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de Vlam K, Maksymowych WP, Gallo G, Rahman P, Mease P, Krishnan V, McVeigh CJ, Lisse J, Zhu D, Bolce RJ, Conaghan PG. Exploring the Effects of Ixekizumab on Pain in Patients with Ankylosing Spondylitis Based on Objective Measures of Inflammation: Post Hoc Analysis from a Large Randomized Clinical Trial. Rheumatol Ther 2024:10.1007/s40744-024-00660-7. [PMID: 38637464 DOI: 10.1007/s40744-024-00660-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The objective of this analysis is to evaluate the improvement in spinal pain with ixekizumab, placebo, and adalimumab based on objective measures of inflammation response in patients with ankylosing spondylitis (AS). METHODS The COAST-V 52-week, double-blind, placebo-controlled, randomized phase III trial examined the efficacy of ixekizumab in patients with active AS; adalimumab was used as an active reference arm. Treatment effects on reduction in pain were assessed by objective measures of controlled and persisting inflammation (defined by magnetic resonance imaging [MRI], C-reactive protein [CRP], or MRI + CRP status). Pathway analysis was used to analyze treatment effect that was not attributable to reduction in inflammation biomarkers. RESULTS In patients with AS, when inflammation was controlled as assessed by MRI, patients treated with ixekizumab experienced a reduction in spinal pain at night (SP-N, numeric rating scale, ixekizumab mean = - 3.9, p < 0.001, adalimumab mean = - 2.6, p < 0.05) compared to placebo (mean = - 1.6) at week 16. When inflammation was controlled as assessed by MRI + CRP, ixekizumab and adalimumab had numerically greater reductions at week 16 in SP-N versus placebo. All ixekizumab groups had further improvements at week 52. When inflammation was persisting as assessed by MRI + CRP, ixekizumab-treated patients had significant reduction in SP-N (mean = - 3.7, p < 0.001) versus placebo (mean = - 1.7), improvement with adalimumab did not reach significance (mean = - 2.6, p = 0.06). In the pathway analysis at week 16, ixekizumab had a greater effect on pain outcomes compared to adalimumab. CONCLUSION This post hoc analysis is supportive of the hypothesis that ixekizumab reduces pain in AS by additional mechanisms other than the reduction of measurable inflammation. TRIAL REGISTRATION NUMBER NCT02696785.
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Affiliation(s)
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology at the University of Alberta, Edmonton, Alberta, Canada
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, USA
| | - Proton Rahman
- Department of Medicine, Memorial University, St. John's, Newfoundland, A1C 5B8, Canada
| | - Philip Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Jun YK, Yoon H, Koh SJ, Kim AH, Kim KW, Park JW, Lee HJ, Kang HW, Im JP, Park YS, Kim JS. Concomitant ankylosing spondylitis can increase the risk of biologics or small molecule therapies to control inflammatory bowel disease. Intest Res 2022; 21:244-251. [PMID: 35929093 PMCID: PMC10169522 DOI: 10.5217/ir.2022.00057] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Patients with inflammatory bowel disease (IBD) are diagnosed with ankylosing spondylitis (AS) often. However, the disease course of patients with both IBD and AS is not well understood. This study aims to evaluate the effect of concomitant AS on IBD outcomes. Methods Among the 4,722 patients with IBD who were treated in 3 academic hospitals from 2004 to 2021, 55 were also diagnosed with AS (IBD-AS group). Based on patients' electronic medical records, the outcomes of IBD in IBD-AS group and IBD group without AS (IBD-only group) were appraised. Results The proportion of patients treated with biologics or small molecule therapies was significantly higher in IBD-AS group than the proportion in IBD-only group (27.3% vs. 12.7%, P= 0.036). Patients with both ulcerative colitis and AS had a significantly higher risk of biologics or small molecule therapies than patients with only ulcerative colitis (P< 0.001). For univariable logistic regression, biologics or small molecule therapies were associated with concomitant AS (odds ratio, 4.099; 95% confidence interval, 1.863-9.021; P< 0.001) and Crohn's disease (odds ratio, 3.552; 95% confidence interval, 1.590-7.934; P= 0.002). Conclusions Concomitant AS is associated with the high possibility of biologics or small molecule therapies for IBD. IBD patients who also had AS may need more careful examination and active treatment to alleviate the severity of IBD.
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Affiliation(s)
- Yu Kyung Jun
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Joon Koh
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - A Hyeon Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Woo Kim
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jun Won Park
- Seoul National University College of Medicine, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jung Lee
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyoun Woo Kang
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jong Pil Im
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Soo Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Sung Kim
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Hong YM, Yoon KT, Cho M. Primary Biliary Cholangitis with Ankylosing Spondylitis. Korean J Gastroenterol 2022; 79:270-273. [PMID: 35746842 DOI: 10.4166/kjg.2022.048] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
Primary biliary cholangitis is a chronic inflammatory autoimmune liver disease that is characterized by a positive antimitochondrial antibodies test and progressive destruction of the small intrahepatic bile duct. Ankylosing spondylitis is a chronic, systemic, inflammatory disease of the spine and the sacroiliac joints. The association between these two is very low. This paper reports a rare case who had ankylosing spondylitis and developed primary biliary cholangitis.
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Affiliation(s)
- Young Mi Hong
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea
- Liver Center, Pusan National University of Yangsan Hospital, Yangsan, Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea
- Liver Center, Pusan National University of Yangsan Hospital, Yangsan, Korea
| | - Mong Cho
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea
- Liver Center, Pusan National University of Yangsan Hospital, Yangsan, Korea
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Abstract
Biologics are an integral part of modern strategies for treatment of rheumatoid arthritis (RA) and spondylarthritis (SpA), including psoriatic arthritis (PsA). Biologics are biotechnologically produced proteins that have inhibiting effects on humoral and cellular components of rheumatic inflammation. Substance classes used in rheumatology are tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL‑6, IL-12, IL-17 and IL-23 inhibitors effective against cytokines as well as the T lymphocyte activation inhibitor abatacept and the B lymphocyte-depleting rituximab. There are clear recommendations for the use of biologics for RA patients inadequately responding to one or more conventional synthetic disease-modifying antirheumatic drugs and for ankylosing spondylitis (AS) and nonradiographical axial SpA patients with an inadequate response to at least two nonsteroidal antirheumatic drugs. For PsA the recommended use depends on the most prominent manifestations in each case. Treatment with biologics should follow the treat to target principle, with a defined and validated treatment target. Treatment in cases of RA and SpA should target remission or at least a low or minimum disease activity. The safety of treatment with biologics has been intensively investigated. There are very specific contraindications for individual substance classes with a focus on an increased risk of infections. The standard procedure before starting treatment with biologics includes the exclusion of latent tuberculosis and hepatitis B. The TNF-alpha inhibitors have a protective effect with respect to myocardial infarction, stroke and venous thromboembolism.
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Zhang WY, Chen XT, Wang XQ, Zhang LL, Luo J. [Electronic focusing high-nergy extracorporeal shockwave combined with conventional oral medicine for the treatment of ankylosing spondylitis]. Zhongguo Gu Shang 2021; 34:1020-1024. [PMID: 34812018 DOI: 10.12200/j.issn.1003-0034.2021.11.007] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To observe the progress of disease activity and sacroiliac joint imaging in patients with ankylosing spondylitis treated by extracorporeal shockwave combined with conventional oral medicine, and find a new safe and effective therapeutic method. METHODS The clinical data of 30 patients with ankylosing spondylitis treated from January 2018 to December 2018 were retrospectively analyzed. Including 20 males and 10 females, aged from 18 to 50 years with an average of (34.50±9.60) years. All 30 patients had different degrees of sacroiliac joint bone marrow edema on MRI before treatment. Thirty patients were divided into treatment group and control group according to different treatment methods. Among them, 15 cases in control group were treated with non-steroidal anti-inflammatory drugs and sulfasalazine enteric-coated tablets, for the 15 cases in treatment group, in addition to oral medicine in line with control group, electronic focusing high-energy extracorporeal shockwave therapy was added. The course of disease, age, pre- and post-treatment erythrocyte sedimentation rate, C-reactive protein in the two groups were analyzed; and visual analogue scale (VAS) and spondyloarthritis research consortium Canada (SPARCC) scoring system were used to evaluate the pain of the sacroiliac joint and the structural damage of the sacroiliac joint;Bath ankylosing spondylitis disease activity index (BASDAI) was calculated. RESULTS All patients were followed up for at least 3 months. One month after treatment, VAS, and SPARCC scores in treatment group were significantly better than in control group (P<0.05). After 1 month of treatment, there was no significant difference in BASDAI, erythrocyte sedimentation rate and C-reactive protein between two groups(P>0.05). VAS, BASDAI, SPARCC, erythrocyte sedimentation rate, and C-reactive protein of all patients after treatment were significantly improved compared with those before treatment (P< 0.01). CONCLUSION Electronic focusing high-energy extracorporeal shockwave combined with conventional oral medicine in the treatment of ankylosing spondylitis has a good clinical effect in rapidly relieving pain, improving disease activity, and preventing imaging progress. In addition, it is safe and non-invasive, which is worthy of clinical application.
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Affiliation(s)
- Wan-Yi Zhang
- Luoyang Osteopathic Traumatological Hospital, Luoyang 471002, Henan, China
| | - Xian-Tao Chen
- Luoyang Osteopathic Traumatological Hospital, Luoyang 471002, Henan, China
| | - Xiao-Qing Wang
- Luoyang Osteopathic Traumatological Hospital, Luoyang 471002, Henan, China
| | - Lei-Lei Zhang
- Luoyang Osteopathic Traumatological Hospital, Luoyang 471002, Henan, China
| | - Jiao Luo
- Luoyang Osteopathic Traumatological Hospital, Luoyang 471002, Henan, China
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Abstract
BACKGROUND/AIMS Because ankylosing spondylitis (AS) mainly affects sacroiliac joints, special attention should be given to normal labour and pregnancy outcomes. Here, we investigate pregnancy outcomes in Korean women with AS. METHODS Based on data from the Korean Health Insurance Review and Assessment Service claims database since July 2007, maternal complications were compared between women with AS and 1:10 matched general population by maternal age and year of delivery. Additionally, the 27 deliveries from 21 patients with AS who were seen at a tertiary hospital were retrospectively evaluated using 1:4 matched control group by maternal and gestational age. RESULTS In the population-based cohort, there were 1,293 deliveries in 996 patients with AS. Higher maternal age and more comorbidities were reported than in the general population. However, compared to age and delivery-year matched population, only the rate of Caesarean section (CS) was higher in women with AS (odds ratio, 1.52; 95% confidence interval, 1.36 to 1.70). Incidence of other maternal complications was comparable between women with AS and control subjects. In the hospital-based cohort, the CS rate was higher in women with AS (44.4% vs. 20.4%, p = 0.002). Causes of CS was not different in both groups, including previous uterine surgery. There were no significant differences in foetal outcomes, including growth restriction, foetal malformations and Apgar score. CONCLUSION CS deliveries were performed more often in women with AS. However, other maternal complications and offspring complications were similar between women with AS and healthy control subjects.
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Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Sun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Yong-Gil Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3279 Fax: +82-2-3010-6969 E-mail:
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Lim JM, Cho OH. Effects of Home-and-Workplace Combined Exercise for Patients with Ankylosing Spondylitis. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:181-188. [PMID: 33741506 DOI: 10.1016/j.anr.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/10/2020] [Revised: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effects of home-and-workplace combined exercise on physical function, depression, and work-related disability in patients with ankylosing spondylitis. METHODS This study adopted a non-randomized quasi-experimental design. Fifty-two patients were recruited: home-and-workplace combined exercise (n = 17), home exercise (n = 18), and control group (n = 17). RESULTS The home-and-workplace combined exercise group showed improvement in spinal mobility and pulmonary function and significantly lower absenteeism and overwork impact than the home-exercise group and control group. The home-and-workplace combined exercise and home exercise groups showed a higher level of activity improvement than the control group. CONCLUSION home-and-workplace combined exercise can be recommended to patients with ankylosing spondylitis to enhance their physical function, including spinal mobility and pulmonary function, and reduce work-related disability.
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Affiliation(s)
- Jong Mi Lim
- Department of Nursing, Shinsung University, Dangjin, Republic of Korea.
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea.
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Almasi S, Farahani B, Samiei N, Rezaei Y, Mahmoodi H, Qorbani M. Echocardiographic and Electrocardiographic Findings in Patients with Ankylosing Spondylitis without Cardiovascular Risk Factors. J Tehran Heart Cent 2021; 15:43-49. [PMID: 33552193 PMCID: PMC7825462 DOI: 10.18502/jthc.v15i2.4182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/17/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.
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Affiliation(s)
- Simin Almasi
- Rheumatology Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Farahani
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Mahmoodi
- Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran.,Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Li C, Niu GQ, Jiang WL, Chen H, Liu LT, Zhou QK, Cheng JW. [Experimental study of individualized 3D printing-guided template combined with thoracolumbar pedicle screw placement for the treatment of ankylosing spondylitis]. Zhongguo Gu Shang 2020; 33:649-54. [PMID: 32700489 DOI: 10.12200/j.issn.1003-0034.2020.07.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate accuracy and safety of individualized 3D printing guided template for thoracolumbar pedicle screw placement in patients with ankylosing spondylitis. METHODS From January 2016 to September 2019, thoracolumbar spine three-dimensional CT data of 8 patients with ankylosing spondylitis were included, Mimics 17.0 and ideaMaker computer software were applied to design thoracolumbar pedicle screw guided template of patients with AS, physical model of all patients (T10-L2)were printed by 3D printer, 2 parts in each patient, and divided into guide-plate-assisted screw group (experimental group) and free-hand nail group (control group). Thoracolumbar pedicle screws of both groups were placed by the same spinal surgeon. The accuracy of pedicle screw placement between two groups were evaluated according to results of postoperative CT, the accuracy of the fixation of thoracolumbar pedicle screw was divided into 4 grades, grade 0 and 1 screws were acceptable nails, grade 2 and 3 screws were unacceptable nails. The diameter and length of pedicle screws, the distance between entry point and posterior median line designed by preoperative 3D printing were compared with actual use in operation. RESULTS Twenty three blocks of thoracolumbar 3D printing screw of ankylosing spondylitis guided templates were designed and printed in guide-plate-assisted screw group, 46 screws were inserted and 44 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (4.20±1.15) min, the frequency of X-ray was (5.00±1.25) times and the average adjustment times of screw and Kirschner needle during screw placement was (1.76±1.32) times. In the control group, 46 nails were placed by traditional surgical method and 30 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (14.67±2.23) min, the frequency of X-ray fluoroscopy was (14.46±2.21) times and the average times of Kirschner needle adjustment was (4.76±3.39) times. The success rates between experimental group and control group were 95.65%(44 / 46) and 56.22%(30 / 46) respectively, and had statistical difference (χ2=13.538, P<0.05). There was no significant difference in diameter, length of pedicle screws and the distance of posterior median line between virtual designed by 3D printing before operation and actual situation in opertaion (P>0.05). The operation time of inserting a single screw, the times of X-ray fluoroscopy, and the average times of adjustment screw and Kirschner needle in experimental group were significant less than those in control group(P<0.01). CONCLUSION The personalized guide template assisted the thoracolumbar fixation designed by 3D printing could significantly improve safety, accuracy and efficiency of surgery, especially suitable for thoracolumbar vertebral bodies requiring posterior pedicle screw fixation for fracture or dislocation with AS.
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Affiliation(s)
- Chao Li
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Guo-Qi Niu
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Wei-Li Jiang
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Hui Chen
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Lu-Tan Liu
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Qian-Kun Zhou
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Jia-Wei Cheng
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
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Ren WF, Hu JT, Gao Y, Du WB, Zhang HL, Wu YJ, Wu FQ, Chai L, Quan RF. [Whole exome sequencing in a pedigree with ankylosing spondylitis]. Zhongguo Gu Shang 2020; 33:672-6. [PMID: 32700495 DOI: 10.12200/j.issn.1003-0034.2020.07.017] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To choose the disease-causing gene in a Chinese pedigree with ankylosing spondylitis (AS) by whole-exome sequencing (WES), and provide theory basis for mechanism of disease. METHODS Clinical data of AS pedigree were collected, including 2 males, the age were 48 and 18 years old, the course of disease were 23 and 4 years. Whole blood genomic DNA of AS was extracted to perform whole exome sequencing, the results were compared with human databases, common variations which had been reported were wiped out, then non synonymous single nucleotide variants(SNVs) from the family members were combined, and candidate genes was selected initially. RESULTS Totally 80 G data was obtained from AS family with high quality.By comparing results between patient and normal subject, and filtering with number of biological database, the result showed heterozygous mutation of JAK2 gene 12 exon c.1709 A>G (p.Tyr570Cys) may be the potential disease-causing gene. The variant c.1151T>C of MUC3A gene may be one of the causes of intestinal symptoms in the family members. CONCLUSION It is feasible to find t candidate gene mutations of AS by Exon sequencing. The mutation c.1709 A>G in gene JAK2 identified by whole exome sequencing might be the pathogenic mutation in this AS pedigree.
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Affiliation(s)
- Wei-Fan Ren
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Jing-Tao Hu
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Yang Gao
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Wei-Bin Du
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - He-Lou Zhang
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Yi-Jiang Wu
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Feng-Qing Wu
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Le Chai
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
| | - Ren-Fu Quan
- Xiaoshan District Hospital of Traditional Chinese Medicine in Hangzhou City, Hangzhou 311201, Zhejiang, China
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Xie Y, Yang KH, Lyu Q, Zheng Y, Huang CB, Li ZB, Liu SY, Fang LK, Wang XQ, Zhou YQ, Liang BL, Zha ZG, Jiang B, Zhou J, Yankov Z, Gu JR. [Practice guideline for patients with ankylosing spondylitis/spondyloarthritis]. Zhonghua Nei Ke Za Zhi 2020; 59:511-8. [PMID: 32594684 DOI: 10.3760/cma.j.cn112138-20200505-00448] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.
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Choi SJ, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. Liver enzyme elevation in patients with ankylosing spondylitis treated with tumor necrosis factor inhibitors: a single-center historical cohort study. Korean J Intern Med 2020; 35:723-731. [PMID: 31870134 PMCID: PMC7214361 DOI: 10.3904/kjim.2018.407] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS Tumor necrosis factor inhibitors (TNFi) have been known to induce liver enzyme elevation, sometimes associated with viral reactivation or toxic hepatitis. We evaluated the incidence and risk factors of TNFi-associated liver enzyme elevation in Korean ankylosing spondylitis (AS) patients who previously had normal liver enzymes. METHODS Retrospectively, we collected data from the records of 363 AS patients treated with TNFi at a tertiary hospital from 2003 to 2017. Liver enzyme elevation was defined as abnormal elevation of aspartate aminotransferase and/or alanine aminotransferase levels on two or more consecutive visits. Patients with previously diagnosed liver disease were excluded. RESULTS The incidence of liver enzyme elevation was 23.7% (occurring in 86 of 363 patients). The median duration of TNFi exposure before liver enzyme elevation was 3.72 months (interquartile range, 1.77 to 12.51). There was no difference in the occurrence of liver enzyme elevation with concomitant disease-modifying anti-rheumatic drugs and TNFi compared to TNFi alone (23.9% vs. 23.6%). In multivariate analysis, the hazard ratios for liver enzyme elevation were 4.62 (95% confidence interval [CI], 1.43 to 15.01) for male sex, 4.06 (95% CI, 2.11 to 7.84) for underlying non-alcoholic fatty liver disease, and 2.53 (95% CI, 1.38 to 4.64) for hyperlipidemia. After switching to another TNFi, the liver enzyme elevation was not normalized in nine of 13 patients. CONCLUSION Liver enzyme elevation was observed in a quarter of patients with AS receiving a TNFi. Male sex, non-alcoholic fatty liver disease, and hyperlipidemia were independent risk factors for liver enzyme elevation. Switching to another TNFi had a limited effect on restoring normal liver enzyme levels.
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Affiliation(s)
- Su Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Yong-Gil Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3279 Fax: +82-2-3010-6969 E-mail:
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Koo BS, Jo S, Kwon E, Shin JH, Hur JW, Kim TH. Effect of biologics in the level of cytokines in the synovial fluid of patients with ankylosing spondylitis. Korean J Intern Med 2020; 35:465-473. [PMID: 31830775 PMCID: PMC7060997 DOI: 10.3904/kjim.2018.364] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Biologics are very effective drugs for patients with ankylosing spondylitis (AS). However, there are patients who are not responding to biologics. This study aimed to evaluate the level of tumor necrosis factor α (TNF-α), interleukin (IL)-23, and IL-17 from synovial fluid in patients with AS and rheumatoid arthritis (RA) and differences of the level of those cytokines according to drugs. METHODS Synovial fluid was obtained from 34 patients (42 samples) with AS and 45 patients (47 samples) with RA with active arthritis of the knee, and the cytokine levels were measured. The differences in the levels between patients treated with and without biologics (biologics and non-biologics groups, respectively) were analyzed in AS and RA. The correlations between cytokines were examined in the non-biologics and biologics groups. RESULTS The TNF-α level in AS was significantly lower than that in RA (p = 0.016). The IL-17 and IL-23 levels were not different between AS and RA (p = 0.409 and p = 0.562, respectively). In AS and RA, TNF-α, IL-17, and IL-23 showed good correlation among each other in the non-biologics group. However, there was no significant correlation in biologics group. In some patients in the AS group, the IL-17 or IL-23 level was markedly elevated in the biologics group. CONCLUSION Treatment with biologics affects the cytokine profile in inflammatory synovial fluid in patients with both AS and RA. Furthermore, IL-23 and IL-17 cytokine might be an important factor in some patients who are unresponsive to biologics in AS.
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Affiliation(s)
- Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sungsin Jo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eunji Kwon
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Ji Hui Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Correspondence to Tae-Hwan Kim, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9245 Fax: +82-2-2298-8231 E-mail:
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Park EJ, Kim H, Jung SM, Sung YK, Baek HJ, Lee J. The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus. Korean J Intern Med 2020; 35:41-59. [PMID: 31935319 PMCID: PMC6960050 DOI: 10.3904/kjim.2019.411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022] Open
Abstract
Biological disease-modifying antirheumatic drugs (bDMARDs) are highly effective agents for the treatment of inf lammatory arthritis; however, they also possess a potential risk for serious infection. Recently, with the rapid expansion of the bDMARDs market in Korea, reports of serious adverse events related to the agents have also increased, necessitating guidance for the use of bDMARDs. Current work entitled, "Expert consensus for the use of bDMARDs drugs for inflammatory arthritis in Korea," is the first to describe the appropriate use of bDMARDs in the management of inflammatory arthritis in Korea, with an aim to provide guidance for the local medical community to improve the quality of clinical care. Twelve consensus statements regarding the use of bDMARDs for the management of rheumatoid arthritis and ankylosing spondylitis were generated. In this review, we provide detailed guidance on bDMARDs use based on expert consensus, including who should prescribe, the role of education, indications for use, and monitoring strategies for safety.
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Affiliation(s)
- Eun-Jung Park
- Division of Rheumatology, Department of Medicine, National Medical Center, Seoul, Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- Correspondence to Jisoo Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: +82-2-2650-6164 Fax: +82-2-2650-2590 E-mail:
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15
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Silva TS, Guimarães CLM, Xavier IP, Rego VRPDA. Lobular capillary hemangioma in a patient with ankylosing spondylitis using adalimumab: an exuberant presentation. An Bras Dermatol 2019; 94:751-753. [PMID: 31789263 PMCID: PMC6939071 DOI: 10.1016/j.abd.2019.02.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/03/2019] [Indexed: 11/15/2022] Open
Abstract
Lobular capillary hemangioma or pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes. Most patients present a single lesion. It manifests clinically as an erythematous, friable, and fast-growing tumor. This report details a case with exuberant presentation in a patient with ankylosing spondylitis, using adalimumab. Factors triggering pyogenic granuloma are not well known. They may spontaneously regress, but most require treatment.
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Affiliation(s)
- Thadeu Santos Silva
- Dermatology Service, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Teaching and Care Outpatient Clinic, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | | | - Isabela Pimenta Xavier
- Dermatology Outpatient Clinic, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Vitória Regina Pedreira de Almeida Rego
- Dermatology Outpatient Clinic, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil; Dermatology Service, Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
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16
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Li A, Huang Y, Zheng S, Tang C, Zhu J, Li J. Clinical observation of Qushi Xiezhuo formula in reducing monosodium urate crystal deposition in patients with axial spondyloarthritis. J TRADIT CHIN MED 2019; 39:722-729. [PMID: 32186123] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate effect of Qushi Xiezhuo formula (QSXZF) on axial spondyloarthritis (AxSpA) with a high incidence of monosodium serum urate (MSU) crystal deposition. METHODS In this prospective cohort study, 62 AxSpA patients diagnosed with MSU crystal deposition from October 2012 to July 2015 were recruited for follow-up observation for 1 year after discharge from the hospital. Patients were divided into a case group with QSXZF treatment and a control group without any interventions. X-ray and dual-energy computed tomography were used to assess structural damage in the pelvis and sacroiliac joint and the volume of the MSU crystals. The Wilcoxon rank-sum test and Fisher's exact test were used to compare the proportion and distribution between the groups. RESULTS A decrease in C-reactive protein (CRP) level, relief from back pain, and an increase in MSU crystal depositions were found in control patients. Compared with the control group, QSXZF reduced CRP levels and back pain to a greater extent, as well as reduced erythrocyte sedimentation rate levels, serum uric acid levels, Ankylosing Spondylitis Disease Activity Score, morning stiffness and MSU crystal deposition. CONCLUSION QSXZF can lower progress of radiogrphaic grade at sacroiliac joint in AxSpA/AS patients with MSU crystal deposition by decreasing the inflammation response and reducing the serum uric acid and volume of MSU crystal deposition in sacroiliac joint. The above process may be attributed to the relieving the Qi-movement disturbance in the body, and eliminating turbidity and dampness by QSXZF.
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Affiliation(s)
- Aiwu Li
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yinger Huang
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Songyuan Zheng
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Cuiping Tang
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Junqing Zhu
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Juan Li
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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17
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Xuan WB, Qian BP, Qiao M, Huang JC, Qiu Y, Wang B, Yu Y. [Change of esophageal length measured on computed tomography after corrective osteotomy for cervicothoracic kyphosis in patients with ankylosing spondylitis and its clinical significance]. Zhonghua Yi Xue Za Zhi 2019; 99:2276-2281. [PMID: 31434402 DOI: 10.3760/cma.j.issn.0376-2491.2019.29.006] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the change of esophageal length measured on computed tomography after C(7) pedicle subtraction osteotomy (PSO) for cervicothoracic kyphosis in ankylosing spondylitis (AS) patients and its clinical significance. Methods: Eight male AS patients with cervicothoracic kyphosis, who underwent PSO at C(7) level from December 2014 to November 2018 at Nanjing Drum Tower Hospital, were retrospectively reviewed. The mean age was (35±7) years (range, 26-49 years). The cervicothoracic kyphosis, C(2)-T(1) sagittal vertical axis (SVA) and angle of fusion levels (AFL) were measured on lateral cervical radiographs and chin-brow vertical angle (CBVA) was measured on clinical photographs preoperatively and postoperatively. Anterior height of the osteotomized vertebra (AHOV) and esophageal length from the lower endplate of C(6) to the inferior endplate of the lower instrumented vertebrae were measured on sagittal plane of reconstructed computed tomography preoperatively and postoperatively. Oswestry Disability Index (ODI), Neck Disability Index (NDI) and Numerical Rating Scale (NRS) were collected to evaluate the clinical outcomes. Results: The average follow-up duration was (15±9) months (range, 3-51 months). The average correction of cervicothoracic kyphosis, C(2)-T(1)SVA, AFL and CBVA was 35.9°±7.3°, (44.7±11.6) mm, 32.0°±4.8° and 38.1°±11.5°, respectively. The average reduction of AHOV was (5.6±1.6) mm. ODI was improved from 17±14 preoperatively to 13±10 at the final follow-up. The NDI before operation and at the final follow-up was 18±15 and 10±6, respectively. The preoperative NRS was 4.8±2.4, and it decreased to 1.0±1.2 at the final follow-up. The change of esophageal length showed significant correlation with the improvement of cervicothoracic kyphosis, C(2)-T(1)SVA, AFL and CBVA(r=0.84, 0.83, 0.83, 0.73, all P<0.05). Conclusions: The operation of C(7)PSO increases esophageal length after cervicothoracic kyphosis in AS patients. The esophageal elongation is closely related with changes of parameters measured on radiographs and clinical photographs. Spine surgeons should be aware of the potential risk of esophagus-related complications caused by esophagus lengthening after C(7)PSO.
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Affiliation(s)
- W B Xuan
- School of Medicine, Southeast University, Nanjing 210009, China
| | - B P Qian
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - M Qiao
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - J C Huang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Y Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - B Wang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Y Yu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
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18
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Zhu XB, Yuan LL, Han GS, Han JZ, Zhou JS. [Short term effect of total hip arthroplasty through direct anterior approach for the treatment of ankylosing spondylitis with hip flexion deformity]. Zhongguo Gu Shang 2019; 32:141-145. [PMID: 30884930 DOI: 10.3969/j.issn.1003-0034.2019.02.009] [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] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the short term clinical efficacy of direct anterior approach(DAA) total hip arthroplasty for the treatment of ankylosing spondylitis with hip flexion deformity. METHODS From September 2014 to June 2017, 15 cases of ankylosing spondylitis with flexion deformity of the hip were treated with total hip arthroplasty through DAA approach including 12 males(17 hips) and 3 females(4 hips) with an average age of 34.4 years old ranging from 21 to 57 years old. Harris score system was used before and after operation to evaluate hip function, total hip activity and visual analogue scale (VAS) were used to evaluate the clinical efficacy. RESULTS All 15 patients were followed up for an average of 26.2 months. In the operation, 1 case of great trochanter avulsion was given wire binding, and 1 case of linear split of the femur were given by wire binding. There were no hematoma, nerve injury and deep vein thrombosis of lower extremity. No prosthesis loosening and sinking were observed in the follow-up of X-ray film after operation. There was no heterotopic ossification after operation. After operation, 18 hips pain were relieved completely, and 3 hips pain were found when walking, which all satisfied with the daily life self-care requirements. Harris hip score, total hip motion and VAS score at 1 week after operation were significantly different from those before operation(P<0.05). There was no significant difference in the scores of HHS, total hip motion and VAS at 1, 6 months after operation(P>0.05). At the final follow-up, the Harris score was 91.2±5.3, the total hip mobility was (217.1±29.7)°, and the postoperative VAS pain score was 1.2±0.5, which was significantly different from the preoperative score(P<0.05). CONCLUSIONS DAA approach THA has good effect in treating AS hip nonfunctional ankylosis with less trauma, less pain and quick recovery. It has a good short term effect, which can effectively improve the quality of life of patients.
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Affiliation(s)
- Xun-Bing Zhu
- Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China;
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Abstract
Spondyloarthritides (SpA) are inflammatory rheumatic diseases affecting the axial skeleton, peripheral joints and entheses, and also manifest at extraskeletal sites. According to the more recently introduced nomenclature, predominant axial SpA is distinguished from predominant peripheral SpA. Axial SpA is further divided into radiographic and nonradiographic axial SpA. Genetic factors are relevant, with HLA-B27 being most important. The interleukin 23/17 pathway seems to be relevant and points towards new therapeutic targets. Inflammatory back pain is the leading symptom in axial SpA and has certain characteristics. In addition, HLA-B27 and sacroiliitis on imaging are important for diagnosis. Therapy consists of physiotherapy, nonsteroidal anti-inflammatory drugs (first line) and biologicals (second line). Conventional disease-modifying antirheumatic drugs are effective only in peripheral arthritis.
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20
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Vieira RM, do Nascimento FBP, Barbosa Júnior AA, Pereira ICMR, Sachetto Z, Appenzeller S, Reis F. Spectrum of central nervous system involvement in rheumatic diseases: pictorial essay. Radiol Bras 2018; 51:262-267. [PMID: 30202131 PMCID: PMC6124581 DOI: 10.1590/0100-3984.2016.0066] [Citation(s) in RCA: 3] [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] [Indexed: 11/21/2022] Open
Abstract
The rheumatic diseases, which include systemic lupus erythematosus, rheumatoid
arthritis, Behçet's disease, scleroderma, and ankylosing spondylitis, are
characterized by involvement of connective tissue, with multiple manifestations.
In those diseases, there can be involvement of the peripheral or central nervous
system, and that involvement can be primary, presenting as a major feature of
the clinical presentation, or secondary, as an effect of the drugs used in order
to control a given disease or its complications. Knowledge of the wide variety
of imaging findings is crucial to the diagnosis of a rheumatic disease,
especially in the early stages, enabling effective treatment and minimizing
disability. This pictorial essay, presenting cases from the records of two
tertiary teaching hospitals, encompasses cases of patients diagnosed with
rheumatic disease and illustrates the neuroradiological findings on magnetic
resonance imaging and computed tomography, in order to emphasize the importance
of these methods for properly diagnosing rheumatic diseases.
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Affiliation(s)
- Renata Mendes Vieira
- MD, Resident in Radiology and Diagnostic Imaging at the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | | | - Alcino Alves Barbosa Júnior
- Medical Coordinator of the Neuroradiology Group at the Hospital Israelita Albert Einstein, Professor of Neuromorphology at the Faculdade de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | - Zoraida Sachetto
- PhD, Professor in the Department of Internal Medicine of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Simone Appenzeller
- Associate Professor in the Department of Rheumatology of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Fabiano Reis
- PhD, Head of the Neuroradiology Sector, Professor in the Department of Radiology and Diagnostic Imaging of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Ji XJ, Sun K, Hu ZY, Zhang Y, Ma YP, Sun Z, Li KP, Zhu J, Zhang JL, Huang F. [Comparison of clinical manifestations according to HLA-B(27) genotype in ankylosing spondylitis patients: real-world evidence from smart management system for spondyloarthritis]. Zhonghua Nei Ke Za Zhi 2018. [PMID: 29518861 DOI: 10.3760/cma.j.issn.0578-1426.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The aim of this study was to set up a large, longitudinal and prospective database to compare the clinical manifestations in human leucocyte antigen (HLA)-B(27) positive and negative patients with ankylosing spondylitis(AS) based on real-world evidence in Chinese population. Methods: A total of 897 outpatients with confirmed AS were recruited consecutively by smart management system for spondyloarthritis (SMSP) from April 13, 2016 to June 6, 2017 in Chinese PLA General Hospital from 30 provinces and autonomous regions. 801 patients with HLA-B(27) data were included in the analysis. Demographic and clinical parameters including Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), ankylosing spondylitis disease activity score (ASDAS), arthritis, enthesitis, Bath ankylosing spondylitis metrology index (BASMI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between HLA-B(27) positive and negative groups. Results: A total of 801 patients were included in the analysis with an average age of (30.7±8.8) years. There were 659 males and 142 females and HLA-B(27) was present in 88.0%(705/801). Males were significantly more in HLA-B(27) positive patients [83.3%(587/705) vs. 75.0%(72/96); P=0.047].The average age at disease onset was (22.3±7.6)years in HLA-B(27) positive patients and (24.4±8.7) years in HLA-B(2)7 negative ones (P=0.028).There was significant difference in diagnose delay between two groups [14.3(2.5,43.6)months in HLA-B(27) positive patients vs. 20.3(5.0,67.4) months in HLA-B(27) negative ones, P=0.041]. Anterior uveitis was found to be significantly more common in HLA-B(27) positive patients [18.9% (133/705)vs.7.3%(7/96),P=0.005], and knee involvement less common in HLA-B(27) positive patients [4.0%(27/682) vs.10.0%(9/90), P=0.010], conversely. CRP[6.5(3.0, 16.4)mg/L vs. 3.5(1.6, 12.3)mg/L] and ESR[11.0(4.0, 24.0)mm/1h vs. 7.0(3.0, 16.0)mm/1h] were significantly higher in HLA-B(27) positive patients(P=0.005,0.013, respectively).But no differences in BASDAI,ASDAS,BASFI and BASMI were obtained between two groups. Conclusions: HLA-B(27) positive patients had a higher proportion of males, a younger age of onset and a greater risk for occurrence of anterior uveitis, suggesting a poorer prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - F Huang
- Department of Rheumatology, Chinese PLA General Hospital, Beijing 100853, China
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Lee JS, Song YW, Kim TH, Chung WT, Lee SG, Park SH, Song GG, Yu DY, Xu S, Lee EY. Baseline extent of damage predicts spinal radiographic progression in Korean patients with ankylosing spondylitis treated with golimumab. Korean J Intern Med 2018; 33:622-628. [PMID: 28103433 PMCID: PMC5943646 DOI: 10.3904/kjim.2016.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/12/2016] [Accepted: 05/22/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS For patients with ankylosing spondylitis (AS), golimumab has consistent efficacy in controlling disease activity over 5 years but its benefit in preventing radiographic progression was less clear at 4 years. To predict radiographic progression, we analyzed the baseline characteristics of AS patients in a Korean population. METHODS Sixty-eight Korean patients with AS participated in the phase 3, multicenter, randomized, placebo-controlled, double-blind trial (GO-RAISE) which has previously been described. Baseline modified stoke AS spine score (mSASSS) and change in mSASSS from baseline (ΔmSASSS) until week 208 were analyzed in the Korean patients enrolled in the GO-RAISE study. RESULTS Although Korean patients had lower baseline mSASSS compared to non-Korean patients and received active management, radiographic progression was not prevented. Korean patients who did not undergo radiographic progression of spinal lesions of AS were younger and had shorter symptomatic duration, lower Bath AS functional and metrology indices, better chest expansion, and lower baseline mSASSS. The baseline mSASSS and ΔmSASSS were positively correlated in Korean AS patients (p < 0.001). Radiographic progression was more prevalent (80.0%) when baseline mSASSS > 10 and less common (13.0%) with baseline mSASSS = 0. CONCLUSIONS In Korean AS patients, radiographic progression of the spine after 4 years was predicted effectively by the initial severity of the spinal lesion(s) in patients treated with golimumab.
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Affiliation(s)
- Jeong Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Hwan Kim
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Won Tae Chung
- Division of Rheumatology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Seung Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sung Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | - Stephen Xu
- Department of Biostatistics, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Eun Young Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0852 Fax: +82-2-762-9662 E-mail:
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Huang ZX, Guo XQ, Deng WM, Zheng SL, Guo X, Huang YK, Li TW. [Efficacy of Yisaipu tapering in the treatment of ankylosing spondylitis]. Zhonghua Yi Xue Za Zhi 2018; 98:1158-1161. [PMID: 29690728 DOI: 10.3760/cma.j.issn.0376-2491.2018.15.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the efficacy of Yisaipu tapering in patients with ankylosing spondylitis (AS). Methods: A total of 87 cases of AS patients from Guangdong Second Provincial General Hospital who were treated with Yisaipu and celecoxib were retrospectively analyzed from February 2013 to April 2017.All patients received full dose Yisaipu and celecoxib in the initial 12 weeks.After that, the patients in the full dose group maintained Yisaipu (50 mg/w) treatment from the 13(rd) to 24(th) week, while tapering group received Yisaipu 50 mg subcutaneous injection once every other week.By using AS disease activity score (ASDAS), Bath AS functional index (BASFI) and magnetic resonance (MR) score of sacroiliac joint (SIJ) plus recording adverse events, differences of efficacy and safety between groups were compared. Results: ASDAS and BASFI of tapering group were 1.1±0.7 and 1.3±1.1, while those of full dose group were 1.0±0.7 and 1.1±1.0, respectively.No significant difference of ASDAS or BASFI was found between groups.Besides, the MR scores of tapering and full dose groups were 8±7 and 8±6 respectively before therapy, while they were significantly lower in the 24(th) week (4±4 and 4±3, P<0.05). However, changes of MR score between groups were similar (P>0.05). Conclusion: Dose tapering of Yisaipu subcutaneous injection might be effective for keeping stable of disease activity and function in patients with AS.Its efficacy is similar to those of full dose Yisaipu.
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Affiliation(s)
- Z X Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
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Jeong H, Eun YH, Kim IY, Kim H, Ahn JK, Lee J, Koh EM, Cha HS. Drug survival of tumor necrosis factor α inhibitors in patients with ankylosing spondylitis in Korea. Korean J Intern Med 2018; 33:407-416. [PMID: 27729625 PMCID: PMC5840589 DOI: 10.3904/kjim.2016.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/04/2016] [Accepted: 04/12/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS To evaluate drug survival of the tumor necrosis factor α inhibitors (TNFi) and risk factors for the drug discontinuation in patients with ankylosing spondylitis (AS). METHODS We retrospectively evaluated 487 AS patients at a single tertiary hospital. Among the TNFi users, drug survival and risk factors of TNFi discontinuation were investigated. RESULTS Among 487 patients, 128 AS patients were treated with at least one TNFi. Patients who were treated with TNFi were younger at disease onset, had more peripheral manifestations, and had higher level of acute phase reactants and body mass index than those of TNFi non-users at baseline. Of 128 patients, 28 patients (21.9%) discontinued first TNFi therapy during the follow-up period of 65.1 ± 27.9 months. In the multivariable analysis, female (hazard ratio [HR], 6.08; 95% confidence interval [CI], 2.27 to 16.27; p = 0.003), hip involvement (HR, 2.52; 95% CI, 1.08 to 5.87; p = 0.033) and a high C-reactive protein (CRP; HR, 1.10; 95% CI, 1.00 to 1.21; p = 0.044) were risk factors for drug discontinuation. Etanercept showed better survival rate than infliximab. The main reason for discontinuation of TNFi was inefficacy. CONCLUSIONS TNFi discontinuation rate of Korean patients with AS seems to be similar to those with the European patients. Female sex, hip involvement, CRP, and the type of TNFi were associated with TNFi discontinuation.
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Affiliation(s)
- Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Hee Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Young Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Hoon-Suk Cha, M.D. Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3435 Fax: +82-2-3410-3849 E-mail:
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Ma H, Sun F, Zhang YM, Zhang H, Zhu J, Deng XH, Zhang JL, Huang F. [The safety and efficacy of golimumab in treatment of 25 patients with active ankylosing spondylitis]. Zhonghua Nei Ke Za Zhi 2017; 56:935-939. [PMID: 29202535 DOI: 10.3760/cma.j.issn.0578-1426.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To evaluate the efficacy and safety of golimumab in patients with active ankylosing spondylitis (AS). Methods: This was a randomized, double-blind, placebo-controlled trial. The subjects were randomized to receive either golimumab 50mg subcutaneously or placebo every 4 weeks. Patients in both groups received golimumab 50mg from week 24 to week 48. The primary endpoint was the proportion of at least 20% improvement in the Assessment of Spondyloarthritis International Society (ASAS20) at week 14. The secondary endpoints included at least 40% improvement in the Assessment of Spondyloarthritis International Society (ASAS40), ASAS partial-remission, Bath AS functional index, Bath AS disease activity index, Bath AS metrology index, enthesitis index and Jenkins sleep evaluation questionnaire. Results: A total of 25 subjects were included in this study, 13 with golimumab and 12 with placebo. At Week 14, 6(46.2%) subjects achieved ASAS20 in golimumab group and 2(16.7%) in placebo group. Significant improvements of other efficacy endpoints were also found in golimumab group. Golimumab was safe and well to lerated. Most of the adverse events were slightly impaired liver function, where as elevated aspartate aminotransferase and/or alanine aminotransferase returned to normal without drug with drawal. Conclusion: Golimumab improves AS activity, clinical symptoms and sleep disturbance in patients with active AS with good safety and tolerability.
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Affiliation(s)
- H Ma
- Department of Rheumatology, Chinese PLA General Hospital, Beijing 100853, China
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Abstract
Andersson lesion is a destructive vertebral or disco-vertebral lesion that occurs in the late stage of the ankylosing spondylitis. According to the etiology, these lesions are usually classified into localized lesions and extensive lesions. The history of ankylosing spondylitis and characteristic imaging is the key to the diagnosis of Andersson lesion. Conservative treatment may be effective for localized lesions. However, surgical intervention is often required for the failure of conservative treatment and extensive lesions. Currently, the optimal procedure for this problem is spinal osteotomy through pseudarthrosis and debridement via posterior-only approach.
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Ahn SM, Kim YG, Bae SH, Lim DH, Hong S, Park SH, Lee CK, Yoo B. Ileocolonoscopic findings in patients with ankylosing spondylitis: a single center retrospective study. Korean J Intern Med 2017; 32:916-922. [PMID: 28797160 PMCID: PMC5583446 DOI: 10.3904/kjim.2015.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/25/2015] [Accepted: 12/18/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS In some Western countries, up to 50% of patients with ankylosing spondylitis (AS) have subclinical gut inflammation. This study was conducted to evaluate the prevalence and severity of gut inflammation and to determine clinical factors associated with colonic inflammation in Korean AS patients who performed ileocolonoscopy without evidence of established inf lammatory bowel diseases before. METHODS One hundred and eight AS patients who underwent ileocolonoscopy were included in this study. Patients were divided into two groups based on gross ileocolonoscopic findings; patients with inflammatory lesions, and patients without inflammatory lesions. RESULTS Inf lammatory lesions in ileocolonoscopic findings were found in 40 patients. The Ankylosing Spondylitis Disease Activity Score C-reactive protein was higher in the group with inflammatory lesions and gut lesions were found often in the terminal ileum. The risk of inflammatory lesions was higher for AS patients whose symptoms required ileocolonoscopy than for AS patients who underwent routine ileocolonoscopy screening (odds ratio, 3.96). However, abnormal lesions were detected also in 17.6% of the patients who underwent ileocolonoscopy for routine screening and most of them were erosion and ulcer. Among patients with inflammatory lesions (n = 40), 23 showed subclinical gut inflammation associated with AS and 17 were diagnosed finally as Crohn's disease (n = 12), intestinal tuberculosis (n = 4), and ulcerative colitis (n = 1). CONCLUSIONS Our findings suggest that ileocolonoscopy might be recommended regularly in AS patients even without gastrointestinal symptoms, especially in the patients with high AS activity.
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Affiliation(s)
- Soo Min Ahn
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Yong-Gil Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3279 Fax: +82-2-3010-6969 E-mail:
| | - Seung-Hyeon Bae
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
The term spondyloarthritis (SpA) is now increasingly used to classify and diagnose patients who are characterized by inflammation in the axial skeleton and peripheral manifestations (arthritis and enthesitis). The management of SpA should be tailored according to the current manifestations of the disease, the disease activity and functional impairment. The current article focuses on diagnosis and therapy in patients with axial SpA. Diagnostic procedures are discussed in light of diagnostic utility and feasibility in daily routine care. Cornerstones of treatment in patients with axial SpA are a combination of regular exercise and pharmacological treatment options aiming at anti-inflammatory strategies.
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Abstract
Spondyloarthritides (SpA) are inflammatory rheumatic diseases affecting the axial skeleton, peripheral joints and entheses, and also manifest at extraskeletal sites. According to the more recently introduced nomenclature, predominant axial SpA is distinguished from predominant peripheral SpA. Axial SpA is further divided into radiographic and nonradiographic axial SpA. Genetic factors are relevant, with HLA-B27 being most important. The interleukin 23/17 pathway seems to be relevant and points towards new therapeutic targets. Inflammatory back pain is the leading symptom in axial SpA and has certain characteristics. In addition, HLA-B27 and sacroiliitis on imaging are important for diagnosis. Therapy consists of physiotherapy, nonsteroidal anti-inflammatory drugs (first line) and biologicals (second line). Conventional disease-modifying antirheumatic drugs are effective only in peripheral arthritis.
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Li CB, Qi W, Wang ZG, Li ZL, Wei M, Cai X, Zhang Q, Zhu JL, Liu Y, Liu YJ. [Midterm clinical outcome for ankylosing spondylitis patients with early hip-involved diseases treated with arthroscopic technique]. Zhongguo Gu Shang 2017; 30:236-240. [PMID: 29349962 DOI: 10.3969/j.issn.1003-0034.2017.03.010] [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] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the clinical outcome of manipulation release combined with arthroscopic debridement and synovia resection under general anesthesia for early hip involvment in patients with ankylosing spondylitis. METHODS Manipulation release combined with arthroscpic debridement and synovium resection were performed for hip lesion in 22 patients with ankylosing spondylitis from June 2011 to June 2013, incuding 6 males and 16 females with anverage age of 24.7 years ranging from 17 to 23 years. The course of the diseases was from 10 to 41 months(22.1 months on average). After 6 months of conservative treatment, hip pain and other symptoms were no relief. The preoperative and postoperative follow-up evaluation was performed and compared by the hip movement, VAS pain score, mHHS score and NAHS score. RESULTS All the patients were followed up for 26 to 44 months with an average of 30.2 months. The range of motion in active flexion-extension, abduction-adduction, internal-external rotation in 0° flexion and 90° flexion increased from (78.2±10.2)°, (36.3±6.4)°, (31.1±9.2)° and (37.3±10.5)° before operation to (113.5±8.4)°, (55.7±8.4)°, (58.7±2.1)° and (60.1±9.8)° after operation, respectively. The VAS scores decreased from 8.5±9.4 before operation to 5.5±7.1 after operation. The modified Harris and NAHS scores increased from 60.8±6.9 and 56.9±6.25 before operation to 88.1±10.4 and 84.6±5.4 after operation, respectively. CONCLUSIONS Manipulation release combined with arthroscopic debridement and synovium resection under general anesthesia could effectively control the progression of hip lesion in patients with ankylosing spondylitis restoring the ROM, relieve pain symptoms, delay joint deformity and ankylosis with less bleeding, faster recovery, and significantly improve patients' quality of life.
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Affiliation(s)
- Chun-Bao Li
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Wei Qi
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Zhi-Gang Wang
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China;
| | - Zhong-Li Li
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Min Wei
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Xu Cai
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Qiang Zhang
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Juan-Li Zhu
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Yang Liu
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China
| | - Yu-Jie Liu
- Department of Orthopaedics, PLA General Hospital, Beijing 100853, China;
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Suh YS, Kim HO, Cheon YH, Jo W, Hong J, Lee SI. Ankylosing spondylitis associated with primary aldosteronism in a middle-aged woman. Korean J Intern Med 2017; 32:374-377. [PMID: 26842104 PMCID: PMC5339458 DOI: 10.3904/kjim.2015.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/14/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Sang-Il Lee
- Correspondence to Sang-Il Lee, M.D. Division of Rheumatology, Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea Tel: +82-55-750-8853 Fax: +82-55-758-9122 E-mail:
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Kim HY, Kim TW. Crohn's disease with ankylosing spondylitis in an adolescent patient who had undergone long ileo-colonic anastomosis for Hirschsprung's disease as an infant. Intest Res 2017; 15:133-137. [PMID: 28239325 PMCID: PMC5323304 DOI: 10.5217/ir.2017.15.1.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/11/2016] [Accepted: 01/22/2016] [Indexed: 11/05/2022] Open
Abstract
Crohn's disease (CD) is a chronic, idiopathic, inflammatory disorder of the gastrointestinal tract. In rare cases, CD has been associated with Hirschsprung's disease (HD); however, the underlying pathophysiology of this and other comorbidities is not yet fully understood. In this report, we describe the case of a 17-year-old patient who was diagnosed with both CD and ankylosing spondylitis (AS), having undergone a long ileo-colonic anastomosis to treat HD at 12 months of age. To our knowledge, this is the first documented case of CD combined with AS in a patient with HD.
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Affiliation(s)
- Ha Yeon Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tae Wook Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Jeong H, Eun YH, Kim IY, Kim H, Lee J, Koh EM, Cha HS. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea. Korean J Intern Med 2017; 32:158-164. [PMID: 27017388 PMCID: PMC5214726 DOI: 10.3904/kjim.2015.229] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/25/2015] [Accepted: 09/12/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the clinical course of hip arthritis and the risk factors for hip joint replacement in patients with ankylosing spondylitis (AS). METHODS In this retrospective analysis, we evaluated 488 AS patients at a single tertiary hospital. At baseline and the most recent visit to the outpatient clinic from the patients with hip arthritis in AS, radiographic hip arthritis was evaluated using the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h). Also the average of the hip joint space width (interbone distance) at three distinct sites between the acetabulum and femoral head was recorded. RESULTS Among 488 patients with AS, 60 patients (12.3%) had hip arthritis. Erythrocyte sedimentation rate were associated with hip involvement (odds ratio, 1.01; 95% confidence interval [CI], 1.00 to 1.02; p = 0.004). Long disease duration and advanced axial disease were associated with severe hip arthritis (3 ≥ BASRI-h) at baseline. BASRI-h and interbone distance did not significantly change in patients with hip involvement during the follow-up period of 81.4 ± 35.7 months. Five patients had hip joint replacement surgery during follow-up period. The body mass index (BMI) and BASRI-h at baseline were associated with joint replacement surgery (hazard ratio [HR], 1.30; 95% CI, 1.00 to 1.67; p = 0.049 and HR, 20.64; 95% CI, 2.39 to 178.11; p = 0.006, respectively). CONCLUSIONS Most of the patients with hip arthritis in AS showed no significant radiographic progression during the follow-up period. High BMI and advanced hip arthritis at baseline were associated with hip joint replacement surgery in patients with AS.
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Affiliation(s)
- Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Hee Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Young Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Hoon-Suk Cha, M.D. Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3435 Fax: +82-2-3410-3849 E-mail:
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Kim H, Lee J, Ahn JK, Hwang J, Park EJ, Jeong H, Cha HS, Koh EM. Predictive factors of radiographic progression in ankylosing spondylitis. Korean J Intern Med 2015; 30:391-7. [PMID: 25995670 PMCID: PMC4438294 DOI: 10.3904/kjim.2015.30.3.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/28/2013] [Accepted: 07/23/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.
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Affiliation(s)
- Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwon Hwang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Jung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Seon CS, Park YS, Jung YM, Choi JH, Son BK, Ahn SB, Kim SH, Jo YJ. Gastric outlet obstruction due to gastric amyloidosis mimicking malignancy in a patient with ankylosing spondylitis. Clin Endosc 2013; 46:651-5. [PMID: 24340260 PMCID: PMC3856268 DOI: 10.5946/ce.2013.46.6.651] [Citation(s) in RCA: 5] [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: 10/29/2012] [Revised: 11/30/2012] [Accepted: 02/12/2013] [Indexed: 01/01/2023] Open
Abstract
Amyloidosis is a group of disorders characterized by the extracellular accumulation of insoluble, fibrillar proteins in various organs and tissues. It is classified, on the basis of the identity of the precursor protein, as primary, secondary, or familial amyloidosis. Gastrointestinal amyloidosis usually presents as bleeding, ulceration, malabsorption, protein loss, and diarrhea. However, gastric amyloidosis with gastric outlet obstruction mimicking linitis plastica is rare. We report a case of gastrointestinal amyloidosis with gastric outlet obstruction in a patient with ankylosing spondylitis. The patient was indicated for subtotal gastrectomy because of the aggravation of obstructive symptoms, but refused the operation and was transferred to another hospital. Three months later, the patient died of aspiration pneumonia during medical treatment.
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Affiliation(s)
- Choon Sik Seon
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
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Albayrak I, Bağcacı S, Sallı A, Kucuksen S, Uğurlu H. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis. Korean J Intern Med 2013; 28:614-8. [PMID: 24009460 PMCID: PMC3759770 DOI: 10.3904/kjim.2013.28.5.614] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/23/2012] [Accepted: 09/17/2012] [Indexed: 01/18/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.
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Affiliation(s)
- Ilknur Albayrak
- Department of Physical Therapy and Rehabilitation, Beysehir Public Hospital, Konya, Turkey.
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