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HLA-DR4 may be genetically linked to the spondyloarthropathies
Ankylosing spondylitis (AS) was first described as a pathological entity in the 1690s by a medical student who found, in a French graveyard, a skeleton in which the ilium, sacrum, and 15 lowest vertebrae were completely fused.1 Several similar descriptions were reported during the 18th century. A number of isolated clinical descriptions were reported throughout the 19th century, culminating in the detailed classical descriptions by Bechterew, Strümpell, and Marie in the late 19th century. By the mid-1930s, the classical pathological and radiographic features of AS had been described. Nevertheless, rheumatologists, particularly in America, tended to view AS a variant of rheumatoid arthritis (RA) and referred to the disorder as “rheumatoid spondylitis”.2 This view was partly based on the similarity between the two diseases of the early inflammatory histology in the peripheral joints and in the cervical spine.3 It even prevailed for several decades after the discovery of rheumatoid factor and the observation that patients with “rheumatoid spondylitis” were almost uniformly seronegative.4 Other entities with both axial and peripheral arthritis, including Reiter's syndrome …
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