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Rubbert-Roth A, Kakehasi AM, Takeuchi T, Schmalzing M, Palac H, Coombs D, Liu J, Anyanwu SI, Lippe R, Curtis JR. Malignancy in the Upadacitinib Clinical Trials for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis. Rheumatol Ther 2024; 11:97-112. [PMID: 37982966 PMCID: PMC10796874 DOI: 10.1007/s40744-023-00621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION This article aims to describe malignancies in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), or non-radiographic axial spondyloarthritis (nr-axSpA) treated with upadacitinib (UPA) or active comparators. METHODS This integrated safety analysis includes data from 11 phase 3 UPA trials across RA (6 trials), PsA (2 trials), AS (2 trials; one phase 2b/3), and nr-axSpA (1 trial). Treatment-emergent adverse events (TEAEs) were summarized for RA (pooled UPA 15 mg [UPA15], pooled UPA 30 mg [UPA30], adalimumab 40 mg [ADA], methotrexate monotherapy [MTX]), PsA (pooled UPA15, pooled UPA30, ADA), AS (pooled UPA15), and nr-axSpA (UPA15). TEAEs were reported as exposure-adjusted event rates (events/100 patient-years). RESULTS Median treatment duration ranged from 1.0 to 4.0 years (with a maximum of 6.6 years in RA). Across treatments and indications, rates of malignancy excluding nonmelanoma skin cancer (NMSC) ranged from 0.2 to 1.1, while NMSC ranged from 0.0 to 1.4. In RA, rates of malignancy excluding NMSC were generally similar between UPA15, UPA30, ADA, and MTX (breast and lung cancer were the most common). In RA and PsA, Kaplan-Meier analyses revealed no differences in event onset of malignancy excluding NMSC with UPA15 versus UPA30 over time. In RA, NMSC rates were higher with UPA30 than UPA15; both UPA15 and UPA30 were higher than ADA and MTX. In PsA, rates of malignancy excluding NMSC and NMSC were generally similar between UPA15, UPA30, and ADA. In AS and nr-axSpA, malignancies were reported infrequently. Few events of lymphoma were reported across the clinical programs. CONCLUSION Rates of malignancy excluding NMSC were generally similar between UPA15, UPA30, ADA, and MTX and were consistent across RA, PsA, AS, and nr-axSpA. A dose-dependent increased rate of NMSC was observed with UPA in RA. TRIAL REGISTRATION ClinicaTrials.gov identifier: NCT02706873, NCT02675426, NCT02629159, NCT02706951, NCT02706847, NCT03086343, NCT03104400, NCT03104374, NCT03178487, and NCT04169373.
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Affiliation(s)
- Andrea Rubbert-Roth
- Division of Rheumatology, Cantonal Clinic St Gallen, Rorschacherstrasse 95, St Gallen, Switzerland.
| | - Adriana M Kakehasi
- Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tsutomu Takeuchi
- Keio University School of Medicine, Tokyo, Japan
- Saitama Medical University, Saitama, Japan
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University of Wϋrzburg, Würzburg, Germany
| | | | | | | | | | - Ralph Lippe
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Zhang S, Qiu Y, Huang L, Bi L, Guo Y, You K, Huang G, Wang Y, Lu H, Jin H, Shan H. Ankylosing spondylitis PET imaging and quantifications via P2X7 receptor-targeting radioligand [ 18F]GSK1482160. Eur J Nucl Med Mol Imaging 2023; 50:3589-3601. [PMID: 37466648 DOI: 10.1007/s00259-023-06342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial spine; however, the quantitative detection of inflammation in AS remains a challenge in clinical settings. We aimed to investigate the feasibility of using a specific P2X7R-targeting 18F-labeled tracer [18F]GSK1482160 for positron emission tomography (PET) imaging and the quantification of AS. METHODS The radioligand [18F]GSK1482160 was obtained based on nucleophilic aliphatic substitution. Dynamic [18F]GSK1482160 and [18F]FDG micro-PET/CT imaging were performed on AS mice (n = 8) and age-matched controls (n = 8). Tracer kinetics modeling was performed using Logan's graphical arterial input function analysis to quantify the in vivo expression of P2X7R. The post-PET tissues were collected for hematoxylin-eosin (H&E), immunohistochemical (IHC), and immunofluorescence (IF) staining. RESULTS [18F]GSK1482160 PET/CT imaging revealed that the specific binding in the ankle joint and sacroiliac joint (SIJ) of the AS at 8 weeks group (BPNDankle-AS-8W (non-displaceable binding potential of the ankle) 3.931 ± 0.74; BPND SIJ-AS-8W (BPBD of the SIJ) 4.225 ± 0.84) were significantly higher than the controls at 8 weeks group (BPNDankle-Ctr-8W 0.325 ± 0.15, BPNDSJJ-Ctr-8W 0.319 ± 0.17) respectively, and the AS at 14 weeks group (BPNDankle-AS-14W 12.212 ± 2.25; BPNDSJJ-AS-14W 13.389 ± 3.60) were significantly higher than the controls at 14 weeks group (BPNDankle-Ctr-14W 0.204 ± 0.16, BPNDSJJ-Ctr-14W 0.655 ± 0.35) respectively. The four groups had no significant difference in the [18F]FDG uptake of ankle and SIJ. IHC and IF staining revealed that the overexpression of P2X7R was colocalized with activated macrophages from the ankle synovium and spinal endplate in mice with AS, indicating that quantification of P2X7R may contribute to the understanding of the pathogenesis of inflammation in human AS. CONCLUSION This study developed a novel P2X7R-targeting PET tracer [18F]GSK1482160 to detect the expression of P2X7R in AS mouse models and provided powerful non-invasive PET imaging and quantification for AS.
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Affiliation(s)
- Shiyanjin Zhang
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China
| | - Yifan Qiu
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Lihua Huang
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Lei Bi
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Yuanqing Guo
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China
| | - Ke You
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China
| | - Guolong Huang
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Yuhan Wang
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China
| | - Hai Lu
- Department of Spine Surgery, Sun Yat-Sen University Fifth Affiliated Hospital, Zhuhai, 519000, Guangdong Province, China.
| | - Hongjun Jin
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
| | - Hong Shan
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
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Oommen AT, Hariharan TD, Kandagaddala M, Chandy VJ, Poonnoose PM, Shankar AA. Spinopelvic Mobility Pattern and Acetabular Anteversion in Stiff Hips With Ankylosing Spondylitis After Total Hip Arthroplasty. Arthroplast Today 2022; 16:182-191. [PMID: 35774417 PMCID: PMC9237950 DOI: 10.1016/j.artd.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Fused hips with spine stiffness in ankylosing spondylitis (AS) reduce spinopelvic mobility. We aimed to assess spinopelvic mobility pattern and acetabular anteversion in AS after total hip arthroplasty (THA). MATERIAL AND METHODS Ninety-four stiff hips in 58 AS individuals (mean age: 37.05) who underwent THA between 2012 and 2018 with a modified lateral approach were included. Twenty-three hips were fused, and 71 hips had mean flexion of 37.67°. Pelvic tilt, pelvic inclination, sacral slope (SS), and lumbar lordosis were correlated with THA, and functional outcomes were assessed at 34.6-month mean follow-up. RESULTS Thirty-seven had a stuck sitting pattern with stuck standing seen in 4 individuals. SS standing before and after THA were 25.08° and 27.30°. SS sitting was 8.99° compared to 16.80°. SS from sitting to standing was reduced (17.7°) in 17 individuals. Spine stiffness in extension was seen in 4 out of 37. Mean acetabular inclination after THA was 42.67°, and acetabular anteversion was 17.48°. Flexion after THA improved to mean 98.47°. Changes in SS from sitting to standing were correlated with THA (r-value: 0.93, P-value: .0001). The Harris Hip Score improved from 25.31 to 82.39 (P-value <.05), and the mean 12-item Short Form Survey at review was 52.18 and 59.55 (physical and mental components). The mean Western Ontario and Mc Master Universities Arthritis Index score was 17.56. CONCLUSIONS Spinopelvic mobility change was <10° after THA in AS, stuck sitting was seen in 37 of 58 (63.8%), and stuck standing was seen in 4 of 58 (6.9%), including spine stiffness in flexion or extension. Acetabular anteversion assessed was 17.48° (standard deviation: 4.41), with significant functional improvement. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Anil Thomas Oommen
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
- Corresponding author. Department of Orthopaedics, Unit II, Christian Medical College Hospital, Scudder Road, Vellore, Tamil Nadu 632004, India. Tel.:+91 416 228 2081.
| | | | - Madhavi Kandagaddala
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Pradeep Mathew Poonnoose
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - A. Arun Shankar
- Department of Orthopaedics, Unit II, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Liu Y, Wang P, Sun YY, Qu J, Li M. Efficacy of thunder-fire moxibustion in treating ankylosing spondylitis of kidney deficiency and governor meridian cold and its influence on TNF-α and RANKL: study protocol for a prospective, nonblinded, single-center, randomized controlled trial. Trials 2022; 23:344. [PMID: 35461283 PMCID: PMC9034605 DOI: 10.1186/s13063-022-06227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is a common chronic inflammatory spondyloarthropathy. It is considered in traditional Chinese medicine (TCM) that the pathogenesis of AS is mainly due to Yang deficiency of kidney governor meridian and internal prosperity of cold evil. Thunder-fire moxibustion is a kind of moxibustion that is characterized in abundance in drug composition, high heat radiation, and strong penetration. Thunder-fire moxibustion on the spinal segment of the governor meridian in treating AS seems compatible with the main pathogenesis of kidney deficiency and governor meridian cold. The trial aims to explore the efficacy of thunder-fire moxibustion in patients with AS of kidney deficiency and governor meridian cold and its influence on bone metabolism, through a prospective randomized trial. Methods Sixty patients with AS of kidney deficiency and governor meridian cold will be recruited and randomly assigned to the treatment group (thunder-fire moxibustion three times a week plus basic treatment) and the control group (basic treatment) at the Center of TCM of Beijing Luhe Hospital Affiliated to Capital Medical University (Beijing, China). Each patient will be treated for 4 weeks. The primary outcome is the efficacy of TCM syndrome, and the secondary outcome indexes will include the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Short-Form-36 Questionnaire (SF-36), tumor necrosis factor-α (TNF-α), and receptor activator of nuclear factor-κB ligand (RANKL). TNF-α and RANKL with observation will be determined once respectively before and after treatment, while the other indexes will be observed once prior to the treatment, 2 weeks post-treatment, and at the end of the treatment. Side effects will be recorded and analyzed as well. Inter-group comparison and analysis will be performed based on the intention-to-treat set and per-protocol set. Discussion This prospective randomized trial will help verify the efficacy of thunder-fire moxibustion in treating AS of kidney deficiency and governor meridian cold, discuss preliminarily its mechanism in treating this disease, and provide high-quality evidences for scientific researches on clinical treatment with thunder-fire moxibustion against AS. Trial registration Chinese Clinical Trial Registry ChiCTR2100044227. Registered on 12 March 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06227-7.
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Affiliation(s)
- Yang Liu
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China
| | - Pei Wang
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China
| | - Yan Yan Sun
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China
| | - Jing Qu
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China
| | - Min Li
- Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China.
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Azadeh H, Alizadeh-Navaei R, Rezaiemanesh A, Rajabinejad M. Immune-related adverse events (irAEs) in ankylosing spondylitis (AS) patients treated with interleukin (IL)-17 inhibitors: a systematic review and meta-analysis. Inflammopharmacology 2022; 30:435-451. [PMID: 35188599 DOI: 10.1007/s10787-022-00933-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by immune system dysregulation and inflammation in the joints. Interleukin (IL)-17 inhibitors are new biological drugs used to treat AS. In this study, we aimed to assess the risk of immune system-related AEs due to targeting IL-17 or IL-17R. METHODS The CENTRAL, PubMed, Scopus, Google Scholar, Clinical Trials Registry, and ICTRP were searched for randomized clinical trials (RCTs) and non-RCTs until February 2021. The risk of irAEs in patients treated with IL-17 inhibitors compared to the placebo or a drug-free control was evaluated. In studies that reported AEs of the IL-17 inhibitors at several different time points, we compared the number of cases/100 patient-year in which irAEs were reported. Subgroup analyses were also performed based on the dose and type of drugs. RESULTS Thirteen studies of 1848 AS patients treated by IL-17 inhibitors (secukinumab, ixekizumab, bimekizumab, and netakimab) and 764 participants who received a placebo were included. The risk of some AEs related to immune function in patients under IL-17 inhibitors treatment was significantly higher than that of the placebo group, including infection and infestation (risk difference RD = 0.09, P = 0.02), nasopharyngitis (RD = 0.04, P < 0.001), opportunistic infections (RD = 0.01, P = 0.04), and neutropenia (RD = 0.04, P = 0.03). Besides, the results of the Cochran Q test showed that there were significant differences between the occurrence of some AEs over time, including infection and infestations (p < 0.001, RCTs), upper respiratory tract infections (p < 0.001, non-RCTs), urinary tract infections (p < 0.001, non-RCTs), and diarrhea (p < 0.01, RCTs). CONCLUSIONS The most common immune system-related AEs in patients treated with IL-17 inhibitors are mucosal and opportunistic infections.
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Affiliation(s)
- Hossein Azadeh
- Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Rezaiemanesh
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Misagh Rajabinejad
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, 18 km khazarabad, Sari, Iran.
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Ye L, Zhou L, Bian J, Zhao J, Li T, Wu X, Xu H. Disease Activity-Guided Stepwise Tapering but Not Discontinuation of Biologics Is a Feasible Therapeutic Strategy for Patients with Ankylosing Spondylitis: Real-World Evidence. Adv Ther 2022; 39:1393-1402. [PMID: 35106691 DOI: 10.1007/s12325-021-01995-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the history of biologics usage in patients with ankylosing spondylitis (AS) in China and to evaluate the impact of drug reduction and withdrawal on disease activity. METHODS Drug administration intervals and disease activity indexes in patients with AS who regularly used etanercept (ETN) biosimilars for more than 1 year and those who withdrew the drugs during the same period in a single center were analyzed retrospectively. RESULTS A total of 108 patients with AS who used ETN biosimilars for more than a year were recruited in this study for analysis. (1) Overall, 98.1% patients with AS increased the intervals between drug administrations, averaging from 4.57 ± 0.15 days during 0-3 months to 8.53 ± 0.43 days during 3-6 months, and to 10.49 ± 0.39 days during 6-12 months. Compared with the baseline parameters, after 3-month and 12-month treatments disease activities were improved significantly, including Patient Global Assessment (PTGA), overall back pain, nocturnal pain, fatigue, Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). (2) Only 59.3% used ETN biosimilars with full dose (3.5 days' interval) in the first 3 months. At baseline, disease activities of these patients were higher than those with reduced dose (5.9 days' interval). However, at 12 months of drug administration there was no significant difference in the overall length of drug administration intervals and disease activities between the two groups. (3) Twenty patients with low disease activity (LDA) discontinued therapy spontaneously; after 3 months, 55% of them experienced disease recurrence (∆ASDAS ≥ 0.9). CONCLUSION Spontaneous dose reduction was a common phenomenon among patients with AS in China, which becomes more notable with increasing relief of symptoms. Most patients could maintain an LDA state after dose reduction. Compared with dose reduction, ETN biosimilar withdrawal was more likely to induce disease recurrence. Therefore, disease activity-guided individualized stepwise tapering may become one of the feasible therapeutic strategies for AS in the future.
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Affiliation(s)
- Lingying Ye
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ling Zhou
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Jianye Bian
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Juan Zhao
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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Li YX, Liu T, Liang YW, Huang JJ, Huang JS, Liu XG, Cheng ZY, Lu SX, Li M, Huang L. Integrative analysis of long non-coding RNA and messenger RNA expression in toll-like receptor 4-primed mesenchymal stem cells of ankylosing spondylitis. Ann Transl Med 2021; 9:1563. [PMID: 34790769 PMCID: PMC8576702 DOI: 10.21037/atm-21-5020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
Background The precise pathogenesis of ankylosing spondylitis (AS) is still largely unknown at present. Our previous study found that toll-like receptor 4 (TLR4) downregulated and performed immunoregulatory dysfunction in mesenchymal stem cells from AS patients (AS-MSCs). The aim of this study was to explore the expression profiles of long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) in TLR4-primed AS-MSCs, and to clarify the potential mechanisms. Methods The immunoregulatory effects of MSCs were determined after TLR4 activation. Next, the differentially-expressed (DE) lncRNAs and mRNAs between AS-MSCs and TLR4-primed AS-MSCs [stimulated by lipopolysaccharide (LPS)] were identified via high-throughput sequencing followed by quantitative real-time PCR (qRT-PCR) confirmation. Finally, bioinformatics analyses were performed to identify the critical biological functions, signaling pathways, and associated functional networks involved in the TLR4-primed immunoregulatory function of AS-MSCs. Results A total of 147 DE lncRNAs and 698 DE mRNAs were identified between TLR4-primed AS-MSCs and unstimulated AS-MSCs. Of these, 107 lncRNAs were upregulated and 40 were downregulated (fold change ≥2, P<0.05), while 504 mRNAs were upregulated and 194 were downregulated (fold change ≥2, P<0.05). Five lncRNAs and five mRNAs with the largest fold changes were respectively verified by qRT-PCR. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses demonstrated that the DE mRNAs and lncRNAs were highly associated with the inflammatory response, such as NOD-like receptor (NLR) signaling pathway, the TNF signaling pathway and the NF-κB signaling pathway. Cis-regulation prediction revealed eight novel lncRNAs, while trans-regulation prediction revealed 15 lncRNAs, respectively. Eight core pairs of lncRNA and target mRNA in the lncRNA-transcription factor (TF)-mRNA network were as follows: PACERR-PTGS2, LOC105378085-SOD2, LOC107986655-HIVEP2, MICB-DT-MICB, LOC105373925-SP140L, LOC107984251-IFIT5, LOC112268267-GBP2, and LOC101926887-IFIT3, respectively. Conclusions TLR4 activation in AS can enhance the immunoregulatory ability of MSCs. Eight core pairs of lncRNA and target mRNA were observed in TLR4-primed AS-MSCs, which could contribute to understanding the potential mechanism of AS-MSC immunoregulatory dysfunction.
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Affiliation(s)
- Yu-Xi Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ting Liu
- Department of Anaesthesia, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Wei Liang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Jun Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun-Shen Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang-Ge Liu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zi-Ying Cheng
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi-Xin Lu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Li B, Guo R, Jiang X, Wu J, Zhang D, Yang C, Zhao Q, Zhang C, Yan H, Wang Z, Wang Q, Huang R, Zhang Z, Hu X, Gao L. Posterior wedge osteotomy assisted by O-arm navigation for treating ankylosing spondylitis with thoracolumbar fractures: an early clinical evaluation. Ann Palliat Med 2021; 10:6694-6705. [PMID: 34237972 DOI: 10.21037/apm-21-1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To explore the feasibility and efficiency of posterior wedge osteotomy assisted by O-arm navigation treatment of ankylosing spondylitis (AS) patients with thoracolumbar fracture. METHODS This is a case series study. A total of 16 cases of AS accompanied by thoracolumbar fractures from January 2012 to July 2015 were retrospectively analyzed. All patients underwent "posterior wedge osteotomy assisted by O-arm navigation". The operation time, blood loss volume, preoperative and postoperative visual analogue scale (VAS), American Spinal Injury Association (ASIA) classification, and spinal imaging parameters [Cobb angle, C7 plumb line (C7PL), and jaw-brow angle] were collected and analyzed. RESULTS The operative time consumption was 120-350 mins and the intra-operative blood loss volume was 200-800 mL. No obvious postoperative complications occurred in any participants. The back pain of all participants was relieved, and the neurological functions of eight participants with spinal cord injury (SCI) were recovered in varying degrees except for one patient with severe SCI. The spinal deformities of the participants were corrected to varying degrees. The fracture sites of 16 participants were all healed, and there was no loosening or detachment of internal fixation during the 6-month follow-up period. CONCLUSIONS Posterior wedge osteotomy assisted by O-arm navigation was shown to be a safe and effective method to treat AS accompanied by thoracolumbar fractures. This treatment strategy can accurately decompress and reduce the fracture and significantly correct the kyphosis, with good surgical effect.
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Affiliation(s)
- Bo Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Guo
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xu Jiang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jionglin Wu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Di Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Canchun Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiancheng Zhao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chi Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haolin Yan
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zheyu Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiwei Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Renyuan Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhilei Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xumin Hu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liangbin Gao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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9
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Ren C, Zhu Q, Yuan H. Imaging features of spinal fractures in ankylosing spondylitis and the diagnostic value of different imaging methods. Quant Imaging Med Surg 2021; 11:2499-2508. [PMID: 34079719 DOI: 10.21037/qims-20-962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Our study aimed to characterize the imaging appearance of spinal fractures in ankylosing spondylitis (AS) and identify situations in which the use of magnetic resonance imaging (MRI) is necessary. Methods A total of 70 cases of spinal fractures associated with AS were retrospectively enrolled. Two radiologists independently reviewed the preoperative images. The location, type, ligament injury, neurological injury, and epidural hematoma following spinal fractures were assessed. Results Only one patient had a vertebral compression fracture, and 69 patients had 77 transverse fractures involving three columns. The most frequent injuries in AS patients were type B3 (N=32, 43.8%) spine fractures, followed by type C (N= 20, 27.4%) spine fractures. There were significant differences in fracture types of the different spine regions (H=14.1, P<0.0001). Most type C spine fractures were located in the lower cervical spine, while most of the type B2 spine fractures were located in the thoracic spine. Transverse fractures were classified as shear or stress type fractures. In total, there were 62 shear fractures and 15 stress fractures. All of the transverse fractures were detected by computed tomography (CT). The accuracy of CT in the diagnosis of the exact anatomic involvement of transverse fractures was significantly higher than that of MRI (χ2=8.36, P=0.014). The anterior longitudinal ligament (ALL) was the most frequently torn ligament. Tears of ossified ligaments were best visualized by sagittal reformatted CT. Lower cervical fractures were more likely to be associated with neurological injury compared with fractures to other regions of the spine (χ2=7.24, P=0.025). There were six epidural hematoma cases, which were only detected by MRI, were found to have fractures of the lower cervical spine. Conclusions We recommend a whole-spine CT examination with three-dimensional reconstruction for detecting a suspected fracture in AS patients. In cases with neurological injury, MRI examinations are always mandatory. AS patients with lower cervical spine fractures require further investigation by MRI. Patients with non-lower cervical spine fractures without any neurological deficits do not need to undergo an immediate MRI.
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Affiliation(s)
- Cui Ren
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qiao Zhu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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10
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Shah NG, Keraliya A, Harris MB, Bono CM, Khurana B. Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT? Spine J 2021; 21:618-626. [PMID: 33130303 DOI: 10.1016/j.spinee.2020.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Both ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny. PURPOSE To assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT. STUDY DESIGN Multicenter, retrospective, case-control study. PATIENT SAMPLE DISH and AS patients presenting after spine trauma between 2007 and 2017. OUTCOME MEASURES Review of CT and MRI findings at the time of presentation. METHODS One hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present. RESULTS Median age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients. CONCLUSION Based on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.
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Affiliation(s)
- Nandish G Shah
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Abhishek Keraliya
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Mitchel B Harris
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Christopher M Bono
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
| | - Bharti Khurana
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA.
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Jiang N, Liu HX, Liang HY, Feng XH, Liu BY, Zhou YY. Osteogenic differentiation characteristics of hip joint capsule fibroblasts obtained from patients with ankylosing spondylitis. Ann Transl Med 2021; 9:331. [PMID: 33708958 PMCID: PMC7944275 DOI: 10.21037/atm-20-7817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Autoimmune disease are fairly common and one that has an excessive degree of disability is Ankylosing spondylitis (AS). As the main cells in connective tissues, fibroblasts may play important roles in AS ossification. The conducted research aims to establish the osteogenic disparity characteristics of fibroblasts cultured in vitro, obtained via AS patients hip joint capsule, as well as investigating the pathological osteogenic molecular workings of AS. Methods AS patients hip joint capsules were acquired and fracture patients as the control with the finite fibroblast line were established by using tissue culture method. AS fibroblast proliferation, cycle and apoptosis, expression of osteogenic marker genes, osteogenic phenotypes, and the activation degree of the bone morphogenetic protein (BMP)/Smads signalling pathway were detected by flow cytometry, western blotting and real-time fluorescent quantitative polymerase chain reaction. Results Proliferative activity in AS fibroblasts were abnormally high, and the apoptotic rate decreased. Compared with normal fibroblasts, the mRNA expression of osteogenic marker genes, expression of osteogenic phenotypes, protein expression of core-binding factor a1 (Cbfa1), Smad1, Smad4, Smad5, phosphorylated (p) Smad1, and pSmad5 in AS fibroblasts were higher; however, the expression of Smad6 was lower. Moreover, recombinant human bone morphogenetic protein-2(rhBMP-2) stimulated Cbfa1 expression by normal and AS fibroblasts through the BMP/Smads signalling pathway. Conclusions The fibroblasts of hip joint capsules in patients with AS cultured in vitro have biologic characteristics of osteogenic differentiation and may be important target cells of AS ossification. The Activated BMP/Smads signalling pathway could potentially be a mechanism relating to fibroblasts differentiating into osteoblasts and an ossification mechanism for AS.
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Affiliation(s)
- Nan Jiang
- Department of Nephrology and Rheumatology, Second Affiliated Hospital of Tianjin University of TCM, Tianjin, China
| | - Hong-Xiao Liu
- Department of Rheumatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui-Ying Liang
- Department of Traditional Chinese Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Xing-Hua Feng
- Department of Rheumatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ben-Yong Liu
- Department of TCM internal medicine, Beijing Massage Hospital, Beijing, China
| | - Ying-Yan Zhou
- Department of Rheumatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Li S, Du CZ, Mao SH, Shi BL, Zhu ZZ, Qiu Y. Both structural damage and inflammation of the lumbar spine contribute to the sagittal imbalance in ankylosing spondylitis patients with thoracolumbar kyphosis. Quant Imaging Med Surg 2021; 11:362-370. [PMID: 33392035 DOI: 10.21037/qims-19-990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The relationship between structural damage and inflammation of the spine and the sagittal imbalance in ankylosing spondylitis (AS) is not well understood. The present study aimed to investigate the correlation between structural damage and inflammation of the lumbar spine and the sagittal imbalance in AS patients with thoracolumbar kyphosis. Methods Forty-five AS patients with thoracolumbar kyphosis were retrospectively reviewed. Six sagittal spinal parameters, including the C7 tilt (C7T), spino-sacral angle (SSA), global kyphosis (GK), the sagittal vertical axis (SVA), thoracic kyphosis (TK), and lumbar lordosis (LL), were measured. Structural damage of the lumbar spine was assessed by the modified Stoke AS Spine Score (mSASSS) on radiographs. Lumbar spinal inflammation was evaluated by the AS spinal magnetic resonance imaging (MRI) activity (ASspiMRI-a) on MRI. Correlation analysis was performed using the paired sample t-test. Multivariable linear regression models were constructed to analyze the contributions of mSASSS and ASspiMRI-a to the sagittal parameters. Results The average values of the sagittal parameters C7T, SSA, GK, SVA, TK, and LL were 68.1°, 80.1°, 77.3°, 168.7 mm, 47.7°, and -0.7°, respectively. The average mSASSS and ASspiMRI-a scores were 9.8 and 10.8, respectively. Correlation analysis showed that the mSASSS and ASspiMRI-a were correlated with C7T, SSA, SVA, and LL (the Spearman correlation coefficients were -0.439, -0.390, 0.424, and 0.530 for mSASSS; -0.406, -0.402, 0.378, and 0.486 for ASspiMRI-a; P<0.05). The C7T, SSA, and SVA were significantly correlated with LL (r=-0.696, -0.779, and 0.633, respectively; P<0.05). There was a weak correlation between the mSASSS and ASspiMRI-a (β=0.299, P=0.046). The multivariable regression models indicated that the sagittal imbalance was determined to a greater extent by the mSASSS than ASspiMRI-a (the β values were -1.550 vs. -0.649 for C7T, -1.865 vs. -1.231 for SSA, 9.161 vs. 3.823 for SVA, and 3.128 vs. 1.717 for LL). Conclusions Both structural damage and inflammation of the lumbar spine contributed to the sagittal imbalance in AS patients with thoracolumbar kyphosis. In the late stages of AS, the sagittal imbalance was more attributable to the structural damage than the inflammation of the lumbar spine.
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Affiliation(s)
- Song Li
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chang-Zhi Du
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Sai-Hu Mao
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ben-Long Shi
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Liang M, Meng Y, Zhou S, Tao Z, Tao L. Research hotspots and trends analysis of ankylosing spondylitis: a bibliometric and scientometric analysis from 2009 to 2018. Ann Transl Med 2020; 8:1445. [PMID: 33313190 PMCID: PMC7723565 DOI: 10.21037/atm-20-1259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background This study utilized bibliometric analysis to qualitatively and quantitatively analyze hotspots and predict trends in the field of ankylosing spondylitis (AS) research. Methods Articles about AS were obtained from the Web of Science Core Collection and PubMed database, and bibliometric analysis was carried out through CiteSpace and the Online Analysis Platform of Literature Metrology and Bibliographic Item Co-Occurrence Matrix Builder (BICOMB). Then, co-word biclustering analysis was conducted to obtain research hotspots and predict trends using gCLUTO software. Results A total of 6,818 articles on AS from 2009 to 2018 were analyzed, showing an increasing publication trend (558 articles in 2009 to 851 articles in 2018). The Journal of Rheumatology was the leading journal in AS research, with an impact factor (IF) of 3.634 and H-index value of 49. In terms of region, the United States led the world in this field, and The University of Toronto was the leading institution for AS research. Van Der Heijde, D was the most prolific author in the field. Eight research hotspots in the field of AS were also identified. Conclusions Our analysis identified eight research hotspots, and predicted that surgical treatment and etiology will be the main AS research trends in the future. This study provides new directions and ideas for future research in AS.
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Affiliation(s)
- Miaomiao Liang
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Yan Meng
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Siming Zhou
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Zhengbo Tao
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Lin Tao
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
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14
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Yeh FC, Chen HC, Chou YC, Lin CL, Kao CH, Lo HY, Liu FC, Yang TY. Positive association of Parkinson's disease with ankylosing spondylitis: a nationwide population-based study. J Transl Med 2020; 18:455. [PMID: 33256841 PMCID: PMC7708134 DOI: 10.1186/s12967-020-02629-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is characterized by excessive production of inflammatory cytokines. Recent evidence suggests that inflammation underlies the neurodegenerative process of Parkinson’s disease (PD). Whether AS has an influence on the development of PD is unclear. We aimed to examine a relationship, if any exists between AS and PD. Methods A population-based matched cohort study was performed using data from the 2000–2010 Taiwan National Health Insurance database. 6440 patients with AS and 25,760 randomly selected, age- and sex-matched controls were included in this study. The risk of PD in the AS cohort was evaluated by using a Cox model. Results This study revealed a positive association between AS and the risk of PD regardless of sex and age (aHR 1.75, p < .001). Particularly, AS cohort to non-AS cohort relative risk of PD significantly increased for the patients aged below 49 and above 65 years (aHR 4.70, p < .001; aHR 1.69, p < .001, respectively) and the patients with and without comorbidities (aHR 1.61, p < .001; aHR 2.71, p < .001, respectively). Furthermore, NSAID use was associated with lower risk of PD (aHR 0.69, p < .05). However, the risk of PD was higher (aHR 2.40, p < .01) in patients with AS receiving immunosuppressants than in those not receiving (aHR 1.70, p < .001). Conclusions Patients with AS had an increased risk of PD which might be related to underlying chronic inflammation. Further research is required to elucidate the underlying mechanism.
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Affiliation(s)
- Fu-Chiang Yeh
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiang-Cheng Chen
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- Department of Health Promotion and Health Education, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Li Lin
- School of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Yi Lo
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Feng-Cheng Liu
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Tse-Yen Yang
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan. .,Molecular and Genomic Epidemiology Center and Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. .,Center for General Education & Master Program of Digital Health Innovation, College of Humanities and Sciences, China Medical University, Taichung, Taiwan. .,Department of Medical Laboratory and Biotechnology, Asia University, Taichung, Taiwan.
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15
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Türkyilmaz A, Ata P, Akbaş F, Yağci İ. The Expression Levels of MicroRNAs Associated with T and B Cell Differentiation/stimulation in Ankylosing Spondylitis. Balkan J Med Genet 2020; 23:25-32. [PMID: 32953406 DOI: 10.2478/bjmg-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Spondyloarthropathies (SpAs), are a group of chronic inflammatory diseases with a number of genetic, physiopathological, clinical and radiological features. Ankylosing spondylitis (AS) is the most common type of spondylo-arthropathies, and >90.0% of patients with ankylosing spondylitis are human leukocyte antigen-B27 (HLA-B2 7)-positive. In recent years, non-HLA genetic factors have been reported to have an effect on ankylosing spondylitis. MicroRNAs (miRNAs), are endogenous non coding RNA molecules containing 18-23 nucleotides that play a role in the post-transcriptional regulation of gene expression. In this study, we aimed to determine the expression levels of miRNAs associated with T- and B-cell differentiation/stimulation in peripheral blood mononuclear cells and their relationship with the etiology of the AS in patients and healthy controls. In a molecular study, peripheral blood mononuclear cell isolation, and total RNA isolation were performed first. In the second step, cDNA synthesis and quantitative real-time PCR (qPCR) expression analysis were completed. Ultimately, in the patient and control group, the expression levels of miR-142-5p and miR-143 were found to be significantly different (p <0.05). According to current knowledge, miR-142-5p andmiR-143 expressions were found to be important for those diseases that share similar etiology with AS. We suggest that miR-142-5p and miR-143 may play a role in the pathogenesis, especially miR- 142-5p may be a potential biomarker and a target molecule for the treatment.
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Hu J, Mao Y, Zhang Y, Ye D, Wen C, Xie Z. Moxibustion for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Ann Palliat Med 2020; 9:709-720. [PMID: 32312058 DOI: 10.21037/apm.2020.02.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/03/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND To systematically evaluate the efficacy of moxibustion in the treatment of ankylosing spondylitis (AS). METHODS Seven electronic databases were systematically searched for relevant studies for inclusion from databases inception to December 31, 2018. Randomized controlled trials investigating the efficacy of moxibustion for AS treatment versus Western medicine (Wm) treatment were included for systematic review and meta-analysis. Effect estimates were pooled using the fixed or random-effects models. Between-study heterogeneity and publication bias were also assessed. Stratification analyses were further performed based on the treatment plan of experimental groups. RESULTS Twenty-six studies were eligible for inclusion with a total of 1,944 AS patients. Meta-analysis showed that compared with those receiving Wm treatment alone, patients receiving moxibustion combined with Wm treatment or moxibustion alone had a higher clinical efficacy rate [odds ratio (OR) =4.21, 95% confidence interval (CI): 2.91 to 6.10, P<0.001 for moxibustion combined with Wm versus Wm; OR =2.43, 95% CI: 1.62 to 3.65, P<0.001 for moxibustion alone versus Wm]. In addition, patients receiving moxibustion combined with Wm treatment had lower levels of C-reactive protein [weighed-median difference (WMD) =-6.33, 95% CI: -9.64 to -3.01, P<0.001] and erythrocyte sedimentation rate (WMD =-7.86, 95% CI: -11.26 to -4.46, P<0.001) after treatment, respectively. Furthermore, moxibustion could also improve Schober test scores (WMD =0.85, 95% CI: 0.15 to 1.55, P=0.017), occipital-wall distances (WMD =-0.55, 95% CI: -0.92 to -0.19, P=0.003), and finger-ground distances (WMD =-3.64, 95% CI: -5.61 to -1.68, P<0.001) of AS patients. CONCLUSIONS This study suggests that moxibustion is an effective complementary treatment for AS patients. However, further large-scale multicenter clinical trials are needed to confirm these findings.
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Affiliation(s)
- Jiaojiao Hu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yingying Mao
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yi Zhang
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ding Ye
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Chengping Wen
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Zhijun Xie
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China.
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Wu H, Cheng WD, Jing J. Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips. Eur J Orthop Surg Traumatol 2020; 30:993-1001. [PMID: 32185574 DOI: 10.1007/s00590-020-02655-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of total hip arthroplasty (THA) via the direct anterior approach (DAA) for the treatment of hip ankylosis in the lateral position. METHODS A retrospective analysis was performed on the clinical data of 24 patients (39 hips) who underwent THA via the DAA in the lateral position for the treatment of hip ankylosis between January 2016 and December 2018. We performed bilateral THA for fifteen patients and unilateral THA for nine patients. Operation time, intraoperative blood loss, length of incisions, straight leg-raising time, length of postoperative hospital stay, operation-related complication, prosthesis position, radiological outcomes, postoperative pain relief (evaluated by VAS) and functional rehabilitation [evaluated by Harris hip score and range of motion (ROM)] were analyzed to determine clinical efficacy. These clinical data were compared and statistically analyzed with the clinical data of another 23 patients (28 hips) who underwent THA via the posterolateral approach (PLA) for the treatment of hip ankylosis in the lateral position. RESULTS Follow-up was performed at 12-15 months. The incision length in the DAA group and the PLA group was (11.12 ± 1.69 vs. 14.36 ± 3.42) cm, the intraoperative blood loss was (371.25 ± 120.55 vs. 396.80 ± 101.21) ml, the operation time was (122.47 ± 25.40 vs. 138.47 ± 24.45) min, the postoperative hospital stay was (9.59 ± 4.62 vs. 12.08 ± 3.58) days, and the straight leg elevation time was (9.20 ± 2.12 vs. 12.34 ± 3.25) days, respectively. The prosthesis of the two groups was in a good position: The average angle of cup anteversion in the DAA group and the PLA group was (10.76 ± 2.84 vs. 15.36 ± 3.42)°, and the average angle of cup abduction in the DAA group and the PLA group was (40.00 ± 3.45 vs. 41.21 ± 2.85)° (P > 0.05). The VAS score, ROM and Harris score at different follow-up time points were significantly improved in the two groups compared with those before surgery. In the first 3 months after surgery, the VAS score, ROM and Harris score of the DAA group were significantly better than those of the PLA group (P < 0.05), but with the extension of the follow-up time, there was no significant difference in the above indicators between the two groups (P > 0.05). One case of greater trochanteric fracture occurred in the DAA group. Two cases of hip posterior dislocations occurred in the PLA group, and no dislocations occurred after manual closed reduction and hip fixation in bed for 1 month to the last follow-up. No complications such as infection, deep vein thrombosis, fat embolism, prosthesis loosening, limb length inequality or joint dislocation were reported. CONCLUSION THA via the DAA for the treatment of hip ankylosis in the lateral position was safe and effective and had the advantage of reduced trauma, quicker recovery of hip function, lower incidence of postoperative dislocation and ability to expose the acetabulum fully and fit the prosthesis properly, providing satisfactory clinical efficacy.
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Ren J, Zhu J, Li D, Li W, Liu F. The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis. Quant Imaging Med Surg 2019; 9:1110-1117. [PMID: 31367565 PMCID: PMC6629574 DOI: 10.21037/qims.2019.06.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/06/2019] [Indexed: 08/29/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse. METHODS In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal. RESULTS After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS. CONCLUSIONS The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.
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Affiliation(s)
- Jiayu Ren
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
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Zhu Y, Li S, Huang Z, Xing W, Li F, Da Y, Xue J, Li M, Sun K, Jia H, Yang X. Association study between matrix metalloproteinase-3 gene (MMP3) polymorphisms and ankylosing spondylitis susceptibility. Mol Genet Genomic Med 2019; 7:e00752. [PMID: 31124320 PMCID: PMC6625098 DOI: 10.1002/mgg3.752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is the second most common cause of inflammatory arthritis worldwide affecting the axial skeleton. Single nucleotide polymorphisms (SNPs) of matrix metalloproteinase‐3 (MMP3) in the development of AS has few been investigated in Chinese population. Methods A total of 362 patients with AS and 362 healthy controls were enrolled in the study. Five SNPs in MMP3 genotypes were identified by Agena MassARRAY. Chi‐squared tests and genetic model were used to evaluate associations. Results rs522616 had a significant risk of AS development compared to those with the TT genotype (p = 0.008). By multiple logistic regression models analysis, in codominant model, rs522616 CT genotypes also had a 1.44‐fold risk (95% CI = 1.06–1.96, p = 0.008) for AS development compared to those with TT genotypes. In recessive model, the CC genotypes was a significantly reduced AS risk for individuals with TT/CT genotype (OR = 0.64; 95% CI = 0.41–0.99, p = 0.040). Conclusion The present study suggests that MMP3 rs522616 polymorphism is associated with AS susceptibility and MMP3 might be a potential diagnostic biomarker for AS. Further independent studies with larger cohorts are warranted to validate our findings in different populations.
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Affiliation(s)
- Yong Zhu
- The Second Affiliated Hospital of Inner, Mongolia Medical University, Hohhot, China
| | - Shunan Li
- The Hohhot First Hospital, Hohhot, China
| | - Zhi Huang
- The Second Affiliated Hospital of Inner, Mongolia Medical University, Hohhot, China
| | - Wenhua Xing
- The Second Affiliated Hospital of Inner, Mongolia Medical University, Hohhot, China
| | - Feng Li
- The Second Affiliated Hospital of Inner, Mongolia Medical University, Hohhot, China
| | - Yifeng Da
- Inner Mongolia Medical University, Hohhot, China
| | - Jianmin Xue
- Inner Mongolia Medical University, Hohhot, China
| | - Manglai Li
- Inner Mongolia Medical University, Hohhot, China
| | - Ke Sun
- Inner Mongolia Medical University, Hohhot, China
| | - Haiyu Jia
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xuejun Yang
- The Second Affiliated Hospital of Inner, Mongolia Medical University, Hohhot, China
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Wang CM, Hong WH, Ho HH, Chen JY, Tsai YL, Pei YC. Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study. Biomed J 2019; 42:124-130. [PMID: 31130248 PMCID: PMC6543501 DOI: 10.1016/j.bj.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 11/19/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is an inflammatory autoimmune disorder that manifested with sacroiliitis at its early stage and developed extensive inflammation with syndesmophytes of the lumbar, thoracic and cervical spines at its later stage. In the present study, we characterized the trunk isometric strength in patients with AS with different disease severity, defined by the radiological images. METHODS In a cross-sectional study conducted in a university-affiliated hospital, thirty-eight male AS patients (23 in the early AS group whose radiological findings showed no syndesmophyte, Modified Stoke Ankylosing Spinal Score (m-SASSS <3); and 15 in the syndesmophyte group, m-SASSS ≥24), and 22 healthy controls were recruited. All subjects received assessments of maximum isometric strength of trunk flexor and extensor muscles at a variety of trunk postures measured by an isokinetic device. RESULTS Under all examined trunk postures, the syndesmophyte AS patient group had the lowest isometric trunk muscle strength among the three groups. The flexion/extension ratio, defined by the ratio between isometric trunk flexor and extensor strengths, was highest among the three groups. CONCLUSIONS Trunk muscle strength significantly decreases in patients with syndesmophyte AS. The decrease of trunk muscle is inhomogeneous, which is more profound in extensor than in flexor muscles.
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Affiliation(s)
- Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsien Hong
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
| | - Huei-Huang Ho
- Department of Rheumatology and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Rheumatology and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Zong HX, Xu SQ, Tong H, Wang XR, Pan MJ, Teng YZ. Effect of anti-tumor necrosis factor α treatment on radiographic progression in patient with ankylosing spondylitis: A systematic review and meta-analysis. Mod Rheumatol 2019; 29:503-509. [PMID: 30220240 DOI: 10.1080/14397595.2018.1525017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Efficacy of anti-tumor necrosis factor (anti-TNF)α treatment in patient with active ankylosing spondylitis (AS) had been proved by many clinical studies. Inflammation and new bone formation in spine were two pivotal aspects in AS. TNF α inhibitor could eliminate inflammation including clinical and laboratory inflammatory manifestation. Paradoxical results whether TNF α antagonist could delay radiographic progression in AS were often been reported simultaneously. OBJECTIVES To review the literature about the effect of TNF α inhibitor on radiographic progression and disease activity in patient with AS. METHODS We conducted a comprehensive search including Medline, EMBASE and the Cochrane Library from 1 January 2000 to 15 August 2017. Two reviewers independently supplemented with hand searching for the reference lists of inclusion. All trials focusing on radiographic progression or disease activity in patients with AS treated with anti-TNF α agents. Primary outcomes were modified Stokes AS Spinal Score (mSASSS), as well as Bath AS disease activity index (BASDAI) and Bath AS functional index (BASFI). Two reviewers independently selected studies and analyzed data. Methodological quality was assessed using the Newcastle-Ottawa scale (NOS). We pooled effects recorded on different scales as Standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. RESULTS We included 14 studies of low to moderate risk of bias with 3,186 patients, compared with control group, there was no effect of mSASSS changes (SMD = -0.12, 95% CI: -1.17-0.93, p value = .82, I2 = 95%) and follow-up (SMD = 0.03, 95% CI: 0.21-0.26, p value = .82, I2 = 36%) estimation in anti-TNF α group. However anti-TNF α agent treatment led to remarkable improvements on both Bath AS disease activity index (BASDAI) (SMD = 1.06, 95% CI: 0.22-1.89, p value = .01, I2 = 96%) and Bath AS functional index (BASFI) (SMD = 0.93, 95% CI: 0.24-1.92, p value = .01, I2 = 97%) scores at 12 weeks. CONCLUSION Our meta-analysis found no significant effect on delaying radiographic progression in AS treated with TNF α inhibitor, although TNF α inhibitor could do improve significantly disease activity and physical function in AS.
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Affiliation(s)
- He-Xiang Zong
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Sheng-Qian Xu
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Hui Tong
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Xin-Rong Wang
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Mei-Juan Pan
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Yu-Zhu Teng
- a Department of Rheumatology and Immunology , the First Affiliated Hospital of Anhui Medical University , Hefei , China
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Abstract
Background Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or non-operatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
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Affiliation(s)
- Etka Kurucan
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - David N Bernstein
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
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Brooks F, Rackham M, Williams B, Roy D, Lee YC, Selby M. Minimally invasive stabilization of the fractured ankylosed spine: a comparative case series study. J Spine Surg 2018; 4:168-172. [PMID: 30069503 DOI: 10.21037/jss.2018.05.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background To compare the outcome of minimally invasive fracture stabilization to traditional open methods in the thoracolumbar region in patients with an ankylosing disorder of the spine. Methods A prospective, ethics-approved database (Spine Tango) at a tertiary referral center was retrospectively reviewed for results of surgery on fractures of the ankylosed thoracolumbar spine. These were then split by surgical technique into two cohorts: minimally invasive surgical fixation (MIS group) or standard open surgery (open group). Results We identified 17 patients who presented with fractures in an ankylosed spine from 2010 to 2017. MIS fixation was performed on 10 and open surgery and fixation on 7. Average age in the MIS group was older than the traditional cohort. There was no difference in the average number of levels stabilized (open =6.9, MIS =7). There was a shorter duration in the operative time and a significant difference in blood loss in favor of the MIS group (P=0.00079). Radiation exposure time and dose were significantly higher in the MIS group (P=0.006). There were no cases of non-union, implant malposition or failure in either group. Two significant complications occurred with the death of one patient in the MIS group, and one death in the open group. Conclusions The MIS technique for fractures of the ankylosed spine has shown an acceptable complication rate and good results comparable to open surgery for a high-risk patient population.
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Affiliation(s)
- Francis Brooks
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Matthew Rackham
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Ben Williams
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Deb Roy
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Yu Chao Lee
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Michael Selby
- Spinal Unit, Royal Adelaide Hospital, Port Road, Adelaide, Australia
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Abraham R, Kelly JJ, Newman JM, Naziri Q, Sodhi N, Khlopas A, George J, Shah NV, Sultan AA, Chughtai M, Barrington JW, Paulino CB, Mont MA. Have the annual trends of total knee arthroplasty in ankylosing spondylitis patients decreased? Ann Transl Med 2018; 5:S29. [PMID: 29299476 DOI: 10.21037/atm.2017.11.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Ankylosing spondylitis (AS) is characterized by osteoproliferation-induced structural damage and spinal inflammation, which lead to spinal deformity and functional disability. Though AS commonly affects the axial skeleton and sacroiliac joints, up to 70% of patients have involvement of the knees and other joints. Despite pharmacological efforts, advancing joint involvement may ultimately require surgical intervention. Total knee arthroplasty (TKA) is effective in managing patients with AS, yet it remains unclear whether or not the annual rates of TKA have been affected. Therefore, the purpose of this study was to evaluate the annual trends of AS patients who underwent TKA. Specifically, we evaluated: (I) the annual trends of TKAs due to AS in the United States population; (II) the annual trends in the proportion of TKAs due to AS in the United States. Methods The Nationwide Inpatient Sample (NIS) was used to identify all patients who underwent TKA between 2002 and 2013 (n=6,492,873). Then, a subsequent query was performed to identify TKA patients who had a diagnosis of AS, defined by the International Classification of Disease 9th revision diagnosis code 720.0. The incidence of TKAs with a diagnosis of AS in the United States was calculated using the United States population as the denominator. Regression models were used to analyze the annual trends of AS in patients who underwent TKA. Results During the study period, 2,986 patients who had AS who underwent TKA were identified. The annual number of TKAs with a diagnosis of AS increased by 168% from 125 to 335. After normalizing to the US population, the incidence of TKAs with AS increased from 0.58 to 1.38 TKAs per million US adults [IRR =1.08 (95% CI: 1.07-1.09), P<0.001]. Out of the 350,122 TKAs in 2002, 125 (0.04%) were due to AS, whereas, out of the 640,695 TKAs in 2013, 335 (0.05%) were due to AS. The prevalence of AS in those who underwent TKA increased from 2002 to 2013 [coefficient =0.002 (95% CI: 0.001-0.003), P=0.004]. Conclusions The annual trends of AS patients undergoing TKA significantly increased during the study period. To the authors' best knowledge, this is the first study to evaluate TKA trends in the AS population. The literature has reported on the ability of non-steroidal anti-inflammatory drugs (NSAIDs) and the potential of tumor necrosis factor-alpha (TNFα) inhibitors to hinder bone disease progression in AS, however, this was not shown to support to the significant changes found in TKA trends during the study period.
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Affiliation(s)
- Roby Abraham
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - John J Kelly
- St. George's University School of Medicine, St. George's, Grenada, West Indies, UK
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - John W Barrington
- Joint Replacement Center of Texas, Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Tang Y, Yang P, Wang F, Xu H, Zong SY. Association of polymorphisms in ERAP1 and risk of ankylosing spondylitis in a Chinese population. Gene 2017; 646:8-11. [PMID: 29278768 DOI: 10.1016/j.gene.2017.12.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023]
Abstract
To explore the association between five polymorphisms in endoplasmic reticulum associated aminopeptidase 1 (ERAP1) gene and risk of ankylosing spondylitis (AS) in a Chinese population. A case-control study enrolled 250 AS patients and 250 healthy controls was carried out. The genotypes of involved polymorphisms (rs27037, rs27038, rs469876, rs27044 and rs27980) in ERAP1 were detected by Sequenom Mass-Array platform. There were significant differences of the level of WBC (white blood cell), Platelets, CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) between AS patients and controls (Pall<0.05). There was statistically association between ERAP1 rs27044 polymorphism and risk of AS, and the carriers with rs27044 CG genotype have an increased the risk for AS (CG versus GG, OR=1.70, 95% CI=1.10-2.62, P=0.015). However, we found no evidence for the association of rs27037, rs469876, and rs27980 polymorphisms in ERAP1 with AS risk. Our findings indicated that ERAP1 rs27044 polymorphism was associated with the susceptibility of AS.
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Affiliation(s)
- Yin Tang
- Department of Clinical Laboratory, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang, Jiangsu 215600, China
| | - Ping Yang
- Department of Clinical Laboratory, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang, Jiangsu 215600, China
| | - Fang Wang
- Department of Clinical Laboratory, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang, Jiangsu 215600, China
| | - Hui Xu
- Department of Clinical Laboratory, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang, Jiangsu 215600, China
| | - Shou-Yang Zong
- Department of Clinical Laboratory, Jinhu People's Hospital of Jiangsu, Jinhu, Jiangsu 211600, China.
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Zhu J, Li A, Jia E, Zhou Y, Xu J, Chen S, Huang Y, Xiao X, Li J. Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study. Arthritis Res Ther 2017; 19:83. [PMID: 28464949 PMCID: PMC5414368 DOI: 10.1186/s13075-017-1286-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies have revealed that ankylosing spondylitis (AS), as the progenitor of axial spondyloarthritis (AxSpA), has been characterized by the insidiously progressive nature of sacroiliitis and spondylitis. Dual-energy computed tomography (DECT) has recently been used to analyse the deposition of monosodium urate (MSU) crystals with higher sensitivity and specificity. However, it remains unclear whether the existence of the MSU crystal deposition detected by DECT at the sacroiliac joint in patients with AxSpA also is associated with the existing structural damage. Here, we performed this study to show the DECT MSU crystal deposits in AxSpA patients without coexisting gout and to ascertain the relationship between the MSU crystal deposition and the structural joint damage of sacroiliac joints. Methods One hundred and eighty-six AxSpA patients without coexisting gout were recruited. The plain radiographs of the sacroiliac joint were obtained, along with the DECT scans at the pelvis and the clinical variables. All statistics based on the left or right sacroiliac joint damage grading (0–4) were calculated independently. Bivariate analysis and ordinal logistic regression was performed between the clinical features and radiographic grades at the sacroiliac joint. Results At the pelvis, large quantities of MSU crystal deposition were found in patients with AxSpA. The average MSU crystal volume at the left sacroiliac joint, the right sacroiliac joint, and the pelvis were 0.902 ± 1.345, 1.074 ± 1.878, and 5.272 ± 9.044 cm3, values which were correlated with serum uric acid concentrations (r = 0.727, 0.740, 0.896; p < 0.001). In bivariate analysis, wide clinical variables were associated with the changes in sacroiliac joint damage. Further, the AxSpA duration, BASFI score, and the volume of MSU crystal at both sides of sacroiliac joint were associated with the progress of radiographic grade at the sacroiliac joints in the ordinal logistic models (left AOR = 1.180, 3.800, 1.920; right AOR = 1.190, 3.034, 1.418; p < 0.01). Conclusions Large quantities of MSU crystal deposition detected by DECT were found at the pelvis in AxSpA patients without coexisting gout. In addition to AxSpA duration and BASFI score, the MSU crystal deposition at the sacroiliac joint is associated with the progress of radiographic grade at sacroiliac joints in those patients.
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Affiliation(s)
- Junqing Zhu
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Aiwu Li
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Ertao Jia
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yi Zhou
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 511400, China
| | - Juan Xu
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Shixian Chen
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yinger Huang
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Xiang Xiao
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Juan Li
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China. .,Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China.
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Qian Y, Wang G, Xue F, Chen L, Wang Y, Tang L, Yang H. Genetic association between TAP1 and TAP2 polymorphisms and ankylosing spondylitis: a systematic review and meta-analysis. Inflamm Res 2017; 66:653-661. [PMID: 28405734 DOI: 10.1007/s00011-017-1047-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a chronic inflammatory joint disease. The transporter associated with antigen processing (TAP) has been identified to play an important role in immune response as well as the HLA-associated diseases. The aim of our meta-analysis was to investigate the contribution of TAP (TAP1 and TAP2) polymorphisms to the risk of AS. METHODS Meta-analyses were performed between 2 polymorphisms in TAP1 (TAP1-333, -637) and 3 polymorphisms in TAP2 (TAP2-379, -565, and -665) and AS. RESULTS The meta-analyses were involved with 6 studies with 415 cases and 659 controls. Significant association was found between TAP1-333Val, TAP1-637Gly, and TAP2-565Thr and AS compared with combined control group (TAP1-333Val: p = 0.009, OR = 1.40, 95% CI 1.09-1.80; TAP1-637Gly: p = 0.002, OR = 1.48, 95% CI 1.15-1.91; p = 0.03, OR = 1.38, 95% CI 1.04-1.84). Subgroup analysis shown that significant association was only found in AS when compared with HLA-B27-negative controls (TAP1-333Val: p = 0.004, OR = 1.53, 95% CI 1.14-2.06; TAP1-637Gly: p = 0.004, OR = 1.52, 95% CI 1.15-2.02; p = 0.02, OR = 1.56, 95% CI 1.09-2.24), but not in AS when compared with HLA-B27-positive controls (p > 0.05). Moreover, no significant associations were found between haplotypes in TAP1 and TAP2 in both the combined and the subgroup analyses (p > 0.05). CONCLUSIONS TAP1-333Val, TAP1-637Gly, and TAP2-565Thr were likely to be associated with AS.
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Affiliation(s)
- Yufeng Qian
- Department of Orthopedics, The First Affiliated Hospital of Suzhou University, Suzhou, 215000, People's Republic of China.,Department of Orthopedics, Changshu First People's Hospital, Changshu, People's Republic of China
| | - Genlin Wang
- Department of Orthopedics, The First Affiliated Hospital of Suzhou University, Suzhou, 215000, People's Republic of China
| | - Feng Xue
- Department of Orthopedics, Changshu First People's Hospital, Changshu, People's Republic of China
| | - Lianghui Chen
- Department of Human Anatomy, Histology and Embryology, Institute of Neuroscience, Changsha Medical University, Changsha, People's Republic of China
| | - Yan Wang
- Department of Human Anatomy, Histology and Embryology, Institute of Neuroscience, Changsha Medical University, Changsha, People's Republic of China
| | - Liang Tang
- Department of Human Anatomy, Histology and Embryology, Institute of Neuroscience, Changsha Medical University, Changsha, People's Republic of China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Suzhou University, Suzhou, 215000, People's Republic of China.
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Zhang Z, Yu K, Dai D, Yuan F, Liang F, Liu N, Xi Y, Sun YY. A complex role of anthrax toxin receptor 2 polymorphisms and capillary morphogenesis protein 2 in ankylosing spondylitis pathogenesis. Clin Rheumatol 2016; 35:2243-50. [PMID: 26728147 DOI: 10.1007/s10067-015-3158-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 01/17/2023]
Abstract
This study investigated the role of anthrax toxin receptor 2 (ANTXR2) gene polymorphisms and capillary morphogenesis protein 2 (CMG2) expression in susceptibility and pathogenesis to ankylosing spondylitis (AS) in the Han Chinese in Beijing. A case-control study was performed using 602 AS patient samples meeting the revised New York criterion and 619 matched controls from Han Chinese individuals. Nineteen single-nucleotide polymorphisms (SNPs) of ANTXR2 genes were selected and genotyped using the Sequenom iPlex platform. Real-time polymerase chain reaction and flow cytometry were performed to investigate the impact of SNP polymorphisms on ANTXR2 transcription and CMG2 expression, respectively. The association of variants with AS was examined with UNPHASED 3.1.5. A novel association was observed between AS and three SNPs in the ANTXR2 gene (rs4690127, rs6823031, and rs4333130; P = 0.004, 0.011, and 0.013, respectively), confirming the association between rs433130 and AS in the Han Chinese. The strongest haplotype association was observed with rs4690127-rs6823031-rs4333130 (P = 2.5 × 10(-4)). rs6534639 and rs4333130 showed a cis-interaction (P = 0.027) in AS. ANTXR2 messenger RNA (mRNA) expression was significantly higher in the AS group than in the control group (P = 0.039). CMG2 expression in the lipopolysaccharide (LPS)-stimulated group was significantly lower than that in the control group (P = 0.018). This study reports a novel association between ANTXR2 and AS in the Han Chinese. ANTXR2 genetic polymorphisms affect ANTXR2 mRNA transcription and CMG2 expression. The opposing results observed for ANTXR2 transcription and CMG2 expression suggest a complex role of ANTXR2 polymorphisms in AS pathogenesis.
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Saglam Y, Ozturk I, Cakmak MF, Ozdemir M, Yazicioglu O. Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results. Acta Orthop Traumatol Turc 2016; 50:443-7. [PMID: 27492583 PMCID: PMC6197352 DOI: 10.1016/j.aott.2016.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 02/06/2023]
Abstract
Introduction The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). Patients and methods One hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorr's classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. Results Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorr's type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01). Conclusion Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.
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Affiliation(s)
- Yavuz Saglam
- Biruni University Hospital, Orthopedics and Traumatology Department, Istanbul, Turkey.
| | - Irfan Ozturk
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mehmet Fevzi Cakmak
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Mustafa Ozdemir
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
| | - Onder Yazicioglu
- Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul, Turkey
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Westerveld LA, van Bemmel JC, Dhert WJA, Oner FC, Verlaan JJ. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J 2014; 14:729-40. [PMID: 23992936 DOI: 10.1016/j.spinee.2013.06.038] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 04/02/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The clinical outcome of patients with ankylosing spinal disorders (ASDs) sustaining a spinal fracture has been described to be worse compared with the general trauma population. PURPOSE To investigate clinical outcome (neurologic deficits, complications, and mortality) after spinal injury in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) compared with control patients. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE All patients older than 50 years and admitted with a traumatic spinal fracture to the Emergency Department of the University Medical Center Utrecht, the Netherlands, a regional level-1 trauma center and tertiary referral spine center. OUTCOME MEASURES Data on comorbidity (Charlson comorbidity score), mechanism of trauma, fracture characteristics, neurologic deficit, complications, and in-hospital mortality were collected from medical records. METHODS With logistic regression analysis, the association between the presence of an ASD and mortality was investigated in relation to other known risk factors for mortality. RESULTS A total of 165 patients met the inclusion criteria; 14 patients were diagnosed with AS (8.5%), 40 patients had DISH (24.2%), and 111 patients were control patients (67.3%). Ankylosing spinal disorder patients were approximately five years older than control patients and predominantly of male gender. The Charlson comorbidity score did not significantly differ among the groups, but Type 2 diabetes mellitus and obesity were more prevalent among DISH patients. In many AS and DISH cases, fractures resulted from low-energy trauma and showed a hyperextension configuration. Patients with AS and DISH were frequently admitted with a neurologic deficit (57.1% and 30.0%, respectively) compared with controls (12.6%; p=.002), which did not improve in the majority of cases. In AS and DISH patients, complication and mortality rates were significantly higher than in controls. Logistic regression analysis showed the parameters age and presence of DISH to be independently, statistically significantly related to mortality. CONCLUSIONS Many patients with AS and DISH showed unstable (hyperextension) fracture configurations and neurologic deficits. Complication and mortality rates were higher in patients with ASD compared with control patients. Increasing age and presence of DISH are predictors of mortality after a spinal fracture.
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Affiliation(s)
- L A Westerveld
- Department of Orthopaedics, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - J C van Bemmel
- Department of Orthopaedics, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - W J A Dhert
- Department of Orthopaedics, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F C Oner
- Department of Orthopaedics, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - J J Verlaan
- Department of Orthopaedics, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Abstract
There are numerous studies showing the role of human leukocyte antigens (HLAs) related with susceptibility or resistance to certain diseases. The aim of this study was to determine the association of HLA-B27 with ankylosing spondylitis (AS), polyarthralgia, lumboishialgia, acute anterior uveitis (AAU), psoriatic arthritis (PA), synovitis coxae and rheumatoid arthritis (RA) in patients from Vojvodina, Serbia. An HLA I class typing was performed by the serological immunomagnetic two-color fluorescence method using peripheral blood T lymphocytes in 97 patients and 224 healthy controls from the population of Vojvodina, Serbia. We calculated HLA-B27 frequencies, relative risk (RR), ethiologic fraction (EF), e.g., population attributive risk, when RR was greater than 1, while, preventive fraction (PF) was calculated when RR was lower than 1. This study revealed the strongest association of AS with HLAB27 antigen: RR = 25.0, while the EF was greater than 0.15, respectively. The χ2 test showed the significant difference (p <0.05) in HLA-B27 in patients with AS in comparison to controls (χ2 = 52.5). It was concluded that there is a positive association of HLA-B27 with AS and that HLA-B27 can serve as a marker for predisposition to diseases.
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Yi L, Wang J, Guo X, Espitia MG, Chen E, Assassi S, Jin L, Zou H, Reveille JD, Zhou X. Profiling of hla-B alleles for association studies with ankylosing spondylitis in the chinese population. Open Rheumatol J 2013; 7:51-4. [PMID: 24062861 PMCID: PMC3778539 DOI: 10.2174/1874312920130628001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022] Open
Abstract
Human leucocyte antigen (HLA) B*27 is a susceptibility allele to ankylosing spondylitis (AS). However, major AS-associated subtypes of HLA-B*27 and other HLA-B alleles vary in different ethnic populations. Herein, we examined HLA-B alleles in a total of 360 AS patients and 350 controls of Chinese Han ancestry. The HLA-B genotyping was performed with sequence-based typing (SBT) method. Six HLA-B*27 subtypes B*27:04, B*27:05, B*27:07, B*27:08, B*27:10 and B*27:15 were observed in the cohorts. HLA-B*27:04:01 and -B*27:05:02 appeared significantly increased in AS patients, which indicated as two major susceptibility alleles to AS. Homozygous B*27 was observed only in AS patients. There are 30 HLA-B alleles identified in the studies. HLA-B*15, especially B*15:01:01:01, appeared as the major allele type in the Chinese controls. Some common HLA-B alleles such as HLA-B*15, B*13, B*46 and B*51 were significantly reduced in Chinese AS patients. In conclusion, the studies profiled the HLA-B alleles, and identified major susceptibility subtypes of B27 to AS in Han Chinese population
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Affiliation(s)
- Lin Yi
- Division of Rheumatology and Clinical Immunogenetics, University of Texas Medical School at Houston, USA ; Gansu College of Traditional Chinese Medicine, Lanzhou, Gansu, China
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Walker BF. Ankylosing spondylitis: a summary and review. COMSIG Rev 1993; 2:64-7. [PMID: 17989750 PMCID: PMC2050130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A review of the etiology, clinical, radiological and laboratory presentation, differential diagnosis and management.
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