Ankylosing spondylitis

Revealing the role of natural killer cells in ankylosing spondylitis: identifying diagnostic biomarkers and therapeutic targets

BACKGROUND

Ankylosing spondylitis (AS) is a chronic autoimmune disease that primarily affects the axial joints. Immune cells play a key role in the pathogenesis of AS. This study integrated bioinformatics methods with experimental validation to explore the role of natural killer (NK) cells in AS.

METHODS

Two microarray datasets, GSE25101 and GSE73754, were selected, and the scRNA-seq data were obtained from GSE194315 and Liu's research. Differentially expressed genes (DEGs) and functional enrichment analysis were performed respectively. Weighted gene co-expression network analysis (WGCNA) was conducted to identify key modules of co-expressed genes and genes involved in NK cell function. The diagnostic value of the identified key genes was evaluated using ROC curves, logistic regression analysis, and a nomogram. Real-time PCR (RT-PCR) was used to quantified the expression of genes. Statistical analysis was conducted using the R software package, and a p-value of less than 0.05 was considered statistically significant.

RESULTS

Pathways enrichment analysis revealed the involvement of NK cell-mediated immune pathways and regulation of the innate immune response, indicating the crucial role of innate immunity, especially NK cells, in AS pathogenesis. The construction of a co-expression network revealed that the MElightyellow module was most relevant to the NK cell-mediated immune pathway. IL2RB, CD247, PLEKHF1, EOMES, S1PR5, FGFBP2 from the MElightyellow module were identified as key genes involved in NK cell-mediated immune response and served as potential diagnostic biomarkers for AS, with moderate to high diagnostic values based on AUC values. Further analysis using scRNA-seq profiling revealed the higher expression level of IL2RB, CD247, PLEKHF1, S1PR5, FGFBP2 in NK cells compared to that in other cell types. CD247, PLEKHF1, EOMES, S1PR5, and FGFBP2 were reduced expressed in AS patients as compare to control group verified by scRNA-seq data, CD247, EOMES, FGFBP2, IL2RB and S1PR5 were reduced expressed verified by RT-PCR, and PLEKHF1, S1PR5, and FGFBP2 was upregulated after TNF-α blocker therapy.

CONCLUSION

The study revealed the potential role of NK cells and identified IL2RB, CD247, PLEKHF1, EOMES, S1PR5, and FGFBP2 as key genes associated with NK cells in the pathogenesis of AS.

Multidisciplinary management of a Spondyloarthritis presenting with bladder involvement as the initial clinical symptom: a rare case report

BACKGROUND

Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases that can present with diverse extra-articular manifestations. However, bladder involvement as the primary clinical presentation has not been previously reported.

CASE PRESENTATION

We present a case report of a 55-year-old male with a 20-year history of recurrent left lower abdominal pain and lower urinary tract symptoms (LUTS). Despite multiple treatments for presumed chronic prostatitis and cystitis, symptoms persisted. Imaging revealed bladder wall alterations and inflammatory changes in bilateral sacroiliac joints. Laboratory tests showed positive HLA-B27 expression. Histopathological examination of bladder tissue demonstrated chronic inflammation with eosinophilic infiltration and vasculitis. These findings led to a diagnosis of SpA, despite the absence of typical musculoskeletal symptoms. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors resulted in complete resolution of urological symptoms and normalization of bladder morphology. After one month of continuous management, the patient experienced significant relief from left lower abdominal pain (NRS 2-3) and LUTS. The patient reported complete alleviation of pain (NRS 0) and LUTS at the three-month follow-up. No recurrence was observed during a 1-year follow-up period.

CONCLUSIONS

This case highlights the potential for SpA to manifest primarily with urological symptoms, emphasizing the need for clinicians to consider systemic inflammatory conditions in cases of refractory LUTS. The successful diagnosis and management underscore the importance of interdisciplinary collaboration between urology and rheumatology.

Effects of depression on patients suffering from ankylosing spondylitis: a comparative study

BACKGROUND

Ankylosing spondylitis (AS) is a sustained inflammatory pathology that manifests as increasing rigidity and a continuous decline in spinal flexibility, leading to increasing lumbar pain during rest.

OBJECTIVES

This study primarily aimed to evaluate depression assessments using the Beck Depression Inventory (BDI) and delineate depressive symptomatology in patients diagnosed with AS compared to those without this condition.

DESIGN AND SETTING

A comparative study was conducted in Medical Centers in Málaga, Spain.

METHODS

A cohort of 102 participants, with a mean age of 46,80 ± 10,54 years, was divided into two sets: 51 individuals diagnosed with AS (cases) and another 51 without AS (controls), each harmonized across variables such as body mass index, age, and sex. Demographic variables were systematically gathered from each participant, and the BDI responses were accurately recorded and subsequently analyzed for comparison.

RESULTS

Of the total sample, the sex distribution was 29.4% male and 70.6% female. BDI scores were higher for the AS group (19.25 ± 15.5) than for the control group (5.33 ± 7). Notably, there were clear statistical differences (P < 0.01) in the BDI categories, with elevated levels observed in participants with AS.

CONCLUSION

Individuals with AS experienced higher levels of depression than those without AS. Furthermore, there were sex differences within the case group, with a higher percentage of women than men at any level of depression. Notably, there was a moderate inverse correlation between the number of years since diagnosis and depression level.

A secukinumab dose-escalation study in patients with ankylosing spondylitis not achieving inactive disease after 16 weeks of treatment

OBJECTIVE

To investigate the clinical response at week 52 in patients with AS who received secukinumab 300 vs 150 mg after inadequate response to 150 mg at week 16.

METHODS

ASLeap (NCT03350815) was a randomized, double-blind, parallel-group, multicentre, phase 4 trial. After 16 weeks of open-label secukinumab 150 mg (Treatment Period 1), patients who did not achieve inactive disease [AS Disease Activity Score (ASDAS) <1.3] at both week 12 and 16 were considered to have an inadequate response and were randomized 1:1 to receive secukinumab 300 or 150 mg every 4 weeks until week 52 (Treatment Period 2). The primary efficacy variable was achievement of ASDAS <1.3 at week 52 using week 16 as baseline. Safety was evaluated by the incidence of treatment-emergent adverse events (TEAEs) through week 52.

RESULTS

Of 322 patients treated with secukinumab in Treatment Period 1, 207 (64.3%) had inadequate response. Similar proportions of patients with inadequate response randomized to secukinumab 300 mg (n = 101) and 150 mg (n = 105) in Treatment Period 2 completed the study (83.8% and 84.3%, respectively). At week 52, 8.8% and 6.7% of patients receiving secukinumab 300 and 150 mg, respectively, achieved ASDAS <1.3. The incidence of TEAEs was similar in both groups through week 52. No new safety signals were observed.

CONCLUSION

Patients with AS who did not achieve ASDAS <1.3 after receiving secukinumab 150 mg for 16 weeks experienced similar clinical response and safety through week 52 regardless of dose escalation.

TRIAL REGISTRATION

ClinicalTrials.gov, http://clinicaltrials.gov, NCT03350815.

Effect of biological treatment on the thiol/disulfide parameters in patients with axial spondyloarthritis

OBJECTIVE

Aim of this study is to compare the thiol/disulfide variables before treatment, at the 3rd and 6th months of biologic treatment in patients with axSpA.

MATERIALS & METHODS

Consecutive patients with axial spondyloarthritis to whom biologic treatment was initiated in our clinic were enrolled upon consent. Demographics, clinical characteristics, laboratory parameters and treatment agents were collected. Disease activity scores and thiol-disulfide balance parameters were recorded at baseline and 3rd, 6th months of treatment. Statistical analyses were performed in all patients and in subgroups of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients.

RESULTS

In all patients, total thiol levels were significantly increased at 6th month in comparison to baseline values (470.5 ± 74.7 vs 491.9 ± 69.6, p = 0.047). Native thiol levels were increased at 6th month close to significance (438.9 ± 70.4 vs 458.8 ± 63.7, p = 0.060). Moderately strong negative correlations were observed between native thiol levels and disease activity parameters (BASDAI: p = 0,019; ASDAS-CRP: p = 0,035; ASDAS-ESR: p = 0,030), and between total thiol levels and disease activity parameters (BASDAI: p = 0,031; ASDAS-CRP: p = 0,020; ASDAS-ESR: p = 0,026) at 6th month evaluation.

DISCUSSION & CONCLUSIONS

Our results demonstrated oxidative stress reducing effect of biologics in axSpA patients parallel to suppression of disease activity at 6th month of the treatment.

Photoacoustic Imaging in Inflammatory Orthopedic Diseases: Progress toward Precise Diagnostics and Predictive Regulation

With the intensification of aging issues, inflammatory orthopedic diseases almost occur in the majority of elderly people, which is becoming increasingly severe. Photoacoustic imaging (PAI) is a non-invasive visualization technique for a clear diagnosis of the inflammation areas through detecting acoustic signals generated by the laser irradiation. The combination of "light input" and "acoustic output" provides unprecedented scalability as well as high penetration depth and resolution. This new imaging technology can also present more anatomical information and feedback status of inflammatory activity for the orthopedic diseases. Especially in inflammation imaging, this technology can effectively supplement current clinical imaging methods in diagnosis, staging, and monitoring of pathophysiological processes. With the rapid development of these new technologies, the goals of precise diagnosis, predictive regulation, and ultimately personalized treatment strategies are becoming increasingly realistic. Herein, this article introduces various orthopedic inflammations and related imaging technology applications. It covers the types of PA nanoprobes and their research progress in orthopedic inflammation, as well as the potential applications of PAI in various aspects. The review also discusses the recent researches and emerging translational applications of PAI in orthopedic inflammation, as well as the prospects and future development challenges of clinical transformation.

Do quality of life and work productivity change in early axial spondyloarthritis and non-axial spondyloarthritis patients after 2 years?

OBJECTIVE

The objective of this study was to compare health-related quality of life (HRQoL) and work productivity in axial SpA (axSpA) and non-axSpA patients with chronic back pain of <2 years.

METHODS

Baseline and 2-year data for patients included in the SPondyloArthritis Caught Early cohort were analysed. HRQoL was assessed by the physical (PCS) and mental component summary (MCS) scores of the 36-Item Short-Form Health Survey, and presenteeism, absenteeism, work productivity loss (WPL) and activity impairment (AI) by the Work Productivity and Activity Impairment questionnaire. Linear or zero-inflated negative binomial regression was conducted to compare 2-year outcomes between groups (axSpA and non-axSpA), adjusting for the baseline value, sex, age and use of NSAIDs.

RESULTS

There were 265 axSpA and 108 non-axSpA patients: males 52% vs 26%, mean age 29 vs 31 years, respectively. At baseline, non-axSpA patients showed worse PCS (mean 28.6 axSpA vs 26.6 non-axSpA), presenteeism (31.1% vs 37.3%), absenteeism (8.2% vs 10.3%), WPL (34.7% vs 44.1%) and AI (39.6% vs 48.5%). MCS was not impaired in either group. After 2 years, PCS, presenteeism, WPL and AI significantly improved in both groups; absenteeism only improved in axSpA. In multivariable analysis, axSpA (vs non-axSpA) was associated with 22% less WPL [incidence rate ratio (95% CI): 0.78 (0.62; 0.98)] and 18% less AI [0.82 (0.69; 0.97)].

CONCLUSION

HRQoL and work productivity are more impaired in non-axSpA (vs axSpA) at baseline and also after 2 years. Although most outcomes improve in both groups, axSpA is associated with larger reductions in WPL and AI.

Fat mass and obesity-associated protein in mesenchymal stem cells inhibits osteoclastogenesis via lnc NORAD/miR-4284 axis in ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis (AS) is recognized as a long-term inflammatory disorder that leads to inflammation in the spine and joints, alongside abnormal bone growth. In previous studies, we reported that mesenchymal stem cells (MSCs) derived from individuals with AS demonstrated a remarkable inhibition in the formation of osteoclasts compared to those obtained from healthy donors. The mechanism through which MSCs from AS patients achieve this inhibition remains unclear.

AIM

To investigate the potential underlying mechanism by which MSCs from individuals with ankylosing spondylitis (AS-MSCs) inhibit osteoclastogenesis.

METHODS

We analysed fat mass and obesity-associated (FTO) protein levels in AS-MSCs and MSCs from healthy donors and investigated the effects and mechanism by which FTO in MSCs inhibits osteoclastogenesis by coculturing and measuring the levels of tartrate-resistant acid phosphatase, nuclear factor of activated T cells 1 and cathepsin K.

RESULTS

We found that FTO, an enzyme responsible for removing methyl groups from RNA, was more abundantly expressed in MSCs from AS patients than in those from healthy donors. Reducing FTO levels was shown to diminish the capacity of MSCs to inhibit osteoclast development. Further experimental results revealed that FTO affects the stability of the long non-coding RNA activated by DNA damage (NORAD) by altering its N6-methyladenosine methylation status. Deactivating NORAD in MSCs significantly increased osteoclast formation by affecting miR-4284, which could regulate the MSC-mediated inhibition of osteoclastogenesis reported in our previous research.

CONCLUSION

This study revealed elevated FTO levels in AS-MSCs and found that FTO regulated the ability of AS-MSCs to inhibit osteoclast formation through the long noncoding RNA NORAD/miR-4284 axis.

Evaluating the performance of large language models in health education for patients with ankylosing spondylitis/spondyloarthritis: a cross-sectional, single-blind study in China

OBJECTIVES

To evaluate the potential of large language models (LLMs) in health education for patients with ankylosing spondylitis (AS)/spondyloarthritis (SpA), focusing on the accuracy of information transmission, patient acceptance and performance differences between different models.

DESIGN

Cross-sectional, single-blind study.

SETTING

Multiple centres in China.

PARTICIPANTS

182 volunteers, including 4 rheumatologists and 178 patients with AS/SpA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Scientificity, precision and accessibility of the content of the answers provided by LLMs; patient acceptance of the answers.

RESULTS

LLMs performed well in terms of scientificity, precision and accessibility, with ChatGPT-4o and Kimi models outperforming traditional guidelines. Most patients with AS/SpA showed a higher level of understanding and acceptance of the responses from LLMs.

CONCLUSIONS

LLMs have significant potential in medical knowledge transmission and patient education, making them promising tools for future medical practice.

Expression of Tim-3 on neutrophils as a novel indicator to assess disease activity and severity in ankylosing spondylitis

Objective

To investigate the expression of Tim-3 on neutrophils in ankylosing spondylitis (AS) patients and its correlation with disease activity, severity, and inflammatory markers.

Methods

Sixty-two AS patients from Guangdong Second Provincial General Hospital and 38 healthy controls (HC) were enrolled. Clinical data, physical exams, and laboratory measurements were recorded. Flow cytometry measured Tim-3 and PD-1 expression on neutrophils, real-time PCR quantified mRNA levels and protein expression of Tim-3 was determined by Western blot. We analyzed the correlation between Tim-3 mean fluorescence intensity (MFI) on neutrophils, inflammatory markers, and AS disease activity and severity.

Results

Tim-3 expression on neutrophils was higher in AS patients than in HC, showing a positive correlation with erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and Ankylosing Spondylitis Disease Activity Score (ASDAS). Active AS patients (ASDAS ≥ 1.3) had increased Tim-3 MFI compared to inactive ones (ASDAS < 1.3). Regular treatment with non-steroidal anti-inflammatory drugs (NSAIDs), biological disease-modifying anti-rheumatic drugs (bDMARDs), and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) over a month significantly reduced Tim-3 MFI in AS patients.

Conclusion

Elevated Tim-3 expression on neutrophils correlates with increased inflammatory markers and AS activity. Treatment lowered Tim-3 MFI, suggesting its potential as an indicator for assessing AS disease activity and severity and as a feedback mechanism to reduce tissue damage from inflammation.

The causal relationship between obstructive sleep apnea and rheumatic disease: A bidirectional Mendelian randomization study

Background and Objective

Multiple studies have shown a substantial association between obstructive sleep apnea (OSA) and rheumatic disease. However, traditional studies are susceptible to confounding factors or reverse causal relationships, and the exact causal relationship still needs to be clearly defined. This study aims to use a bidirectional two-sample Mendelian randomization (MR) analysis to investigate the causal association between OSA and rheumatoid immune diseases.

Methods

We conducted a two-sample bidirectional MR analysis by using large-scale genome-wide association studies (GWAS) summary statistics to investigate whether there is a causal relationship between OSA and rheumatic disease. Inverse variance weighted (IVW) was used as the primary analysis approach, supplemented by MR-Egger and Weighted median methods. Sensitivity analyses were conducted to ensure the robustness of the results.

Results

The MR predicted ankylosing spondylitis (AS) was associated with risk of OSA (IVW: OR = 1.0239, 95% CI = 1.0086 to 1.0394, P = 0.0021; MR-Egger: OR = 1.0374, 95% CI = 1.0089 to 1.0668, P = 0.0326; weighted median: OR = 1.0287, 95% CI = 1.0109 to 1.0467, P = 0.0014). However, no bidirectional causal association was found between other rheumatic disease and OSA. The sensitivity analysis confirmed the robustness of the results.

Conclusions

Our analysis suggests a potential causal relationship between AS and OSA. There was no direct causal relationship between OSA and other rheumatic disease. We need more experimental research on specific pathological and physiological mechanisms in the future.

Aortic regurgitation in ankylosing spondylitis-an echocardiography follow-up study

OBJECTIVES

To investigate the long-term course of aortic regurgitation (AR) and the width of the proximal ascending aorta (PAA) in patients with ankylosing spondylitis (AS).

METHOD

This is a follow-up cohort study of patients with AS examined with echocardiography at inclusion (2009 to 2011). Out of the initial 187, a subgroup of 52 patients (54% men, mean age 62 years) was selected for follow-up based on presence/absence of AR at baseline; 26 with AR (18 mild, 7 moderate, 1 severe) and 26 age/sex-matched without AR. These patients were re-examined with echocardiography in 2014 by an independent observer. Severity of AR and PAA diameter were assessed. Related samples Wilcoxon signed rank and Mann-Whitney U tests were used to analyze the change (Δ) in PAA diameter.

RESULTS

Regarding the 26 patients with AR at baseline, two had an aggravated grade, 16 an unchanged grade, and eight a less severe AR versus baseline. Two of the 26 patients with no AR at baseline had a mild grade of AR at follow-up. The mean (SD) ΔPAA diameter was 0 (3) mm, and no statistically significant ΔPAA diameter was found overall or in analyses stratified by sex and baseline presence of AR.

CONCLUSIONS

Most patients with AS had an unchanged grade of AR and PAA diameter at follow-up 3 to 5 years after the initial echocardiography. These findings suggest that the average progress of AR in patients with AS is slow and that progression of PAA dilatation seems rare. Key points • Aortic regurgitation (AR) is not uncommon in patients with ankylosing spondylitis (AS) and caused by aortic root dilatation and/or cusp fibrosis/retraction, but little is known about its course. • According to this repeated echocardiography study in median 4.3 years after the baseline evaluation, the majority of patients had no progress of AR or increase in the proximal ascending aorta diameter. • AR in AS is rarely rapidly progressive.

Acupuncture for ankylosing spondylitis: An updated systematic review and meta-analysis

BACKGROUND

 Existing evidence is insufficient to support that acupuncture is effective in treating ankylosing spondylitis (AS) due to the constraints of acupuncture site and manipulation, and relatively straightforward study treatments and indicators.

OBJECTIVE

 By incorporating high-quality original literature, this study aims to evaluate the effectiveness of acupuncture for AS and to demonstrate acupuncture as a non-drug supplementary and alternative means for treating AS.

METHODS

 We searched seven databases from their inception to March 31, 2023. Only randomized controlled trials (RCTs) with PEDro score ≥ 6 that compared traditional acupuncture alone or in combination with non-acupuncture therapy on diagnostic AS were considered. The PEDro, ROB2, and STATA tools were used for quality evaluation and statistical analysis.

RESULTS

 A total of 21 RCTs covering 1884 patients were included. Meta-analysis showed that acupuncture had positive effects on Western medicine effective rate (RR = 1.223, 95%CI: 1.150, 1.301, P < 0.001), traditional Chinese medicine effective rate (RR = 1.175, 95%CI: 1.111, 1.243, P < 0.001), pain score (visual analogue scale, SMD = -0.666, 95%CI: -0.801, -0.531, P < 0.001), spinal function including bath ankylosing spondylitis function index score (SMD = -0.827, 95%CI: -0.945, -0.708, P < 0.001), bath ankylosing spondylitis disease activity index score (SMD = -1.069, 95%CI: -1.190, -0.949, P < 0.001), and bath ankylosing spondylitis metrology index score (SMD = -0.699, 95%CI: -0.887, -0.511, P < 0.001), ankylosing spondylitis quality of life score(SMD = -0.619, 95%CI: -0.917, -0.322, P < 0.001), C-reactive protein levels (SMD = -0.980, 95%CI: -1.092, -0.868, P < 0.001) and erythrocyte sedimentation rate value (SMD = -0.701, 95%CI: -0.810, -0.591, P < 0.001).

CONCLUSION

 Though with a high risk of bias, the high-quality studies indicate that acupuncture is a beneficial complementary and alternative therapy for AS patients, as it can reduce pain intensity and improve effective rate, spinal function, and anti-inflammatory response.

The effects of baduanjin qigong exercise via telerehabilitation in ankylosing spondylitis: A randomized controlled study

BACKGROUND AND PURPOSE

Baduanjin qigong exercises have previously been reported to improve Ankylosing Spondylitis (AS) symptoms. The aim of this study was to examine the effectiveness of 12-week Baduanjin qigong exercises in patients with AS.

METHOD

Fifty-nine patients with AS aged 18-64 were included in the study. The participants were divided into two groups. The intervention group performed Baduanjin qigong online exercise program, control group received home exercises for 45 min twice a week for 12 weeks. Before and after the 12-week exercise program, patients were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)-Functional Index (BASFI)-Metrology Index (BASMI), chest expansion measurement, Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), and Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL).

RESULTS

When the groups were compared after the intervention, there was a significant difference in favor of the intervention group in the BASMI (p: 0.00-0.04), FSS (p:0.01), and chest expansion (p:0.04). Also, the delta values of the groups were compared; the intervention group was found to be superior in terms of PSQI (p:0.01), BASFI (p:0.00), and BASMI (p:0.04).

CONCLUSION

Baduanjin qigong should be added to rehabilitation programs as a complementary method to improve fatigue levels, chest expansion, flexibility, functionality, and quality of life in patients with AS.

Vertebral Column Decancellation for Correcting Cervicothoracic Kyphotic Deformity in Patients With Ankylosing Spondylitis

OBJECTIVE

Surgery to correct the cervicothoracic kyphotic deformity in ankylosing spondylitis (AS) can be associated with serious neurovascular risks. According to the literature, there are no clinical reports documenting the use of vertebral column decancellation (VCD) in the treatment of cervicothoracic kyphotic deformity in patients with AS. The purpose of the present study was to retrospectively analyze and evaluate the effect of VCD on cervicothoracic kyphotic deformity in patients with AS.

METHODS

Records of eight patients with cervicothoracic kyphotic deformity who underwent VCD at C7 in our institution were retrospectively reviewed. The mean duration of clinical follow-up after surgery was 19 months. The cervical lordosis (CL) and C2-C7 sagittal vertical axis (SVA) were meticulously measured on full-length spine radiographs. The chin-brow vertical angle (CBVA) was measured on clinical photographs. Outcome measures utilized included the Neck Disability Index (NDI), the Japanese Orthopaedic Association (JOA) Score, and a Visual Analog Scale (VAS) for neck pain. The data analysis was performed using SPSS version 26.0 for Windows. For paired data adhering to a normal distribution, we utilized paired sample t-tests to analyze preoperative and postoperative imaging parameters. Statistical significance was established at a p value threshold of < 0.01.

RESULTS

All eight patients successfully completed the surgery. With an average VCD osteotomy angle of 47.6° ± 8.1° (±SD), the mean preoperative CBVA was 81.1° ± 17.6° (±SD), while the immediate postoperative value was 19.9° ± 5.7° (±SD). The overall average correction was 61.2° ± 18.9°. The mean preoperative cervical sagittal imbalance was 93.4 ± 27.3 mm (±SD), while the immediate postoperative value was 40.2 ± 18.9 mm (±SD). The overall average correction was 53.2 ± 28.1 mm. None of the eight patients experienced intraoperative complications, including nerve or vascular injury, cerebrospinal fluid leakage, or any other related complications. In the cohort of eight patients, the mean values for estimated blood loss, surgical time, and hospital stay were 1313 mL, 248 min, and 18 days, respectively. In comparison to preoperative scores, statistically significant improvement was noted in all patients in the postoperative period with regard to NDI, JOA, and VAS (p < 0.01, using a paired t-test).

CONCLUSION

The VCD procedure proves to be a dependable and efficient approach for addressing cervicothoracic kyphotic deformities. It achieves remarkable corrections in cervical kyphosis and CBVA.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: 2400090375.

Exploring the antiquity of rheumatoid arthritis: A case study from medieval Transylvania

OBJECTIVE

To evaluate erosive pathological lesions on a skeleton from medieval Transylvania.

MATERIALS

A skeleton from a Székely archaeological site in Transylvania was examined and radiocarbon dated to Cal 1300 CE - 1415 CE.

METHODS

The skeletal remains were examined macroscopically and with radiographic imaging. A differential diagnosis was conducted following established protocols.

RESULTS

The individual was estimated to be a probable adult female. Periarticular erosive lesions involving multiple synovial joints, particularly on the small joints of the hands and feet, were observed.

CONCLUSIONS

A differential diagnosis identifies lesions characteristic of rheumatoid arthritis dating prior to the mid-15th century.

SIGNIFICANCE

The significance of this diagnosis is great since researchers debate the antiquity and spread of rheumatoid arthritis. Some researchers hypothesize that RA originated in the Americas and spread to Europe after the mid-15th century. However, this study asserts that RA existed in Europe prior to European colonization of the Americas.

LIMITATIONS

Only 30-40 % of the skeletal material was excavated, potentially impacting the differential diagnosis.

SUGGESTIONS FOR FURTHER RESEARCH

This case encourages researchers to explore the presence of RA in other medieval groups within and beyond Transylvania as a means to reconstruct the antiquity and geographical distribution of the condition.

Association Between Inflammatory Arthritis, Genetic Risk, and the Long-Term Risk of Degenerative Aortic Stenosis: A Prospective Cohort Study

BACKGROUND

Inflammatory arthritis is recognized to increase cardiovascular disease risk, but its association with degenerative aortic stenosis is not well understood.

METHODS

This prospective cohort study used participants from the UK Biobank, focusing on 4 major types of inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout. The primary outcome was the incidence of degenerative aortic stenosis. The primary analysis used Cox proportional hazards models to evaluate the association between inflammatory arthritis and the long-term risk of degenerative aortic stenosis, as well as to explore potential effect modifiers. Genetic risk was evaluated using polygenic risk scores and self-reported family history of cardiovascular diseases.

RESULTS

The study included 497 567 participants, with 271 129 women (54.5%) and 468 015 White individuals (94.1%). The median age was 58 years. Over a median follow-up of 12.58 years, 4571 cases (0.9%) of degenerative aortic stenosis were identified. Compared with the control group, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout were associated with increased risks of degenerative aortic stenosis by 54% (hazard ratio [HR], 1.54 [95% CI, 1.28-1.85]), 72% (HR, 1.72 [95% CI, 1.19-2.50]), 176% (HR, 2.76 [95% CI, 1.43-5.32]), and 36% (HR, 1.36 [95% CI, 1.20-1.54]), respectively. These associations were independent of genetic risk (P for interaction>0.05). Additionally, we identified significant interactions between sex (P for interaction=0.036), age (P for interaction<0.001), and socioeconomic status (P for interaction=0.014) with rheumatoid arthritis, ankylosing spondylitis, and gout on the incidence of degenerative aortic stenosis, respectively.

CONCLUSIONS

Inflammatory arthritis is significantly associated with an increased long-term risk of degenerative aortic stenosis, underscoring the need for enhanced risk assessment for degenerative aortic stenosis in these populations.

Shared Genes and Pathways in Ulcerative Colitis and Ankylosing Spondylitis: Functional Validation and Implications for Diagnosis

Background

Associations between ulcerative colitis (UC) and ankylosing spondylitis (AS) have been reported in multiple studies, but the common etiologies of UC and AS remain unknown. Thus, in the current study, we aimed to investigate the shared genes and relevant mechanisms in UC and AS.

Methods

Using datasets for UC (GSE113079) and AS (GSE1797879), we initially identified differentially expressed genes (DEGs) through differential expression analysis. The DEGs from both datasets were intersected to identify common DEGs, relevant to both UC and AS, which were used in receiver operating characteristic (ROC) curve analysis to confirm key genes in the shared pathway. Gene set enrichment analysis (GSEA) was used to obtain information on key gene pathways and interactions with UC or AS-related diseases, followed by immune infiltration analysis. Finally, peripheral blood samples of AS and UC were used to verify the mRNA expression of the eight key genes using reverse transcription-polymerase chain reaction (RT-PCR).

Results

Our results revealed that GMFG, GNG11, CLEC4D, CMTM2, VAMP5, S100A8, S100A12 and DGKQ are potential diagnostic biomarkers of AS and UC. Rimegepant, eptinezumab, methotrexate, atogepant, and ubrogepant were identified as potential drugs for S100A12 and S100A8 in patients with UC and AS. GSEA showed that these key genes were associated with antigen processing and presentation, natural killer cell mediated cytotoxicity and the T cell receptor signaling pathway in AS and UC, and were significantly associated with immune cells in various immune-related pathways. Subsequent functional experiments revealed significant increases in the mRNA expressions of S100A12 and VAMP5 in patients with AS and UC. Additionally, CLEC4D mRNA expression was notably higher in patients with UC than in healthy controls.

Conclusion

Key genes and shared pathways were identified in UC and AS, which may improve understanding of their relationship and guide diagnosis and treatment strategies.

Genetic Susceptibility and Disease Activity in Ankylosing Spondylitis: The Role of G Protein-Coupled Receptor 35rs4676410 Polymorphism in a Turkish Population

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disorder with a significant genetic predisposition. Genome-wide association studies (GWAS) have identified immune-related loci, including the G Protein-Coupled Receptor 35 (GPR35) gene, as potential contributors to AS pathogenesis. This study aimed to evaluate the association between the rs4676410 polymorphism in the GPR35 gene and both AS susceptibility and disease activity in a Turkish population. Methods: This case-control study included 200 participants (100 AS patients and 100 healthy controls). DNA was isolated from blood samples, and the rs4676410 polymorphism was analyzed using real-time polymerase chain reaction (PCR). Disease activity in AS patients was assessed using the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and disease activity scores including C-reactive protein (ASDAS-CRP) scores. Statistical analyses were conducted using IBM SPSS 26. Results: The rs4676410 polymorphism was significantly associated with AS susceptibility. The AA genotype and A allele were more prevalent in AS patients, indicating an increased risk of developing AS. Among disease activity measures, ASDAS-CRP scores were significantly higher in patients with the AA genotype (p = 0.043), while no significant differences were observed for BASFI and BASDAI scores across genotypes. Conclusion: The findings suggest that the rs4676410 polymorphism in the GPR35 gene is associated with AS susceptibility and may influence disease activity through elevated inflammatory responses. These results highlight the potential of the AA genotype and A allele as genetic markers for AS and underscore the importance of integrating genetic insights into personalized treatment approaches.

Wnt5a exacerbates pathological bone features and trabecular bone loss in curdlan-injected SKG mice via osteoclast activation

Many studies on osteoblasts have suggested that Wnt5a plays a crucial role in excessive osteoblast activity, which is responsible for ectopic new bone formation, but research on osteoclasts in ankylosing spondylitis (AS) remains relatively limited. This study aimed to explore whether Wnt5a influences osteoclastmediated bone resorption in curdlan-injected SKG mice, a model that mimics AS. Compared to the Vehicle group, the Wnt5a treatment group exhibited statistically higher clinical arthritis scores and increased hindpaw thickness values. Micro- computed tomography (microCT) analysis of hindpaws revealed a significant increase in inflamed and ectopic bone density in the Wnt5a-treated group compared to the Vehicle group. Histological examination also showed pronounced inflammation and structural bone damage in the bone marrow of ankles in the Wnt5a-treated group. Intriguingly, microCT analysis of the femur revealed that trabecular bone loss was markedly observed in the Wnt5a-treated group. Both the number of TRAP-positive osteoclasts and their activity were statistically greater in the Wnt5a-treated group compared to the Vehicle group. Serum markers of bone resorption, but not bone formation, were also significantly elevated in the Wnt5a-treated group. Notably, promotion of osteoclast differentiation by Wnt5a was inhibited following treatment with anti-Wnt5a. These findings suggest that targeting Wnt5a could be a promising strategy for mitigating pathological bone features in AS by modulating osteoclast activity. [BMB Reports 2025; 58(2): 75-81].

[Transosseous lacerations in the ankylosed cervical spine]

Transosseous lacerations represent a particular type of discoligamentous injury of the cervical spine and occur in ankylosing diseases of the spine, with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) being the primary entities. The altered biomechanics of the spine due to the underlying disease pose special challenges in the diagnostics and treatment. Even low-energy trauma can cause severe injuries of the cervical spine, which are often difficult to accurately diagnose due to the difficult assessability of the conventional projection radiography used in the primary diagnostics. In addition to a correct diagnosis a differentiated treatment concept is crucial as treatment courses can be complicated by pre-existing comorbidities, which are present in the majority of cases. Due to a high rate of secondary neurological deficits without adequate stabilization, surgical stabilization is generally recommended. Unlike the treatment of "classical" discoligamentous injuries in the mobile cervical spine, long segment dorsal instrumented spondylodesis is the standard of care for these cases, whereby ventral stabilization is also of value, either as a stand-alone or possibly additive procedure. The intraoperative site, which deviates from that of a normal patient, can present an additional challenge.

Association of ankylosing spondylitis with the risk of cancer: a meta-analysis of cohort studies

OBJECTIVES

The potential impact of ankylosing spondylitis (AS) on cancer risk remains unclear. This study seeks to investigate the relationship between AS and different types of cancers.

METHODS

A literature search on PubMed, EMBASE and Cochrane Library up to 10 July 2023 was conducted. Two investigators selected eligible studies and extracted relevant data. The study used the random-effects model to explore the causality between AS and cancer, utilizing relative risk (RR) as a measure for the study.

RESULTS

A total of 20 cohorts with >330 000 participants were included. The pooling analysis shows AS being associated with a higher risk of cancers (RR = 1.16, 95% CI: 1.07-1.26, P = 0.001, I2 = 70.60%). In the subgroup analysis, AS has a higher cancer risk in Asia, but this association is not significant in Europe. Individual investigations indicate that AS is associated with an increased risk of bone cancer (RR = 3.41, 95% CI: 1.45-7.99, P = 0.005, I2 = 0.00%), thyroid gland cancer (RR = 1.76, 95% CI: 1.29-2.40, P < 0.001, I2 = 13.70%), multiple myeloma (RR = 1.74, 95% CI: 1.42-2.15, P < 0.001, I2 = 27.20%), leukaemia (RR = 1.52, 95% CI: 1.27-1.82, P < 0.001, I2 = 0.00%), kidney cancer (RR = 1.45, 95% CI: 1.08-1.94, P = 0.014, I2 = 0.00%), prostate cancer (RR = 1.43, 95% CI: 1.17-1.74, P < 0.001, I2 = 82.80%) and non-Hodgkin's lymphoma (RR = 1.42, 95% CI: 1.17-1.73, P < 0.001, I2 = 0.00%). However, there is no significant correlation with connective tissue cancer, brain cancer, testicular and other male cancers, bladder cancer, female cancers, skin cancer, and cancers of the digestive system and respiratory system.

CONCLUSION

AS appears to be related to cancer development. The results highlighted the necessity for large-scale studies, considering influencing factors such as AS course, medication histories and potential biases when examining cancer risk.

Exploring the molecular mechanism of Epimedium for the treatment of ankylosing spondylitis based on network pharmacology, molecular docking, and molecular dynamics simulations

Ankylosing spondylitis (AS) is a rheumatic disease that causes inflammation and bone formation in the spine. Despite significant advances in treatment, adverse side effects have triggered research into natural compounds. Epimedium (EP) is a traditional Chinese herb with a variety of pharmacological activities, including antirheumatic, anti-inflammatory, and immunomodulatory activities; however, its direct effects on AS treatment and the underlying molecular mechanisms have not been systematically studied. Thus, here, we used network pharmacology, molecular docking, and molecular dynamics simulations to explore the targets of EP for treating AS. We constructed an interaction network to elucidate the complex relationship between EP and AS. Sixteen active ingredients in EP were screened; 80 potential targets were identified. In particular, 8-(3-methylbut-2-enyl)-2-phenylchromone, anhydroicaritin, and luteolin were the core components and TNF, IL-6, IL-1β, MMP9, and PTGS2 were the core targets. The GO and KEGG analyses indicated that EP may modulate multiple biological processes and pathways, including the AGE-RAGE, TNF, NF-κB/MAPK, and TLR signaling pathways, for AS treatment. Molecular docking and molecular dynamics simulations showed good affinity between the active components and core targets of EP, with stable binding within 100 nanoseconds. In particular, 8-(3-methylbut-2-enyl)-2-phenylchromone possessed the highest free energy of binding to PTGS2 and TNF (-115.575 and - 87.676 kcal/mol, respectively). Thus, EP may affect AS through multiple pathways, including the alleviation of inflammation, oxidative stress, and immune responses. In summary, we identified the active components and potential targets of EP, highlighting new strategies for the further experimental validation and exploration of lead compounds for treating AS.

Genetic causality between insomnia and specific orthopedic conditions: Insights from a two-sample Mendelian randomization study

OBJECTIVE

To investigate the genetic causality for the insomnia and common orthopedic diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), osteoporosis (OP), and gout (GT).

METHODS

The genome-wide association study (GWAS) summary data on insomnia were obtained from a published study, while the GWAS summary data on RA, AS, OP, and GT were sourced from the FinnGen consortium. We utilized the TwoSampleMR package of the R software (version 4.1.2) to conduct a two-sample Mendelian randomization (MR) analysis. Our primary method of analysis was the random-effects inverse variance weighted (IVW) approach. Subsequently, we conducted a series of sensitivity analyses for the MR analysis.

RESULTS

The MR analysis revealed a positive genetic causal relationship between insomnia and RA (P = 0.016, odds ratio [OR] 95 % confidence interval [CI] = 1.112 [1.020-1.212]). However, no significant genetic causal relationship was observed between insomnia and AS (P = 0.194, OR 95 % CI = 1.121 [0.944-1.331]), OP (P = 0.788, OR 95 % CI = 1.016 [0.904-1.142]), and GT (P = 0.757, OR 95 % CI = 1.018 [0.912-1.136]). The MR analysis did not exhibit heterogeneity, horizontal pleiotropy, outlier effects, or dependence on a single SNP, and demonstrated normal distribution, which guaranteed the robustness of the results.

CONCLUSION

The results of this study suggest that insomnia may be a significant risk factor for RA, and controlling insomnia may represent a promising strategy for preventing RA. While insomnia was not observed to be associated with AS, OP, and GT at the genetic level, other levels of association cannot be excluded.

Acupuncture therapy in autoimmune diseases: A narrative review

We provide a narrative review of experimental and clinical evidence for the effect of acupuncture in autoimmune diseases, based on randomized controlled studies, systematic review and meta-analyses, published between the years 2000-2023. Acupuncture in experimental models of rheumatoid arthritis (RA), multiple sclerosis, psoriasis, ulcerative colitis (UC) downregulated inflammatory cytokine expression, increased IL-10 expression, improved Treg cell differentiation, and also modulated macrophage polarization in RA and UC models. The anti-inflammatory effect of acupuncture in autoimmune disorders has been demonstrated to involve vagal-adrenal and cholinergic anti-inflammatory pathways. The analgesic effect of acupuncture involves both peripheral and central anti-nociceptive mechanisms. Randomized controlled studies support the use of acupuncture in rheumatoid arthritis, fibromyalgia, Crohn's disease and in Sjogren's syndrome. Some evidence indicates that acupuncture may be beneficial as a symptomatic treatment for multiple sclerosis, myasthenia gravis, psoriasis and ankylosing spondylitis.

Fast, Present and Future of the Concept of Spondyloarthritis

PURPOSE OF REVIEW

Axial spondyloarthritis (axSpA) is a rather prevalent chronic inflammatory rheumatic disease that affects already relatively young patients. It has been known better since the end of the nineteenth century but quite a lot has been learned since the early 60ies when the first classification (diagnostic) criteria for ankylosing spondylitis (AS) were agreed on. I have been part of many developments in the last 30 years, and I'm happy to have been able to contribute to the scientific progress in terms of diagnosis, imaging, pathophysiology and therapy. When I was asked to write a manuscript about the SpA concept I felt honored. Thus, the purpose of this extensive review was, on the one hand, to describe the history of AS and axSpA, and on the other hand, to reason about the concept and the gestalt of axSpA, and finally to deliver some ideas what future researchers could possibly do to further study the disease.

RECENT FINDINGS

The last 3 decades were full of innovations for both, classification and treatment of axSpA which also helped us to learn about the pathophysiology. Thus, TNFa, IL-17, IL-23 and Janus kinase are established targets to reduce inflammation. IL-17 and IL-23 are very special in that regard because they both work for psoriasis but only anti-IL-17 agents which don't work in IBD are approved for axSpA, while IL 23 inhibitors are approved for both, psoriasis and IBD, but they don't work in axSpA. New imaging techniques such as low dose CT and synthetic MRI are likely to improve the detection of both active and structural lesions of axSpA. This manuscript tries to describe the most important findings about axSpA. The main aim of research remains to discover the pathophysiology and to further improve treatment options in order to reduce and abolish inflammation and prevent new bone formation to increase the quality of life of our patients. The differences between male and female disease and the role of the immune system in axSpA are now the main challenges, and the role of special T-cell receptors seem to deserve special interest.

Evolving trends in the prevalence and treatment of ankylosing spondylitis in Korea from 2010 to 2023: a population-based study

Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, resulting in severe pain, decreased mobility, and irreversible structural damage. This study explores the evolving prevalence, patient demographics, and treatment trends for AS in the Korean population from 2010 to 2023, alongside advancements in targeted therapies. This population-based study utilized data from the National Health Insurance Database covering 2010 to 2023. AS cases were identified using at least two ICD-10 (International Classification of Diseases, 10th Revision) codes and rare intractable disease registration codes, excluding diagnoses of rheumatoid arthritis and systemic lupus erythematosus. The annual prevalence of AS was calculated and standardized to the 2017 population. Patient characteristics, comorbidities, and treatment patterns were assessed. The prevalence of AS increased from 26.76 per 100,000 individuals in 2010 to 81.87 per 100,000 in 2023. The proportion of patients over 50 years rose from 19.5 to 32.5%, and female representation increased from 17.9 to 24.0%. Comorbidities such as metabolic syndrome and musculoskeletal complications became more prevalent. Tumor necrosis factor-alpha inhibitor prescriptions rose from 29.7 to 41.6%, while the use of conventional synthetic disease-modifying antirheumatic drugs declined. The introduction of interleukin-17 and Janus kinase (JAK) inhibitors, particularly as second- and third-line therapies, marked a significant development. The prevalence of AS has surged between 2010 and 2023, particularly among older and female patients. The concurrent rise in comorbidities underscores the need for integrated care. Future research should focus on optimizing therapeutic sequences and evaluating long-term outcomes in this changing patient population.

Analysis of ASAS health index and its influencing factors in ankylosing spondylitis: a prospective study based on the population of Chaoshan region

Objective

This study aimed to evaluate the health-related quality of life (HRQoL) in ankylosing spondylitis (AS) patients in the Chaoshan region and identify factors influencing the ASAS Health Index (ASAS-HI) to enhance comprehensive AS treatment strategies.

Methods

A survey of ASAS-HI was conducted on 82 AS patients from the rheumatology outpatient department of the First Affiliated Hospital of Shantou University Medical College. The Bath Ankylosing Spondylitis Global Score (BAS-G) assessed overall health status, the Ankylosing Spondylitis Quality of Life Questionnaire (AS-QOL) evaluated quality of life, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured disease activity, and the Bath Ankylosing Spondylitis Functional Index (BASFI) assessed functional difficulties. Inflammatory markers and patient data were collected, and univariate/multivariate logistic regression analyses were used to explore influencing factors of ASAS-HI.

Results

The mean ASAS-HI score was 3.52 ± 3.12. ASAS-HI was positively correlated with BASDAI (r = 0.478, p < 0.001), ASDAS-CRP (r = 0.406, p < 0.001), BASFI (r = 0.338, p < 0.002), and BAS-G (r = 0.335, p < 0.002). Patients with ASDAS-ESR ≥ 2.1, ASDAS-CRP ≥ 2.1, and spinal tenderness had significantly higher ASAS-HI scores than others (p < 0.001). Spinal tenderness and radiographic grading were identified as key influencing factors.

Conclusion

ASAS-HI is significantly impacted by disease activity and functional limitations. Early assessment of ASAS-HI is crucial for optimizing disease management in AS patients.

A posterior trans-intervertebral osteotomy with anterior support for kyphosis deformity secondary to ankylosing spondylitis: a technical note

BACKGROUND

This study aimed to assess the efficacy of a novel spinal osteotomy technique, the posterior trans-intervertebral osteotomy with anterior support, in individuals diagnosed with ankylosing spondylitis. This study utilized computer software to simulate the osteotomy procedure, predict orthopedic outcomes, and assist in preoperative planning.

METHODS

Four patients with ankylosing spondylitis underwent posterior trans-intervertebral osteotomy with anterior support that post-operative follow-up of more than 1 year. Osteotomy was performed using the intervertebral space approach with the cage placed anteriorly in the intervertebral space to improve the correction. Perioperative clinical symptoms, imaging data, and surgical factors were also documented.

RESULTS

Patients who underwent posterior trans-intervertebral osteotomy with anterior support achieved good clinical results with favorable correction rates and minimal estimated blood loss. The average preoperative, postoperative and follow-up Cobb angles were 90.5° (range: 86-96°), 43.5° (range: 34-52°) and 46.25°(range: 37-55°), respectively. The average estimated blood loss was 500 mL (range: 300-800 mL). Patients with preoperative deficits improved their neurological status, and no complications were observed throughout the postoperative period. Pain, self-image, and mental health in the SRS-22 demonstrated significant improvement at the final follow-up compared to preoperative values. The satisfaction with management score was 3.25 ± 0.65.

CONCLUSIONS

Posterior trans-intervertebral osteotomy with an anterior support procedure was performed through the intervertebral space and subsequent implantation of a cage within the transpedicular space, effectively addressing the constraints associated with the conventional trans-intervertebral osteotomy method. Our preliminary findings indicate that posterior trans-intervertebral osteotomy with anterior support is potentially more secure than the conventional method for correcting ankylosing spondylitis kyphosis.

Association between ankylosing spondylitis and neurodegenerative diseases: Systematic review and meta-analysis

BACKGROUND

Increasing evidence indicates the mechanism of overlapping immune dysfunction and inflammation disorder shared by ankylosing spondylitis (AS) and neurodegenerative diseases (NDs). However, the exact correlation between the two is still unclear. Different studies have reported inconsistent results about how AS and NDs are related.

OBJECTIVE

This study aimed to investigate the association between AS and risk of NDs.

METHODS

We searched electronic databases including PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify studies reporting relationship between NDs risk and AS published before April 10th, 2024. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were estimated. All analyses were conducted using Stata V.12.0 software.

RESULTS

A total of 15 comparisons out of 10 studies involving 851,936 participants were included. The results showed that the risk of NDs was higher among AS patients than those who were not (OR: 1.36, 95% CI: 1.15-1.60, P<0.001). In addition, subgroup analysis showed that AS was associated with an increased risk of Parkinson's disease (PD) development (OR: 1.55, 95% CI: 1.31-1.83, P<0.001), whereas there is no observed association with Alzheimer's disease (AD) and dementia (OR: 1.22, 95% CI: 0.96-1.55, P=0.098; OR: 1.34, 95% CI: 0.96-1.87, P=0.089, respectively).

CONCLUSION

The current meta-analysis identified AS as a risk factor for the development of NDs. Clinicians should be aware of the potential association between these diseases. Further research is necessary to confirm the causal relationship and underlying mechanisms between AS and NDs.

Converting an HLA-B27 flow assay from the BD FACSCanto to the BD FACSLyric

HLA-B27 is a major histocompatibility complex (MHC) class I antigen which exhibits strong association (90%) with ankylosing spondylitis. HLA-B27 detection in patients by flow cytometry is a widely used clinical test, performed on many different flow cytometer models. We sought to develop and validate a test conversion protocol for the HLA-B27 test performed on the BD FACSCanto to BD's newer FACSLyric flow cytometers. The development and validation experiments were performed using anti-HLA-B27*FITC/CD3*PE antibody-stained whole blood patient specimens. The anti-HLA-B27*FITC logarithmic median fluorescence (LMF) results on the BD FACSCanto were converted to median fluorescence intensity (MFI) values on the BD FACSLyric. Clustering of the HLA-B27 positive and negative values, using a 3rd order polynomial equation, resulted in a conversion of the BD FACSCanto cutoff values, negative (<150 LMF) and positive (≥160 LMF), to negative (<4530 MFI) and positive (≥6950 MFI) on the BD FACSLyric. Accuracy was assessed by comparing the flow results obtained on the BD FACSCanto and BD FACSLyric to a molecular PCR based assay. Additional validation parameters (compensation verification, intra- and inter-assay precision, and instrument comparison) were performed per the recommendations outlined in the Clinical and Laboratory Standards Institute (CLSI) H62 guidelines for validation of flow cytometry assays.

Associations of IL6R and IL10 Gene Polymorphisms with Susceptibility to Ankylosing Spondylitis with or without Acute Anterior Uveitis

BACKGROUND

This research aims to explore the associations between ten candidate single nucleotide polymorphisms (SNPs) on Interleukin-6 receptor (IL6R) and Interleukin-10 (IL10) genes and ankylosing spondylitis (AS) patients with or without acute anterior uveitis (AAU).

METHODS

This study involved a case-control approach that examined 354 cases with AS and AAU, 377 AS cases without AAU, and 918 healthy controls. Genotyping of ten SNPs of IL10 and IL6R genes was performed using iPLEX Gold genotyping method. The allele and genotype frequencies of cases and healthy individuals were contrasted using the chi-square test. The IL10 mRNA level in various IL10 genotypes was tested using real-time PCR.

RESULTS

Two loci associated with AS with AAU were identified: IL10//rs3790622 (OR = 0.664; 95%CI = 0.503-0.878; Pc = 0.038); IL10//rs3021094 (OR = 1.365; 95%CI = 1.110-1.679; Pc = 0.032). The other eight loci located on IL10 and IL6R did not show significant associations with the diseases. Additionally, as shown by functional experiments, there was no correlation between the mRNA expression of IL10 and various genotypes.

CONCLUSION

Our study suggests that the IL10 gene contributes to the susceptibility of the Chinese population to AS with AAU.

Clinical features of juvenile onset ankylosing spondylitis in Japanese patients

OBJECTIVES

This retrospective study aimed to examine the clinical features of juvenile onset ankylosing spondylitis (JoAS) in Japanese patients.

METHODS

We examined clinical symptoms (including initial symptoms) and the progression to diagnosis of AS in 17 Japanese JoAS patients at Nagoya university hospital between January 2004 and May 2023. Initial symptoms considered were pain at axial joints and/or extra-axial joints.

RESULTS

Mean ages (± standard deviation) at onset and diagnosis of AS were 12.9 (± 2.0) and 19.6 (± 9.6) years, respectively. The back was the most common site of initial symptoms (7 patients; 41.2%), followed by the hip (5 patients; 29.4%) and knees (5 patients; 29.4%). Initial symptoms were limited to extra-axial joints and axial joints in 9 (52.9%) and 7 (41.2%) patients, respectively. Nine patients (52.9%) were recognised as a musculoskeletal disease other than AS, such as oligoarticular juvenile idiopathic arthritis.

CONCLUSIONS

Sites of initial symptoms frequently were the back, hip, and knees, with 52.9% of patients having initial symptoms limited to extra-axial joints. More than half of the patients recognised musculoskeletal diseases other than AS.

Risk factor analysis of vertebral fractures requiring surgery in patients with ankylosing spondylitis

OBJECTIVES

This study aimed to determine the risk factors for vertebral fractures requiring surgery in patients with ankylosing spondylitis (AS).

METHODS

We included 60 patients with AS diagnosed by using the modified New York criteria and who were treated in our department from April 2004 to March 2019. We evaluated age, sex, disease duration, C-reactive protein, erythrocyte sedimentation rate, ankylosed sacroiliac joint, bamboo spine, number of ankylosed vertebrae, and treatment (nonsteroidal anti-inflammatory drugs, prednisolone, conventional synthetic disease-modifying antirheumatic drugs, biological disease-modifying antirheumatic drugs, and spine surgery for vertebral fracture) at the final follow-up of the nonsurgical group and the preoperative follow-up of the surgical group.

RESULTS

At the final follow-up, the mean age was 49 years, 46 patients (75%) were male, and the mean disease duration was 27 years. Additionally, 8 (13.3%) and 43 patients (71%) underwent surgical and medical treatments, respectively. The group of surgery for vertebral fracture had significantly higher C-reactive protein levels, which was also significantly associated with vertebral fracture surgery by multivariate analysis.

CONCLUSIONS

C-reactive protein was identified as a risk factor for vertebral fractures requiring surgery. Control of systemic inflammation in patients with AS may reduce the risk of vertebral fractures requiring surgery.

The mediating role of the genetically predicted N6, N6, N6-trimethyllysine levels in the association between HLA DR on CD14- CD16+ monocytes and ankylosing spondylitis

This study explores the hidden connection between HLA DR on CD14- CD16+ monocytes and ankylosing spondylitis (AS), with a particular emphasis on investigating and measuring the impact of 1091 blood metabolites as potential mediators. We harnessed the power of summary-level data extracted from a comprehensive genome-wide association study to delve into the intricate relationship between genetically predicted HLA DR on CD14- CD16+ monocytes (3621 cases) and AS (1193 cases and 374,621 controls). Furthermore, we employed a two-step Mendelian randomization (MR) methodology to elucidate the extent to which blood metabolites contribute to the effects observed in CD14- CD16+ monocytes, ultimately influencing the development of AS. This methodological approach provides a comprehensive and rigorous exploration of the interplay between blood metabolites and AS, shedding light on the underlying mechanisms governing this intricate association. Through MR analysis, our investigation revealed an increase in HLA DR on CD14- CD16+ monocytes within plasma, which correspondingly led to a reduction in the incidence of AS. The primary MR analysis yielded an odds ratio of 0.64 with a 95% confidence interval spanning from 0.53 to 0.78, underscoring the protective effect of elevated HLA DR on CD14- CD16+ monocytes against the development of AS. Furthermore, our study found no compelling evidence to suggest that AS exerts any discernible influence on HLA DR on CD14- CD16+ monocytes. Instead, our investigation identified N6, N6, N6-trimethyllysine levels (TML), a blood metabolite, as the sole mediator in the relationship between HLA DR on CD14- CD16+ monocytes and AS. Notably, the genetic prediction of AS mediated by TML accounted for a substantial -2.98% proportion of the observed variance. Our investigation has delineated a causal association between HLA DR on CD14- CD16+ monocytes and AS. Specifically, HLA DR on CD14- CD16+ monocytes exhibited a protective effect against the development of AS. Conversely, AS mediated by TML emerged as a risk factor, though the precise impact of HLA DR on CD14- CD16+ monocytes on AS pathogenesis remains enigmatic. It is imperative to embark on further investigations into potential mediators. In a clinical setting, it is imperative to carefully monitor the patient's HLA DR on CD14- CD16+ monocytes levels.

Current Concepts and Medical Management for Patients with Radiographic Axial Spondyloarthritis

Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL23/ IL17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigen-B27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.

Improvement in spinal pain at night and its impact on long-term outcomes in radiographic axial spondyloarthritis: Results from Ixekizumab COAST-V randomised trial

INTRODUCTION

Spinal pain at night is a major contributor to the patient burden of radiographic axial spondyloarthritis (r-axSpA), resulting in substantial functional limitations and impairment of health-related quality of life (QoL). Ixekizumab (IXE), an interleukin-17A inhibitor, has shown efficacy in patients with r-axSpA.

OBJECTIVE

To assess spinal pain at night improvement up to week (W) 52 in COAST-V and to determine if clinically important improvement in spinal pain at night at W16 is associated with improvement in disease activity and other patient-reported outcomes (PROs) at W16 and W52.

METHODS

The 52 W phase 3 COAST-V trial investigated the efficacy of IXE in patients with r-axSpA that were naïve to biological disease-modifying anti-rheumatic drug (bDMARD). Patients were randomised to IXE every two weeks (Q2W), IXE every four weeks (Q4W), adalimumab (ADA) Q2W, or placebo up to W16. Patients were categorised as achieving or not achieving a ≥3-point improvement, considered a clinically important improvement (CII), in spinal pain at night at W16. Associations between achieving CII in spinal pain at night at W16 and change from baseline in disease activity (ASDAS, ASAS40), Fatigue severity NRS, JSEQ, WPAI and the SF-36 survey, were tested using analysis of covariance (continuous variables) and logistic regression (binary variables).

RESULTS

At W16, 63.0 % (n=51), 46.7 % (n=42), and 32.2 % (n=28) of patients treated with IXE Q4W, ADA Q2W, and placebo, respectively, had reached a CII in spinal pain at night. Of those who were treated with IXE Q4W and achieved a CII in spinal pain at night at W16, 58.8 % and 66.7 % achieved an ASDAS <2.1 at W16 and W52 while 25.5 % and 29.4 % of patients also achieved ASDAS <1.3 at W16 and W52, respectively. Results at W16 and W52 show an improvement in disease activity, functioning, and health related QoL for patients who achieved a CII in spinal pain at night at W16.

CONCLUSION

A larger proportion of patients treated with IXE Q4W achieved rapid and clinically meaningful improvement in spinal pain at night versus placebo, with improvements maintained up to W52. Achieving a CII in spinal pain at night at W16 was associated with improved disease activity, functioning, PROs, and QoL at W16 and W52.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02696785.

Trends and gender disparities in the incidence of rheumatic diseases: a regional study from 2018 to 2021

Rheumatic diseases encompass a range of entities affecting the musculoskeletal system and connective tissue due to immune dysregulation. These entities include rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis that present significant medical and social challenges by impacting individuals' quality of life and working capacity. In developing countries, where healthcare access is limited, the burden of these diseases is particularly severe. Analyzing the regional epidemiological characteristics of rheumatic diseases may enhance our understanding of risk factors and aid in developing targeted preventive measures. This study utilized data from the Republican Centre for Health Development in Kazakhstan from 2018 to 2021. The incidence of various rheumatic diseases was examined in the adult population of Shymkent, Kazakhstan, including rheumatoid arthritis, gout, osteoarthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, and ankylosing spondylitis. Shymkent's total number of rheumatic disease cases rose from 52,617 in 2018 to 52,781 in 2021. Primary morbidity increased from 18,381 to 21,677 cases. Incidence rates for systemic lupus erythematosus, systemic scleroderma, and ankylosing spondylitis increased, while cases of rheumatoid arthritis and osteoarthritis showed fluctuation. Gender distribution analysis revealed that women were more frequently affected by rheumatoid arthritis and systemic lupus erythematosus whereas men were more prone to ankylosing spondylitis. The results underscore the need to tailor diagnostic and treatment approaches to account for age-and gender-specific differences in rheumatic diseases. The increased incidence of some diseases calls for new prevention and treatment strategies. This study highlights the significant burden of rheumatic diseases in Shymkent, Kazakhstan and emphasizes the importance of local epidemiological research in adapting medical practices to regional specifics.

Progress in targeted therapy for ankylosing spondylitis: A review

Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial osteoarticular inflammation and tendon enthesitis with unclear pathogenesis. Nonsteroidal anti-inflammatory drugs and antirheumatic drugs used in the traditional treatment of AS have some problems such as drug intolerance and inadequate treatment response. Since the introduction of biological agents in the treatment of AS, they have completely changed the treatment concept of AS, and because of their safety and good tolerance, they have become the main choice for clinical AS patients. This article systematically summarizes the current status of targeted therapy for AS worldwide, analyzes the advantages and disadvantages of different types of biological agents in the treatment of AS, and provides an objective evaluation of clinical targeted therapy for AS, in order to provide a new perspective for clinical standardized treatment.

Functional exercise capacity in patients with ankylosing spondylitis

OBJECTIVE

This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test.

METHODS

This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed.

RESULTS

The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040).

CONCLUSION

The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance.

Identification of novel protein biomarkers and therapeutic targets for ankylosing spondylitis using human circulating plasma proteomics and genome analysis

The proteome serves as the primary basis for identifying targets for treatment. This study conducted proteomic range two-sample Mendelian randomization (MR) analysis to pinpoint potential protein markers and treatment targets for ankylosing spondylitis (AS). A total of 4907 data points on circulating protein expression were collected from a large-scale protein quantitative trait locus investigation involving 35,559 individuals. Using data from a Finnish study on AS as the outcome, the dataset comprised 166,144 individuals of European ancestry (1462 cases and 164,682 controls), and causal relationships were determined through bidirectional Mendelian randomization of two samples. Proteins were further validated and identified through single-cell expression analysis, certain cells showing enriched expression levels were detected, and possible treatment targets were optimized. Increased HERC5 expression predicted by genes was related to increased AS risk, whereas the expression of the remaining five circulating proteins, AIF1, CREB3L4, MLN, MRPL55, and SPAG11B, was negatively correlated with AS risk. For each increase in gene-predicted protein levels, the ORs of AS were 2.11 (95% CI 1.44-3.09) for HERC5, 0.14 (95% CI 0.05-0.41) for AIF1, 0.48 (95% CI 0.34-0.68) for CREB3L4, 0.54 (95% CI 0.42-0.68) for MLN, 0.23 (95% CI 0.13-0.38) for MRPL55, and 0.26 (95% CI 0.17-0.39) for SPAG11B. The hypothesis of a reverse causal relationship between these six circulating proteins and AS is not supported. Three of the six protein-coding genes were expressed in both the AS and healthy control groups, while CREB3L4, MLN, and SPAG11B were not detected. Increased levels of HERC5 predicted by genes are related to increased AS risk, whereas the levels of the remaining five circulating proteins, AIF1, CREB3L4, MLN, MRPL55, and SPAG11B, negatively correlate with AS risk. HERC5, AIF1, and MRPL55 are potential therapeutic targets for AS. This study advanced the field by employing a novel combination of proteomic range two-sample MR analysis and single-cell expression analysis to identify potential protein markers and therapeutic targets for AS. This approach enabled a comprehensive understanding of the causal relationships between circulating proteins and AS, which has not been extensively explored in previous studies.

Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial

BACKGROUND

Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date.

OBJECTIVE

This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS.

METHODS

The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan.

RESULTS

A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference -0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference -0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05).

CONCLUSIONS

The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility.

Educational needs and its associated factors among patients with ankylosing spondylitis in China: a multicenter cross-sectional study

Objective

Patient education is an important part of ankylosing spondylitis (AS) management. Effective patient education should be targeted at specific priorities and needs of the patients. However, the educational needs of patients with AS in China have not been systematically explored. The purpose of this study was to assess the level of educational needs and analyze associated factors in patients with AS in China.

Methods

This multicenter cross-sectional study was conducted at five hospitals in China. The Chinese version of the Educational Needs Assessment Tool (ENAT) was used to measure educational needs. Disease activity and physical function were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Multiple linear regression analysis was used to identify the predictors of educational needs.

Results

This study included 163 patients with AS. The mean ENAT score was 86.25 (31.64). Patients wanted to know more about the arthritis process, self-help measures, and treatments. Multiple linear regression analysis indicated that younger age, being female, higher disease activity, and no family history of AS (p < 0.05) were positive predictors of educational needs.

Conclusion

Patients with AS in China have considerable educational needs, particularly in the domains of arthritis, self-help, and treatment. Female patients and patients with younger age, higher disease activity, and no family history may have higher educational needs. These factors should be considered when conducting need-based patient education programs. Healthcare professionals should integrate need-based patient education into rheumatology care in the future.

Causal relationship between ankylosing spondylitis and ocular inflammatory diseases: a Mendelian randomization study

Background

Observational studies have shown an increased risk of ocular inflammatory diseases in patients with ankylosing spondylitis (AS), but the genetically predicted association remains unclear. The aim of this study was to systematically assess the causal relationship between AS and ocular inflammatory diseases.

Methods

We conducted a two-sample Mendelian randomization (MR) analysis to investigate the causal relationship between AS and several common ocular inflammatory diseases based on genome-wide association study (GWAS) data and public health data. Five methods, namely, inverse-variance weighted (IVW), MR-Egger, weighted median, weighted mode, and simple mode, were used. Sensitivity analysis was performed using MR-Egger intercept, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), Cochran's Q test, outlier methods, leave-one-out analysis, and funnel plots.

Results

The MR analysis showed a significantly increased risk of uveitis (ORIVW = 2.825, 95%CIIVW = 1.709-4.672, and PIVW < 0.001), iridocyclitis (ORIVW = 3.806, 95%CIIVW = 2.809-5.157, and PIVW < 0.001), scleritis (ORIVW = 1.738, 95%CIIVW = 1.190-2.539, and PIVW < 0.001), and episcleritis (ORIVW = 5.113, 95%CIIVW = 2.067-12.645, and PIVW = 0.004) associated with AS. However, no correlation was found between genetically predicted AS and keratitis (ORIVW = 1.041, 95%CIIVW = 0.886-1.222, and PIVW = 0.628) and optic neuritis (ORIVW = 0.868, 95%CIIVW = 0.441-1.709, and PIVW = 0.682).

Conclusion

AS increases the genetically predicted risk for uveitis, iridocyclitis, scleritis, and episcleritis. No potential association of AS with keratitis and optic neuritis was found. It may provide clues for the prevention of AS complications.

Review of the updated definitions and concepts of spinal lesions in axial spondyloarthritis

Spinal imaging may support the diagnosis of axial spondyloarthritis when typical findings are recognized in an appropriate clinical context and it can also indicate disease activity. In May 2022, the definitions for inflammatory and structural spinal lesions in axial spondyloarthritis were updated and validated by the Assessment of SpondyloArthritis international Society (ASAS) magnetic resonance imaging (MRI) working group. The aims of this paper are to demonstrate and describe imaging findings of the spine in patients with axial SpA, including the latest updated definitions by the ASAS, and to show complications in patients with long-standing disease.

Obstetric and neonatal outcomes in women with Ankylosing spondylitis - an evaluation of a population database

BACKGROUND

Ankylosing Spondylitis (AS) is a systemic chronic rheumatic disease characterized by involvement of the axial skeletal and sacroiliac joints. Although this disease is not rare amongst women of reproductive age, data regarding pregnancy outcomes have demonstrated conflicting results. We therefore aimed to compare pregnancy and perinatal outcomes between women who suffered from AS to those who did not.

METHODS

A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Included in the study were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. Women with an ICD-9 diagnosis of AS before or during pregnancy were compared to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups using multivariate logistic regression models adjusting for potential confounders.

RESULTS

A total of 9,096,788 women were inclusion in the analysis. Amongst them, 383 women (3.8/100,000) had a diagnosis of AS and the rest were controls. Women with AS, compared to those without, were more likely to be older; Caucasian; from higher income quartiles; suffer from thyroid disorders, and have multiple pregnancies (p < 0.001, all). After adjusting for confounders, patients in the AS group, compared to those without, had a higher rate of cesarean delivery (CD) (aOR 1.47, 95% CI 1.14-1.91, p = 0.003); gestational diabetes (aOR 1.55, 95% CI 1.02-2.33, p = 0.038); and placenta previa (aOR 3.6, 95% CI 1.6-8.12, p = 0.002). Regarding neonatal outcomes, patients with AS, compared to those without, had a higher rate of small-for-gestational-age (SGA) neonates (aOR 2.19, 95% CI 1.22-3.93, p = 0.009); and intrauterine fetal death (IUFD) (aOR 3.46, 95% CI 1.11-10.83, p = 0.033).

CONCLUSION

Women diagnosed with AS have an increased risk of obstetric complications, including CD, as well as an increased risk of SGA and IUFD.

Application of methylation in the diagnosis of ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease, mainly characterized by perifibrocartilage osteitis of the sacroiliac joints and spinal enthesitis. To date, the exact pathogenesis of AS remains elusive. It is generally believed that AS is a multifactorial disease involving genetics, infection, environment, and immunity. Among them, genetic factors are the primary determinants of disease risk and severity. In recent years, epigenetic mechanisms such as DNA methylation have been extensively surveyed with respect to the pathogenesis of AS. This review summarizes the latest research progress of methylation in AS, from whole-genome sequencing to individual differentially methylated gene. And finally, the role of methylase in AS inflammation, autophagy, and osteogenic differentiation was explored. In summary, the results of this review attempt to explain the role of methylation in the occurrence and development of AS and point out the shortcomings of current methylation research, providing directions for subsequent methylation research in AS.