Evidence that HLA-B*2706 is not protective against spondyloarthropathy.

OBJECTIVE: Studies in Southeast Asia showed that HLA-B*2704 is positively associated with spondyloarthropathy (SpA), while B*2706 does not occur in such patients. In view of the absence of an association between B*2706 and SpA it was suggested that B*2706 protects against the disease, while it is supposed that B*2704 presents pathogenetic peptides. We studied families in which both B*2704 and B*2706 occurred to see whether in B*2704/B*2706 heterozygotes the effect of one of the subtypes shows a preponderance over the other. METHODS: Two families of mixed Chinese/Indonesian origin were studied. HLA-B27 subtyping was performed by polymerase chain reaction in combination with sequence specific oligonucleotide probes. RESULTS: In one family, members with B*2704, B*2706, or both occurred. In the other family B*2704, B*2706, and B*2708 were present. In both families SpA was seen only in B*2704 positive members, while the B*2706 and B*2708 positive members were healthy, except some B*2704/B*2706 or B*2704/B2708 heterozygotes. CONCLUSION: The pathogenic influence of B*2704 is thus dominant over the supposed protective influence of B*2706. It is probable that B*2704 can present pathogenetic peptides, while a protective influence of B*2706 does not exist. B*2708, which was until now described in only a few cases, behaved in this study as B*2706 and is probably not associated with SpA.

Clinical features of spondyloarthropathy in Chinese and native Indonesians.

The prevalence of spondyloarthropathy (SpA) in Chinese Indonesians is much higher than in native Indonesians. This is due to HLA-B27 subtype differences. In the present study we re-examined the clinical features of SpA in Indonesians to see whether, besides the HLA-B27 subtype differences, other factors affect the frequency of SpA. Seventy two patients with SpA were re-examined. The patients came from two clinics for rheumatic diseases. The overall entry ratio of Chinese to native Indonesians was 1:2. Ankylosing spondylitis (AS) was more frequent among the Chinese (n = 32, 94% B27 positive) than among the native Indonesians (n = 5, 40% B27 positive). HLA-B27 subtyping was performed on 22 of the 37 HLA-B27-positive AS patients. Twenty Chinese were positive for B*2704 and two native Indonesians were B*2705 positive. The clinical features of AS and reactive arthritis (ReA) showed no differences between the two populations and were similar to the clinical descriptions in other parts of the world. In conclusion, it can be stated that in spite of HLA-B27 subtype differences the clinical features of SpA in Chinese and native Indonesians are fully comparable.

HLA-B27 subtypes positively and negatively associated with spondyloarthropathy.

OBJECTIVE: Eleven subtypes of HLA-B27 have been identified. If some of these subtypes had a stronger association with spondyloarthropathy (SpA) than others, this might tell us which peptides are of pathogenetic importance. A subtype preponderance has not been proved in Caucasians or in Asian Indians. Our objective was to determine whether some subtypes are positively or negatively associated with SpA in Indonesia. METHODS: Cells of 34 HLA-B27 positive patients with SpA (fulfilling the European Spondylarthropathy Study Group criteria) and 26 HLA-B27 positive controls, all living in Java, Indonesia, were sampled. Patients and controls were divided according to their presumed ethnic origin. HLA-B27 subtyping (B*2701-09) was performed by polymerase chain reaction in combination with sequence specific oligonucleotide probes to analyze polymorphism in exons 2 and 3 of HLA-B27. RESULTS: HLA-B*2701, *2702, *2703, *2708, and *2709 were found in neither group. HLA-B*2704 was found in 23/34 (68%) of the patients and in only 4/26 (15%) of the controls (p < 0.01). HLA-B*2706 was found in none of the 34 patients, but in 21/26 (81%) of the controls (p < 0.01). One drawback of the study was that most patients were of Chinese descent and most controls were native Javanese. Nevertheless, the absence of SpA among HLA-B*2706 positive individuals is noteworthy. CONCLUSION: HLA-B*2704 is positively associated with SpA (RR = 11.5), while *2706 is negatively associated with this disease (RR < 0.007). The results confirm the findings of Lopez-Larrea, et al in Thailand.

NSAID-induced gastrointestinal damage. Epidemiology, risk and prevention, with an evaluation of the role of misoprostol. An Asia-Pacific perspective and consensus.

The problem of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity was reviewed by members of the Asia Pacific League of Associations for Rheumatology (APLAR) in a consensus conference in September 1992. This paper by the participants presents the consensus conclusions incorporating knowledge from recent publications. There had been a high level of concern that much of the toxicity had resulted from extensive and indiscriminate prescribing of NSAIDs. The implementation of evidence-based guidelines was considered likely to be able to effect a substantial reduction in toxicity without significant loss of overall therapeutic benefit. The evidence from which such guidelines could be developed is critically appraised.

Higher relative risk of spondyloarthropathies among B27 positive Indonesian Chinese than native Indonesians.

We assessed the prevalence of HLA-B27 among ethnic Indonesian and Indonesian Chinese patients with ankylosing spondylitis (AS) or related spondyloarthropathies, and also among healthy controls. HLA-B27 was found in 23 (62.2%) of 37 Chinese patients and 4% of 176 Chinese healthy controls (p < 0.001). In contrasts only 2 (8.3%) of 24 native Indonesian patients and 13 (9%) of 145 healthy controls were HLA-B27+, indicating the lack of association of HLA-B27 with spondyloarthropathies in native Indonesians. These findings also suggest that HLA-B27 Chinese Indonesians carry a greater relative risk of developing AS and related spondyloarthropathies than native Indonesians, although the prevalence of HLA-B27 in the general population is more than 2 times higher in native Indonesians.

Vibrio parahaemolyticus as a cause of gastroenteritis in Indonesia.

Vibrio parahaemolyticus was isolated from rectal swabs in two cases of acute gastroenteritis from different districts of Jakarta.