This thesis focuses on health inequity in Spondyloarthritis (SpA) and potential drivers for this. The general lack of evidence on the role of socioeconomic factors, mainly at the level of the... Show moreThis thesis focuses on health inequity in Spondyloarthritis (SpA) and potential drivers for this. The general lack of evidence on the role of socioeconomic factors, mainly at the level of the individual, but also at the wider societal level, on disease outcomes in SpA, stimulated the undertaking of the individual studies described in the thesis. The possibility to study socioeconomic factors give a unique dimension to the analyses presented and provide more insights that complement the existing body of evidence. The studies presented also highlight much unmet need in our understanding of disease and in particular the intricate relationships between biological and non-biological factors that drive adverse outcomes in SpA. Many of these relationships are naturally complex and the observed effects on outcomes, multifactorial in origin. The thesis has three overarching aims, all pertaining to better understanding the role of socioeconomic factors in SpA, from different angles, both at the individual as well as the country-level and the impact on outcomes, namely imaging and work outcomes. Show less
The studies present in this thesis fall into two broad areas: the first focusing on filarial infection, Ig (immunoglobulin)E levels and risk factors for infection, while the second deals with the... Show moreThe studies present in this thesis fall into two broad areas: the first focusing on filarial infection, Ig (immunoglobulin)E levels and risk factors for infection, while the second deals with the possible associations between nematode infection and allergy. Compared to ELISA, RAST is superior in detecting filarial specific IgE in endemic area of Brugia malayi. Levels of filaria-specific IgE and IgG4 in children up to 10 years correlated with maternal antibody levels. Genetic factors had a more pronounced effect in children than in adults. The use of objective measurements, such as skin prick test (SPT) and IgE levels are required when conducting epidemiological studies of allergic diseases in Indonesia. Study on risk factors of allergy in Indonesia showed that nutritional status of children in the high socioeconomic school negatively associate with SPT and IgE positivity but we did not show a statistically significant role for helminths in inhibiting SPT responses. In endemic area of lymphatic filariasis, genetic factors contribute significantly to both total and allergen-specific IgE, whereas environmental factors influence the clustering of SPT positivity. By using several TLR ligands it was demonstrated that the dynamics of cytokine production following the innate immune stimulation can differ according to helminth infection status. Show less
