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Canayaz E, Altikardes ZA, Unsal A, Korkmaz H, Gok M. Development and validation of machine learning algorithms for early detection of ankylosing spondylitis using magnetic resonance images. Technol Health Care 2025; 33:1182-1198. [PMID: 40331561 DOI: 10.1177/09287329241297887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and spine, often leading to disability if not diagnosed and treated early.ObjectiveIn this study, we present the development and validation of machine learning (ML) algorithms for AS detection only using Short Tau Inversion Recovery (STIR) sequenced magnetic resonance (MR) images.MethodsThe detection process is based on creating Gray Level Co-occurrence Matrices (GLCM) from MR images, followed by the computation of Haralick features and the training of ML-based models. A total of 696 MR images (AS+: 348, AS-: 348) were utilized for AS detection. Models were trained and tested on 70% of the dataset using a 10-fold cross-validation method to prevent overfitting, while the remaining 30% of the data was used for validation. In addition, care was taken to ensure that different images from the same patient were not split between the training and validation sets during this separation process to prevent potential data leakage.ResultsThe proposed ML-based model demonstrated superior performance during the validation phase (accuracy: 0.885, AUC: 0.941). The results of our study show promising outcomes when compared to previous works employing GLCM-based ML detection models.Conclusions: This study introduces a new perspective on AS detection, focusing on the assignment of ML techniques to STIR-sequenced MR images with a notable absence of literature on interpreting ML models for AS detection. This typology also addresses a lack of knowledge, as most models do not provide practical interpretability or knowledge alongside accurate prediction. The system also offers an effective strategy for early and correct diagnosis of AS, which is important for timely intervention and treatment planning.
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Affiliation(s)
- Emre Canayaz
- Vocational School of Technical Sciences, Marmara University, Istanbul, Türkiye
| | - Zehra Aysun Altikardes
- Department of Electrical and Electronics Engineering, Institute of Pure and Applied Sciences, Marmara University, Istanbul, Turkey
| | - Alparslan Unsal
- Faculty of Medicine, Department of Internal Medicine Division of Radiology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Hayriye Korkmaz
- Faculty of Technology, Electrical and Electronics Engineering, Department of Electrical and Electronics Engineering, Marmara University, Istanbul, Turkey
| | - Mustafa Gok
- Faculty of Medicine, Department of Internal Medicine Division of Radiology, Aydin Adnan Menderes University, Aydin, Turkey
- Faculty of Medicine, Department of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Delcourt C, Fakih O, Prati C, Chouk M, Wendling D, Verhoeven F. Impact of treatments on fatigue in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2025; 64:1585-1597. [PMID: 39388256 DOI: 10.1093/rheumatology/keae549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/06/2024] [Accepted: 09/21/2024] [Indexed: 10/15/2024] Open
Abstract
OBJECTIVES Fatigue is frequent in axial SpA (axSpA) and is difficult to improve. This systematic review aimed to assess the effects of axSpA treatment on fatigue. METHODS A systematic review following the PRISMA recommendations was performed on PubMed, Cochrane and Embase databases. We included controlled interventional studies, cohort studies conducted in patients with axSpA meeting the ASAS 2009 criteria and measuring fatigue between 12 and 156 weeks of treatment. We excluded studies not written in English, case reports, abstracts, systematic reviews, meta-analysis and studies with missing data. A meta-analysis was performed for anti-TNF/anti-IL-17/JAK inhibitors randomized controlled trials evaluating fatigue at week 12-16. RESULTS A total of 1672 studies were identified, of which 34 were selected for analysis. Twelve studies evaluated anti-TNF with a significant reduction in fatigue measured by various scores (FACIT, MFI, NRS, VAS, FSS) in 11 studies. Among the four studies evaluating anti-IL-17, three showed a reduction in fatigue, with a dose effect for secukinumab. Two studies evaluated JAK inhibitors and showed a reduction in fatigue. The meta-analysis showed no differences between the DMARDs. Concerning non-pharmacological treatments, 12 of 16 studies showed a reduction in fatigue using physical activity, cryotherapy and magnetotherapy. Two studies showed that the addition of physical activity to anti-TNF reduced fatigue more significantly. Finally, one study showed a greater efficacy in men, and two studies suggested it in non-radiographic form. CONCLUSION This review shows a beneficial effect of DMARD and non-pharmacological treatment on fatigue in axSpA in short and medium terms with a greater effect when combining them.
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Affiliation(s)
| | - Olivier Fakih
- Service de Rhumatologie, CHU Besançon, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU Besançon, Besançon, France
- UMR1098 RIGHT- EFS- INSERM- Université de Franche Comté, Besançon, France
| | - Mickaël Chouk
- Service de Rhumatologie, CHU Besançon, Besançon, France
| | | | - Frank Verhoeven
- Service de Rhumatologie, CHU Besançon, Besançon, France
- UMR1098 RIGHT- EFS- INSERM- Université de Franche Comté, Besançon, France
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Falloon K, Dossaji Z, Mude P, Abushamma S, Ananthakrishnan A, Barnes EL, Bhalla J, Bhattacharya A, Cheemalavagu S, Colombel JF, Cross RK, Ermann J, Ha C, Herfarth H, Horst S, Hou J, Husni ME, Kline TM, Kuhn KA, Long MD, Loftus EV, Lukin DJ, Patel A, Rubin DT, Scherl EJ, Shah SA, Siaton BC, Sleiman J, Qazi T, Weisman MH, Cohen BL, Feagan BG, Rieder F. Diagnosis of Inflammatory Bowel Disease-Associated Peripheral Arthritis: A Systematic Review. Inflamm Bowel Dis 2025; 31:812-842. [PMID: 38836521 DOI: 10.1093/ibd/izae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA) decreases quality of life and remains poorly understood. Given the prevalence of this condition and its negative impact, it is surprising that evidence-based disease definitions and diagnostic strategies are lacking. This systematic review summarizes available data to facilitate development and validation of diagnostics, patient-reported outcomes, and imaging indices specific to this condition. METHODS A literature search was conducted. Consensus or classification criteria, case series, cross-sectional studies, cohort studies, and randomized controlled trials related to diagnosis were included. RESULTS A total of 44 studies reporting data on approximately 1500 patients with pSpA were eligible for analysis. Data quality across studies was only graded as fair to good. Due to large heterogeneity, meta-analysis was not possible. The majority of studies incorporated patient-reported outcomes and a physical examination. A total of 13 studies proposed or validated screening tools, consensus, classification, or consensus criteria. A total of 28 studies assessed the role of laboratory tests, none of which were considered sufficiently accurate for use in diagnosis. A total of 17 studies assessed the role of imaging, with the available literature insufficient to fully endorse any imaging modality as a robust diagnostic tool. CONCLUSIONS This review highlights existing inconsistency and lack of a clear diagnostic approach for IBD-associated pSpA. Given the absence of an evidence-based approach, a combination of existing criteria and physician assessment should be utilized. To address this issue comprehensively, our future efforts will be directed toward pursuit of a multidisciplinary approach aimed at standardizing evaluation and diagnosis of IBD-associated pSpA.
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Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Zahra Dossaji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Pooja Mude
- Department of Gastroenterology, Ascension Providence, Southfield, MI, USA
| | - Suha Abushamma
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | | | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jaideep Bhalla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Shashank Cheemalavagu
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina Ha
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hou
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - M Elaine Husni
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Theresa M Kline
- Cleveland Clinic Foundation, Cleveland Clinic Library, Cleveland, OH, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Dana J Lukin
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Aditi Patel
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David T Rubin
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Ellen J Scherl
- Department of Gastroenterology and Hepatology, Weill Cornell Medical Center, NY, NY, USA
| | - Samir A Shah
- Department of Gastroenterology, Brown University, Providence, RI, USA
| | - Bernadette C Siaton
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Sleiman
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Michael H Weisman
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., London, ON, Canada
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH, USA
- Cleveland Clinic Program for Global Translational Inflammatory Bowel Disease, Cleveland Clinic, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, OH, USA
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Pei W, Xu L, Zhong H, Wang Z, Yao R, Zhang L, Yang J, Li J, Feng Y, Lin Q, Li D, Zhou X, Pei D, Guo Y, Ma L, Luo Y, Zuo S, Wang L, Yan R, Su Y. Clinical features of inflammatory arthritis in daily practice-China's perspective. Clin Rheumatol 2025; 44:969-978. [PMID: 39853560 DOI: 10.1007/s10067-024-07262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 11/21/2024] [Accepted: 12/02/2024] [Indexed: 01/26/2025]
Abstract
OBJECTIVE This study aimed to analyze and compare the proportion of patients with different types of inflammatory arthritis and investigate the clinical characteristics, including symptoms and signs, medication choices, and disease activity, in the daily clinical practice of China. METHODS Patients with inflammatory arthritis were recruited from 16 Grade-A tertiary hospitals between August 2021 and April 2022. The medical profiles, encompassing sociodemographic characteristics, clinical and laboratory date, were collected. RESULTS This study included 2,693 patients with arthritis, with rheumatoid arthritis (RA) accounting for the highest proportion (50.50%). Significant differences were observed in terms of age, gender, body mass index (BMI), disease duration, smoking and family history among patients with different types of inflammatory arthritis. Physical activity and cold exposure were identified as the main predisposing factors for RA, psoriatic arthritis (PsA), osteoarthritis (OA), and ankylosing spondylitis (AS), while alcohol consumption was the most common inducing factor for gout. Hypertension and hyperlipidemia were the primary concomitant diseases in RA, OA, and AS, whereas hyperuricemia and hypertension were mainly associated with gout, psoriasis and diabetes were the most common comorbidities in PsA. Peripheral joints were predominantly affected in PsA, RA, OA, and gout, while axial joints were mainly affected in AS. Methotrexate and leflunomide were the main therapeutic drugs for RA, while biologics were commonly prescribed for PsA and AS. OA and gout patients mainly utilized nonsteroidal anti-inflammatory drugs (NSAIDs). CONCLUSION Patients with different types of inflammatory arthritis exhibited varying predisposing factors, joint inflammation, concomitant diseases, and medication choices, highlighting the importance of individualized approaches in the clinic. Key Points • 2,693 patients classified and diagnosed with inflammatory arthritis were recruited in this study from 16 Grade-A tertiary hospitals in China between August 2021 and April 2022. • This study analyzed and compared the proportion of patients with different types of arthritis in routine clinical practice in China. • Joint inflammation, comorbidities, and medication choices were assessed among patients with the most common types of arthritis in this study. • This study also provided some epidemiologically relevant information about inflammatory arthritis patients in China.
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Affiliation(s)
- Wenwen Pei
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Liling Xu
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Hua Zhong
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Ziye Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Ranran Yao
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Yang
- Department of Rheumatology and Immunology, Mianyang Central Hospital, Mianyang, China
| | - Jingyang Li
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, China
| | - Yuan Feng
- Department of Rheumatology and Immunology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Qi Lin
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dongsheng Li
- Department of Rheumatology, Ganzhou People's Hospital, Ganzhou, China
| | - Xinyao Zhou
- Division of Rheumatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongxue Pei
- Department of Rheumatology, Jilin Hospital of Integrated Traditional Chinese and Western Medicine, Jilin, China
| | - Yanqiu Guo
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Yaping Luo
- Department of Rheumatology, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei, China
| | - Shufei Zuo
- Department of Rheumatology and Immunology, Xinxiang Central Hospital, Xinxiang, China
| | - Lin Wang
- Department of Rheumatology, Shaoyang Central Hospital, Shaoyang, China
| | - Rui Yan
- Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing, China
| | - Yin Su
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
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Rahimli Ocakoglu S, Vatansever A, Atak Z, Yanardag N, Coskun BN, Akselim S, Ocakoglu G. Evaluation of Sacroiliac Joint Shape in Women with Ankylosing Spondylitis According to Mode of Birth Delivery: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 61:39. [PMID: 39859021 PMCID: PMC11767063 DOI: 10.3390/medicina61010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/27/2024] [Accepted: 12/28/2024] [Indexed: 01/27/2025]
Abstract
Background and Objectives: Ankylosing spondylitis (AS) is a chronic progressive inflammatory process of the axial skeleton and sacroiliac joints (SIJ). Symptoms typically appear between the ages of 20 and 40, although there are also cases of juvenile-onset AS. This suggests that most patients with AS are of reproductive age at the time of diagnosis. The study aimed to identify differences in the shape of the sacroiliac joint depending on the type of birth (vaginal delivery (V/D) and the cesarean section(C/S) in patients with ankylosing spondylitis. Materials and Methods: On pelvis X-ray images of women n = 36 with AS and n = 34 in the control group, 12 landmarks were marked, and differences in SIJ shape between the study groups were assessed using generalized Procrustes Analysis. Results: The results showed that the anterior point of the SIJ had an enlarged shape in the V/D group compared with the C/S group, even in the control group. There was a difference between the mean right and left SIJ shapes of the AS group patients with V/D and the controls with C/S (p = 0.007 and p < 0.001). The superior part of the right SIJ tended to be enlarged in V/D-delivered AS patients, compared to the C/S control group. On the left side, the middle region of the SIJ was statistically enlarged in AS patients with V/D compared to the healthy C/S group. Conclusions: This study demonstrates that vaginal delivery is associated with increased sacroiliac joint (SIJ) enlargement in both healthy individuals and those with ankylosing spondylitis (AS). Our findings suggest that delivery type independently influences SIJ morphology, and cesarean section (C/S) may serve as a protective procedure for preserving SIJ shape in AS patients. These results underline the importance of individualized obstetric planning for AS patients to mitigate potential risks to SIJ morphology.
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Affiliation(s)
| | - Alper Vatansever
- Department of Anatomy, Faculty of Medicine, Bursa Uludag University, 16059 Bursa, Turkey
| | - Zeliha Atak
- Department of Obstetrics and Gynecology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Nurefsan Yanardag
- Department of Obstetrics and Gynecology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Belkis Nihan Coskun
- Department of Rheumatology, Faculty of Medicine, Uludag University, 16059 Bursa, Turkey
| | - Sinem Akselim
- Department of Physical Medicine and Rehabilitation, Bursa City Hospital, 16110 Bursa, Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics, Faculty of Medicine, Bursa Uludag University, 16059 Bursa, Turkey
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Zhang Z, Pan Y, Lu Y, Ye L, Zheng M, Zhang G, Chen D. The TabNet Model for Diagnosing Axial Spondyloarthritis Using MRI Imaging Findings and Clinical Risk Factors. Int J Rheum Dis 2024; 27:e70004. [PMID: 39690496 DOI: 10.1111/1756-185x.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/03/2024] [Accepted: 12/02/2024] [Indexed: 12/19/2024]
Abstract
OBJECTIVES The aim of this study is to develop and validate a model for predicting axial spondyloarthritis (axSpA) based on sacroiliac joint (SIJ)-MRI imaging findings and clinical risk factors. METHODS The study is implemented on the data of 942 patients which contains of 707 patients with axSpA and 235 patients with non-axSpA. To begin with, the patients were split into training (n = 753) and validation (n = 189) cohorts. Secondly, multiple assessors manually extract the features of active inflammation (bone marrow edema) and structural lesions (erosions, sclerosis, ankylosis, joint space changes, and fat lesions). Meanwhile, we utilize 11 machine learning models and TabNet to develop imaging models, which contain six clinical risk factors for clinical models and combined clinical-imaging models. Finally, the diagnostic performance of the aforementioned models was evaluated in the validation cohort including accuracy, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, F1-score, and Matthew's correlation coefficient (MCC). RESULTS Six features were extracted from the imaging findings. The combined clinical-imaging models outperform the clinical and imaging models. In contrast, the combined clinical-imaging model via TabNet (CCMRT) achieved the optimal AUC of 0.93(95% CI: 0.89, 0.97). Furthermore, it is observed that the bilateral joint space changes and right-sided erosions, HLA-B27 positivity, and CRP values significantly affected axSpA diagnostic prediction. CONCLUSION The prediction model based on clinical risk factors and SIJ-MRI imaging features can distinguish axSpA and non-axSpA effectively. In addition, the TabNet demonstrates superior diagnostic efficacy compared with machine learning models.
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Affiliation(s)
- Zhaojuan Zhang
- College of Information Engineering, China Jiliang University, Zhejiang, Hangzhou, China
| | - Yiling Pan
- College of Information Engineering, China Jiliang University, Zhejiang, Hangzhou, China
| | - Yanjie Lu
- Institute of Intelligent Media Computing, Hangzhou Dianzi University, Zhejiang, Hangzhou, China
- Shangyu Institute of Science and Engineering Co. Ltd., Hangzhou Dianzi University, Shaoxing, China
| | - Lusi Ye
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mo Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guodao Zhang
- Institute of Intelligent Media Computing, Hangzhou Dianzi University, Zhejiang, Hangzhou, China
- Shangyu Institute of Science and Engineering Co. Ltd., Hangzhou Dianzi University, Shaoxing, China
| | - Dan Chen
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Burmester GR, Stigler J, Rubbert-Roth A, Tanaka Y, Azevedo VF, Coombs D, Lagunes I, Lippe R, Wung P, Gensler LS. Safety Profile of Upadacitinib up to 5 Years in Psoriatic Arthritis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis: An Integrated Analysis of Clinical Trials. Rheumatol Ther 2024; 11:737-753. [PMID: 38683479 PMCID: PMC11111431 DOI: 10.1007/s40744-024-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION This integrated analysis of the phase 2/3 and phase 3 SELECT trials describes the safety profile of upadacitinib, an oral Janus kinase inhibitor, for up to 5 years of exposure across psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA) (including pooled axial spondyloarthritis [axSpA]). METHODS Safety data from five trials of upadacitinib in PsA (2 trials), AS (2 trials), and nr-axSpA (1 trial) were analyzed up to a data cut-off of August 15, 2022. One PsA study included adalimumab as an active comparator. Treatment-emergent adverse events (TEAEs) were summarized for PsA (pooled upadacitinib 15 mg once daily and adalimumab 40 mg biweekly), AS (pooled upadacitinib 15 mg), nr-axSpA (upadacitinib 15 mg), and pooled axSpA (pooled upadacitinib 15 mg from axSpA trials). TEAEs were reported as exposure-adjusted event rates per 100 patient-years (E/100 PY). RESULTS A total of 1789 patients (PsA, n = 907; AS, n = 596; nr-axSpA, n = 286) received ≥ 1 dose of upadacitinib 15 mg for 3689 PY of exposure or adalimumab (n = 429) for 1147 PY of exposure. Overall TEAEs and serious TEAEs were highest in PsA and numerically higher with upadacitinib versus adalimumab; rates were similar between AS and nr-axSpA. In PsA, higher rates of serious infection, herpes zoster (HZ), lymphopenia, and nonmelanoma skin cancer (NMSC) were observed with upadacitinib versus adalimumab. Rates of malignancy excluding NMSC, adjudicated major adverse cardiovascular events, and adjudicated venous thromboembolic events were comparable between upadacitinib and adalimumab in PsA and were similar across diseases. CONCLUSION Higher rates of serious infection, HZ, lymphopenia, and NMSC were observed with upadacitinib versus adalimumab in PsA; slightly elevated rates for most of these TEAEs were seen with upadacitinib in PsA versus axSpA. Upadacitinib 15 mg demonstrated a generally consistent safety profile across disease states with no new safety signals identified. TRIAL REGISTRATION SELECT-AXIS 1: NCT03178487; SELECT-AXIS 2: NCT04169373; SELECT-PsA 1: NCT03104400; SELECT-PsA 2: NCT03104374.
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Affiliation(s)
- Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Jayne Stigler
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Cantonal Clinic St Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Sankt Gallen, Switzerland
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Kitakyushu, 807-8555, Japan
| | - Valderilio F Azevedo
- Rheumatology Unit, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, Curitiba, Paraná, 80000-000, Brazil
| | - Derek Coombs
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Ivan Lagunes
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Ralph Lippe
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Peter Wung
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Lianne S Gensler
- Department of Medicine/Rheumatology, University of California San Francisco, 400 Parnassus Ave B1, San Francisco, CA, 94143, USA
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Chen DQ, Xu WB, Que ZQ, Xiao KY, Sun NK, Cai DX, Feng JY, Rui G. Therapeutic potential of single-nucleotide polymorphism-mediated IL6R inhibitors in ankylosing spondylitis treatment. Front Med (Lausanne) 2024; 11:1368346. [PMID: 38835791 PMCID: PMC11148286 DOI: 10.3389/fmed.2024.1368346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/01/2024] [Indexed: 06/06/2024] Open
Abstract
Objective Interleukin-6 (IL-6) is a multiple-effect cell factor implicated in the etiopathogenesis of several rheumatologic disorders. The blockade of the IL-6 pathway via IL6R inhibitors effectively treats these disorders. However, the clinical significance of the IL6R blockade for ankylosing spondylitis (AS) therapy remains controversial. With advances in genomics, increasing evidence has revealed the role of heritability in the etiology of disease, and Mendelian randomization (MR) analyses are being used more broadly to infer causation. Therefore, this MR study aims to evaluate the potential therapeutic utility of IL6R-targeted approaches in AS. Methods The C-reactive protein (CRP) level was used as an exposure factor, and rheumatoid arthritis (RA) was used as a positive control. As-related genome-wide association study (GWAS) data were used as the primary outcome of drug-targeted MR analyses to test the relation between IL6R blockers and AS. Inverse variance weighting (IVW) is the primary analytical approach. Various sensitivity tests were performed to check the robustness and trustworthiness of the causality estimation, including consistency, heterogeneity, and pleiotropy analyses. In addition, repeated analysis was conducted using different GWAS data related to exposures and outcomes to examine the results for stability. Results According to the IVW results, IL6R inhibitors significantly reduced the risk of AS in ukb-b-18194 (OR: 0.995, 95% CI 0.993-0.996, P = 5.12 × 10-08) and ukb-a-88 (OR: 0.994, 95% CI 0.993-0.996, P = 6.25 × 10-15). Moreover, repeated analyses were performed using different exposure-related GWAS data, yielding similar results, ukb-b-18194 (OR: 0.995, 95% CI 0.993-0.997, P = 1.25 × 10-06) and ukb-a-88 (OR: 0.995, 95% CI 0.994-0.997, P = 7.81 × 10-09). Heterogeneity analyses and pleiotropy analyses indicated no significant heterogeneity or pleiotropy. Conclusion This MR analysis result further validates that the IL-6 pathway may contribute to the pathogenesis of AS and that the inhibition of IL6R reduces the risk of AS. These findings may guide future studies and provide more favorable drug treatment options for people at high risk of AS.
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Affiliation(s)
- Ding-Qiang Chen
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhi-Qiang Que
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ke-Yi Xiao
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Nai-Kun Sun
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Di-Xin Cai
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Yi Feng
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Furst A, Gill T. Exploring the role of gut microbes in spondyloarthritis: Implications for pathogenesis and therapeutic strategies. Best Pract Res Clin Rheumatol 2024; 38:101961. [PMID: 38851970 DOI: 10.1016/j.berh.2024.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/11/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
The gut microbiota plays a pivotal role in regulating host immunity, and dysregulation of this interaction is implicated in autoimmune and inflammatory diseases, including spondyloarthritis (SpA). This review explores microbial dysbiosis and altered metabolic function observed in various forms of SpA, such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), acute anterior uveitis (AAU), and SpA-associated gut inflammation. Studies on animal models and clinical samples highlight the association between gut microbial dysbiosis, metabolic perturbations and immune dysregulation in SpA pathogenesis. These studies have received impetus through next-generation sequencing methods, which have enabled the characterization of gut microbial composition and function, and host gene expression. Microbial/metabolomic studies have revealed potential biomarkers and therapeutic targets, such as short-chain fatty acids, and tryptophan metabolites, offering insights into disease mechanisms and treatment approaches. Further studies on microbial function and its modulation of the immune response have uncovered molecular mechanisms underlying various SpA. Understanding the complex interplay between microbial community structure and function holds promise for improved diagnosis and management of SpA and other autoimmune disorders.
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Affiliation(s)
- Alec Furst
- School of Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Tejpal Gill
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, 97239, USA.
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10
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Schaefer RO, Rutsch N, Schnake KJ, Aly MM, Camino-Willhuber G, Holas M, Spiegl U, Muijs S, Albers CE, Bigdon SF. Rigid spine injuries - A comprehensive review on diagnostic and therapeutic challenges. BRAIN & SPINE 2024; 4:102811. [PMID: 38681176 PMCID: PMC11052905 DOI: 10.1016/j.bas.2024.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Injuries to the rigid spine have a distinguished position in the broad spectrum of spinal injuries due to altered biomechanical properties. The rigid spine is more prone to fractures. Two ossification bone disorders that are of particular interest are Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH). DISH is a non-inflammatory condition that leads to an anterolateral ossification of the spine. AS on the other hand is a chronic inflammatory disease that leads to cortical bone erosions and spinal ossifications. Both diseases gradually induce stiffening of the spine. The prevalence of DISH is age-related and is therefore higher in the older population. Although the prevalence of AS is not age-related the occurrence of spinal ossification is higher with increasing age. This association with age and the aging demographics in industrialized nations illustrate the need for medical professionals to be adequately informed and prepared. The aim of this narrating review is to give an overview on the diagnostic and therapeutic measures of the ankylosed spine. Because of highly unstable fracture configurations, injuries to the rigid spine are highly susceptible to neurological deficits. Diagnosing a fracture of the ankylosed spine on plain radiographs can be challenging. Moreover, since 8% of patients with ankylosing spine disorders (ASD) have multiple non-contagious fractures, a CT scan of the entire spine is highly recommended as the primary diagnostic tool. There are no consensus-based guidelines for the treatment of spinal fractures in ASD. The presence of neurological deficit or unstable fractures are absolute indications for surgical intervention. If conservative therapy is chosen, patients should be monitored closely to ensure that secondary neurologic deterioration does not occur. For the fractures that have to be treated surgically, stabilization of at least three segments above and below the fracture zone is recommended. These fractures mostly are treated via the posterior approach. Patients with AS or DISH share a significant risk for complications after a traumatic spine injury. The most frequent complications for patients with thoracolumbar burst fractures are respiratory failure, pseudoarthrosis, pneumonia, and implant failure.
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Affiliation(s)
| | - Niklas Rutsch
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mohamed M. Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Martin Holas
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Ulrich Spiegl
- Klinik für Unfallchirurgie und Orthopädie, Klinik München Harlaching, Sanatoriumspl. 2, 81545, München, Germany
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | - Christoph E. Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Sebastian F. Bigdon
- Department of Orthopaedic Surgery, Sonnenhof Spital, University Bern, 3006, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
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Sertdemir AL, Şahin AT, Duran M, Çelik M, Tatar S, Oktay İ, Alsancak Y. Association between syndecan-4 and subclinical atherosclerosis in ankylosing spondylitis. Medicine (Baltimore) 2024; 103:e37019. [PMID: 38241528 PMCID: PMC10798725 DOI: 10.1097/md.0000000000037019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Despite advances in the diagnosis and treatment of ankylosing spondylitis (AS), the risk of cardiovascular complications in AS patients is still higher than in the general population. Macrophages are at the intersection of the basic pathogenetic processes of AS and atherosclerosis. Although syndecan-4 (SDC4) mediates a variety of biological processes, the role of SDC4 in macrophage-mediated atherogenesis in AS patients remains unclear. Herein, we aimed to investigate the role of SDC4 in subclinical atherosclerosis in AS patients. METHODS Subjects were selected from eligible AS patients and control subjects without a prior history of AS who were referred to the rheumatology outpatient clinics. All participants' past medical records and clinical, and demographic characteristics were scanned. In addition, carotid intima-media thickness (CIMT) measurement and disease activity index measurement were applied to all patients. RESULTS According to our data, serum SDC4 level was significantly higher among AS patients compared with the control group (6.7 [1.5-35.0] ng/mL vs 5.1 [0.1-12.5] ng/mL, P < .001). The calculated CIMT was also significantly higher in AS patients than in the control group (0.6 [0.3-0.9] mm vs 0.4 (0.2-0.7), P < .001]. Additionally, serum C-reactive protein level and SDC4 level were independent predictors of AS and strongly associated with CIMT. Linear regression analysis showed that serum SDC4 level was the best predictor of CIMT (P = .004). CONCLUSION Our data indicate that serum SDC4 levels provide comprehensive information about the clinical activity of the disease and subclinical atherosclerosis in AS patients.
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Affiliation(s)
- Ahmet L. Sertdemir
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet T. Şahin
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mustafa Duran
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Mustafa Çelik
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sefa Tatar
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İrem Oktay
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Yilmaz PD, Kadiyoran C, Goktepe MH, Akkubak Y, Icli A, Kucuk A. Syndecan 1 may slow the progression of subclinical atherosclerosis in patients with ankylosing spondylitis. Clin Exp Hypertens 2023; 45:2156529. [PMID: 36524421 DOI: 10.1080/10641963.2022.2156529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Pinar Diydem Yilmaz
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cengiz Kadiyoran
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mevlut Hakan Goktepe
- Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Akkubak
- Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Faculty of Health Sciences, Konya, Turkey
| | - Abdullah Icli
- Department of Cardiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Adem Kucuk
- Department of Rheumatology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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13
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Yılmaz E. Can restless legs be a sign of something else? A case report of spondyloarthritis presenting with restless legs syndrome and a review of the literature. Reumatismo 2023; 75. [PMID: 38115781 DOI: 10.4081/reumatismo.2023.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/30/2023] [Indexed: 12/21/2023] Open
Abstract
Restless legs syndrome (RLS) is a chronic movement disorder characterized by an urge or need to move the limbs, usually associated with uncomfortable sensations in the legs and sleep disorders. In general, two clinical forms of RLS are described: primary and secondary. Although primary RLS has a familial component, the underlying mechanism is still not fully understood but seems to be related to abnormalities in the dopaminergic and glutamatergic pathways of the central nervous system. The secondary forms of the syndrome are associated with iron deficiency, renal failure, pregnancy, diabetes mellitus, peripheral neuropathy, and several rheumatologic disorders such as rheumatoid arthritis and Sjögren's syndrome. In a few clinical trials, an increased frequency of RLS has been reported in patients with spondyloarthritis. In this report, a case of coexistence of spondyloarthritis and RLS is presented, showing satisfactory improvement with conservative treatment and additionally adding naproxen. Anemia of chronic disease occurring in rheumatic diseases, and associated iron deficiency may contribute to the development of RLS.
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Affiliation(s)
- E Yılmaz
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakıf University, Istanbul.
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14
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Stisen ZR, Skougaard M, Christensen KR, Ainsworth MA, Hansen RL, Thomsen SF, Mogensen M, Dreyer L, Kristensen LE, Jørgensen TS. Exploring disease-related and treatment-related issues and concerns experienced by adults with spondyloarthritis, inflammatory bowel disease and psoriasis to identify unmet needs: a qualitative clinical concept mapping study. BMJ Open 2023; 13:e071586. [PMID: 38081674 PMCID: PMC10729280 DOI: 10.1136/bmjopen-2023-071586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Exploring patients' perspectives for significant factors of relevance in living with a chronic disease is important to discover unmet needs and challenges. The primary objective of this study was to explore disease-related and treatment-related issues and concerns experienced by adults with spondyloarthropathies (SpA) and associated diseases. As a secondary objective, we wanted to explore whether these factors were generic or disease dependent. DESIGN We used group concept mapping (GCM), a validated qualitative method, to identify disease-related and treatment-related issues and concerns. Participants generated statements in the GCM workshops and organised them into clusters to develop concepts. Furthermore, participants rated each statement for importance from 1: 'not important at all' to 5: 'of great importance'. SETTING Participants were recruited during routine care at the outpatient clinic at the hospitals in the period from May 2018 to July 2022. PARTICIPANTS Eligible participants were adults ≥18 years and diagnosed with axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA), psoriasis (PsO) or inflammatory bowel disease -split into Crohn's disease (CD) and ulcerative colitis (UC). RESULTS 52 patients participated in the 11 workshops divided into groups according to their diagnosis. They created a total of 1275 statements that generated 10 AxSpA concepts, 7 PsA concepts, 7 PsO concepts, 10 CD concepts and 11 UC concepts. The highest rated concepts within each disease group were: AxSpA, 'lack of understanding/to be heard and seen by healthcare professionals' (mean rating 4.0); PsA, 'medication (effects and side effects)' (mean rating 3.8); PsO, 'social and psychological problems, the shame' (mean rating 4.0); CD, 'positive attitudes' (mean rating 4.3) and UC; 'take responsibility and control over your life' (mean rating 4.0). CONCLUSION People with SpA and associated diseases largely agree on which concepts describe their disease-related and treatment-related issues and concerns with a few of them being more disease-specific.
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Affiliation(s)
- Zara R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Marie Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mark Andrew Ainsworth
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Rebekka Lund Hansen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
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15
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Miloslavsky EM. Approach to laboratory ordering and interpretation in rheumatology. Postgrad Med J 2023; 99:954-961. [PMID: 37117152 DOI: 10.1136/pmj-2022-141864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
Abstract
Evaluation of suspected rheumatic disease is a significant challenge due to overlapping and sometimes non-specific clinical features. Most laboratory tests in rheumatic disease have incomplete sensitivity and specificity, leading to positive results without disease and negative results despite disease presence. Therefore, judicious ordering and correct interpretation of laboratory testing in rheumatology is critical in order to provide high-value care. Herein we review laboratory testing in rheumatology in the context of a framework for approaching rheumatic disease.
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Affiliation(s)
- Eli M Miloslavsky
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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16
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Betsinger TK, Scott AB. Back-to-back: The co-occurrence of DISH and ankylosing spondylitis from early modern Poland. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:1-6. [PMID: 36375277 DOI: 10.1016/j.ijpp.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This case study evaluates an individual with skeletal changes consistent with DISH and ankylosing spondylitis. We present here an evaluation of the individual's pathological skeletal changes and a review of the potential diagnoses. Finally, we offer a differential diagnosis of co-morbidity infrequently found in the paleopathological record. MATERIALS The skeletal remains of a male, aged 50 + years from the early modern Polish (17th-18th century CE) site of Drawsko 1. METHODS Skeletal remains were examined for the presence of spondyloarthropathies. RESULTS The individual presented with anterolateral fusion of the vertebral bodies of T6-T10 with a "dripping candle wax" appearance, fusion of the right costovertebral joint at rib 8, fusion of the left apophyseal joints of T8-T10, and the calcification of the supraspinous ligament at T3-T4. The left sacroiliac joint shows intra-articular and para-articular fusion; the right has bony changes consistent with ongoing fusion. Entheseal reactions were noted on the left clavicle, scapulae, first metacarpals, ulnae, and humerii. Diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis (AS), reactive arthritis (RA), psoriatic arthritis (PA), and enteropathic arthritis (EA) are considered as differential diagnoses. CONCLUSIONS Based on the skeletal pattern of involvement, the individual suffered from both DISH and AS, which has previously been reported once in the paleopathological literature since 1950. The clinical literature indicates that co-occurrence of these two conditions is possible, with approximately 40 individuals affected. SIGNIFICANCE This case study is significant for demonstrating the co-occurrence of DISH and AS in the paleopathological record. Additionally, this case contributes to the understanding of heterogenous frailty and syndemics. LIMITATIONS No radiographs were taken to confirm the differential diagnosis. No aDNA analysis was conducted. SUGGESTIONS FOR FURTHER RESEARCH The remains have been reburied; no further analysis is possible.
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Affiliation(s)
- Tracy K Betsinger
- Department of Anthropology, SUNY Oneonta, 108 Ravine Parkway, 138 Physical Sciences, Oneonta, NY 13820, United States.
| | - Amy B Scott
- Department of Anthropology, University of New Brunswick, 13 Macaulay Lane, Annex C, Suite 28, Fredericton, NB E3B 5A3, Canada.
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Bhagavathula AS, Bentley BL, Woolf B, Dissanayaka TD, Rahmani J. Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis. REUMATOLOGÍA CLÍNICA 2023; 19:136-142. [DOI: 10.1016/j.reuma.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
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Bhagavathula AS, Bentley BL, Woolf B, Dissanayaka TD, Rahmani J. Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis. REUMATOLOGIA CLINICA 2023; 19:136-142. [PMID: 36906389 DOI: 10.1016/j.reumae.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/28/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke. METHODS A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity. RESULTS A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33-1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23-1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=-0.0010, P=0.951). CONCLUSION This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy at Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Barry L Bentley
- Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, UK; Collaboration for the Advancement of Sustainable Medical Innovation, University College London, London, UK
| | - Benjamin Woolf
- Department of Psychological Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Thusharika D Dissanayaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Reijnierse M. Axial Skeleton Bone Marrow Changes in Inflammatory Rheumatologic Disorders. Semin Musculoskelet Radiol 2023; 27:91-102. [PMID: 36868247 PMCID: PMC9984269 DOI: 10.1055/s-0043-1761496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Magnetic resonance imaging (MRI) of the axial skeleton, spine, and sacroiliac (SI) joints is critical for the early detection and follow-up of inflammatory rheumatologic disorders such as axial spondyloarthritis, rheumatoid arthritis, and SAPHO/CRMO (synovitis, acne, pustulosis, hyperostosis, and osteitis/chronic recurrent multifocal osteomyelitis). To offer a valuable report to the referring physician, disease-specific knowledge is essential. Certain MRI parameters can help the radiologist provide an early diagnosis and lead to effective treatment. Awareness of these hallmarks may help avoid misdiagnosis and unnecessary biopsies. A bone marrow edema-like signal plays an important role in reports but is not disease specific. Age, sex, and history should be considered in interpreting MRI to prevent overdiagnosis of rheumatologic disease. Differential diagnoses-degenerative disk disease, infection, and crystal arthropathy-are addressed here. Whole-body MRI may be helpful in diagnosing SAPHO/CRMO.
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Affiliation(s)
- Monique Reijnierse
- Musculoskeletal Radiology, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Wang CR, Tsai HW. Seronegative spondyloarthropathy-associated inflammatory bowel disease. World J Gastroenterol 2023; 29:450-468. [PMID: 36688014 PMCID: PMC9850936 DOI: 10.3748/wjg.v29.i3.450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Seronegative spondyloarthropathy (SpA) usually starts in the third decade of life with negative rheumatoid factor, human leukocyte antigen-B27 genetic marker and clinical features of spinal and peripheral arthritis, dactylitis, enthesitis and extra-articular manifestations (EAMs). Cases can be classified as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, or juvenile-onset spondyloarthritis. Joint and gut inflammation is intricately linked in SpA and inflammatory bowel disease (IBD), with shared genetic and immunopathogenic mechanisms. IBD is a common EAM in SpA patients, while extraintestinal manifestations in IBD patients mostly affect the joints. Although individual protocols are available for the management of each disease, the standard therapeutic guidelines of SpA-associated IBD patients remain to be established. Nonsteroidal anti-inflammatory drugs are recommended as initial therapy of peripheral and axial SpA, whereas their use is controversial in IBD due to associated disease flares. Conventional disease-modifying anti-rheumatic drugs are beneficial for peripheral arthritis but ineffective for axial SpA or IBD therapy. Anti-tumor necrosis factor monoclonal antibodies are effective medications with indicated use in SpA and IBD, and a drug of choice for treating SpA-associated IBD. Janus kinase inhibitors, approved for treating SpA and ulcerative colitis, are promising therapeutics in SpA coexistent with ulcerative colitis. A tight collaboration between gastroenterologists and rheumatologists with mutual referral from early accurate diagnosis to appropriately prompt therapy is required in this complex clinical scenario.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
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21
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Gutiérrez-Sánchez J, Parra-Izquierdo V, Flórez-Sarmiento C, Jaimes DA, De Ávila J, Bello-Gualtero JM, Ramos-Casallas A, Chila-Moreno L, Pacheco-Tena C, Beltrán-Ostos A, Chalem-Choueka P, Bautista-Molano W, Romero-Sánchez C. Implementation of screening criteria for inflammatory bowel disease in patients with spondyloarthritis and its association with disease and endoscopic activity. Clin Rheumatol 2023; 42:415-422. [PMID: 36053473 PMCID: PMC9873707 DOI: 10.1007/s10067-022-06297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
There is little literature on the implementation of screening criteria for inflammatory bowel disease (IBD) in patients with spondyloarthritis (SpA). This study aimed to apply IBD screening criteria in a group of patients with SpA without IBD diagnosis and correlate them to endoscopic findings and disease activity. A total of 82 patients with SpA were included. The IBD screening test and ileocolonoscopy with digital chromoendoscopy with magnification and histological analysis were performed. The data were analysed with Chi-square test/Fisher's exact test and multiple correspondence analysis. The major screening criteria found in 48.7% of the patients were associated with a history of infection (p = 0.037). Rectal bleeding was associated with the diagnosis of ankylosing spondylitis, acute inflammation, enthesitis and tissue architecture alteration in the ileum (p < 0.050). Diarrhoea was associated with a higher disease activity score (p = 0.02). Minor screening criteria were associated with painful inflammatory joint (p = 0.05), high disease activity score (p = 0.001) and high calprotectin levels (p = 0.050). Abdominal pain (36.9%) was associated with axial/peripheral compromise (p = 0.017), inflammatory back pain (p = 0.01), enthesitis (p = 0.021), higher disease activity score (p = 0.023) and acute ileum inflammation (p = 0.046). Diarrhoea of 4 weeks and abdominal pain were the most prevalent major and minor screening criteria, respectively, being related to early manifestations of inflammatory bowel compromise and higher disease activity score. This screening test grants a chance of opportune referral of SpA patients from rheumatology to gastroenterology.
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Affiliation(s)
- Jaiber Gutiérrez-Sánchez
- grid.466717.50000 0004 0447 449XRheumatology and Immunology Department/Clinical Immunology Group, Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412208.d0000 0001 2223 8106School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada/Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia
| | - Viviana Parra-Izquierdo
- grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia ,Gastroadvanced SAS IPS, Carrera 23 # 45C-31, Bogotá, Colombia
| | - Cristian Flórez-Sarmiento
- grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia ,Gastroadvanced SAS IPS, Carrera 23 # 45C-31, Bogotá, Colombia
| | | | - Juliette De Ávila
- grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
| | - Juan Manuel Bello-Gualtero
- grid.466717.50000 0004 0447 449XRheumatology and Immunology Department/Clinical Immunology Group, Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412208.d0000 0001 2223 8106School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada/Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia
| | - Alejandro Ramos-Casallas
- grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
| | - Lorena Chila-Moreno
- grid.412208.d0000 0001 2223 8106School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada/Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
| | - César Pacheco-Tena
- Investigación Y Biomedicina De Chihuahua S.C., Calle 16 # 1600, Chihuahua, Chihuahua México
| | - Adriana Beltrán-Ostos
- grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
| | - Philippe Chalem-Choueka
- grid.488837.8Fundación Instituto de Reumatología Fernando Chalem, Calle 73 # 20A - 27, Bogotá, Colombia
| | - Wilson Bautista-Molano
- grid.412208.d0000 0001 2223 8106School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada/Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
| | - Consuelo Romero-Sánchez
- grid.466717.50000 0004 0447 449XRheumatology and Immunology Department/Clinical Immunology Group, Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412208.d0000 0001 2223 8106School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada/Hospital Militar Central, Transversal 3ª # 49-00, Bogotá, Colombia ,grid.412195.a0000 0004 1761 4447School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Av. Carrera 9 # 131A-02, Bogotá, Colombia
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22
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Evaluation of middle ear and hearing status of ankylosing spondylitis patients with wideband tympanometry and pure tone audiometry tests. Eur Arch Otorhinolaryngol 2022; 280:2273-2281. [PMID: 36385656 DOI: 10.1007/s00405-022-07750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the middle and inner ear function and hearing status of Ankylosing spondylitis (AS) patients. METHODS One hundred twenty-four ears of 62 patients with AS and 90 ears (control group) of 45 healthy subjects were included in the study. The hearing levels of the participants were assessed with pure tone and high-frequency audiometry at the octave frequency between 250 and 16,000 Hz. The absorbance rates and resonance frequencies of middle ear were measured with the wideband tympanometry (WBT) test. AS group was divided into subgroups based on the disease activity, duration of follow-up, medications used for AS, and the subgroups were compared according to hearing status and absorbance and resonance frequencies of middle ears. RESULTS A statistically significant difference was found between the AS and control groups in terms of air and bone conduction thresholds at frequencies of 250, 500, 1000, 2000, and 4000 Hz and the mean PTA1, PTA2, and PTA3 values (p < 0.05). In contrast, no statistically significant difference was observed between two groups in terms of high-frequency thresholds (8000-16,000 Hz). Although the middle ear resonance frequency obtained from the WBT test was higher in the AS group compared to the control group, no significant difference was observed (p > 0.05). The severity of disease adversely affected the hearing threshold at 250, and 500 Hz for air conduction, at 500 Hz for bone conduction threshold, and at PTA1 (p < 0.05). The duration and severity of disease did not affect absorbance values of WBT (p > 0.05). CONCLUSION To our knowledge, this is the first study to demonstrate the effects of AS patients on the middle ear function with WBT and to report middle ear absorbance values and resonance frequency changes in AS patients. The higher resonance frequency values found by WBT in AS patients may be due to the stiffness that develops as a result of middle ear involvement. According to pure tone and high-frequency audiometry findings, it has been seen that AS leads to SNHL especially at low frequencies.
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23
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Güzel Ş, Umay E, Öztürk EA, Gürçay E. Foot Deformity in Patients With Ankylosing Spondylitis: Is It Associated With Functionality and Disease Activity? J Foot Ankle Surg 2022; 61:1017-1022. [PMID: 35227596 DOI: 10.1053/j.jfas.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 11/08/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Foot involvement affects mobility and functionality in patients with ankylosing spondylitis but it remains unknown if foot deformities in ankylosing spondylitis patients affect functionality, disease activity, and quality of life. The aim of this study was to evaluate in detail the presence of a relationship between radiologically detected foot deformities in ankylosing spondylitis patients and both clinical and electrophysiological findings. The cross-sectional study included 110 patients with ankylosing spondylitis who were diagnosed according to the Assessment in Spondyloarthritis International Society criteria and were followed in our hospital. Demographic and clinical data of all patients were recorded. Bilateral lateral foot x-rays and electrophysiology examinations were evaluated in all subjects. The arch in the dominant foot of the patients was classified in 3 groups as pes cavus, pes planus, or normal. The clinical outcomes, physical examination and electrophysiological findings were compared between the groups, and correlations were examined of the foot deformities with these parameters. Foot deformities were determined at a high rate (74.5%). These deformities affected foot pain, disability and quality of life. Pes cavus deformity was found to be associated with hip pain and enthesopathy. In the electrophysiological studies, the presence of pes planus was found to be associated with the findings of the tibial and sural nerve conduction studies, and the presence of pes cavus with the findings of the peroneal nerve conduction study. In conclusion, foot deformities may have an effect on the quality of life and functionality in ankylosing spondylitis patients.
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Affiliation(s)
- Şükran Güzel
- Baskent University, Faculty of Medicine, Physical Medicine and Rehabilitation Clinic, Ankara Hospital, Ankara, Turkey.
| | - Ebru Umay
- Associate Professor, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
| | - Erhan Arif Öztürk
- Associate Professor, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
| | - Eda Gürçay
- Professor, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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24
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Medrado LN, Mendonça MLM, Budib MB, Oliveira-Junior SA, Martinez PF. Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review. Rheumatol Int 2022; 42:1681-1691. [PMID: 35633390 DOI: 10.1007/s00296-022-05145-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/05/2022] [Indexed: 01/01/2023]
Abstract
Spondyloarthritis and rheumatoid arthritis are classified as inflammatory arthritis and represent a significant source of pain and disability. Non-pharmacological intervention with physical exercise is among the therapeutic approaches most used by health professionals. This study aimed to investigate the effectiveness of aquatic exercise in the treatment of inflammatory arthritis. The review was registered on the PROSPERO (CRD42020189602). The databases (PubMed, PEDro, Web of Science, and SciELO) were searched for studies involving adults with inflammatory arthritis and subjected to rehabilitation with aquatic exercise compared to any other control group, from the year 2010 to March 2022. Pain, disease activity, and physical function were regarded as primary outcomes. Two reviewers completed the eligibility screening and data extraction, and disagreements were resolved by a third reviewer. The methodological quality was assessed using the PEDro scale. A total of 5254 studies were identified, and nine articles were included, totalling 604 participants. Regarding pain, two studies showed that aquatic exercise was superior to home exercise. One study showed that disease activity was significantly improved in the aquatic group compared to the land-based exercise and the control groups (no exercise). Two studies reported that therapy containing aquatic exercise was able to improve physical function. Overall, the studies included in this review indicate that aquatic exercise is effective in treating pain, disease activity, and physical function in individuals with inflammatory arthritis. However, further studies carrying stronger evidence should be conducted to determine whether the treatment with aquatic exercise is superior to other types of therapies.
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Affiliation(s)
- Larissa Nakahata Medrado
- Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil
| | - Maria Lua Marques Mendonça
- Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil
| | - Mariana Bogoni Budib
- Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil
| | - Silvio Assis Oliveira-Junior
- Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil
| | - Paula Felippe Martinez
- Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil.
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25
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Azadeh H, Alizadeh-Navaei R, Rezaiemanesh A, Rajabinejad M. Immune-related adverse events (irAEs) in ankylosing spondylitis (AS) patients treated with interleukin (IL)-17 inhibitors: a systematic review and meta-analysis. Inflammopharmacology 2022; 30:435-451. [PMID: 35188599 DOI: 10.1007/s10787-022-00933-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by immune system dysregulation and inflammation in the joints. Interleukin (IL)-17 inhibitors are new biological drugs used to treat AS. In this study, we aimed to assess the risk of immune system-related AEs due to targeting IL-17 or IL-17R. METHODS The CENTRAL, PubMed, Scopus, Google Scholar, Clinical Trials Registry, and ICTRP were searched for randomized clinical trials (RCTs) and non-RCTs until February 2021. The risk of irAEs in patients treated with IL-17 inhibitors compared to the placebo or a drug-free control was evaluated. In studies that reported AEs of the IL-17 inhibitors at several different time points, we compared the number of cases/100 patient-year in which irAEs were reported. Subgroup analyses were also performed based on the dose and type of drugs. RESULTS Thirteen studies of 1848 AS patients treated by IL-17 inhibitors (secukinumab, ixekizumab, bimekizumab, and netakimab) and 764 participants who received a placebo were included. The risk of some AEs related to immune function in patients under IL-17 inhibitors treatment was significantly higher than that of the placebo group, including infection and infestation (risk difference RD = 0.09, P = 0.02), nasopharyngitis (RD = 0.04, P < 0.001), opportunistic infections (RD = 0.01, P = 0.04), and neutropenia (RD = 0.04, P = 0.03). Besides, the results of the Cochran Q test showed that there were significant differences between the occurrence of some AEs over time, including infection and infestations (p < 0.001, RCTs), upper respiratory tract infections (p < 0.001, non-RCTs), urinary tract infections (p < 0.001, non-RCTs), and diarrhea (p < 0.01, RCTs). CONCLUSIONS The most common immune system-related AEs in patients treated with IL-17 inhibitors are mucosal and opportunistic infections.
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Affiliation(s)
- Hossein Azadeh
- Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Rezaiemanesh
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Misagh Rajabinejad
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, 18 km khazarabad, Sari, Iran.
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26
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Bengtsson K, Forsblad-d'Elia H, Deminger A, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LTH. Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis: results from a national register-based cohort study. Rheumatology (Oxford) 2021; 60:2725-2734. [PMID: 33216939 PMCID: PMC8213429 DOI: 10.1093/rheumatology/keaa692] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/07/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To estimate the incidence and strength of association of extra-articular manifestations [EAMs, here: anterior uveitis (AU), IBD and psoriasis] in patients with AS, undifferentiated SpA (uSpA) and PsA, compared with controls. METHODS Three mutually exclusive cohorts of patients aged 18-69 years with AS (n = 8517), uSpA (n = 10 245) and PsA (n = 22 667) were identified in the Swedish National Patient Register 2001-2015. Age-, sex- and geography-matched controls were identified from the Swedish Population Register. Follow-up began 1 January 2006, or six months after the first SpA diagnosis, whichever occurred later, and ended at the first date of the EAM under study, death, emigration, 70 years of age, and 31 December 2016. Incidence rates (IRs) and incidence rate ratios were calculated for each EAM, and stratified by sex and age. RESULTS Incidence rate ratios for incident AU, IBD and psoriasis were significantly increased in AS (20.2, 6.2, 2.5), uSpA (13.6, 5.7, 3.8) and PsA (2.5, 2.3, n.a) vs controls. Men with AS and uSpA had significantly higher IRs per 1000 person-years at risk for incident AU than women with AS (IR 15.8 vs 11.2) and uSpA (IR 10.1 vs 6.0), whereas no such sex difference was demonstrated in PsA or for the other EAMs. CONCLUSIONS AU, followed by IBD and psoriasis, is the EAM most strongly associated with AS and uSpA. Among the SpA subtypes, AS and uSpA display a largely similar pattern of EAMs, whereas PsA has a considerably weaker association with AU and IBD.
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Affiliation(s)
- Karin Bengtsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Anna Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Sofia Exarchou
- Department of Clinical Sciences, Lund University, Malmö and Helsingborg, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
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27
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Lu CC, Huang GS, Lee TSH, Chao E, Chen HC, Guo YS, Chu SJ, Liu FC, Kao SY, Hou TY, Chen CH, Chang DM, Lyu SY. MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis. J Transl Med 2021; 19:298. [PMID: 34243762 PMCID: PMC8268359 DOI: 10.1186/s12967-021-02959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27. Methods One hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage. Results All individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001). Conclusion Structural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.
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Affiliation(s)
- Chun-Chi Lu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology, University of Washington, Seattle, USA
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, National Defense Medical Center, National Defense Medical Center, No. 100, Zhengrong St., Zhongzheng Dist, Keelung City, 202, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - En Chao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.,Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yong-Si Guo
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Cheng Liu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Kao
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Yun Hou
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chen-Hung Chen
- Division of Rheumatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Deh-Ming Chang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Sin-Yi Lyu
- Division of Radiology, Tri-Service General Hospital, National Defense Medical Center, Keelung branch, Taipei, Taiwan.
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28
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Neves JSF, Visentainer JEL, Reis DMDS, Rocha Loures MA, Alves HV, Zacarias JMV, Sell AM. IL17F: A Possible Risk Marker for Spondyloarthritis in HLA-B*27 Negative Brazilian Patients. J Pers Med 2021; 11:jpm11060520. [PMID: 34200121 PMCID: PMC8228173 DOI: 10.3390/jpm11060520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/24/2022] Open
Abstract
HLA-B*27 is an important marker for spondyloarthritis (SpA), however, many SpA patients are HLA-B*27 negative. Thus, the aim of this study was to investigate the influence of IL17, TNF and VDR gene polymorphisms in SpA patients who were HLA-B*27 negative. This case-control study was conducted in 158 patients [102 patients with ankylosing spondylitis (AS) and 56 with psoriatic arthritis (PsA)] and 184 controls. HLA-B*27 genotyping was performed using PCR-SSP and IL17A (rs2275913), IL17F (rs763780), TNF-308 (rs1800629), TNF-238 (rs361525), FokI C>T (rs2228570), TaqI C>T (rs731236), ApaI A>C (rs7975232), and BsmI C>T (rs1544410) using PCR-RFLP. Statistical analyses were performed by Chi-square and logistic regression using OpenEpi and SNPStats software. The IL17F C allele frequency was higher in patients with SpA, AS and PsA compared to controls. The IL17F T/C genotype frequency was higher in SpA patients in an overdominant inheritance model and when men and women were separately analyzed. IL17A_IL17F AC haplotype was significantly associated to the risk for SpA patients. As for VDR, the ApaI a/a was a potential risk factor for SpA in men. In conclusion, IL17F C variant contributed to the risk of SpA in Brazilian patients who were HLA-B*27 negative and could be a potential marker for SpA.
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Affiliation(s)
- Janisleya Silva Ferreira Neves
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
| | - Jeane Eliete Laguila Visentainer
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine and Department of Basic Health Sciences, Maringá State University, Paraná 87030-900, Brazil
| | - Denise Manjurma da Silva Reis
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
| | - Marco Antonio Rocha Loures
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
- Department of Medicine, Maringa State University, Paraná 87030-900, Brazil
| | - Hugo Vicentin Alves
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
| | - Joana Maira Valentini Zacarias
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
- Correspondence: or ; Tel.: +55-44-99961-7338
| | - Ana Maria Sell
- Post Graduation Program in Biosciences and Physiopathology, Department of Clinical Analysis and Biomedicine, Maringá State University, Paraná 87030-900, Brazil; (J.S.F.N.); (J.E.L.V.); (D.M.d.S.R.); (M.A.R.L.); (H.V.A.); (A.M.S.)
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29
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Carlin E, Marzo-Ortega H, Flew S. British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. Int J STD AIDS 2021; 32:986-997. [PMID: 34014782 DOI: 10.1177/09564624211020266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
These guidelines update the 2008 UK guideline for the management of sexually acquired reactive arthritis. The guideline is aimed at those over the age of 16 years, presenting to healthcare professionals working in sexual health services. The recommendations are primarily aimed at services offering level 3 care in sexually transmitted infection management within the United Kingdom. However, the principles will apply to those presenting to level 1 and 2 services, and appropriate local referral pathways will need to be developed.
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Affiliation(s)
- Elizabeth Carlin
- Integrated Sexual Health Service, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK.,Integrated Sexual Health Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 246751University of Leeds, Leeds, UK
| | - Sarah Flew
- Integrated Sexual Health Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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30
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Carbo MJ, Paap D, Maas F, Baron AJ, van Overbeeke LC, Siderius M, Bootsma H, Wink F, Arends S, Spoorenberg A. The mSQUASH; a valid, reliable and responsive questionnaire for daily physical activity in patients with axial spondyloarthritis. Semin Arthritis Rheum 2021; 51:719-727. [PMID: 34144381 DOI: 10.1016/j.semarthrit.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023]
Abstract
AIM Adaptation of the Short QUestionnaire to Assess Health-enhancing physical activity (SQUASH) in order to improve measurement properties in axSpA patients. METHODS The original SQUASH was adapted using a qualitative stepwise approach with in-depth interviews including healthcare professionals and patients. Content validity was explored by comparing modified-SQUASH (mSQUASH) and original SQUASH. Next, mSQUASH was validated according to the OMERACT filter. International Physical Activity Questionnaire (IPAQ) was used as comparator and tri-axial accelerometer as gold standard for criterion validity and classification accuracy of intensity. Construct validity was assessed using Spearman correlations with clinical outcome assessments. For test-retest reliability, intra-class correlation coefficients (ICCs) were calculated. Responsiveness was assessed using standardized response mean (SRM), stratified by Anchor method. RESULTS The mSQUASH measured a systematically higher activity count and had less missing values (8% vs. 16%) then SQUASH. mSQUASH correlated better with accelerometer compared to IPAQ (ρ = 0.60 vs. ρ = 0.34). Accelerometer measured most activity in light intensity, whereas mSQUASH and IPAQ predominately measured moderate intensity. Correlations with ASDAS, BASDAI, BASFI and ASQoL were better for mSQUASH then IPAQ. Test-retest reliability was good in both questionnaires. In contrast to IPAQ, responsiveness was in correspondence with self-reported changes in physical activity for mSQUASH (SRM -0.84 for improvement and 0.88 for decrease). The average completion time of the mSQUASH was 7 minutes. CONCLUSIONS The development of the mSQUASH resulted in an easy applicable, valid, reliable and responsive questionnaire for the assessment of daily physical activity in axSpA patients, which can be used in research and daily clinical practice.
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Affiliation(s)
- Marlies Jg Carbo
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Davy Paap
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Rehabilitation Medicine, University of Medical Center Groningen, University of Groningen, the Netherlands
| | - Fiona Maas
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands; Department of Rehabilitation Medicine, University of Medical Center Groningen, University of Groningen, the Netherlands
| | - Anna Jetske Baron
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Laura C van Overbeeke
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Mark Siderius
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Freke Wink
- Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
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31
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Increased prevalence of pelvic venous congestion sign on sacroiliac MRI in women with clinically suspected sacroiliitis. North Clin Istanb 2021; 7:551-556. [PMID: 33381693 PMCID: PMC7754859 DOI: 10.14744/nci.2020.48030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/29/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To compare the prevalence of pelvic venous congestion (PVC) sign on sacroiliac and hip MRI in women of reproductive age as a possible cause of pain mimicking sacroiliitis. METHODS: This retrospective study included 727 MRI examinations (401 sacroiliac joint MRI and 326 hip joint MRI) that were performed between January 2010 and December 2017. Images were evaluated for the presence of sacroiliitis, presence of PVC sign and presence of other incidental findings of musculoskeletal and genitourinary disorders. After removing patients with other musculoskeletal and genitourinary disorders that may cause pain (n=188), remaining 539 (322 sacroiliac and 217 hip), MRI examinations were re-analyzed for the presence of PVC sign. RESULTS: Four hundred one patients with sacroiliac MRI examination had 120 (29.9%) PVC sign and 326 patients with hip MRI examinations had 54 (16.6%) PVC sign (p<0.001). After removing patients with other musculoskeletal and genitourinary disorders that may cause pain, 322 patients with sacroiliac MRI had 102 (31.7%) PVC sign and 217 patients with hip MRI examinations had 38 (17.5%) PVC sign (p<0.001). No significant difference was found between patients with acute sacroiliitis and patients without acute sacroiliitis concerning PVC prevalence (p>0.05). There were also no significant differences between other comparable incidental findings. CONCLUSION: Significantly increased PVC prevalence in sacroiliac MRI exams may be attributable to PCS simulating clinical sacroiliitis.
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32
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Alahmari ASA, Qari SK, Asiri RI, Almohammadi TA, Alalawi MA, Aljahdali HM, Alnasser AH, Alaqeel FA, Kazim OA, Qasem HAO. An Overview on the Role of Surgical Management in Ankylosing Spondylitis. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/9azbvu4zlt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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33
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Atzeni F, Nucera V, Gerratana E, Fiorenza A, Gianturco L, Corda M, Sarzi-Puttini P. Cardiovascular Consequences of Autoimmune Rheumatic Diseases. Curr Vasc Pharmacol 2020; 18:566-579. [PMID: 31985379 DOI: 10.2174/1570161118666200127142936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 12/23/2022]
Abstract
The increased risk of cardiovascular disease (CVD) among patients with autoimmune rheumatic diseases such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus has been extensively documented. Sub-clinical atherosclerosis can be assessed using various non-invasive imaging techniques. However, the mechanisms underlying the higher risk of atherosclerotic CVD in patients with autoimmune rheumatic diseases are not fully known, although they seem to include chronic low-grade systemic inflammation leading to prolonged endothelial activation, accompanied by a pro-thrombotic/pro-coagulant and autoantibody state. Furthermore, sub-clinical atherosclerosis is also influenced by other traditional risk factors for CVD. Including the individual components of the metabolic syndrome (MetS: obesity, impaired glucose metabolism, dyslipidemia and high blood pressure), the degree of which is higher in these patients than in controls. The aim of this narrative review is to discuss the CV manifestations and risk factors involved in the increased risk of CVD among patients with autoimmune rheumatic diseases.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, Messina, Italy
| | | | | | - Luigi Gianturco
- Cardiology Unit, Beato Matteo Hospital, GSD Hospitals, Vigevano, Pavia, Italy
| | - Marco Corda
- Cardiology Unit, Brotzu Hospital, Cagliari, Italy
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34
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Grinnell-Merrick LL, Lydon EJ, Mixon AM, Saalfeld W. Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature. Rheumatol Ther 2020; 7:667-684. [PMID: 32935330 PMCID: PMC7695767 DOI: 10.1007/s40744-020-00234-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic immune-mediated disease characterized by psoriatic skin and nail changes, peripheral joint inflammation, enthesitis, dactylitis, and/or axial involvement, either alone or in combination with each other. The presence of axial involvement has been shown to be a marker of PsA severity; however, there is no widely accepted definition of axial involvement in PsA (axPsA) or consensus on how or when to screen and treat patients with suspected axPsA. Chronic back pain is a prominent feature of axPsA and is thought to have a relevant role in early identification of disease. Chronic back pain can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). However, MBP can complicate recognition of IBP and delay diagnosis of axPsA. While MBP can also be associated with chronic back pain of ≥ 3 months in duration that is typical of IBP, IBP is characterized by inflammation of the sacroiliac joint and lower spine that is differentiated from MBP by key characteristic features, including insidious onset at age < 40 years, improvement with exercise but not with rest, and nighttime pain. This review discusses the differences in identification and management of IBP and MBP in patients with PsA with axPsA. The summary of available evidence highlights the importance of appropriate and timely screening, difficulties and limitations of differential diagnoses and treatment, and unmet needs in axPsA.
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Affiliation(s)
| | | | - Amanda M Mixon
- Arthritis and Rheumatology Clinic of Northern Colorado, Fort Collins, CO, USA
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35
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Razumova IY, Godzenko AA. [Nonsteroidal anti-inflammatory drugs in the treatment of anterior uveitis associated with spondyloarthritis]. Vestn Oftalmol 2020; 136:70-77. [PMID: 33084282 DOI: 10.17116/oftalma202013606170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anterior uveitis (AU) is one of the common extraskeletal manifestations of spondyloarthritis (SpA). The course of AU in patients with SpA is characterized by frequent relapses. The article considers the question of local and systemic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of SpA-associated uveitis exacerbations.
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Affiliation(s)
| | - A A Godzenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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36
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Roussou E. Spondyloarthritis in African Populations Compared to Europeans Living in the United Kingdom. Mediterr J Rheumatol 2020; 32:39-55. [PMID: 34386701 PMCID: PMC8314888 DOI: 10.31138/mjr.32.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 08/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background: With the aim to study Spondyloarthritis in patients originating from Africa and compare the disease with the way it is manifested in Europeans, data was analysed from 62 African patients and compared with 56 Europeans living in the same geographical area (north East London, United Kingdom) and treated under the same health system (NHS). Data analysed were demographic, social and clinical characteristics. Results: Comparisons showed differences in prevalence of psoriasis (more in Caucasians), uveitis (more in Africans), smoking (more in Europeans), and significantly fewer patients of African origin declared family history of SpA. African patients have less disease activity (but not significantly better measured by BASDAI), and statistically significant better functional ability (BASFI) compared to Europeans. No difference has been noted in gender distribution, age of disease onset, disease duration, delay in diagnosis, disease associations with IBD, night pain, or overall wellbeing. Conclusions: SpA is different in Africans in that it shows to be milder in terms of disease activity and functional ability with more uveitis less psoriasis and less family history of SpAs.
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Affiliation(s)
- Euthalia Roussou
- Rheumatology Department, Department of Rheumatology and Rehabilitation, Barley Lanes, United Kingdom
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37
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Hossain RR, Al-Ani HH, Sims JL, Lindsay K, Niederer RL. Rates of spondyloarthropathies vary with age and ethnicity in HLAB27 uveitis. Br J Ophthalmol 2020; 105:1395-1398. [PMID: 32863277 DOI: 10.1136/bjophthalmol-2020-316150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/13/2020] [Accepted: 08/07/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS To determine associations between HLAB27-positive uveitis, ethnicity and seronegative spondyloarthropathies (SpAs) in a New Zealand population. METHODS Retrospective observational cohort study. Medical records of all subjects with uveitis at Auckland District Health Board from 2008 to 2018 were reviewed for HLAB27 status, age of presentation, ethnicity and SpA. RESULTS In 10 years, 2567 subjects with uveitis were seen and 492 (19.2%) were HLAB27-positive. Of the HLAB27-positive subjects, 301 were male (60.3%) and median age was 37.8 years (IQR 29.7-50.0). Ethnicities were Caucasian (n=298, 60.6%), Asian (n=111, 22.6%), Maori (n=41, 8.2%) and Pacific Islander (n=38, 7.7%). Uveitis classification was anterior (n=478, 97.2%), intermediate (n=40, 8.1%), panuveitis (n=9, 1.8%) and scleritis (n=2, 0.4%). Maori or Pacific Islander ethnicity was associated with intermediate or panuveitis (p=0.003). Ankylosing spondylitis occurred in 163 subjects (33.1%); 29 (17.8%) were Maori or Pacific Islander. Subjects were younger (OR 0.982, p=0.009) and male (OR 1.980, p=0.001). There was no association with ethnicity or uveitis classification. Psoriatic arthritis (PsA) occurred in 11 subjects (2.2%). Chronic anterior uveitis was more common with PsA (27.3% vs 7.1%, p=0.023). There was no association with gender or ethnicity. Inflammatory bowel disease occurred in 19 subjects (3.8%) and reactive arthritis occurred in 14 subjects (2.8%). None developed chronic anterior uveitis (p=0.246 and p=0.227, respectively). There was no association with age at presentation, gender, ethnicity or uveitis classification. CONCLUSION This cohort of New Zealand-based subjects with HLAB27-positive uveitis showed a difference in age and ethnicity in uveitis subtypes and SpAs.
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Affiliation(s)
- Ruhella R Hossain
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Haya H Al-Ani
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Karen Lindsay
- Department of Rheumatology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand .,Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
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38
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Vinci C, Infantino M, Raturi S, Tindell A, Topping LM, Strollo R, Amital H, Shoenfeld Y, Gertel S, Grossi V, Manfredi M, Rutigliano IM, Bandinelli F, Li Gobbi F, Damiani A, Pozzilli P, Mcinnes IB, Goodyear CS, Benucci M, Nissim A. Immunoglobulin A antibodies to oxidized collagen type II as a potential biomarker for the stratification of spondyloarthritis from rheumatoid arthritis. Scand J Rheumatol 2020; 49:281-291. [PMID: 32314641 DOI: 10.1080/03009742.2020.1713395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The discovery of diseased tissue-specific neoantigens offers the opportunity to develop important disease tissue-specific biomarkers that can help in the prediction, diagnosis, and stratification of diseases. This opportunity is specifically significant for autoimmune diseases where diagnostic biomarkers are not available. Inflammatory autoimmune diseases are commonly associated with local generation of large amounts of reactive oxidants. We have previously identified oxidative post-translationally modified (oxPTM) tissue-specific neoantigens in rheumatoid arthritis (RA) and type 1 diabetes that elicit an immune response. In the current study, we studied the presence and clinical significance of antibodies to oxPTM collagen type II (CII) in patients with spondyloarthritis (SpA). METHOD Levels of antibodies specific to native CII and oxPTM-CII were assessed by enzyme-linked immunosorbent assay. RESULTS Immunoglobulin G (IgG) binding to oxPTM-CII was observed in 52%, 83%, and 28% of serum samples from patients with axial spondyloarthritis (axSpA), RA, and psoriatic arthritis (PsA), respectively. Importantly, while strong IgA anti-oxPTM-CII responses were detected in axSpA and PsA patients, with 47% and 84% respective binders, no IgA anti-oxPTM-CII was detected in RA patients. IgA anti-oxPTM-CII reactivity in axSpA patients treated with biologics was higher and more frequent, with 85% binders compared to 9% binders in patients treated with synthetic disease-modifying anti-rheumatic drugs. CONCLUSION Our data imply that SpA and PsA are associated with the presence of antibodies to oxPTM-CII, suggesting that there may be a humoral component that may distinguish patients with SpA from RA. Our approach could be adapted to other diseases, particularly to inflammatory autoimmune diseases.
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Affiliation(s)
- C Vinci
- Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London , London, UK.,Department of Endocrinology and Diabetes, Campus Biomedico , Rome, Italy
| | - M Infantino
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital , Florence, Italy
| | - S Raturi
- Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London , London, UK
| | - A Tindell
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow, UK
| | - L M Topping
- Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London , London, UK
| | - R Strollo
- Department of Endocrinology and Diabetes, Campus Biomedico , Rome, Italy
| | - H Amital
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre , Ramat Gan, Israel
| | - Y Shoenfeld
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre , Ramat Gan, Israel
| | - S Gertel
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre , Ramat Gan, Israel
| | - V Grossi
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital , Florence, Italy
| | - M Manfredi
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital , Florence, Italy
| | - I M Rutigliano
- Rheumatology Unit, Sab.Giovanni di Dio Hospital , Florence, Italy
| | - F Bandinelli
- Rheumatology Unit, Sab.Giovanni di Dio Hospital , Florence, Italy
| | - F Li Gobbi
- Rheumatology Unit, Sab.Giovanni di Dio Hospital , Florence, Italy
| | - A Damiani
- Rheumatology Unit, Sab.Giovanni di Dio Hospital , Florence, Italy
| | - P Pozzilli
- Department of Endocrinology and Diabetes, Campus Biomedico , Rome, Italy
| | - I B Mcinnes
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow, UK
| | - C S Goodyear
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow, UK
| | - M Benucci
- Rheumatology Unit, Sab.Giovanni di Dio Hospital , Florence, Italy
| | - A Nissim
- Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London , London, UK
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39
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Reijnierse M. Radiographic/MR Imaging Correlation of Paravertebral Ossifications in Ligaments and Bony Vertebral Outgrowths: Anatomy, Early Detection, and Clinical Impact. Magn Reson Imaging Clin N Am 2020; 27:641-659. [PMID: 31575398 DOI: 10.1016/j.mric.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article focuses on the variety of imaging features of paravertebral ossifications that are of practical interest in the diagnosis of diseases. The spinal anatomy is reviewed and correlated to paravertebral ligamentous ossifications and their potential clinical impact. A vertebral bony outgrowth is secondary to inflammation or degeneration and can be characterized based on its origin and growth direction, in addition to appreciation of intervertebral disc space preservation or loss. Imaging in rheumatology patients is highlighted because early detection of disease is of increasing importance. A correlation between radiographs and MR imaging is made.
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Affiliation(s)
- Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300RC Leiden, The Netherlands.
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Jang HS, Proos A, Koe L, Anderson J, Fulton R, Fernando SL. High accuracy of HLA-B*27 genotyping by allele-specific real-time polymerase chain reaction in a heterogeneous population compared to flow cytometry and single nucleotide polymorphism detection assays. Pathology 2020; 52:256-261. [PMID: 31902620 DOI: 10.1016/j.pathol.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/29/2019] [Accepted: 09/15/2019] [Indexed: 12/17/2022]
Abstract
HLA-B27 is a risk marker for ankylosing spondylitis and other associated seronegative spondyloarthropathies. We compared three methods of HLA-B*27 typing in a New South Wales (NSW) population: flow cytometry, rs4349859 single nucleotide polymorphism (SNP) detection assay, and allele-specific real-time polymerase chain reaction (RT-PCR) analysis of exons 2 and 3. Over a 5-month period, 543 samples underwent flow cytometric testing and RT-PCR high-resolution melt analysis of rs4349859 SNP and of exon 2 (5' fragment) and exon 3. In the third method, positive samples were further analysed with fluorescent resonance emission transfer (FRET) RT-PCR of exon 2 fragments, 2a and 2b. HLA-B*27 and other genotypes were confirmed by Sanger sequencing of a 600 base pair fragment of exons 2 and 3. In our cohort, the rs4349859 SNP method had 78.6% sensitivity and 98.7% specificity. Screening with exon 2 (5' fragment) and exon 3 RT-PCR provided 100% sensitivity. Further testing with exon 2a and 2b FRET RT-PCR produced 100% specificity. This cascade approach with allele-specific RT-PCR assays was able to differentiate all samples into HLA-B*27 subtypes. HLA-B*27 genotyping with allele-specific RT-PCR assays, to screen for and confirm HLA-B27 positive samples, was more sensitive and specific than flow cytometry and rs4349859 SNP assays. It is a potentially cost-effective method for differentiating HLA-B27 subtypes. Our cascade genetic testing approach is suitable for replacing the current flow cytometric HLA-B27 assay for the heterogeneous NSW population.
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Affiliation(s)
- Helena S Jang
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Annè Proos
- Molecular Genetics Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lisa Koe
- Molecular Genetics Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Janet Anderson
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Richard Fulton
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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Haridy Y, Witzmann F, Asbach P, Reisz RR. Permian metabolic bone disease revealed by microCT: Paget's disease-like pathology in vertebrae of an early amniote. PLoS One 2019; 14:e0219662. [PMID: 31390345 PMCID: PMC6685605 DOI: 10.1371/journal.pone.0219662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/29/2019] [Indexed: 01/22/2023] Open
Abstract
Bone remodeling is an essential physiological process in growth and healing. In modern systems deviations from normal bone physiology in the form of pathologies aid in the understanding of normal bone metabolism. Here we use external morphology and X-ray microtomography to diagnose and describe a metabolic bone disease in an amniote from the early Permian. The specimen consists of two fused tail vertebrae of a small varanopid from early Permian (289 million years old) cave deposits near Richards Spur, Oklahoma, USA. Inspection of the outer morphology reveals that the fusion encompasses the vertebral centra, zygopophyses and haemal arches, with the fusion zones distinctly swollen on the left side of the specimen. With visualization of its internal structure by microCT, this specimen is diagnosed as a complex metabolic bone disease. The radiological imaging suggests a pathologically high bone turnover rate, as shown by abnormal bone formation in some areas and increased bone resorption in others. This supports that the varanopid suffered from a metabolic bone disease similar to Paget’s disease of bone as seen in humans today, which is linked to both genetic and viral factors. This finding extends the occurrence of Paget-like disease to the early Permian, and–provided a viral component was present–would also be by far the oldest evidence of viral infection in the fossil record.
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Affiliation(s)
- Yara Haridy
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
- * E-mail:
| | - Florian Witzmann
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
| | - Patrick Asbach
- Institut für Radiologie, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Robert R. Reisz
- International Center of Future Science, Dinosaur Evolution Research Centre, Jilin University, Changchun, China
- Department of Biology University of Toronto Mississauga, Mississauga, Ontario, Canada
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Abstract
The triggers and pathogenesis of axial spondyloarthritis (axSpA) are not yet completely understood. However, therapeutic agents targeting tumor necrosis factor-α and interleukin-17 inflammatory pathways have proven successful in suppressing many of the clinical symptoms and signs of axSpA, giving us an indication of which pathways are responsible for initiating and maintaining the inflammation. The mechanisms that eventuate in syndesmophytes and ankyloses are less clear. This review addresses these two critical pathways of inflammation, discussing their nature and these factors that may activate or enhance the pathways in patients with axSpA. In addition, genetic and other markers important to the inflammatory pathways implicated in axSpA are explored, and prognostic biomarkers are discussed. Treatment options available for the management of axSpA and their associated targets are highlighted.
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Affiliation(s)
- Daniel E Furst
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - James S Louie
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Sahli H, Bachali A, Tekaya R, Mahmoud I, Sedki Y, Saidane O, Abdelmoula L. Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features. Foot Ankle Surg 2019; 25:226-230. [PMID: 29409278 DOI: 10.1016/j.fas.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. METHODS We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. RESULTS Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). CONCLUSION In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.
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Affiliation(s)
- Hana Sahli
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Asma Bachali
- Department of Clinical Biology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia.
| | - Raoudha Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Ines Mahmoud
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Yassine Sedki
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Olfa Saidane
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Leila Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
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Endo Y, Fujikawa K, Koga T, Mizokami A, Mine M, Tsukada T, Uetani M, Kawakami A. Characteristics of late-onset spondyloarthritis in Japan: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14431. [PMID: 30762750 PMCID: PMC6407927 DOI: 10.1097/md.0000000000014431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.
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Affiliation(s)
- Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital
| | | | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Disease-Modifying Effects of Long-Term and Continuous Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Spondyloarthritis. Adv Pharmacol Sci 2019; 2019:5324170. [PMID: 30838041 PMCID: PMC6374855 DOI: 10.1155/2019/5324170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/06/2019] [Indexed: 01/21/2023] Open
Abstract
Spondyloarthritis or spondyloarthropathy (SpA) is a group of related rheumatic disorders, which presents with axial and nonaxial features, affecting structures within the musculoskeletal system, as well as other bodily systems. Both pharmacological and nonpharmacological therapeutic options are available for SpA. For decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been used as the first-line drugs to treat the disease. Research has shown that other than pain relief, NSAIDs have disease-modifying effects in SpA. However, to achieve these effects, continuous and/or long-term NSAID use is usually required. This review will give an overview of SpA, discuss NSAIDs and their disease-modifying effects in SpA, and highlight some of the important adverse effects of long-term and continuous NSAID use, particularly those related to the gastrointestinal, renal, and cardiovascular systems.
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Güneşaçar R, Kelleci BM, Özkars MY, Adanır İ, Çelik M. PCR-SSP tekniğine dayalı laboratuvar yapımı HLA-B*27 optimizasyonu ve test kiti geliştirilmesi. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.429882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Association of High-Sensitivity Troponin T With Left Ventricular Dysfunction in Ankylosing Spondylitis. J Clin Rheumatol 2018; 26:87-93. [PMID: 30418346 DOI: 10.1097/rhu.0000000000000951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a systemic inflammatory disease, and cardiac dysfunction has not been clearly described clinically. High-sensitivity cardiac troponin T (hs-cTnT) is a noninvasive marker for subclinical myocardial injury. OBJECTIVE In this study, we aimed to investigate any relationship between hs-cTnT and left ventricular (LV) function evaluated via tissue Doppler imaging in AS patients with no known cardiac risk factor. METHODS Our study used a cross-sectional case protocol design and was conducted between January 2016 and June 2016. In total, 40 AS patients (17 females and 23 males) were age and sex matched with healthy volunteers (20 females and 20 males) and enlisted for this study. Detailed transthoracic echocardiography was performed, and tissue Doppler imaging was used to assess systolic and diastolic functions. High-sensitivity cardiac troponin T levels were measured and compared between 2 groups. RESULTS Compared with control subjects, AS patients had lower early (Em)/late (Am) diastolic myocardial velocities, mitral annular plane systolic excursion, and end-diastolic distance from the mitral annulus to the LV apex. Conversely, they had greater systolic myocardial velocity (Sm), isovolumetric relaxation time, and displacement index (p < 0.001, for all). Higher hs-cTnT levels were measured in AS patients (0.45 ± 0.22 vs. 1.11 ± 0.27, p < 0.001), and multivariate logistic regression analyses revealed that hs-cTnT was an independent predictor of LV diastolic dysfunction in AS patients. CONCLUSIONS These data show that AS patients had impaired LV functions and increased hs-cTnT levels. Tissue Doppler imaging may be a useful tool for detection of early functional LV abnormalities, and hs-cTnT may be valuable biomarker of diastolic LV dysfunction in AS patients.
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Abstract
OBJECTIVES We sought to characterize the correlation between diagnoses made during telerheumatology and face-to-face visits and to document patients' satisfaction with telerheumatology visits. METHODS This quality assurance study of the use of telerheumatology evaluated new patients referred to a Veterans Affairs rheumatology clinic. Patients were seen at a community clinic by a nurse practitioner with a rheumatologist participating in the encounter via telelink. All of the patients had a second face-to-face visit with the same rheumatologist. Diagnoses made during telerheumatology and face-to-face visits were compared. Patients' satisfaction with telerheumatology was ascertained. RESULTS Thirty-eight patients were included in the study. Initially, 23 were diagnosed as having an inflammatory or rheumatic condition; 15 were subsequently confirmed at the face-to-face visits. All of the patients with inflammatory, rheumatic conditions were identified at the telerheumatology visits. The overall correlation was 79% between the telerheumatology and face-to-face visits. Among patients with inflammatory, rheumatic conditions, 66% preferred a face-to-face visit compared with 41% among those without such conditions (not significant). Immediately after the telerheumatology visit, all of the patients gave a 10 out of 10 rating for satisfaction. During the subsequent telephone survey, 30 remained highly satisfied with the telemedicine encounter (10 out of 10 rating). CONCLUSIONS Telerheumatology at the Palo Alto Veterans Affairs was well received by patients; provided an accurate diagnosis of noninflammatory, nonrheumatic conditions; and may be appropriate for screening and prioritizing patients for in-person rheumatology clinics.
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Affiliation(s)
- Tracy U Nguyen-Oghalai
- From the University of Southern California, Los Angeles, and Palo Alto Veterans Administration Hospital, Palo Alto, California
| | - Kathy Hunter
- From the University of Southern California, Los Angeles, and Palo Alto Veterans Administration Hospital, Palo Alto, California
| | - Michael Lyon
- From the University of Southern California, Los Angeles, and Palo Alto Veterans Administration Hospital, Palo Alto, California
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Baccouche K, Mani L, Elamri N, Fathallah N, Zaghouani H, Belghali S, Zeglaoui H, Bouajina E. Musculoskeletal ultrasonography of the Achilles tendon and plantar fascia in spondyloarthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Krishnan Y, Grodzinsky AJ. Cartilage diseases. Matrix Biol 2018; 71-72:51-69. [PMID: 29803938 PMCID: PMC6146013 DOI: 10.1016/j.matbio.2018.05.005] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 01/13/2023]
Abstract
Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs, providing joint lubrication, forming the external ears and nose, supporting the trachea, and forming the long bones during development and growth. The structure and organization of cartilage's extracellular matrix (ECM) are the primary determinants of normal function. Most diseases involving cartilage lead to dramatic changes in the ECM which can govern disease progression (e.g., in osteoarthritis), cause the main symptoms of the disease (e.g., dwarfism caused by genetically inherited mutations) or occur as collateral damage in pathological processes occurring in other nearby tissues (e.g., osteochondritis dissecans and inflammatory arthropathies). Challenges associated with cartilage diseases include poor understanding of the etiology and pathogenesis, delayed diagnoses due to the aneural nature of the tissue and drug delivery challenges due to the avascular nature of adult cartilages. This narrative review provides an overview of the clinical and pathological features as well as current treatment options available for various cartilage diseases. Late breaking advances are also described in the quest for development and delivery of effective disease modifying drugs for cartilage diseases including osteoarthritis, the most common form of arthritis that affects hundreds of millions of people worldwide.
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Affiliation(s)
- Yamini Krishnan
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Alan J Grodzinsky
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA; Department of Mechanical Engineering, MIT, Cambridge, MA 02139, USA; Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA 02139, USA.
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