By Barend J. van Royen, Ben A. C. Dijkmans
The 1st and simply interdisciplinary advisor devoted to the topic, this reference leads readers in the course of the pathogenic, genetic, medical, and biomechanical elements of ankylosing spondylitis (AS) and addresses concerns with regards to results review, scientific therapy, surgical issues, affliction administration, and genetics.
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Extra resources for Ankylosing Spondylitis: Diagnosis and Management
Misfolding of B27 occurs to a greater extent than with other class I antigens, and appears to be related to the composition of its B pocket (61). B27 molecules can form homodimers, through the formation of disulﬁde bonds involving the unpaired B-pocket Cys67 residue, and possibly other residues. Misfolded and homodimeric B27 tends to accumulate in the ER and be slowly degraded in the cytosol, and it has been hypothesized that this may cause disease, perhaps through the generation of ‘‘stress responses’’ in the ER (62,63).
Source: From Ref. 51. The History of Ankylosing Spondylitis 19 Figure 13 (A, B) X-ray lumbar spine and pelvis of Piero il Gottoso showing ﬂattening lumbar lordosis, joint space narrowing hip, and ankylosis sacroiliac joints. Source: From Ref. 51. Figure 14 Metacarpal bones of left hand of Giuliano dei Medici, and Duca di Nemour. Note fusion of ﬁrst phalanx fourth metacarpal. Source: From Ref. 51. 20 Dequeker and de Vlam between the two diseases. Indeed, enteric infections with Klebsiella pneumoniae and Escherichia coli have been implicated in the pathogenesis of AS in genetically susceptible hosts (66,67).
The linked-gene model of AS does not explain the occurrence of spondyloarthritis in B27-transgenic mice and rats (44,51). However, neither model is entirely representative of the human condition, as discussed earlier. Arthritogenic Peptide Hypothesis The arthritogenic peptide model is based on the natural function of HLA class I molecules to present endogenous peptides to T lymphocytes. Recognition of antigens as ‘‘foreign’’ by the T-cell receptor (TCR) can trigger an immune response, typically via CD8 positive cytotoxic T lymphocytes (CTLs).
Ankylosing Spondylitis: Diagnosis and Management by Barend J. van Royen, Ben A. C. Dijkmans