.

    Google Scholar 

  91. Ejaz A, Iftikhar A, Iftikhar N. Patterns of Psoriatic Arthritis. J Coll Physicians Surg Pak. 2009;19:553–6.

    PubMed  Google Scholar 

  92. Aggarwal A, Hissaria P, Misra R. Juvenile ankylosing spondylitis - is it the same disease as adult ankylosing spondylitis? Rheumatol Int. 2005;25:94–6.

    Article  PubMed  Google Scholar 

  93. Prakash S, Mehra N, Bhargava S, Malaviya A. Reiter's disease in north India: a clinical and immunogenetic study. Rheumatol Int. 1983;3:101–4.

    Article  CAS  PubMed  Google Scholar 

  94. Roussou E, Chopra S, Ngandu DL. Phenotypic and clinical differences between Caucasian and South Asian patients with psoriatic arthritis living in North East London. Clin Rheumatol. 2013;32:591–9.

    Article  PubMed  Google Scholar 

  95. Singh G, Kumari N, Aggarwal A, Krishnani N, Misra R. Prevalence of subclinical amyloidosis in ankylosing spondylitis. J Rheumatol. 2007;34:371–3.

    PubMed  Google Scholar 

  96. Mittal VK, Malhotra KK, Bhuyan UN, Malaviya AN. Kidney involvement in seronegative spondarthritides. Indian J Med Res. 1983;78:670–5.

    CAS  PubMed  Google Scholar 

  97. Naqi R, Ahsan H, Azeemuddin M. Spinal changes in patients with ankylosing spondylitis on MRI: case series. J Pak Med Assoc. 2010;60:872–5.

    PubMed  Google Scholar 

  98. Prakash S, Bansal R, Rajagopalan P, Mehra NK, Malaviya AN. Immunological studies in seronegative spondyloarthropathies. Br J Rheumatol. 1983;26:146–50.

    Article  Google Scholar 

  99. Prakash S, Mehra NK, Malaviya AN. Immunoglobulin A and M deficiency in "unclassified" HLA B27-related arthropathy. Arthritis Rheum. 1983;26:1175–6.

    Article  CAS  PubMed  Google Scholar 

  100. Malaviya AN, Kapoor S, Garg S, Ahmad I, Raja RR. A new strategy of drug treatment in NSAID-unresponsive ankylosing spondylitis: combination of pamidronate and methylprednisolone monthly intravenous infusions on the background of a combination of disease modifying drugs sulfasalazine and methotrexate. J Assoc Physicians India. 2007;55:193–7.

    CAS  PubMed  Google Scholar 

  101. Sandhya P, Danda D, Mathew J, Gattani A. Outcome of patients with seronegative spondyloarthritis continuing sulfasalazine and methotrexate after a short course of infliximab therapy - experience from a tertiary care teaching hospital in South India. Clin Rheumatol. 2011;30:997–1001. This paper is of importance as it provides a possible strategy for cost reduction by dose-adjustment of biologicals.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to gratefully acknowledge the help extended by Professor V. R. Joshi, Senior Consultant Rheumatologist, Hinduja Hospital, Mumbai.

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Conflict of Interest

Anand N. Malaviya has served on boards for and received honoraria from Johnson & Johnson, Bristol-Myers Squibb, Pfizer, Roche, Sanofi Aventis, IPCA, and Reddy’s, and has had travel/accommodations expenses covered/reimbursed by Johnson & Johnson, IPCA, and Sanofi Aventis. Sujata Sawhney, Narinder K. Mehra, and Uma Kanga declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Rheumatology, Indian Spinal Injuries Centre Superspeciality Hospital, MM Road, Vasant Kunj, New Delhi, 110070, India

    Anand N. Malaviya

  2. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India

    Sujata Sawhney

  3. Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Narinder K. Mehra & Uma Kanga

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  1. Anand N. Malaviya
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Correspondence to Anand N. Malaviya.

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This article is part of the Topical Collection on Spondyloarthritis

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Malaviya, A.N., Sawhney, S., Mehra, N.K. et al. Seronegative Arthritis in South Asia: An Up-to-date Review. Curr Rheumatol Rep 16, 413 (2014). https://doi.org/10.1007/s11926-014-0413-z

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  • DOI: https://doi.org/10.1007/s11926-014-0413-z

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