{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:09:20Z","timestamp":1789582160594,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"1005","license":[{"start":{"date-parts":[[2009,7,1]],"date-time":"2009-07-01T00:00:00Z","timestamp":1246406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Ankylosing spondylitis (AS) represents a chronic inflammatory bone disease of the axial skeleton that manifests as chronic back pain and progressive stiffness of the spine. It characteristically affects young adults with a peak age of onset between 20\u201330 years. In contrast to Western Europe and North America, the disease is rare in Sub-Saharan Africa where the majority of the population is HLA-B27 negative. Even in some African populations where HLA-B27 is prevalent (for example, in Gambia and Senegal, where 3\u20136% of the general population has HLA-B27), the disease is also said to be rare. However, some other genetic markers may be involved in the causation of AS in the HLA-B27 negative population, and when it occurs in this subgroup of patients it has a similar manifestation with HLA-B27 negative white patients and these patients rarely develop anterior uveitis. The clinical presentation of the disease in Africa is generally milder; most affected individuals do not have a family history of AS, the patients are older at onset of the disease, and the majority of them lack extra-articular manifestations such as anterior uveitis compared with the situation in Western Europe and North America. In conclusion, AS in sub-Saharan Africa seems to represent a subgroup of the disease, which may open the window to a greater understanding of the pathophysiology of the condition.<\/jats:p>","DOI":"10.1136\/pgmj.2007.064717","type":"journal-article","created":{"date-parts":[[2009,7,6]],"date-time":"2009-07-06T04:01:08Z","timestamp":1246852868000},"page":"353-357","source":"Crossref","is-referenced-by-count":34,"title":["Ankylosing spondylitis in sub-Saharan Africa"],"prefix":"10.1093","volume":"85","author":[{"given":"D A","family":"Belachew","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Addis Ababa University , Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Sandu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Addis Ababa University , Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Schaller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Addis Ababa University , Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Guta","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Addis Ababa University , Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2009,7,5]]},"reference":[{"key":"2023041909290711700_b1","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1016\/S0140-6736(07)60635-7","article-title":"Ankylosing spondylitis","volume":"369","author":"Braun","year":"2007","journal-title":"Lancet"},{"key":"2023041909290711700_b2","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1038\/ncprheum0591","article-title":"The assessment of ankylosing spondylitis in clinical practice","volume":"3","author":"Sengupta","year":"2007","journal-title":"Nat Clin Pract Rheumatol"},{"key":"2023041909290711700_b3","first-page":"1236","article-title":"The natural history of ankylosing spondylitis as defined by radiological progression","volume":"29","author":"Brophy","year":"2002","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b4","first-page":"169","article-title":"Managing neurologic complications in cervical spine surgery, Curr Opin Orthoped","volume":"16","author":"Freedman","year":"2005"},{"key":"2023041909290711700_b5","first-page":"79","article-title":"Complement-mediated muscle involvement in juvenile ankylosing spondylitis","volume":"14","author":"Vercelli","year":"2004","journal-title":"Basic Appl Myol"},{"key":"2023041909290711700_b6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1093\/rheumatology\/25.2.175","article-title":"A review of 100 patients with ankylosing spondylitis with particular reference to socio-economic effects","volume":"25","author":"Wordsworth","year":"1986","journal-title":"Br J Rheumatol"},{"key":"2023041909290711700_b7","first-page":"1981","article-title":"Clinical vertebral fractures in patients with ankylosing spondylitis","volume":"31","author":"Vosse","year":"2004","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b8","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1136\/ard.40.3.317","article-title":"Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis","volume":"40","author":"Young","year":"1981","journal-title":"Ann Rheum Dis"},{"key":"2023041909290711700_b9","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1002\/ana.410140610","article-title":"Cauda equina syndrome secondary to long-standing ankylosing spondylitis","volume":"14","author":"Bartleson","year":"1983","journal-title":"Ann Neurol"},{"key":"2023041909290711700_b10","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1136\/ard.53.11.714","article-title":"Neurological disturbances in ankylosing spondylitis","volume":"53","author":"Tyrrell","year":"1994","journal-title":"Ann Rheum Dis"},{"key":"2023041909290711700_b11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00002281-200007000-00008","article-title":"Spondyloarthropathies in sub-Saharan Africa","volume":"12","author":"Moustafa","year":"2000","journal-title":"Curr Opin Rheumatol"},{"key":"2023041909290711700_b12","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1038\/ncprheum0118","article-title":"Mechanisms of disease: infection and spondyloarthritis","volume":"2","author":"Inman","year":"2006","journal-title":"Nat Clin Pract Rheumatol"},{"key":"2023041909290711700_b13","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.berh.2006.03.005","article-title":"Non-major-histocompatibility-complex of ankylosing spondylitis","volume":"20","author":"Brown","year":"2006","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2023041909290711700_b14","first-page":"1568","article-title":"Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial","volume":"31","author":"Gonzalez-Lopez","year":"2004","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b15","first-page":"1167","article-title":"Spondyloarthropathies in patients attending the rheumatology unit of Lom\u00e9 hospital","volume":"20","author":"Mijiyawa","year":"1993","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b16","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1002\/art.1780231206","article-title":"Ankylosing spondylitis in African blacks","volume":"23","author":"Chalmers","year":"1980","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b17","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1136\/ard.56.1.68","article-title":"Ankylosing spondylitis in West Africans: evidence for non-HLA B27 protective effect","volume":"56","author":"Brown","year":"1997","journal-title":"Ann Rheum Dis"},{"key":"2023041909290711700_b18","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1136\/ard.49.6.400","article-title":"Rheumatic disorders in Zimbabwe: a prospective analysis of patients attending the rheumatic diseases clinic","volume":"49","author":"Stein","year":"1990","journal-title":"Ann Rheum Dis"},{"issue":"(suppl 3)","key":"2023041909290711700_b19","first-page":"39","article-title":"HLA-B27 in ankylosing spondylitis: differences in frequency and relative risk in American Blacks and Caucasians","volume":"4","author":"Khan","year":"1977","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b20","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/art.1780200401","article-title":"Comparison of clinical features of HLA-B27 positive and negative patients with ankylosing spondylitis","volume":"20","author":"Khan","year":"1977","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b21","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1002\/art.10584","article-title":"Association of ankylosing spondylitis with HLA\u2013B*1403 in a West African population","volume":"46","author":"Lopez-Larrea","year":"2002","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b22","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/00002281-199507000-00001","article-title":"HLA\u2013B27 and its subtypes in world populations","volume":"7","author":"Khan","year":"1995","journal-title":"Curr Opin Rheumatol"},{"key":"2023041909290711700_b23","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1002\/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G","article-title":"Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors","volume":"41","author":"Braun","year":"1998","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b24","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1002\/art.20990","article-title":"The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria?","volume":"52","author":"Rudwaleit","year":"2005","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b25","first-page":"980","article-title":"Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis","volume":"26","author":"Sporenberg","year":"1999","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b26","article-title":"The epidemiology of chronic rheumatism, vol 1 Oxford: Blackwell","author":"Kellgren","year":"1963"},{"key":"2023041909290711700_b27","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/art.1780270301","article-title":"The risk of developing ankylosing spondylitis in HLA-B27 positive individuals","volume":"27","author":"van der Linden","year":"1984","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b28","first-page":"1899","article-title":"The Cochrane review of physiotherapy interventions for ankylosing spondylitis","volume":"32","author":"Dagfinrud","year":"2005","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b29","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/BF02208352","article-title":"Factors related to change in global health after group physical therapy in ankylosing spondylitis","volume":"14","author":"Hidding","year":"1995","journal-title":"Clin Rheumatol"},{"key":"2023041909290711700_b30","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1148\/radiology.194.2.7824736","article-title":"Early sacroilitis in patients with spondylarthropathy: evaluation with dynamic gadolinium-enhanced","volume":"194","author":"Bollow","year":"1995","journal-title":"Radiology"},{"key":"2023041909290711700_b31","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1136\/ard.2003.011247","article-title":"How to diagnose axial spondyloarthritis early","volume":"63","author":"Rudwaleit","year":"2004","journal-title":"Ann Rheum Dis"},{"key":"2023041909290711700_b32","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/BOR.0b013e3280ad46a9","article-title":"New therapeutic approaches for spondyloarthritis","volume":"19","author":"Manadan","year":"2007","journal-title":"Curr Opin Rheumatol"},{"key":"2023041909290711700_b33","first-page":"722","article-title":"Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials","volume":"33","author":"Chen","year":"2006","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b34","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1002\/1529-0131(199911)42:11<2325::AID-ANR10>3.0.CO;2-C","article-title":"Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondylarthropathies: a Department of Veterans Affairs cooperative study","volume":"42","author":"Clegg","year":"1999","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b35","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/art.1780380507","article-title":"Sulfasalazine in the treatment of spondylarthropathy. A randomized, multicenter, double-blind, placebo-controlled study","volume":"38","author":"Dougados","year":"1995","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b36","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1080\/030097400750002021","article-title":"Methotrexate in the treatment of ankylosing spondylitis","volume":"29","author":"Sampaio-Barros","year":"2000","journal-title":"Scand J Rheumatol"},{"key":"2023041909290711700_b37","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1002\/art.21588","article-title":"Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data","volume":"53","author":"Baraliakos","year":"2005","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b38","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1002\/art.10139","article-title":"A six-month randomized, controlled, double-blind, dose response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis","volume":"46","author":"Maksymowych","year":"2002","journal-title":"Arthritis Rheum"},{"key":"2023041909290711700_b39","first-page":"144","article-title":"Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy","volume":"28","author":"Maksymowych","year":"2001","journal-title":"J Rheumatol"},{"key":"2023041909290711700_b40","first-page":"315","article-title":"Cervical spondylosis: a literature review with attention to the African population","volume":"3","author":"Belachew","year":"2007","journal-title":"Arch Med Sci"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/85\/1005\/353\/50020349\/postgradmedj-85-353.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/85\/1005\/353\/50020349\/postgradmedj-85-353.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T09:39:41Z","timestamp":1681897181000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/85\/1005\/353\/7007447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,7,1]]},"references-count":40,"journal-issue":{"issue":"1005","published-online":{"date-parts":[[2009,7,5]]},"published-print":{"date-parts":[[2009,7,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.2007.064717","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2009,7]]},"published":{"date-parts":[[2009,7,1]]}}}