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Lee TH, Lee S, Koo BS, Joo KB, Kim TH. Radiographic involvement of cervical facet joints in ankylosing spondylitis: a longitudinal analysis in correlation with vertebral body lesions. BMC Rheumatol 2023; 7:11. [PMID: 37280716 DOI: 10.1186/s41927-023-00334-x] [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: 05/15/2022] [Accepted: 04/28/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The inability to assess structural changes in facet joints is a limitation of established radiographic scoring systems for ankylosing spondylitis (AS). We compared radiographic evidence of ankylosis in cervical facet joints and cervical vertebral bodies in patients with AS. METHODS We analysed longitudinal data collected from 1106 AS patients and assessed 4984 spinal radiographs obtained up to 16 years of follow-up. Comparisons between cervical facet joints and cervical vertebral bodies focused on the presence of ankylosis, which was defined by at least one facet joint exhibiting complete ankylosis (according to the method of de Vlam) or at least one vertebral body with a bridging syndesmophyte (according to the modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). Ankylosis was assessed over time using spinal radiographs collected during follow-up periods stratified in 4-year increments. RESULTS Patients with cervical facet joint ankylosis had higher cervical mSASSS, sacroiliitis grades, and inflammatory markers, with more prevalent hip involvement and uveitis. Overall, the numbers of spinal radiographs indicating ankylosis were comparable between cervical facet joints (17.8%) and cervical vertebral bodies (16.8%), and they usually presented together (13.5%). We observed similar proportions of radiographs with ankylosis only in cervical facet joints (4.3%) and cervical vertebral bodies (3.3%). As damage progressed, configurations with both cervical facet joint ankylosis and bridging syndesmophytes became more predominant with longer follow-up times, while configurations with cervical facet joint ankylosis only or bridging syndesmophytes only were less frequently observed. CONCLUSIONS Evidence of cervical facet joint ankylosis appears as often as bridging syndesmophytes on routine AS spinal radiographs. Presence of cervical facet joint ankylosis should be considered because it may have a higher disease burden.
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Affiliation(s)
- Tae-Han Lee
- Department of Rheumatology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital, Seoul, South Korea
| | - Bon San Koo
- Division of Rheumatology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, South Korea
| | - Kyung Bin Joo
- Department of Radiology, Hanyang University Hospital, Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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Choi MH, Yoon IY, Kim WJ. Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis: A case report. World J Clin Cases 2023; 11:2043-2050. [PMID: 36998969 PMCID: PMC10044947 DOI: 10.12998/wjcc.v11.i9.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Manubriosternal joint (MSJ) disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement. In patients with ankylosing spondylitis (AS), a type of systemic arthritis, chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.
CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain. There were no abnormal findings on lateral sternum X-ray, but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography. We performed additional laboratory tests, and he was finally diagnosed with AS. For pain relief, we performed ultrasound-guided intra-articular (IA) corticosteroid injections into the MSJ. After the injections, his pain nearly resolved.
CONCLUSION For patients complaining of anterior chest pain, AS should be considered, and single-photon emission computed tomography-computed tomography can be helpful in diagnosis. In addition, ultrasound-guided IA corticosteroid injections may be effective for pain relief.
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Affiliation(s)
- Min-Hee Choi
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - In-Young Yoon
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
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Mete O, Oskay D, Haznedaroğlu Ş, Tufan A, Yildiz TI. Comparison of shoulder muscle strength, shoulder range of motion and scapular motion in men with ankylosing spondylitis and healthy men: a case-controlled study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background/Aims Ankylosing spondylitis mainly affects the vertebral column, meaning that the assessment of the physical function of the upper extremity and scapulothoracic region in ankylosing spondylitis is often overlooked. Therefore, the aim of this study was to investigate shoulder muscle strength, shoulder active range of motion and three-dimensional scapular motion in patients with ankylosing spondylitis. Methods The study included 18 men with ankylosing spondylitis, and 16 age-matched typically healthy men as the control group. Muscle strength, active range of motion, and three-dimensional scapular motion were assessed with a digital hand-held dynamometer, an inclinometer, and an electromagnetic tracking device respectively. Results A decrease in shoulder flexion and abduction muscle strength on both the dominant side (P<0.001, P=0.001) and non-dominant side (P<0.001, P<0.001) was found in the ankylosing spondylitis group compared to the control group. A decrease in shoulder flexion, abduction, and external and internal rotation active range of motion on both the dominant side (P=0.001, P<0.001, P=0.015, P<0.001, respectively) and non-dominant side (P=0.001, P<0.001, P=0.017, P<0.001 respectively) was observed in the ankylosing spondylitis group. There was an increase in the upward rotation of the scapula on the non-dominant side at 30, 60, and 90° humeral elevations in the ankylosing spondylitis group compared to the control group (P=0.018, P=0.003, P=0.001 respectively). The other parameters of the scapular motion did not differ between groups (P>0.05). Conclusions This study showed that shoulder muscle strength and active range of motion were lower, and the upward rotation of the scapula was greater in men with ankylosing spondylitis compared to typically healthy men. The kinetics and kinematics parameters of the shoulder and scapula should be considered when assessing the physical function of patients with ankylosing spondylitis.
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Affiliation(s)
- Oguzhan Mete
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Gazi University, Ankara, Turkey
| | | | | | - Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Hacettepe University, Ankara, Turkey
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Bittar M, Yong WC, Magrey M, Khan MA. Worldwide Differences in Clinical Phenotype of Axial Spondyloarthritis. Curr Rheumatol Rep 2021; 23:76. [PMID: 34586533 DOI: 10.1007/s11926-021-01043-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the variations in the clinical presentation of axial spondyloarthritis (axSpA) across the globe. RECENT FINDINGS We searched the PubMed database and screened more than 1360 articles; 60 of them were selected based on relevance to the topic being discussed and the goals of the review. Most of the clinical manifestations, including IBP, peripheral arthritis, and extra-articular involvement are seen in different regions of the world, but with appreciable clinical heterogeneity, possibly related to a smaller number of patients from some countries, and global variation in the prevalence of HLA-B27. For example, HLA-B27-positive patients have an earlier age of onset, higher prevalence of acute anterior uveitis, and greater familial occurrence. Peripheral arthritis and enthesitis are most commonly seen among axSpA patients from Latin America and Asia, whereas IBD appears to be slightly more common among Middle Eastern and North African patients. The main weakness encountered while reviewing these data is that some studies were small, and others were cross-sectional and retrospective; hence the inferences may have a selection bias. AxSpA is a very heterogenous disease with varied presentation across the globe, in part related to HLA-B27 positivity. It is imperative to further investigate the key regional differences as they impact timely disease recognition and initiation of early treatment. Therefore, there is a need for a large worldwide systematic study to capture the clinical picture of AxSpA in a more uniform manner.
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Affiliation(s)
- Mohamad Bittar
- Division of Connective Tissue Disease (Rheumatology), Department of Medicine, The University of Tennessee Health Science Center, 956 Court Avenue, Coleman Building, Suite G326, Memphis, TN, 38163, USA.
| | - Wai Chung Yong
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Marina Magrey
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Muhammad Asim Khan
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
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Lee JS, Song YW, Kim TH, Chung WT, Lee SG, Park SH, Song GG, Yu DY, Xu S, Lee EY. Baseline extent of damage predicts spinal radiographic progression in Korean patients with ankylosing spondylitis treated with golimumab. Korean J Intern Med 2018; 33:622-628. [PMID: 28103433 PMCID: PMC5943646 DOI: 10.3904/kjim.2016.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/12/2016] [Accepted: 05/22/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS For patients with ankylosing spondylitis (AS), golimumab has consistent efficacy in controlling disease activity over 5 years but its benefit in preventing radiographic progression was less clear at 4 years. To predict radiographic progression, we analyzed the baseline characteristics of AS patients in a Korean population. METHODS Sixty-eight Korean patients with AS participated in the phase 3, multicenter, randomized, placebo-controlled, double-blind trial (GO-RAISE) which has previously been described. Baseline modified stoke AS spine score (mSASSS) and change in mSASSS from baseline (ΔmSASSS) until week 208 were analyzed in the Korean patients enrolled in the GO-RAISE study. RESULTS Although Korean patients had lower baseline mSASSS compared to non-Korean patients and received active management, radiographic progression was not prevented. Korean patients who did not undergo radiographic progression of spinal lesions of AS were younger and had shorter symptomatic duration, lower Bath AS functional and metrology indices, better chest expansion, and lower baseline mSASSS. The baseline mSASSS and ΔmSASSS were positively correlated in Korean AS patients (p < 0.001). Radiographic progression was more prevalent (80.0%) when baseline mSASSS > 10 and less common (13.0%) with baseline mSASSS = 0. CONCLUSIONS In Korean AS patients, radiographic progression of the spine after 4 years was predicted effectively by the initial severity of the spinal lesion(s) in patients treated with golimumab.
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Affiliation(s)
- Jeong Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Hwan Kim
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Won Tae Chung
- Division of Rheumatology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Seung Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sung Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | - Stephen Xu
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Eun Young Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0852 Fax: +82-2-762-9662 E-mail:
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Jeong H, Eun YH, Kim IY, Park EJ, Kim H, Lee J, Jeon CH, Koh EM, Cha HS. Effect of tumor necrosis factor α inhibitors on spinal radiographic progression in patients with ankylosing spondylitis. Int J Rheum Dis 2018; 21:1098-1105. [PMID: 29611287 DOI: 10.1111/1756-185x.13270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hyemin Jeong
- Division of Rheumatology; Department of Internal Medicine; Soonchunhyang University Hospital; Bucheon South Korea
| | - Yeong Hee Eun
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - In Young Kim
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Eun-Jung Park
- Department of Medicine; Jeju National University Hospital; Jeju South Korea
| | - Hyungjin Kim
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jaejoon Lee
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Chan Hong Jeon
- Division of Rheumatology; Department of Internal Medicine; Soonchunhyang University Hospital; Bucheon South Korea
| | - Eun-Mi Koh
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Hoon-Suk Cha
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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Li S, Yang D, Peng T, Wu Y, Tian Z, Ni B. Innate lymphoid cell-derived cytokines in autoimmune diseases. J Autoimmun 2017; 83:62-72. [PMID: 28479212 DOI: 10.1016/j.jaut.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/31/2017] [Accepted: 05/01/2017] [Indexed: 02/07/2023]
Abstract
The most recently recognized types of immune cells, the innate lymphoid cells (ILCs), have been sub-divided according to respective distinct expression profiles of regulatory factors or/and cytokines. ILCs have also been shown to participate in a variety of beneficial immune responses, including participation in attack against pathogens and mediation of the pre-inflammatory and inflammatory responses through their production of pro-inflammatory cytokines. As such, while the ILCs exert protective effects they may also become detrimental upon dysregulation. Indeed, recent studies of the ILCs have revealed a strong association with the advent and pathogenesis of several common autoimmune diseases, including psoriasis, inflammatory bowel disease (IBD) and multiple sclerosis (MS). Though the ILCs belong to lineage negative cells that are distinctive from the Th cells, the profiles of secreted cytokines from the ILCs overlap with those of the corresponding Th subsets. Nevertheless, considering that the ILCs belong to the innate immune system and the Th cells belong to the adaptive immune system, it is expected that the ILCs should function at the early stage of diseases and the Th cells should exert predominant effects at the late stage of diseases. Therefore, it is intriguing to consider targeting of ILCs for therapy by targeting the corresponding cytokines at the early stage of diseases, with the late stage cytokine targeting mainly influencing the Th cells' function. Here, we review the knowledge to date on the roles of ILCs in various autoimmune diseases and discuss their potential as new therapeutic targets.
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Affiliation(s)
- Sirui Li
- Department of Pathophysiology and High Altitude Pathology, Third Military Medical University, Chongqing 400038, PR China; Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China; Battalion 3 of Cadet Brigade, Third Military Medical University, Chongqing 400038, PR China
| | - Di Yang
- Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China
| | - Tingwei Peng
- Department of Pathophysiology and High Altitude Pathology, Third Military Medical University, Chongqing 400038, PR China; Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China; Battalion 3 of Cadet Brigade, Third Military Medical University, Chongqing 400038, PR China
| | - Yuzhang Wu
- Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China.
| | - Zhiqiang Tian
- Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China.
| | - Bing Ni
- Department of Pathophysiology and High Altitude Pathology, Third Military Medical University, Chongqing 400038, PR China; Institute of Immunology, PLA, Third Military Medical University, Chongqing 400038, PR China.
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Lee S, Lee JY, Hwang JH, Shin JH, Kim TH, Kim SK. Clinical importance of inflammatory facet joints of the spine in ankylosing spondylitis: a magnetic resonance imaging study. Scand J Rheumatol 2016; 45:491-498. [PMID: 27098409 DOI: 10.3109/03009742.2016.1150506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aims of this study were to assess the reliability of a novel magnetic resonance imaging (MRI) scoring system for inflammatory lesions of facet joints and to clarify the clinical significance of facet joint inflammation in ankylosing spondylitis (AS). METHOD A total of 53 AS patients (45 males, 84.9%) were assessed for active inflammatory lesions involving the facet joints, as indicated by bone marrow oedema, at 23 discovertebral units (DVUs) between C2 and S1 using a novel scale, the AS Activity of the Facet joint (ASAFacet). The reliability of the ASAFacet was evaluated using intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS ICC values for the ASAFacet scores were 0.857 [95% confidence interval (CI) 0.741-0.919] for inter-observer and 0.941 (95% CI 0.873-0.969) for intra-observer reliability. Inflammatory activity scores in facet joints were evenly distributed at all spine levels (p = 0.294 for ASAFacet), whereas vertebral body inflammation was more prominent in the thoracic spine than in the cervical and lumbar spine [p < 0.001 for the AS spine MRI activity (ASspiMRI-a) score, p = 0.002 for the Berlin method, and p < 0.001 for the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index]. ASAFacet scores were closely associated with erythrocyte sediment rate (ESR) and C-reactive protein (CRP) levels (p < 0.05, respectively). Patients with peripheral arthritis had fewer lesions involving the vertebral bodies or facet joints than patients without peripheral arthritis (p < 0.001 for the four different MRI activity indexes). CONCLUSIONS This study suggests that recognition of facet joint inflammation has the potential to contribute to our understanding of clinical outcomes in AS.
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Affiliation(s)
- S Lee
- a Department of Radiology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - J Y Lee
- a Department of Radiology , Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - J H Hwang
- b Department of Preventive Medicine , Catholic University of Daegu School of Medicine , Daegu , South Korea
| | - J H Shin
- c Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - T-H Kim
- c Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - S-K Kim
- d Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Centre , Catholic University of Daegu School of Medicine , Daegu , South Korea
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Soker G, Bozkirli E, Soker E, Gulek B, Arslan M, Memis D, Yilmaz C. Magnetic resonance imaging evaluation of shoulder joint in patients with early stage of ankylosing spondylitis: A case-control study. Diagn Interv Imaging 2016; 97:419-24. [DOI: 10.1016/j.diii.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/30/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
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Gunes A, Erkol Inal E, Tok L, Tok O. Assessment of Corneal Parameters with Scheimpflug Imaging in Patients with Ankylosing Spondylitis. Semin Ophthalmol 2015; 32:276-280. [PMID: 26337454 DOI: 10.3109/08820538.2015.1068340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate corneal parameters of patients with ankylosing spondylitis (AS) by Scheimpflug imaging and also to clarify the associations between disease severity and clinical status of AS and corneal parameters. METHODS Fifty-seven patients with AS and 57 healthy subjects were included in this cross-sectional study. All participants underwent a detailed ophthalmological evaluation. Corneal parameters were measured by Pentacam. In addition, Schirmer test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI) scores were evaluated. Duration of disease and scores of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life scale (ASQoL) of the patients were recorded. The laboratory evaluation consisted of human leukocyte antigen (HLA)-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). RESULTS Corneal parameters were significantly different between patients with AS and healthy controls. The mean central corneal thickness (538 ± 26 µm versus 569 ± 27 µm, p < 0.001) and the mean corneal volume (59.8 ± 3.33 mm3 versus 62.3 ± 3.40 mm3, p < 0.001) were reduced significantly in AS patients compared to those in healthy controls. The values of TBUT and Schirmer test scores were significantly lower in AS patients than in controls. Also, corneal fluorescein staining and OSDI scores were higher in AS patients than in controls. Factors related to the corneal parameters were dry eye tests (TBUT, Schirmer test, corneal fluorescein staining), OSDI score, and CRP (p < 0.05 for all). CONCLUSION The AS patients have thinner corneas compared to control subjects, which may be affected by tear disfunction and inflammatory processes.
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Affiliation(s)
- Alime Gunes
- a Department of Ophthalmology , Süleyman Demirel University Faculty of Medicine , Isparta , Turkey
| | - Esra Erkol Inal
- b Department of Physical Medicine and Rehabilitation , Süleyman Demirel University Faculty of Medicine , Isparta , Turkey
| | - Levent Tok
- a Department of Ophthalmology , Süleyman Demirel University Faculty of Medicine , Isparta , Turkey
| | - Ozlem Tok
- a Department of Ophthalmology , Süleyman Demirel University Faculty of Medicine , Isparta , Turkey
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Prevalence of HLA-B27 in Moroccan healthy subjects and patients with ankylosing spondylitis and mapping construction of several factors influencing AS diagnosis by using multiple correspondence analysis. Rheumatol Int 2015; 35:1889-94. [DOI: 10.1007/s00296-015-3342-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/01/2015] [Indexed: 01/13/2023]
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Kim H, Lee J, Ahn JK, Hwang J, Park EJ, Jeong H, Cha HS, Koh EM. Predictive factors of radiographic progression in ankylosing spondylitis. Korean J Intern Med 2015; 30:391-7. [PMID: 25995670 PMCID: PMC4438294 DOI: 10.3904/kjim.2015.30.3.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/28/2013] [Accepted: 07/23/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.
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Affiliation(s)
- Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwon Hwang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Jung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jeong H, Yoon JY, Park EJ, Hwang J, Kim H, Ahn JK, Lee J, Koh EM, Cha HS. Clinical characteristics of nonradiographic axial spondyloarthritis in Korea: a comparison with ankylosing spondylitis. Int J Rheum Dis 2014; 18:661-8. [DOI: 10.1111/1756-185x.12458] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Hyemin Jeong
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Ji Y. Yoon
- Department of Radiology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Eun-Jung Park
- Department of Medicine; Jeju National University Hospital; Jeju South Korea
| | - Jiwon Hwang
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Hyungjin Kim
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Joong K. Ahn
- Department of Medicine; Kangbook Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jaejoon Lee
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Eun-Mi Koh
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Hoon-Suk Cha
- Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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Kim TJ, Lee S, Joo KB, Park DJ, Park YW, Lee SS, Kim TH. The presence of peripheral arthritis delays spinal radiographic progression in ankylosing spondylitis: Observation Study of the Korean Spondyloarthropathy Registry. Rheumatology (Oxford) 2014; 53:1404-8. [PMID: 24609061 DOI: 10.1093/rheumatology/keu014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine whether the presence of peripheral arthritis can affect radiographic structural damage in patients with AS. METHODS A total of 915 subjects comprising 363 patients with a history of peripheral arthritis and 552 patients without a history of peripheral arthritis obtained from the Observation Study of the Korean SpA Registry (OSKAR) were analysed looking at the relationship of peripheral arthritis history in a cross-sectional survey as well as the radiographic damage score according to the presence or absence of peripheral arthritis. Radiographs and clinical information were available for 501 subjects (205 peripheral arthritis patients and 296 without peripheral arthritis) at a mean follow-up of 2.7 years. The modified Stoke AS Spinal Score (mSASSS) was examined by two experienced radiologists to validate the results. Reliability was evaluated using the intraclass correlation coefficient for each radiograph. RESULTS The agreement between the two readers regarding the mSASSS was good. On simple comparison there was a significant difference in the mSASSS between patients with a history of peripheral arthritis and those without [mean 14.62 (s.e.m. 0.83) vs 18.78 (0.79), P < 0.001]. The mSASSS change was stratified according to the presence or absence of peripheral arthritis at baseline. After adjusting for multiple comparisons by Bonferroni correction, the patients with peripheral arthritis had less mSASSS change than those without peripheral arthritis [3.08 (s.e.m. 0.61) vs 5.18 (0.47), P = 0.008]. CONCLUSION The presence of peripheral arthritis delays spinal radiographic progression in AS.
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Affiliation(s)
- Tae-Jong Kim
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Seunghun Lee
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Kyung Bin Joo
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Dong-Jin Park
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yong-Wook Park
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Department of Radiology and Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
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Koko V, Ndrepepa A, Skënderaj S, Ploumis A, Backa T, Tafaj A. An epidemiological study on ankylosing spondylitis in southern Albania. Mater Sociomed 2014; 26:26-9. [PMID: 24757397 PMCID: PMC3990378 DOI: 10.5455/msm.2014.26.26-29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/18/2014] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To evaluate the incidence and prevalence of ankylosing spondylitis (AS) in southern Albania and to assess the association of various demographic risk factors with the severity of disease. MATERIAL AND METHODS This is an observational study with cross-sectional analyses, conducted in the region of Gjirokaster, between 1995 until 2011. The diagnosis of AS was based on the modified New York criteria. Data on population are obtained from the reports of the National Institute of Statistics. RESULTS Between 1995 and 2011, there were 54 patients diagnosed with AS. Of them, 48 subjects were males (88.9%) and 6 subjects females (11.1%). The AS prevalence in adult population (≥14 years of age), in December 2010, was 0.061%. The 5-year incidence (2006-2010) in adult population was 0.006 %. The mean age at the onset of disease was 29.7±8.4 years. The mean age in 2011 (n=50 subjects) was 51.6±12.7 years. The duration of the disease was 22.7±11.2 years. More than two thirds of the patients (70.3%) were in the advanced radiological stages of the disease. A younger age at the onset of the disease, longer delay in diagnosis, lower educational level and smoking were significant independent factors associated with the advanced forms of the disease. CONCLUSION In southern Albania, the AS prevalence in 2010 was 0.061% and the 5-year incidence (2006-2010) was 6 new cases per 105 adults. The incidence and prevalence of AS in Southern Albania are close to the respective regional epidemiological data.
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Affiliation(s)
| | - Ana Ndrepepa
- IBE Institut, Ludwig-Maximilian University, Munich, Germany
| | - Skënder Skënderaj
- Service of Professional Diseases, University Hospital Center of Tirana Albania
| | - Avraam Ploumis
- Department of Orthopaedics and Rehabilitation, University of Ioannina Medical School, Greece
| | - Teuta Backa
- Department of Rheumatology, University Hospital Center of Tirana, Albania
| | - Argjend Tafaj
- Department of Rheumatology, University Hospital Center of Tirana, Albania
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Jamshidi AR, Shahlaee A, Farhadi E, Fallahi S, Nicknam MH, Bidad K, Barghamadi M, Mahmoudi M. Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis. Mod Rheumatol 2013; 24:499-504. [DOI: 10.3109/14397595.2013.844302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Inanır A, Yigit S, Sariyildiz MA, Sogut E. Outcomes of Turkish Ankylosing Spondylitis Patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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The relationship between peripheral arthritis and anti-cyclic citrullinated peptide antibodies in ankylosing spondylitis. Joint Bone Spine 2013; 80:399-401. [DOI: 10.1016/j.jbspin.2012.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/03/2012] [Indexed: 02/01/2023]
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19
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Xueyi L, Lina C, Zhenbiao W, Qing H, Qiang L, Zhu P. Levels of Circulating Th17 Cells and Regulatory T Cells in Ankylosing Spondylitis Patients with an Inadequate Response to Anti−TNF-α Therapy. J Clin Immunol 2012; 33:151-61. [DOI: 10.1007/s10875-012-9774-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 08/15/2012] [Indexed: 12/14/2022]
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20
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Mei Y, Pan F, Gao J, Ge R, Duan Z, Zeng Z, Liao F, Xia G, Wang S, Xu S, Xu J, Zhang L, Ye D. Increased serum IL-17 and IL-23 in the patient with ankylosing spondylitis. Clin Rheumatol 2010; 30:269-73. [PMID: 21161669 DOI: 10.1007/s10067-010-1647-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 11/21/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
Interleukin 17 (IL-17) is a Th17 cytokine associated with inflammation, autoimmunity, and defense against some bacteria; it has been implicated in many chronic autoimmune diseases including psoriasis, multiple sclerosis, and systemic sclerosis. However, whether IL-17 plays a role in the pathogenesis of ankylosing spondylitis (AS) remains unclear. To analyze the content of IL-17 and IL-23 in the serum from patients with AS compared with health control subject, 50 patients with AS and 43 healthy volunteers were recruited. Serum IL-17 levels were examined by enzyme linked immunosorbent assay (ELISA). Statistic analyses were performed by SPSS 13.0. Results show that the serum IL-17 and IL-23 levels were significantly elevated in AS patients as compared with normal controls. Nevertheless, no associations of serum IL-17 and IL-23 levels with clinical and laboratory parameters were found; no significant difference regarding serum IL-17 and IL-23 levels was found between less active AS and more active AS. However, there was a strong positive association between the serum levels of IL-17 and IL-23 in the AS patients. Our results indicate increased serum IL-17 and IL-23 levels in AS patients, suggesting that this two cytokine may play critical roles in the pathogenesis of AS. Therefore, further studies are required to confirm this preliminary data.
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Affiliation(s)
- Yang Mei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
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21
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Kristensen LE, Karlsson JA, Englund M, Petersson IF, Saxne T, Geborek P. Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register. Arthritis Care Res (Hoboken) 2010; 62:1362-9. [PMID: 20506310 DOI: 10.1002/acr.20258] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice. METHODS Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years. RESULTS The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19-0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27-0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25-1.04], P = 0.062), whereas no differences were found comparing the 3 anti-tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97-1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34-1.10], P = 0.10) also showed trends to entail better drug adherence. CONCLUSION AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.
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Affiliation(s)
- L E Kristensen
- South Sweden Musculoskeletal Research Centre, Lund University Hospital, Lund University, Sweden.
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22
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Atagunduz P, Aydin SZ, Bahadir C, Erer B, Direskeneli H. Determinants of early radiographic progression in ankylosing spondylitis. J Rheumatol 2010; 37:2356-61. [PMID: 20843901 DOI: 10.3899/jrheum.100094] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the demographic and clinical characteristics associated with early, extensive radiographic changes in ankylosing spondylitis (AS). METHODS Radiographic severity was assessed cross-sectionally in 235 patients with AS using the Bath AS Radiological Index spine score (BASRI-s). Patients with extensive radiographic changes on the lumbar portion of BASRI-s were defined as the early axial ankylosis (EAA) Group. ANCOVA and logistic regression analyses were used to identify factors affecting EAA. RESULTS Most study patients were men (139/235, 59.0%). Mean disease duration was 12.4 ± 9.3 years. Fifteen percent of women and 34.8% of men with AS were in the EAA group. HLA-B27-positive men with AS had significantly higher BASRI-lumbar scores, while HLA-B27 had no effect on radiographic progression of axial disease in women with AS. Peripheral joint involvement was associated with slow radiographic progression. Hip involvement had no effect on axial progression but uveitis was more frequent in the male EAA group. The odds for an HLA-B27-positive male patient with AS who did not have peripheral arthritis of having a BASRI-lumbar score of 3 or higher were 3.4 (77% chance to have axially progressive disease). Presence of uveitis increased these odds to 93%. Only 15% of female patients with AS had EAA, and the absence of peripheral arthritis was the only clinical measure associated with EAA in this group. CONCLUSION EAA was more frequent in men with AS than in women. Absence of peripheral arthritis, HLA-B27 positivity, and uveitis were associated with multiple syndesmophytes or fusion of multiple vertebrae of the lumbar vertebrae.
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Affiliation(s)
- Pamir Atagunduz
- Marmara University, School of Medicine, Department of Rheumatology, Tophanelioglu Cad. 13/15, Uskudar, Istanbul, Turkey.
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Bodur H, Ataman S, Buğdaycı DS, Rezvani A, Nas K, Uzunca K, Emlakçıoğlu E, Karatepe AG, Durmuş B, Sezgin M, Ayhan F, Yazgan P, Duruöz T, Yener M, Gürgan A, Kırnap M, Cakar E, Altan L, Soydemir R, Capkın E, Tekeoğlu I, Aydın G, Günendi Z, Nacır B, Sallı A, Oztürk C, Memiş A, Turan Y, Kozanoğlu E, Sivrioğlu K. Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IP. Rheumatol Int 2010; 32:169-76. [PMID: 20711591 DOI: 10.1007/s00296-010-1599-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 07/28/2010] [Indexed: 11/25/2022]
Abstract
A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 ± 10.7 years). Mean disease duration was 12.1 ± 8.5 years, and mean time from initial symptom to diagnosis was 5 ± 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was ≥4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.
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Affiliation(s)
- Hatice Bodur
- Ankara Numune Training & Research Hospital, Mürsel Uluç M, 937 S, No: 35/17, 06450 Ankara, Turkey.
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24
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Kim TJ, Kim TH. Clinical spectrum of ankylosing spondylitis in Korea. Joint Bone Spine 2010; 77:235-40. [DOI: 10.1016/j.jbspin.2009.11.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 11/04/2009] [Indexed: 11/24/2022]
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25
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Jung YO, Kim I, Kim S, Suh CH, Park HJ, Park W, Kwon SR, Jeong JC, Lee YJ, Ryu HJ, Park YB, Lee J, Lee YH, Seo YI, Chung WT, Hong SJ, Hong YS, Baek HJ, Choi HJ, Kang HJ, Lee CH, Kim SH, Kim HA. Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females. J Korean Med Sci 2010; 25:532-5. [PMID: 20357993 PMCID: PMC2844591 DOI: 10.3346/jkms.2010.25.4.532] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 07/23/2009] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.
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Affiliation(s)
- Young-Ok Jung
- Division of Rheumatology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Inje Kim
- Division of Rheumatology, Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Suho Kim
- Division of Rheumatology, Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Chang-Hee Suh
- Division of Allergy-Rheumatology, Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Han Jung Park
- Division of Allergy-Rheumatology, Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Seoung Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Cheon Jeong
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Jung Ryu
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Bae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - You-Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Young Il Seo
- Division of Rheumatology, Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Won Tae Chung
- Division of Rheumatology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, KyungHee University Medical Center, KyungHee University, Seoul, Korea
| | - Yeon-Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Our Lady of Mercy Hospital, Catholic University of Korea, College of Medicine, Incheon, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical center, Incheon, Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical center, Incheon, Korea
| | - Hyo-Jong Kang
- Division of Rheumatology, Department of Internal Medicine, Pundang Jesaeng General Hospital, Seongnam, Korea
| | - Chan-Hee Lee
- Division of Rheumatology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Ozgocmen S, Ardicoglu O, Kamanli A, Kaya A, Durmus B, Yildirim K, Baysal O, Gur A, Karatay S, Altay Z, Cevik R, Erdal A, Ersoy Y, Sarac AJ, Tekeoglu I, Ugur M, Nas K, Senel K, Ulusoy H. Pattern of disease onset, diagnostic delay, and clinical features in juvenile onset and adult onset ankylosing spondylitis. J Rheumatol 2009; 36:2830-3. [PMID: 19884272 DOI: 10.3899/jrheum.090435] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. METHODS A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. RESULTS Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. CONCLUSION JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.
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Affiliation(s)
- Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Gevher Nesibe Hospital, Erciyes University, School of Medicine, Kayseri, Turkey.
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Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis. Clin Rheumatol 2009; 29:65-70. [PMID: 19813046 DOI: 10.1007/s10067-009-1290-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 07/24/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
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Mansouri LE, Bahiri R, Abourazzak FE, Abouqal R, Hajjaj-Hassouni N. Two distinct patterns of ankylosing spondylitis in Moroccan patients. Rheumatol Int 2009; 29:1423-9. [DOI: 10.1007/s00296-009-0873-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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29
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Higher Prevalence of Extra-Articular Manifestations in Ankylosing Spondylitis With Peripheral Arthritis. J Clin Rheumatol 2008; 14:264-6. [PMID: 18824928 DOI: 10.1097/rhu.0b013e31817b8789] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Bodur H, Ataman S, Akbulut L, Evcik D, Kavuncu V, Kaya T, Günaydin R, Kuran B, Kotevoğlu N, Bal A, Aydoğ E, Altay Z, Uğurlu H, Kocabaş H, Olmez N, Yazgan P, Gürsoy S, Madenci E, Ozel S, Delialioğlu SU. Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol 2008; 27:1119-25. [PMID: 18357499 DOI: 10.1007/s10067-008-0877-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 01/09/2008] [Accepted: 02/28/2008] [Indexed: 11/30/2022]
Abstract
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.
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Affiliation(s)
- H Bodur
- Physical Medicine and Rehabilitation (PMR) Department, Ankara Numune Training and Research Hospital, Mürsel Uluç Ankara, Turkey.
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Ho HH, Yu KH, Chen JY, Lin JL, Wu YJJ, Luo SF, Liou LB. Coexisting ankylosing spondylitis and gouty arthritis. Clin Rheumatol 2007; 26:1655-61. [PMID: 17356931 DOI: 10.1007/s10067-007-0563-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/18/2007] [Accepted: 01/18/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the clinical characteristics of patients with coexisting ankylosing spondylitis (AS) and gout. Between July 1987, and October 2004, sixty-five patients with coexisting AS and gout were enrolled. The clinical manifestations of both AS and gout in these patients were studied. Of the 65 patients included in the study, 61 were men and four were women (men-to-women ratio, 15.3:1). Sixty-three subjects were Han Chinese, and two were Atayal Aborigines. Mean ages at onset of AS and gout were 29.3 +/- 15.6 years (range 7-63) and 42.2 +/- 13.2 years (range 20-74), respectively. Fifty-six patients developed gout after (15.5 +/- 11.2 years; range, 1-51 years) onset of AS; nine patients developed gout before (average, 3.4 +/- 2.2 years; range. 1-7 years) onset of AS. Forty-four (67.7%) patients had chronic peripheral arthritis and all 65 (100%) patients had acute peripheral arthritis. Thirty-three (50.8%) cases had heel pain (enthesopathy), including 22 (33.9%) with chronic heel pain, seven (10.8%) with acute heel pain, and four (6.2%) with concurrent acute and chronic heel pain. Sixty-one (93.9%) subjects were HLA-B27 antigen positive. Medical conditions potentially associated with hyperuricemia or gout were urolithiasis (n = 17), hypertension (n = 21), diabetes mellitus (n = 8), hyperlipidemia (n = 34), congestive heart failure (n = 6), coronary heart disease (n = 5), and stroke (n = 3). The following drugs were prescribed: diuretics (n = 7), low-dose aspirin (n = 4), antituberculous drugs (n = 1), and sulphasalazine (n = 34). Six (6.2%) patients had iatrogenic Cushing syndrome with adrenal insufficiency. Patients with coexisting AS and gout are not rare. Distinguishing between peripheral arthritis or enthesopathies of AS and gout is essential, especially when the course of AS arthritis becomes acute or the course of gout becomes chronic.
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Affiliation(s)
- Huei-Huang Ho
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-shin Street, Kuei-Shan, Tao-Yuan, Taiwan.
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Howe HS, Zhao L, Song YW, Springer L, Edmonds J, Gu J, Yu DTY. Seronegative Spondyloarthropathy – Studies from the Asia Pacific Region. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n2p135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent therapeutic advances, in particular the use of anti-tumour necrosis factor (anti-TNF) agents, have revived interest in the seronegative spondyloarthropathies (SpA), a group of arthritides characterised by axial skeletal involvement and the absence of rheumatoid factor. The purpose of this article is to review the studies that have been done in the Asia Pacific region, as a broad understanding of the scope and severity of this group of diseases would enable rheumatologists and physicians in this part of the world to better manage their patients. The majority of genetic studies have focused on the associations of HLA-B27 with ankylosing spondylitis (AS) and SpA, while a few studies examined the associations of the CARD, IL-1, LMP2, TAP and TGF with AS. There are a handful of studies on the immunological responses to bacteria and cytokine levels in AS. The onset and clinical features of SpA have been reported from most countries in the region, but no data on patient outcomes, using current measurement tools such as the Bath Ankylosing Spondylitis Disease Activity index (BASDAI), is available. Validation of these instruments of measurement as well as classification criteria in different ethnic populations is necessary where no prior data exist. Future studies will likely be focused on better clinical characterisation of patient cohorts, particularly with regard to the use of currently used measurement tools for disease activity and spinal function and mobility, and the identification of the need for biologic therapy in each country.
Key words: ESSG criteria, Genetics, Immunological and clinical features
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Affiliation(s)
| | - Like Zhao
- the Third Affiliated Hospital of Sun Yat-sen University, People’s Republic of China
| | | | | | | | - Jieruo Gu
- the Third Affiliated Hospital of Sun Yat-sen University, People’s Republic of China
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Mansour M, Cheema GS, Naguwa SM, Greenspan A, Borchers AT, Keen CL, Gershwin ME. Ankylosing Spondylitis: A Contemporary Perspective on Diagnosis and Treatment. Semin Arthritis Rheum 2007; 36:210-23. [PMID: 17011612 DOI: 10.1016/j.semarthrit.2006.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 07/10/2006] [Accepted: 08/01/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVES In recent years, great progress has been made in the development of diagnostic tools, therapeutic approaches, and validated outcome measures in the understanding of the pathogenesis of ankylosing spondylitis (AS). The purpose of this review was to summarize these developments. METHODS We performed a PubMed search for the period 1978 to 2005, using the keyword, "ankylosing spondylitis," resulting in a total of 4878 publications, including 778 reviews. Articles were then selected based on their discussion of recent diagnostic tools and new treatment approaches in the pathogenesis of AS, leading to a final total of 104 articles. RESULTS In recent years, there have been 2 major developments in the management of AS that make earlier diagnosis possible and offer the hope of alleviating pain and preventing structural changes that result in loss of function. These developments include the use of magnetic resonance imaging to visualize the inflammatory changes in the sacroiliac joint and the axial spine, and the demonstration that tumor necrosis factor blocking agents are highly efficacious in reducing spinal inflammation and possibly in slowing radiographic progression. CONCLUSIONS There have been major advances in both the diagnostic tools and the therapeutic regimens available for patients with AS.
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Affiliation(s)
- Mark Mansour
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA 95616, USA
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Althoff CE, Hermann KG, Braun J, Sieper J. [Ankylosing spondylitis--current state of imaging including scoring methods]. Z Rheumatol 2006; 65:688-99. [PMID: 17119899 DOI: 10.1007/s00393-006-0122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conventional radiography and magnetic resonance imaging (MRI) are currently the most widely used imaging methods for the initial diagnostic evaluation and follow-up of patients with ankylosing spondylitis (AS). Scintigraphy, computed tomography (CT), and positron emission tomography (PET) only play minor roles, although some are being further developed. AS is characterized by inflammatory changes to the sacroiliac joints (SIJs) and spine, as well as asymmetrical arthritis of the peripheral joints and joints near the trunk. The diagnosis of AS is based on clinical parameters and the presence of chronic inflammatory changes to the SIJs on conventional radiographs. Typical radiographic changes also involve the spine. MRI depicts not only chronic changes, but also active inflammatory lesions, which are important for the diagnosis of early disease and precursors of AS. The scoring system of choice for quantifying spinal changes depicted by conventional radiography is the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). MRI allows the quantitative evaluation of changes involving the SIJs and the spine. Various MRI scoring systems have been proposed to quantify these changes, but they require further validation. This review article presents the imaging modalities used in AS patients, typical findings, and relevant methods of analysis. The most recent developments are discussed.
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Affiliation(s)
- C E Althoff
- Institut für Radiologie, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Schumannstrasse 20/21, 10117, Berlin, Deutschland.
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