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Kang KH, Seok SY, Cho JH. Concurrently Occurring Spinal Cord Cross-Section and Aortic Injury After a Chalk-Stick Fracture and Dislocation in Patient with Ankylosing Spondylitis: Clinical Image. World Neurosurg 2024; 184:149-151. [PMID: 38278209 DOI: 10.1016/j.wneu.2024.01.097] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
A 74-year-old woman with ankylosing spondylitis presented with back pain and complete paraplegia after a fall. A radiologic finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography, along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture) and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with ankylosing spondylitis, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.
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Affiliation(s)
- Kyun Ho Kang
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Yun Seok
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Jae Hwan Cho
- Departments of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Braun J, Poddubnyy D. [Diagnosis and classification of axial spondyloarthritis (axSpA) - the current status]. Dtsch Med Wochenschr 2024; 149:513-520. [PMID: 38621686 DOI: 10.1055/a-2251-6876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease typically characterized by inflammatory back pain (IBP). The term axSpA has largely replaced the long-used term ankylosing spondylitis (AS). IBP is caused by inflammation in the axial skeleton, with the sacroiliac joints (SIJ) being particularly frequently affected initially. The spine is usually added in later stages, which is then increasingly characterized structurally by the formation of new bone. The overall concept of spondyloarthritis includes other disease manifestations such as uveitis, psoriasis and colitis and comorbidities such as cardiovascular disease and osteoporosis.The ASAS classification criteria for axSpA, in place since 2009, have replaced the 1984 modified New York criteria. In the former, in addition to conventional X-rays, changes in the SIJ detected by magnetic resonance imaging (MRI) and also the detection of HLA B27 have, for the first time, played a role. It is important to note that these are not diagnostic criteria, as they do not exist. This paper outlines 10 points that should be considered when making a diagnosis.
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Affiliation(s)
- Jürgen Braun
- RVZ Steglitz, Berlin, und Ruhr Universität Bochum, Deutschland
| | - Denis Poddubnyy
- Rheumatologie am Campus Benjamin Franklin - Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Berlin, Deutschland
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Kishimoto K, Asai S, Suzuki M, Kihira D, Sato R, Terabe K, Ohashi Y, Maeda M, Imagama S. Intervertebral fusion sites in patients with ankylosing spondylitis: A computed tomography study. Mod Rheumatol 2024; 34:599-606. [PMID: 37489809 DOI: 10.1093/mr/road065] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To examine intervertebral fusion sites along the whole spine of patients with ankylosing spondylitis using computed tomography. METHODS This retrospective study examined intervertebral fusion of five sites (anterior/posterior vertebrae, left/right zygapophyseal joints, and spinous process) on 23 vertebrae in the cervical, thoracic, and lumbar regions of the spine in 40 patients diagnosed with ankylosing spondylitis at our institute between January 2004 and December 2022. RESULTS Mean age [± standard deviation (SD)] was 40.5 (± 17) years, and mean disease duration (± SD) was 11.4 (± 10.5) years at computed tomography evaluation; 55.9% were human leukocyte antigen B-27-positive. Fifteen (37.5%) patients showed intervertebral fusion in the thoracic and/or cervical regions, but not in the lumbar region. Fusion of posterior vertebrae was observed most frequently in the thoracic region, compared to the cervical and lumbar regions. In particular, more than half of the patients showed fusion of posterior vertebrae Th4-Th5 to Th7-Th8. CONCLUSIONS In 37.5% of patients, intervertebral fusion was evident in the thoracic and/or cervical regions but not in the lumbar region. The most common site and region of intervertebral fusion were the posterior vertebrae of the middle thoracic region.
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Affiliation(s)
- Kenji Kishimoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kihira
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Sato
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masataka Maeda
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Lv X, Huang R, Zeng Z, Zhang D, Li B, Lin Y, Zhang Z, Wang Q, Nuertai Y, Huang Z, Wang Z, Yang C, Yan H, Peng X, Zhao Q, Li W, Jiang X, Hu X, Gao L. Postoperative quality of life in patients with ankylosing spondylitis and thoracolumbar kyphosis: risk factors and personalized sagittal reconstruction strategy. J Neurosurg Spine 2024; 40:365-374. [PMID: 38064699 DOI: 10.3171/2023.9.spine23675] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the factors affecting postoperative quality of life in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK), and establish a personalized sagittal reconstruction strategy. METHODS Patients with AS and TLK who underwent pedicle subtraction osteotomy (PSO) from February 2009 to May 2019 were retrospectively included. Quality of life and spinal sagittal radiographic parameters were collected before surgery and at the last follow-up. Patients were divided into two groups based on the attainment of minimal clinically important difference (MCID) on the Bath Ankylosing Spondylitis Functional Index and Oswestry Disability Index. Comparisons of radiographic parameters and clinical outcomes were conducted between and within groups. Regression analysis was used to identify the risk factors within the missing MCID cohort. Sagittal reconstruction equations were established using the pelvic incidence (PI) and thoracic inlet angle (TIA) in the reached MCID cohort. RESULTS The study comprised 82 participants. Significant improvements were observed in most radiographic parameters and all quality-of-life indicators during the final follow-up compared with the preoperative measures (p < 0.05). Factors including cervical lordosis (CL) ≥ 18° (OR 9.75, 95% CI 2.26-58.01, p = 0.005), chin-brow vertical angle (CBVA) ≥ 25° (OR 14.7, 95% CI 3.29-91.21, p = 0.001), and pelvic tilt (PT) ≥ 33° (OR 21.77, 95% CI 5.92-103.44, p < 0.001) independently correlated with a failure to attain MCID (p < 0.05). Sagittal realignment targets were constructed as follows: sacral slope (SS) = 0.84 PI - 17.4° (R2 = 0.81, p < 0.001), thoracic kyphosis (TK) = 0.51 PI + 10.8° (R2 = 0.46, p = 0.002), neck tilt (NT) = 0.52 TIA - 5.8° (R2 = 0.49, p < 0.001), and T1 slope (T1S) = 0.48 TIA + 5.8° (R2 = 0.45, p = 0.002). CONCLUSIONS PSO proved efficacious in treating AS complicated by TLK, yielding favorable outcomes. CBVA ≥ 25°, CL ≥ 18°, and PT ≥ 33° were the primary factors affecting postoperative quality of life in patients with AS. The personalized sagittal reconstruction strategy in this study focused on the subjective sensations and daily needs of patients with AS, which were delineated by the equations SS = 0.84 PI - 17.4°, TK = 0.51 PI + 10.8°, NT = 0.52 TIA - 5.8°, and T1S = 0.48 TIA + 5.8°.
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Affiliation(s)
- Xin Lv
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Renyuan Huang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Ziliang Zeng
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Di Zhang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Bo Li
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Yuhong Lin
- 2Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhilei Zhang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Qiwei Wang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Yelidana Nuertai
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Zhihao Huang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Zheyu Wang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Canchun Yang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Haolin Yan
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xiaoshuai Peng
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Qiancheng Zhao
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Wenpeng Li
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xu Jiang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xumin Hu
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Liangbin Gao
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
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Berbel-Arcobé L, Benavent D, Michelena X, Narváez JA, Nolla JM, Juanola X. Exploring radiographic patterns of the cervical spine, including zygapophyseal joints, in axial spondyloarthritis. RMD Open 2024; 10:e003990. [PMID: 38395456 PMCID: PMC10895234 DOI: 10.1136/rmdopen-2023-003990] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The assessment of the cervical spine (CS) in axial spondyloarthritis (axSpA) and its radiographic characteristics, including the zygapophyseal joints (ZJ), may be helpful for an accurate diagnosis, establishing a prognosis and enhancing treatment decisions. OBJECTIVES To describe the prevalence and characteristics of CS involvement in patients with axSpA and perform a comparison between groups according to cervical radiographic damage. METHODS Patients who fulfilled the Assessment of SpondyloArthritis International Society classification criteria were included from January 2011 to January 2021. Sociodemographic, clinical, radiographic and treatment variables were gathered. Patients were categorised into 'CS group' (Bath Ankylosing Spondylitis Radiology Index ≥2 or De Vlam score ≥3 for ZJ) and 'no CS group' as controls. ZJ fusion and interobserver reliability in ZJ scoring were analysed. RESULTS A total of 340 patients were included, 244 (71.7%) men, with mean age 57±15 years. CS involvement was observed in 181 (53.2%) patients. Patients in the CS group, as compared with no CS group, were predominantly men, older, had a higher body mass index, higher prevalence of smoking, showed higher disease activity, worse functionality and mobility, as well as more structural damage. Sixty-nine patients with CS involvement had ZJ fusion at some level. These patients showed worse mobility and more radiographic damage. Overall, ZJ involvement was observed in 99 patients (29.1%), 20 of whom did not present with vertebral body involvement. CONCLUSION Radiographic evaluation of CS is relevant in patients with axSpA and should be assessed routinely. Evaluation of the ZJ is particularly significant, as it is related to higher disease activity and worse function.
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Affiliation(s)
- Laura Berbel-Arcobé
- Department of Rheumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Diego Benavent
- Department of Rheumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Xabier Michelena
- Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - José Antonio Narváez
- Department of Radiodiagnosis, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Joan Miquel Nolla
- Department of Rheumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Xavier Juanola
- Department of Rheumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
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Reddy SM, Xue K, Husni ME, Scher JU, Stephens-Shields AJ, Goel N, Koplin J, Craig ET, Walsh JA, Ogdie A. Use of the Bath Ankylosing Spondylitis Disease Activity Index in Patients With Psoriatic Arthritis With and Without Axial Disease. J Rheumatol 2024; 51:139-143. [PMID: 38101918 DOI: 10.3899/jrheum.2023-0504] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To evaluate whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a responsive instrument in psoriatic arthritis (PsA) and whether it differentiates between axial and peripheral disease activity in PsA. METHODS Individuals with PsA initiating therapy in a longitudinal cohort study based in the United States were included. Axial PsA (axPsA), most often also associated with peripheral disease, was defined as fulfillment of the Assessment of Spondyloarthritis international Society axial spondyloarthritis classification criteria or presence of axial disease imaging features. Baseline BASDAI, individual BASDAI items, patient global assessment, patient pain, and Routine Assessment of Patient Index Data 3, and score changes following therapy initiation were descriptively reported. Standardized response means (SRMs) were calculated as the mean change divided by the SD of the change. RESULTS The mean (SD) baseline BASDAI score at the time of therapy initiation was 5.0 (2.2) among those with axPsA (n = 40) and 4.8 (2.0) among those with peripheral-only disease (n = 79). There was no significant difference in patient-reported outcome scores between the groups. The mean change for BASDAI was similar among axial vs peripheral disease (-0.75 vs -0.83). SRMs were similar across axial vs peripheral disease for BASDAI (-0.37 vs -0.44) and the individual BASDAI items. CONCLUSION BASDAI has reasonable responsiveness in PsA but does not differentiate between axPsA and peripheral PsA. (ClinicalTrials.gov: NCT03378336).
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Affiliation(s)
- Soumya M Reddy
- S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine and Rheumatology, New York University, New York, New York
| | - Katie Xue
- K. Xue, BS, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Jose U Scher
- S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine and Rheumatology, New York University, New York, New York
| | - Alisa J Stephens-Shields
- A.J. Stephens-Shields, PhD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, and Department of Medicine, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina
| | - Joelle Koplin
- J. Koplin, CRNP, Department of Medicine/Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ethan T Craig
- E.T. Craig, MD, Department of Medicine/Rheumatology, Perelman School of Medicine, University of Pennsylvania, and Department of Medicine/Rheumatology, Michael J. Crescenz Veterans Medical Center, Philadelphia, Pennsylvania
| | - Jessica A Walsh
- J.A. Walsh, MD, MBA, Department of Medicine and Rheumatology, University of Utah, Salt Lake City, Utah
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Department of Medicine/Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Jayaprakash S, Prasad CB, Dhir V, Jain S. Temporomandibular joint ankylosis in ankylosing spondylitis. Rheumatology (Oxford) 2024; 63:e77-e78. [PMID: 37632772 DOI: 10.1093/rheumatology/kead452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Sankar Jayaprakash
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandra Bhushan Prasad
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Celik TO. Letter to the editor: "Association of radiological severity of hip involvement with clinical characteristics and sagittal spinopelvic balance in patients with ankylosing spondylitis". Clin Rheumatol 2024; 43:839. [PMID: 38079011 DOI: 10.1007/s10067-023-06811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Tugba Ozudogru Celik
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey.
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Guo S, Zhang L, Zhou Y. Rebuttal letter on "Association of radiological severity of hip involvement with clinical characteristics and sagittal spinopelvic balance in patients with ankylosing spondylitis". Clin Rheumatol 2024; 43:841-842. [PMID: 38095750 DOI: 10.1007/s10067-023-06831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Shaoyi Guo
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Liang Zhang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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Yin W, Zheng G, Zhang W, Zhai Y, Li H, Sun L, Wang K, Jiang J, Hua Z, Cui X, Yu H. A new mathematical model for evaluating surface changes in the mid-abdominal sagittal plane after two-level pedicle reduction osteotomy in patients with ankylosing spondylitis. BMC Surg 2024; 24:38. [PMID: 38281928 DOI: 10.1186/s12893-023-02285-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The purpose of this study was to create a mathematical model to precalculate the acreage change in the abdominal median sagittal plane (ac-AMSP) of patients with ankylosing spondylitis (AS) for whom two-level pedicle subtraction osteotomy (PSO) was planned. METHODS A single-centre retrospective review of prospectively collected data was conducted among 11 adults with AS. Acreage of the abdominal median sagittal plane (a-AMSP) was performed. The distances and angles between the osteotomy apexes, anterosuperior edge of T12, xiphoid process, superior edge of the pubis, and anterosuperior corner of the sacrum were measured on preoperative thoracolumbar computed tomography. A mathematical model was created using basic trigonometric functions in accordance with the abdominal parameters. Planned osteotomized vertebra angles (POVAs) were substituted into the mathematical model, and the predictive ac-AMSP (P-AC) was obtained. A paired sample t test was performed to determine the differences between the P-AC and actual ac-AMSP (A-AC) and between the predictive acreage change rate (P-CR) and actual acreage change rate (A-CR). RESULTS The mean age and GK were 44.4 ± 8.99 years and 102.9° ± 19.17°, respectively. No significant difference exists between A-CR and P-CR via mathematical modeling (p > 0.05). No statistically significant difference existed between POVA and actual osteotomized vertebra angles (AOVA) (p > 0.05). A statistically significant difference was observed between preoperative and postoperative measurements of LL, SVA, and GK variables (p < 0.001). CONCLUSIONS The novel mathematical model was reliable in predicting the ac-AMSP in AS patients undergoing two-level PSO.
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Affiliation(s)
- Wen Yin
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Guohui Zheng
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Haijiang Li
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Lele Sun
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Kangkang Wang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Jishi Jiang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
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Guo S, Zhang L, Man S, Bian T, Ma S, Wu X, Zhou Y. Association of radiological severity of hip involvement with clinical characteristics and sagittal spinopelvic balance in patients with ankylosing spondylitis. Clin Rheumatol 2024; 43:233-240. [PMID: 37819530 DOI: 10.1007/s10067-023-06789-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This is the first study to analyze the associations between the radiological severity of hip involvement with clinical characteristics and sagittal spinopelvic balance in patients with ankylosing spondylitis (AS). METHOD We evaluated 182 patients with AS who were referred to outpatient clinics. Patient demographic data and clinical and radiographic parameters were collected. Patients were divided into three groups based on the Bath Ankylosing Spondylitis Radiology Hip Index. Clinical characteristics and spinopelvic parameters acquired by a low-dose biplanar imaging system were evaluated among these groups. RESULTS Patients with more severe hip involvement were older and had longer disease duration and diagnostic delay, with lower Harris Hip Score (p < 0.001) and 12-item Short Form Health Survey Physical Component Score (p < 0.001) and higher Bath Ankylosing Spondylitis Disease Activity Index (p = 0.030) and Functional Index (p < 0.001). Patients with more severe hip involvement had significantly higher sacroiliac grade (p < 0.001) and higher modified Stoke Ankylosing Spondylitis Spinal Score (p < 0.001). Patients with moderate and severe hip involvement had similar lumbar lordosis and spino-sacral angle, whereas patients with severe hip involvement had lower pelvic tilt, pelvic femoral angle, higher sacral slope, and sagittal vertical axis. CONCLUSIONS The severity of hip involvement is associated with physical function and is not consistent with the severity of spinal involvement. Severe hip involvement impairs the ability to retrovert the pelvis to accommodate the sagittal deformity, and spinopelvic parameters should be concretely evaluated in preoperative counseling of patients with AS waiting for total hip arthroplasty. Key Points • The severity of hip involvement in patients with AS is associated with physical function. • Severe hip involvement impairs the ability to retrovert the pelvis to accommodate the sagittal deformity.
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Affiliation(s)
- Shaoyi Guo
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Liang Zhang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Siliang Man
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Tao Bian
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Sai Ma
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xinfeng Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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12
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Liu S, Niu T, Wang Y. Beaklike ossification in ankylosing spondylitis. QJM 2023; 116:949. [PMID: 37335876 DOI: 10.1093/qjmed/hcad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- S Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - T Niu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - Y Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
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13
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Dai SM. [Concept and understanding of non-radiographic axial spondyloarthritis]. Zhonghua Yi Xue Za Zhi 2023; 103:3439-3444. [PMID: 37981771 DOI: 10.3760/cma.j.cn112137-20230901-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Since the publication of the classification criteria for axial spondyloarthritis (axSpA) by Assessment of SpondyloArthritis international Society (ASAS), a new disease concept "non-radiographic axial spondyloarthritis (nr-axSpA)" has emerged. Some domestic experts in China have translated it as "radiologically negative" axSpA, but it can easily lead to misunderstandings literally, as not all patients with nr-axSpA are completely free from radiological abnormalities. This article briefly describes the evolution of the concept of axSpA, proposes to translate the term of nr-axSpA directly rather than "radiologically negative" axSpA, compares the differences and similarities between nr-axSpA and radiologically negative axSpA, delineates the relationship between nr-axSpA and early ankylosing spondylitis, and points out not all the patients who meet the ASAS classification criteria for nr-axSpA are genuine patients with axSpA, because of the relatively low specificity of the ASAS classification criteria. Five common scenarios easily leading to misdiagnosis of nr-axSpA are exampled to remind domestic colleagues.
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Affiliation(s)
- S M Dai
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
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14
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Gulec M, Erturk M, Tassoker M, Basdemirci M. Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis. Sci Rep 2023; 13:19762. [PMID: 37957329 PMCID: PMC10643636 DOI: 10.1038/s41598-023-47233-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to examine the difference between the fractal dimension (FD) values of the mandibular trabecular bone and the panoramic mandibular index (PMI), mandibular cortical index (MCI) and mandibular cortical thickness (MCW) of patients with ankylosing spondylitis (AS) and healthy control group. A total of 184 individuals (92 cases, 92 controls), were examined in our study. PMI, MCI, and MCW values were calculated on panoramic images of all individuals. For FD values, the region of interest (ROI) was selected with the size of 100 × 100 pixels from the right-left gonial and interdental regions and 50 × 50 pixels from the condylar region. Degenerative changes in the temporomandibular joint (TMJ) region were recorded. PMI, MCI, and MCW values showed statistically significant differences between the groups (p = 0.000, p < 0.001). The radiological signs of mandibular cortical resorption were more severe in the case group than in the control group. PMI and MCW values were found to be lower in the case group than in the control group. It was determined that the number of C3 and C2 values, among the MCI values, was higher in the case group. Only the FD values of the ROI selected from the condyle region were found to be statistically significant and were lower in the case group (p = 0.026, p < 0.05). Degenerative changes in the TMJ region were significantly more frequent in the case groups (p = 0.000, p < 0.001). The fact that the mandibular cortex shows more resorptive features in individuals with AS may require further evaluation in terms of osteoporosis. Because of the low FD values of the condylar regions of these patients and the more frequent degenerative changes, the TMJ region should be followed carefully. Detailed examination of the mandibular cortex and condylar region is beneficial in patients with AS for screening and following osteoporotic changes in these individuals, which is essential for the patient's life quality.
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Affiliation(s)
- Melike Gulec
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Mediha Erturk
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Melek Tassoker
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey.
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Yuce Inel T. Dysphagia secondary to anterior cervical osteophytes in a patient with ankylosing spondylitis. Rheumatology (Oxford) 2023; 62:e329-e330. [PMID: 37184842 DOI: 10.1093/rheumatology/kead217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Affiliation(s)
- Tuba Yuce Inel
- Department of Rheumatology, Bozyaka Education and Research Hospital, Izmir, Turkey
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16
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Ata EB, Durhan G, Bilgin E, Arıyürek OM, Kalyoncu U. Costovertebral and costotransverse joint involvement in spondyloarthritis. Int J Rheum Dis 2023; 26:2141-2150. [PMID: 37612889 DOI: 10.1111/1756-185x.14873] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/30/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Costovertebral (CV), costotransverse (CTr), sternoclavicular (SC), and manubriosternal (MS) joints are impacted in spondyloarthritis (SpA) patients; however, clinical aspects of these involvements require additional evaluation. METHODS A total of 281 SpA patients who had undergone chest computed tomography (CT) for any reason between 2010 and 2020 were included in the study. SpA patients were divided into three groups, ankylosing spondylitis (AS), non-radiographic axial SpA, and psoriatic arthritis. Thirty age- and sex-matched rheumatoid arthritis (RA) patients and 30 non-rheumatic disease individuals were selected for comparison. An experienced radiologist reviewed 24 CV, 20 CTr, 2 SC, and 1 MS joints from a thorax CT for each patient. All joints were classified as: normal (0); suspicious (1), mild (2), moderate (3), or severe (4). RESULTS Total CV and CTr joint scores differed between diseases (p < .001). Male AS patients had higher CV and CTr scores than female AS patients (male CV score: 52 [range 0-96] and CTr score: 22 [range 0-80]; female CV score: 20 [range 0-96] and CTr score: 12 [range 0-79]). Strong negative correlations were detected in AS patients between chest expansion and CV (r = -0.703 p = .007) and CTr (r = -0.763 p = .002) joint involvement; positive correlations between CV and CTr joints, and modified Stoke Ankylosing Spondylitis Spinal Score (p < .05); and no significant association for MS and SC joints. CONCLUSIONS CV and CTr joint involvement on thorax CT was more severe in AS and negatively affected chest expansion. The use of thorax CT scans performed for other indications in the examination of these joints may be advantageous for the early beginning of rehabilitation programs targeted at maintaining chest mobility.
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Affiliation(s)
- Emine Büşra Ata
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emre Bilgin
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Orhan Macit Arıyürek
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ushio Y, Wakiya R, Kameda T, Nakashima S, Shimada H, Miyagi T, Sugihara K, Mino R, Mizusaki M, Chujo K, Kagawa R, Yamaguchi H, Yamamoto Y, Norikane T, Nishiyama Y, Kadowaki N, Dobashi H. Effects of anti-interleukin-17 treatment on osteoblastic activity as assessed by 18F-sodium fluoride positron emission tomography/computed tomography in ankylosing spondylitis: a case report. Scand J Rheumatol 2023; 52:710-712. [PMID: 37485843 DOI: 10.1080/03009742.2023.2232176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Y Ushio
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Wakiya
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - T Kameda
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - S Nakashima
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Shimada
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - T Miyagi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - K Sugihara
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Mino
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - M Mizusaki
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - K Chujo
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Kagawa
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Yamaguchi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - Y Yamamoto
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - T Norikane
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - Y Nishiyama
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - N Kadowaki
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Dobashi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
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18
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Zhong XL, Qian BP, Qiu Y, Huang JC, Liu ZJ. Is the pelvic incidence a determinant factor for kyphosis curve patterns of ankylosing spondylitis patients? J Clin Neurosci 2023; 117:32-39. [PMID: 37748356 DOI: 10.1016/j.jocn.2023.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
To investigate the influence of pelvic incidence (PI) on the kyphosis curve patterns and clinical outcomes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis and to construct a classification of AS according to the PI value for surgical decision-making. 107 AS patients underwent single-level lumbar pedicle subtraction osteotomy (PSO) and finished a minimal of 2-year follow-up. All patients were divided into three groups: low PI (PI ≤ 40°), moderate PI (40° < PI ≤ 60°), and high PI (PI > 60°). Standing lateral radiographs were taken to evaluate the location of kyphotic apex, thoracic kyphosis (TK), lumbar lordosis (LL), C7 sagittal vertical axis (SVA), spino-sacral angle (SSA), global kyphosis (GK), PI, sacral slope (SS), and pelvic tilt (PT). Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate quality of life. Before surgery, a significant difference was shown in the average LL and the mean GK in high PI group was the largest among the three groups. Correction of SVA, GK and LL in high PI group was the smallest among the three group. No significant difference in clinical outcomes was found among the three groups before surgery and at the final follow-up. Regarding the preoperative sagittal profile, the kyphosis curve pattern of moderate PI group is similar to that of low PI group. For AS patients in these two groups, harmonious sagittal alignment can be restored by a single-level PSO. However, the sagittal imbalance is insufficiently realigned by a single-level PSO in a patient with high PI.
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Affiliation(s)
- Xiao-Lin Zhong
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China; Division of Spine Surgery, Department of Orthopaedics, Guangzhou First People's Hospital, School of Medicine, South China of University of Technology, Guangzhou, China
| | - Bang-Ping Qian
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ji-Chen Huang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
| | - Zhuo-Jie Liu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Medical School of Nanjing University, Nanjing, China
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Kiefer D, Braun J, Chatzistefanidi V, Kiltz U, Adolf D, Schwarze I, Kabelitz M, Lange U, Brandt-Jürgens J, Stemmler E, Sartingen S, Baraliakos X. Clinical Relevance of Axial Radiographic Damage in Axial Spondyloarthritis: Evaluation of Functional Consequences by an Objective Electronic Device. J Rheumatol 2023; 50:1422-1429. [PMID: 37061230 DOI: 10.3899/jrheum.2022-1240] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is associated with decreased function and mobility of patients as a result of inflammation and radiographic damage. The Epionics SPINE device (ES), an electronic device that objectively measures spinal mobility, including range of motion (RoM) and speed (ie, range of kinematics [RoK]) of movement, has been clinically validated in axSpA. We investigated the performance of the ES relative to radiographic damage in the axial skeleton of patients with axSpA. METHODS A total of 103 patients with axSpA, 31 with nonradiographic axSpA (nr-axSpA) and 72 with radiographic axSpA (r-axSpA), were consecutively examined. Conventional radiographs of the spine (including presence, number, and location of syndesmophytes) and the sacroiliac joints (SIJs; rated by the modified New York criteria) were analyzed with the ES. Function and mobility were assessed using analyses of covariance and Spearman correlation. RESULTS The number of syndesmophytes correlated positively with Bath Ankylosing Spondylitis Metrology Index scores (r 0.38, P = 0.02) and correlated negatively with chest expansion (r -0.39, P = 0.02) and ES measurements (-0.53 ≤ r ≤ -0.34, all P < 0.03), except for RoM and RoK regarding rotation and RoK for extension of the lumbar and thoracic spines. In the radiographic evaluation of the SIJs, the extent of damage correlated negatively with ES scores and metric measurements (-0.49 ≤ r ≤ -0.33, all P < 0.001). Patients with r-axSpA, as compared to those with nr-axSpA, showed significantly worse ES scores for RoM, RoK, and chest expansion. CONCLUSION The ES scores, in accordance with mobility measurements, correlated well with the presence and extent of radiographic damage in the spine and the SIJs. As expected, patients with r-axSpA had more severe impairments than those with nr-axSpA.
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Affiliation(s)
- David Kiefer
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum;
| | - Jürgen Braun
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Varvara Chatzistefanidi
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Uta Kiltz
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
| | - Daniela Adolf
- D. Adolf, PhD, M. Kabelitz, StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg
| | | | - Maria Kabelitz
- D. Adolf, PhD, M. Kabelitz, StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg
| | - Uwe Lange
- U. Lange, MD, Rheumatologie und klinische Immunologie Campus Kerckhoff, Bad Nauheim, Universität Gießen, Gießen
| | | | - Edgar Stemmler
- E. Stemmler, PhD, S. Sartingen, PhD, Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Sabine Sartingen
- E. Stemmler, PhD, S. Sartingen, PhD, Medical Immunology, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Xenofon Baraliakos
- D. Kiefer, MD, J. Braun, MD, V. Chatzistefanidi, MD, U. Kiltz, MD, X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Bochum
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Yilmaz M, Tunc F. Occurrence of radiopaque and mixed lesions at periapical region in patients with rheumatoid arthritis and ankylosing spondylitis: a retrospective study. BMC Oral Health 2023; 23:781. [PMID: 37875827 PMCID: PMC10594898 DOI: 10.1186/s12903-023-03493-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have different effects on bones, cartilage and joints, sometimes destroying the spine and joints, and other times causing new bone formation. This study aimed to evaluate the effects of RA and AS on the types (radiolucent, radiopaque and mixed) of periapical lesions in jaw bones. METHODS This study included 708 individuals (97 with AS, 327 with RA and 284 healthy controls (C)) and a total of 17,118 teeth (AS: 2,442; RA: 7,638; C: 7,038). The number of teeth, extracted teeth and teeth with root canal treatment and the presence of radiopaque, radiolucent and mixed periapical lesions were recorded from dental panoramic radiographs. Kruskal-Wallis and chi-square tests were used for statistical analysis. RESULTS The frequency of radiopaque lesions in the AS and RA groups was similar (p > 0.05) and significantly higher than in the C group (p < 0.05) (AS: 13.4%; RA: 6.1%; C: 2%). Mixed lesions (AS: 3.1%; RA: 4.0%; C: 0.4%) were statistically significantly higher for the RA group compared to the C group (p < 0.05), while the AS-C and AS-RA groups were similar (p > 0.05). There was no significant difference in terms of radiolucent lesions among groups (p > 0.05). CONCLUSION Radiopaque apical lesions were frequent in RA and AS patients, while mixed lesions were significantly higher in RA patients.
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Affiliation(s)
- Melis Yilmaz
- Faculty of Dentistry, Department of Endodontics, Mersin University, Mersin, Turkey
- Private Practice, Mersin, Turkey
| | - Fatma Tunc
- Faculty of Dentistry, Department of Endodontics, Gaziantep University, Gaziantep, Turkey
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Tocoglu AG, Dogan B, Tuzun S, Akcay EU, Altas AE, Ayhan LT, Yilmaz S, Genc AC, Gonullu E, Tamer A. The relationship between Salusin-α, Salusin-β, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis. Eur Rev Med Pharmacol Sci 2023; 27:9838-9845. [PMID: 37916350 DOI: 10.26355/eurrev_202310_34160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Subclinical atherosclerosis (SA) is often observed in ankylosing spondylitis (AS) patients; Salusin-α (Sal-α), Salusin-β (Sal-β), and Klotho hormones are thought to be associated with atherosclerosis. This study aims to evaluate the relationship between Sal-α, Sal-β, and Klotho levels with SA in AS. PATIENTS AND METHODS The study included patients older than 18 years who applied between August 1, 2019, and September 1, 2019. Patients with AS were included in the AS group, and patients without a known disease were included in the healthy group. Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) measurements were used to assess SA. RESULTS The study group included 38 (40.9%) patients diagnosed with AS, and the control group included 55 (59.1%) participants. CIMT and EATT levels were higher in the AS group than in the healthy group [0.37 (0.17) vs. 0.54±0.18, p<0.001; 0.44±0.11 vs. 0.54 (0.18), p=0.004, respectively]. There was no significant difference in Sal-α, Sal-β, and Klotho levels between the AS and healthy groups (p>0.05). Furthermore, there was no observed relationship between EATT or CIMT and Klotho, Sal-α, or Sal-β in either group (p>0.05). CONCLUSIONS Although SA level was higher in AS patients, there was no relationship between SA and Sal-α, Sal-β, and Klotho levels.
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Affiliation(s)
- A G Tocoglu
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
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Li KJ, Lin HC, Cheng CF, Shih TTF, Lu CH, Wattananon P, Chen WS, Wang HK. Ultrasound characteristics of soft tissues near sacroiliac joints and in the lumbar region of patients with ankylosing spondylitis. Med Ultrason 2023; 25:279-287. [PMID: 37778021 DOI: 10.11152/mu-3973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
AIMS To investigate the musculoskeletal morphomechanical properties (i.e., the thickness and elastic modulus) and the total count of power Doppler signals near the sacroiliac joints in patients with ankylosing spondylitis (AS) and non-AS individuals. MATERIAL AND METHODS Twenty participants with AS [median age (interquartile range): 31.7 (11.04) years] and 19 controls [36.3 (10.5) years] with no AS history were recruited. Bilateral ultrasound image acquisition was performed, including the short posterior sacroiliac ligament, interosseous sacroiliac ligament, long posterior sacroiliac ligament, iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament. The intraclass correlation coefficients (ICC) of ultrasound parameters, laboratory test results of human leukocyte antigen B27, C-reactive protein, and erythrocyte sedimentation rate, and self-reported physical and disease activity scores were also obtained. RESULTS The ligaments and piriformis muscle were thicker and stiffer (greater elastic modulus) in participants with AS than in non-AS participants (all p<0.01). The measurements showed good or excellent reliability (all ICC(3,1) >0.85). The numbers of power Doppler signals detected in the iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament were higher in participants with AS than in non-AS participants (all p<0.001). A correlation was identified between disease duration and the elastic modulus of the piriformis muscle (r=0.640, p=0.003). CONCLUSION We conclude that the ligaments and proximal piriformis muscle of AS participants have increased thickness, elastic modulus, and power Doppler signal than those of non-AS individuals. These reliable findings may serve as potential markers for the early diagnosis of AS and for assessing medication effects.
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Affiliation(s)
- Ko-Jen Li
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Huan-Chen Lin
- School and Graduate Institute of Physical Therapy, college of medicine, National Taiwan University; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiao-Feng Cheng
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | | | - Cheng-Hsun Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | | | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan..
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Hallström M, Klingberg E, Deminger A, Rehnman JB, Geijer M, Forsblad-d'Elia H. Physical function and sex differences in radiographic axial spondyloarthritis: a cross-sectional analysis on Bath Ankylosing Spondylitis Functional Index. Arthritis Res Ther 2023; 25:182. [PMID: 37749599 PMCID: PMC10521572 DOI: 10.1186/s13075-023-03173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Physical function is an important determinant of health-related quality of life in radiographic axial spondyloarthritis patients (r-axSpA). To improve the basis of effective healthcare efforts, we aimed to investigate which demographic and disease-related factors that influence Bath Ankylosing Spondylitis Functional Index (BASFI) in r-axSpA patients overall and stratified by sex. Furthermore, we sought to explore differences between sexes regarding separate BASFI questions and also to explore which factors that may contribute to these differences. METHODS This observational cross-sectional study included patients fulfilling the modified New York criteria for Ankylosing Spondylitis. Patients were assessed with 66/68 joint count and Bath Ankylosing Spondylitis Metrology Index (BASMI) measurements. Lateral X-rays were performed for Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-Reactive Protein (CRP), and BASFI were registered. Multivariable linear regression analyses were used to investigate which factors that associate with BASFI. RESULTS A total of 353 r-axSpA patients were included, mean age 52.2 ± 12.7 years, 62.3% males. No significant sex difference was seen in BASFI scores (2.7 ± 2.0 in males vs 2.9 ± 2.1 in females). Age, body mass index, ASDAS-CRP, BASMI or mSASSS, fatigue, and tenderness were found to associate independently with BASFI in different models (R2 0.53-0.63). Investigation of separate BASFI questions revealed that the ability to look over shoulder was worse in males than females (mean 4.43 ± 3.37 vs 3.74 ± 3.06, p = 0.05) and most strongly correlated with mSASSS and BASMI among separate BASFI questions (r = 0.53, p < 0.001; r = 0.62, p < 0.001). The ability to climb stairs was worse in females than males (mean 2.49 ± 2.77 vs 1.54 ± 2.32, p < 0.001). CONCLUSIONS No difference between male and female r-axSpA patients was seen in BASFI despite significant sex differences in BASMI, mSASSS, and CRP levels. Our results underline the impact of fatigue and tenderness on BASFI. The ability to climb stairs without a handrail was scored worse among females compared to males. Furthermore, the ability to look over the shoulder was worse in males than females and closely related to spinal mobility and structural spinal changes.
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Affiliation(s)
- Magnus Hallström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Deminger
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeannette Beckman Rehnman
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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24
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Zhang W, Yin W, Cui X, Chai Z, Zheng G, Ding Y, Wang H, Zhai Y, Yu H. Operative strategies for ankylosing spondylitis-related thoracolumbar kyphosis: focus on the cervical stiffness, coronal imbalance and hip involvement. BMC Musculoskelet Disord 2023; 24:723. [PMID: 37697276 PMCID: PMC10494390 DOI: 10.1186/s12891-023-06810-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors. METHODS 25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed. RESULTS All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome. CONCLUSION Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
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Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Wen Yin
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Zihao Chai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Guohui Zheng
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Ya Ding
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Hongliang Wang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
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25
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Luan H, Peng C, Liu K, Song X. Comparison of pedicle subtraction osteotomy and vertebral column decancellation for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. J Neurosurg Spine 2023; 39:370-379. [PMID: 37209071 PMCID: PMC10226380 DOI: 10.3171/2023.4.spine23329] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The goal in this study was to compare the efficacy and safety outcomes of vertebral column decancellation (VCD) and pedicle subtraction osteotomy (PSO) for patients with ankylosing spondylitis (AS) with thoracolumbar kyphotic deformity. METHODS This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO). The authors conducted a computer search of PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database to collect controlled clinical studies on the efficacy and safety of VCD and PSO for patients with AS with thoracolumbar kyphotic deformity. The search covered the period from database establishment to March 2023. Two researchers screened the literature, extracted data, and evaluated the risk of bias of the included studies; these researchers recorded the authors and the sample size, and they extracted data on the intraoperative blood loss, Oswestry Disability Index, spine sagittal parameters, operation time, and complications in each study. Meta-analysis was performed using RevMan 5.4 software provided by Cochrane Library. RESULTS A total of 6 cohort studies with a total of 342 patients were included in this study, including 172 patients in the VCD group and 170 patients in the PSO group. The VCD group had lower intraoperative blood loss than the PSO group (mean difference [MD] -274.92, 95% CI -506.63 to -43.20, p = 0.02); significant correction of the sagittal vertical axis compared with the PSO group (MD 7.32, 95% CI -1.24 to 15.87, p = 0.03), and the operation time was shorter than that of the PSO group (MD -80.28, 95% CI -150.07 to -10.48, p = 0.02). CONCLUSIONS This systematic review and meta-analysis showed that VCD had more advantages than PSO in correcting the sagittal imbalance in the treatment of AS with thoracolumbar kyphotic deformity, and VCD had less intraoperative blood loss, shorter operation time, and satisfactory results in improving the quality of life.
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Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University; and
| | - Cong Peng
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University; and
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xinghua Song
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University; and
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26
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Siderius M, Arends S, Wink F, Kroese FGM, Spoorenberg A. Stable bone turnover markers corrected for age and gender during the first year of secukinumab treatment in radiographic axial spondyloarthritis. Clin Exp Rheumatol 2023; 41:1942-1943. [PMID: 37223930 DOI: 10.55563/clinexprheumatol/i2fnno] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Mark Siderius
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Freke Wink
- Rheumatology, Medical Centre Leeuwarden, the Netherlands
| | - Frans G M Kroese
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
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27
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Bäcker HC, Elias P, Hanlon J, Cunningham J, Johnson MA, Turner P. Spinal fractures in fused spines: nonoperative treatment is a reliable alternative. Arch Orthop Trauma Surg 2023; 143:5707-5712. [PMID: 37272986 DOI: 10.1007/s00402-023-04936-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spinal fractures in fused spines such as in ankylosing spondylitis or DISH are typically of type B or C fractures where operative treatment is recommended. The mortality rate in non-operatively treated patients is reported to be 51%. The purpose of this study was to investigate the mortality rate, complication rate and demographics of patients following non-operatively treatment in fused spine injuries. METHODS Between 2019 and 2021, a retrospective study was conducted including all patients who presented to our trauma center with a spinal fracture of a fused spine. Radiology and patient charts were analyzed for fracture pattern, complications, neurological deficit, comorbidities, and mortality rate. RESULTS A total of 49 patients were found at a mean age was 79.8 ± 10.9 years and primarily males were affected in 65.3%. All fractures were of type B and the thoracic spine was involved in 85.7%. The mean follow-up was 6.3 ± 8.2 months and fusion was obtained in all patients. No neurological deficit was observed in any. A total of 13 patients died at a mean age of 86.5 ± 10.0 years after 157.1 ± 158.1 days. 6 patients (10.2%) deceased within the first 6 weeks at a mean age of 91.8 ± 3.8 years. One patient each suffered from heart failure, an acute delirium, end stage colon cancer and subdural hemorrhage. CONCLUSION This study shows that the mortality rate in the first 6 weeks following a fracture in a fused spine is 10.2% for patients above the age of 90 years. Therefore, non-operative treatment should be taken into consideration as the mortality rate in other studies may be overestimated. LEVEL OF EVIDENCE III, retrospective study.
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Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
- Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, Australia.
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital Berlin, Berlin, Germany.
- Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Patrick Elias
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Jack Hanlon
- Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - John Cunningham
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
- Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, Australia
| | - Michael A Johnson
- Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, Australia
| | - Peter Turner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
- Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, Australia
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28
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Börekci A, Kuru Bektaşoğlu P, Ramazanoğlu AF, Hazneci J, Gürer B, Hakan T, Çelikoğlu E. Surgical Management Thoracolumbar Fractures in Patients with Ankylosing Spondylitis: Technical Note with Case Series. World Neurosurg 2023; 176:3-9. [PMID: 37084846 DOI: 10.1016/j.wneu.2023.04.054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is a chronic inflammatory joint disease. Complications such as traumatic spinal fractures are mostly caused by hyperextension and are unstable. We report the cases of 5 patients with AS surgically treated for thoracolumbar fractures. METHODS AND RESULTS We shared our experience of posterior stabilization surgery performed for the treatment of thoracolumbar fractures after traumas such as fall-accident in patients with AS. Patients were all men, and their ages were between 52 and 77 years. The first 3 patients woke up with neurologic deficits and were managed surgically under general anesthesia. We managed the last 2 patients with unilateral short-level stabilization under local anesthesia followed by bilateral long-level stabilization under general anesthesia. No neurologic deterioration was found in the postoperative examination of these 2 patients. We assume that the reason for neurologic deterioration after general anesthesia is the relaxation of muscles. All 3 columns of the spine are affected in patients with AS and the stability is provided by the tone of the muscles around the spine. CONCLUSIONS To prevent postoperative neurologic complications after the surgical treatment of traumatic hyperextension thoracic and lumbar fractures in patients with AS, we recommend securing the fracture level with unilateral short-level stabilization under local anesthesia and then completing the operation with general anesthesia.
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Affiliation(s)
- Ali Börekci
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | | | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Jülide Hazneci
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Bora Gürer
- Department of Neurosurgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Tayfun Hakan
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Erhan Çelikoğlu
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Li Y, Qian BP, Qiu Y, Yu Y, Wang B. Orientation of Osteotomized Vertebrae in 2-Level Pedicle Subtraction Osteotomy Plays a Crucial Role in the Remodeling of Harmonious Sagittal Curve for Severe Thoracolumbar Kyphotic Deformity Caused by Ankylosing Spondylitis. Neurosurgery 2023; 93:128-136. [PMID: 36757186 DOI: 10.1227/neu.0000000000002390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/06/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Few studies reported the remodeling of harmonious sagittal curve after 2-level pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS). OBJECTIVE To investigate how the orientation of osteotomized vertebrae (OV) affects the remodeling of harmonious sagittal curve in patients with AS undergoing 2-level PSO. METHODS Twenty-six patients treated with 2-level PSO were reviewed. Plumb lines of thoracic apex and lumbar apex, the superior/inferior endplate angle of OV, and OV tilt were measured. Patients with AS were grouped based on the postoperative lumbar lordotic apex (LLA, L3 or L4 vs L5 or others). RESULTS The level of thoracic kyphotic apex was positively correlated with that of superior OV postoperatively. Larger sacral slope, L1-L3 lordotic angle, and plumb lines of lumbar apex could be obtained in patients with LLA at L3 or L4, accompanied with larger superior endplate angle of OV and OV tilt of inferior OV ( P < .05). Besides, larger lumbar lordotic angle (LL) was observed in these patients (marginally significant, P = .057). For patients with relocated LLA at L5 or others, lower pelvic incidence was observed, accompanied with significant loss of correction ( P < .05) and worse Visual Analog Scale scores (marginally significant, P = .054) during follow-up. CONCLUSION Ventrally leaning inferior OV combined with dorsally leaning superior OV contributed to the most harmonious sagittal curve defined as thoracic kyphotic apex at T8 or above and LLA at L3 or L4. Sagittal curve with LLA at L5 could be acceptable in patients with more severe kyphosis, especially those with low pelvic incidence.
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Affiliation(s)
- Yao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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30
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Li Y, Qian BP, Qiu Y, Yu Y, Wang B. Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation. Eur Spine J 2023; 32:2293-2302. [PMID: 37154940 DOI: 10.1007/s00586-023-07726-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the clinical- and surgical-related factors of hip joint structural changes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who underwent PSO. METHODS Hip involvement was assessed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and defined by a score of at least 2. 52 patients with BASRI-h scores maintained and 78 patients with BASRI-h scores increased during follow-up were retrospectively reviewed. Clinical data were recorded. Radiological assessment was performed preoperatively, postoperatively, and at the final follow-up. RESULTS No significant difference existed in age, gender and follow-up time between the groups, but earlier onset of AS, longer disease and kyphotic duration, and worse Bath Ankylosing Spondylitis Functional Index (BASFI) scores at the final follow-up were observed in patients with BASRI-h scores increased (P < 0.05). Besides, global kyphosis (GK), T1-pelvic angle (TPA), pelvic tilt (PT) and anterior pelvic plane angle (APPA) were always larger in patients with BASRI-h scores increased, accompanied with more sacral fixation (P < 0.05). Multivariate logistics regression showed that earlier onset of AS, longer kyphotic duration, larger preoperative GK, sacral fixation and larger APPA during follow-up were independent risk factors. CONCLUSION Earlier onset of AS and longer kyphotic duration were the clinical risk factors of hip joint structural changes in AS patients following PSO, while larger preoperative GK, sacral fixation in PSO and larger APPA during follow-up were the surgical-related factors. Surgeons should inform patients with risk factors of the possibility for severe hip joint structural changes after PSO.
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Affiliation(s)
- Yao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
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31
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Nam B, Jo S, Bang SY, Park Y, Shin JH, Park YS, Lee S, Joo KB, Kim TH. Clinical and genetic factors associated with radiographic damage in patients with ankylosing spondylitis. Ann Rheum Dis 2023; 82:527-532. [PMID: 36543524 PMCID: PMC10086301 DOI: 10.1136/ard-2022-222796] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify clinical and genetic factors associated with severe radiographic damage in patients with ankylosing spondylitis (AS). METHODS We newly generated genome-wide single nucleotide polymorphism data (833K) for 444 patients with AS. The severity of radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). To identify clinical and genetic factors associated with severe radiographic damage, multiple linear regression analyses were performed. Human AS-osteoprogenitor and control-osteoprogenitor cells were used for functional validation. RESULTS The significant clinical factors of final mSASSS were baseline mSASSS (β=0.796, p=3.22×10-75), peripheral joint arthritis (β=-0.246, p=6.85×10-6), uveitis (β=0.157, p=1.95×10-3), and smoking (β=0.130, p=2.72×10-2) after adjusting for sex, age and disease duration. After adjusting significant clinical factors, the Ryanodine receptor 3 (RYR3) gene was associated with severe radiographic damage (p=1.00×10-6). For pathway analysis, the PI3K-Akt signalling pathway was associated with severe radiographic damage in AS (p=2.21×10-4, false discovery rate=0.040). Treatment with rhodamine B, a ligand of RYR3, dose-dependently induced matrix mineralisation of AS osteoprogenitors. However, the rhodamine B-induced accelerated matrix mineralisation was not definitive in control osteoprogenitors. Knockdown of RYR3 inhibited matrix mineralisation in SaOS2 cell lines. CONCLUSIONS This study identified clinical and genetic factors that contributed to better understanding of the pathogenesis and biology associated with radiographic damage in AS.
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Affiliation(s)
- Bora Nam
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, South Korea
| | - Sungsin Jo
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, South Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, South Korea
| | - Youngho Park
- Department of Big Data Application College of Smart Convergence, Hannam University, Daejeon, South Korea
| | - Ji Hui Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Ye-Soo Park
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Guri Hospital, Guri, South Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Kyung Bin Joo
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
- Hanyang University Institute for Rheumatology Research (HYIRR), Seoul, South Korea
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Prasad CB, Sankar J, Dhir V, Jain S. Trolley-track sign in ankylosing spondylitis. QJM 2023; 116:231-232. [PMID: 36308443 DOI: 10.1093/qjmed/hcac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- C B Prasad
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - J Sankar
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - V Dhir
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Jain
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Popova V, Kissling S, Micheroli R, Bräm R, de Hooge M, Baraliakos X, Nissen MJ, Möller B, Exer P, Andor M, Distler O, Scherer A, Ospelt C, Ciurea A. Site-specific assessment of spinal radiographic progression improves detection of TNF blocker-associated disease modification in axial spondyloarthritis: longitudinal observational data from the Swiss Clinical Quality Management Registry. Arthritis Res Ther 2023; 25:40. [PMID: 36915202 PMCID: PMC10009926 DOI: 10.1186/s13075-023-03026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES To analyse whether time-varying treatment with tumour necrosis factor inhibitors (TNFi) in radiographic axial spondyloarthritis (r-axSpA) has a differential impact on structural damage progression on different spinal segments (cervical versus lumbar spine). METHODS Patients with r-axSpA in the Swiss Clinical Quality Management cohort were included if cervical and lumbar radiographs were available at intervals of 2 years for a maximum of 10 years. Paired radiographs were scored by two calibrated readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The relationship between TNFi use and progression in the cervical and the lumbar spine was analysed using generalised estimating equation models and adjustment for potential confounding. Radiographic progression per spinal segment was defined as an increase of ≥ 1 mSASSS unit or by the formation of ≥ 1 new syndesmophyte over 2 years. RESULTS Mean ± SD symptom duration was 13.8 ± 9.8 years. Mean ± SD mSASSS progression per radiographic interval was 0.41 ± 1.69 units in the cervical spine and 0.45 ± 1.45 units in the lumbar spine (p = 0.66). Prior use of TNFi significantly reduced the odds of progression in the cervical spine by 68% (OR 0.32, 95% CI 0.14-0.72), but not in the lumbar spine (OR 0.99, 95% CI 0.52-1.88). A more restricted inhibition of progression in the lumbar spine was confirmed after multiple imputation of missing covariate data (OR 0.43, 95% CI 0.24-0.77 and 0.85, 95% CI 0.51-1.41, for the cervical and lumbar spine, respectively). It was also confirmed with progression defined as formation of ≥ 1 syndesmophyte (OR 0.31, 95% CI 0.12-0.80 versus OR 0.56, 95% CI 0.26-1.24 for the cervical and lumbar spine, respectively). CONCLUSION Disease modification by treatment with TNFi seems to more profoundly affect the cervical spine in this r-axSpA population with longstanding disease. Site-specific analysis of spinal progression might, therefore, improve detection of disease modification in clinical trials in axSpA.
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Affiliation(s)
- Vjara Popova
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Seraphina Kissling
- Swiss Clinical Quality Management Foundation, Statistics Group, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | - Manouk de Hooge
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | | | - Michael J Nissen
- Department of Rheumatology, University Hospital Geneva, Geneva, Switzerland
| | - Burkhard Möller
- Deparment of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | | | | | - Oliver Distler
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Statistics Group, Zurich, Switzerland
| | - Caroline Ospelt
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
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Poddubnyy D. Challenges in non-radiographic axial spondyloarthritis. Joint Bone Spine 2023; 90:105468. [PMID: 36182035 DOI: 10.1016/j.jbspin.2022.105468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023]
Abstract
Non-radiographic axial spondyloarthritis (nr-axSpA) is part of the spectrum or continuum of axSpA and is characterized by the absence of definite structural damage in the sacroiliac joints. The introduction of the concept of axSpA with two - non-radiographic and radiographic - stages stimulated activities related to the improvement of early diagnosis and treatment of this disease, but also opened a number of controversial topics in the field. In this article, we are discussing several challenges related to the concept of nr-axSpA, the diagnosis, and the treatment in the historical context and in the light of the recent data.
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Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.
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Ghossan R, Zebouni SH, Farah TY, Fayad F. Diffuse Idiopathic Skeletal Hyperostosis and Ankylosing Spondylitis: A Challenging Case and Review of the Literature. J Radiol Case Rep 2022; 16:1-16. [PMID: 36518159 PMCID: PMC9714563 DOI: 10.3941/jrcr.v16i11.4634] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Diffuse idiopathic skeletal hyperostosis and spondyloarthritis share similarities in clinical and radiological findings. In this article, we report a case of overlapping of these two hyperostotic diseases followed by an extensive narrative review of the literature focusing on the gray areas in the diagnosis of diffuse idiopathic skeletal hyperostosis. Case description We report the case of simultaneous diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis in a 57-year-old man. The diagnosis was made after many collegial meetings based on solid radiological arguments. Conclusion Review of the literature reveals many uncertainties in the diagnosis of diffuse idiopathic skeletal hyperostosis, especially in the radiological evaluation of sacroiliac joints. Diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis frequently overlap in important radiological features leading to diagnostic ambiguity and they can also co-exist in the same patient.
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Affiliation(s)
- Roba Ghossan
- Department of Rheumatology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Lebanon
| | - Soha Haddad Zebouni
- Department of Radiology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Lebanon
| | - Tonine Younan Farah
- Department of Radiology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Lebanon
| | - Fouad Fayad
- Department of Rheumatology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Lebanon
- Correspondence: Fouad Fayad. Department of Rheumatology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Alfred Naccache Street, Achrafieh, Beirut, P.O. Box 166830, Lebanon, ()
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Bang YS, Hwang HW, Bae H, Choi YS, Lim Y, Yi J, Kim H, Su MY, Kim YU. The value of the sacroiliac joint area as a new morphological parameter of ankylosing spondylitis. Medicine (Baltimore) 2022; 101:e31723. [PMID: 36397357 PMCID: PMC9666185 DOI: 10.1097/md.0000000000031723] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A narrowed sacroiliac joint (SIJ) space has been considered to be a major morphologic parameter of ankylosing spondylitis (AS). Previous studies revealed that the sacroiliac joint thickness (SIJT) correlated with AS in patients. However, irregular narrowing is different from thickness. Thus, we devised a method using the sacroiliac joint cross-sectional area (SIJA) as a new morphological parameter for use in evaluating AS. We hypothesized that the SIJA is a key morphologic parameter in diagnosing AS. SIJ samples were collected from 107 patients with AS, and from 85 control subjects who underwent SIJ-view X-rays that revealed no evidence of AS. We measured the SIJT and SIJA at the SIJ margin on X-rays using our picture archiving and communications system. The SIJT was measured at the narrowest point between the sacrum and the ilium. The SIJA was measured as the entire cross-sectional joint space area of the SIJ in the X-ray images. The average SIJT was 3.09 ± 0.61 mm in the control group, and 1.59 ± 0.52 mm in the AS group. The average SIJA was 166.74 ± 39.98 mm2 in the control group, and 68.65 ± 24.11 mm2 in the AS group. AS patients had significantly lower SIJT (P < .001) and SIJA (P < .001) than the control subjects. Receiver operating characteristics curve analysis showed that the best cutoff point for the SIJT was 2.33 mm, with 92.5% sensitivity, 94.1% specificity, and an area under the curve of 0.97 (95% confidence interval: 0.95-0.99). The optimal cutoff point for the SIJA was 106.19 mm2, with 93.5% sensitivity, 95.3% specificity, and an area under the curve of 0.98 (95% confidence interval: 0.97-1.00). Although the SIJT and SIJA were both significantly associated with AS, the SIJA parameter was a more sensitive measurement. We concluded that the SIJA is an easy-to-use, fast, cheap, and useful new morphological parameter for predicting AS.
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Affiliation(s)
- Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - He Won Hwang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hanwool Bae
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Youngsu Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Hyunhae Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea
- * Correspondence: Young Uk Kim, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary’s Hospital, Simgokro 100Gil 25 Seo-gu, Incheon City 22711, Republic of Korea (e-mail: )
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Li J, Wang M, Xu F, Li G, Ye F. Differences of ultrasonographic enthesitis between patients with non-radiographic axial spondylarthritis and ankylosing spondylitis. Chin Med J (Engl) 2022; 135:2640-2641. [PMID: 36583926 PMCID: PMC9945240 DOI: 10.1097/cm9.0000000000002084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Juan Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, China
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Li X, An B, Jiang B, Xu S, Liu H, Zhao H. Pharynx volume derived from three-dimensional computed tomography is associated with difficult intubation in spinal deformity surgery: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e31139. [PMID: 36253975 PMCID: PMC9575825 DOI: 10.1097/md.0000000000031139] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spinal abnormality surgery, including surgery for ankylosing spondylitis and idiopathic scoliosis, can present significant challenges to anesthesiologists because of the potential difficult airway. The bedside screening tests routinely used to detect difficult airways are highly variable. Pharynx volume calculated using three-dimensional (3D) computed tomography (CT) may play a role in predicting difficult airways. We conducted a retrospective cohort study on patients (aged ≥14 years) who received orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis under general anesthesia. Volume of the pharynx air space was calculated through volume rendering technique by 3D reconstruction of patients' cervical spine CT. Patients were divided into 2 groups according to their pharynx volume, pharyngeal volume lower than 16 mL (n = 11) and equal or higher than 16 mL (n = 13). Pharynx volume in low volume group was 10.4 ± 3.6 mL (n = 11), and the counterpart in high volume group was 20.8 ± 5.5 mL (n = 13). The incidence of difficult intubation was significantly higher in low pharynx volume group than in high pharynx volume group (54.5% (6/11) vs 7.6% (1/13), P = .023). Bedside screening tests including modified Mallampati test, inter-incisor gap and thyromental distance, or radiological variables such as anterior neck soft tissue thickness to vocal cords were not different between the 2 groups. Smaller pharynx volume played an important role in difficult airways for patients undergoing orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis.
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Affiliation(s)
- Xiaoyan Li
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Bei An
- Department of Radiology, Peking University People’s Hospital, Beijing, China
| | - Bailin Jiang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Shuai Xu
- Department of Spinal Surgery, Peking University People’s Hospital, Beijing, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Beijing, China
| | - Hong Zhao
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Hong Zhao, Department of Anesthesiology, Peking University People’s Hospital, #11 Xizhimen South Street, Beijing 100044, China (e-mail: )
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Okçu M, Koçak FA, Şaş S, Güçlü K. Epicardial adipose tissue thickness and growth differentiation factor 15 in axial spondyloarthritis: A cross-sectional study. Saudi Med J 2022; 43:1020-1026. [PMID: 36104054 PMCID: PMC9987668 DOI: 10.15537/smj.2022.43.9.20220304] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate growth differentiation factor-15 (GDF-15) levels and the thickness of epicardial adipose tissue (EAT) in patients with axial spondyloarthritis (axSpA) and to evaluate their relationship with functional status, disease activity, disease duration, and the type of medical treatment received by the patients. METHODS This cross-sectional study was carried out at Kırşehir Ahievran University School of Medicine between February and June 2020. Twenty-nine healthy controls and 44 patients with axSpA were included in the study. Gender, age, erythrocyte sedimentation rate, GDF-15, body mass index, complete blood count, ejection fraction, the EAT thickness, and C-reactive protein of all participants were recorded. Ankylosing Spondylitis Quality of Life Index, Bath Ankylosing Spondylitis Functional Index, the disease duration, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Disease Activity Index scores of patients with axSpA were noted. RESULTS Epicardial adipose tissue thickness values (0.35±0.09 cm) in the AxSpA group were higher compared to the control group (0.26±0.06 cm) (p<0.01). Growth differentiation factor-15 levels of the control group and axSpA group were similar. The treatment received by the patients did not have a significant relationship with EAT thickness and GDF-15. Bath Ankylosing Spondylitis Functional Index scores, disease duration, and age were significantly positively correlated with GDF-15 levels. CONCLUSION In this study, EAT thickness values were found to be significantly higher in the axSpA group. In addition, GDF-15 was positively correlated with age, Bath Ankylosing Spondylitis Functional Index score, and disease duration.
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Affiliation(s)
- Mehmet Okçu
- From the Department of Physical Medicine and Rehabilitation (Okçu), Marmara University Faculty of Medicine, Istanbul; from the Department of Physical Medicine and Rehabilitation (Koçak), Kırsehir Ahi Evran University Faculty of Medicine; from the Department of Physical Medicine and Rehabilitation (Şaş), Division of Rheumatology, Kayseri, Erciyes University Faculty of Medicine; and from the Department of Biochemistry (Güçlü), Kırsehir Ahi Evran University Faculty of Medicine, Kırsehir, Turkey.
| | - Fatmanur A. Koçak
- From the Department of Physical Medicine and Rehabilitation (Okçu), Marmara University Faculty of Medicine, Istanbul; from the Department of Physical Medicine and Rehabilitation (Koçak), Kırsehir Ahi Evran University Faculty of Medicine; from the Department of Physical Medicine and Rehabilitation (Şaş), Division of Rheumatology, Kayseri, Erciyes University Faculty of Medicine; and from the Department of Biochemistry (Güçlü), Kırsehir Ahi Evran University Faculty of Medicine, Kırsehir, Turkey.
| | - Senem Şaş
- From the Department of Physical Medicine and Rehabilitation (Okçu), Marmara University Faculty of Medicine, Istanbul; from the Department of Physical Medicine and Rehabilitation (Koçak), Kırsehir Ahi Evran University Faculty of Medicine; from the Department of Physical Medicine and Rehabilitation (Şaş), Division of Rheumatology, Kayseri, Erciyes University Faculty of Medicine; and from the Department of Biochemistry (Güçlü), Kırsehir Ahi Evran University Faculty of Medicine, Kırsehir, Turkey.
| | - Kenan Güçlü
- From the Department of Physical Medicine and Rehabilitation (Okçu), Marmara University Faculty of Medicine, Istanbul; from the Department of Physical Medicine and Rehabilitation (Koçak), Kırsehir Ahi Evran University Faculty of Medicine; from the Department of Physical Medicine and Rehabilitation (Şaş), Division of Rheumatology, Kayseri, Erciyes University Faculty of Medicine; and from the Department of Biochemistry (Güçlü), Kırsehir Ahi Evran University Faculty of Medicine, Kırsehir, Turkey.
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Tu L, Zhao M, Wang X, Kong Q, Chen Z, Wei Q, Li Q, Yu Q, Ye Z, Cao S, Lin Z, Liao Z, Lv Q, Qi J, Jin O, Pan Y, Gu J. Etanercept/celecoxib on improving MRI inflammation of active ankylosing spondylitis: A multicenter, open-label, randomized clinical trial. Front Immunol 2022; 13:967658. [PMID: 36091030 PMCID: PMC9458864 DOI: 10.3389/fimmu.2022.967658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the efficacy and safety of clinical, magnetic resonance imaging (MRI) changes in active ankylosing spondylitis (AS) patients with etanercept and celecoxib alone/combined treatment.MethodsA randomized controlled trial was conducted in three medical centers in China. Adult AS patients with BASDAI ≥4 or ASDAS ≥2.1, CRP >6 mg/L, or ESR 28 mm/1st hour were randomly assigned (1:1:1 ratio) to celecoxib 200 mg bid or etanercept 50 mg qw or combined therapy for 52 weeks. The primary outcomes were SPARCC change of the sacroiliac joint (SIJ) and spine and the proportion of patients achieving ASAS20 response at 52 weeks.ResultsBetween September 2014 and January 2016, we randomly assigned 150 patients (mean age, 32.4 years; mean disease duration, 109 months), and 133 (88.6%) completed the study. SPARCC inflammation scores of the SIJ and spine decreased in the three groups, and significant differences were found between the combined group and the celecoxib group [between-group difference: −6.33, 95% CI (−10.56, −2.10) for SIJ; −9.53, 95% CI (−13.73, −5.33) for spine] and between the etanercept group and the celecoxib group [between-group difference: −5.02, 95% CI (−9.29, −0.76) for SIJ; −5.80, 95% CI (−10.04, −1.57) for spine]. The ASAS20 response rates were 44%, 58%, and 84% in the celecoxib, etanercept, and combined groups, respectively, and a significant difference was only found between the combined and the celecoxib groups.ConclusionEtanercept with or without celecoxib decreases inflammation detected by MRI at 1 year compared to celecoxib alone in active AS patients. The combination of etanercept and celecoxib was superior to celecoxib alone for the primary clinical response.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01934933.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjing Zhao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Radiography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingcong Kong
- Department of Radiography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zena Chen
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiuxia Li
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qinghong Yu
- Department of Rheumatology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
| | - Zhizhong Ye
- Department of Rheumatology, Fourth People’s Hospital of Shenzhen City, Shenzhen, China
| | - Shuangyan Cao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhimin Lin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Qi
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ou Jin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunfeng Pan
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Jieruo Gu,
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Papaioannou I, Pantazidou G, Repantis T, Baikousis A, Korovessis P. An infected Andersson lesion presented with incomplete paraplegia in a patient with ankylosing spondylitis. A unique case report with literature review. Spinal Cord Ser Cases 2022; 8:73. [PMID: 35945214 PMCID: PMC9363441 DOI: 10.1038/s41394-022-00541-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION A relatively rare and unknown entity in patients with ankylosing spondylitis is the Andersson lesion (AL). It was first described by Andersson in 1937 as destructive vertebral or disco-vertebral lesion of the spine without history of trauma. AL may result from inflammation or stress fracture of the rigid spine, while there is no evidence for an infectious origin. To our knowledge, only one case with an infected AL has been published many years ago; we hereby present the second case, but the first one with severe neurologic deterioration. CASE PRESENTATION A 79-year-old male patient was presented to our emergency department and his neurological examination on admission revealed incomplete paraplegia below the Th10 level. Plain radiograms at the level of 10th thoracic vertebra revealed a lesion mimicking a severe vertebral fracture. The computed tomography confirmed the diagnosis of the AL and due to the significant local instability and the neurologic deficit, the patient underwent posterior decompression and stabilization. During decompression, we noticed purulence and extensive debridement was performed. The cultures of the Th10 pus revealed Enterococus sp, while the same pathogen was developed to urine cultures. The patient received intravenous antibiotics for 4 weeks, followed by per os antibiotic therapy. At the 18-month follow-up our patient had significant improvement of this functional status. DISCUSSION Most studies support that inflammatory or traumatic/mechanical (pseudarthrosis) etiology are the most possible causes of Anderson lesions. Possible neurological deterioration should be investigated and demonstrates significant spinal instability. The integrity of the posterior column should be investigated, and exclusion of other concomitant lesions should be done. In cases with instability due to the fractured posterior elements, surgical intervention is mandatory. Spine surgeons should be competent to differentiate fracture from the Andersson lesion. In this rare case we highlight also that spine surgeons should obtain intraoperative cultures in cases with Andersson lesions, to exclude the minor possibility of the infectious origin of the entity and/or the possible secondary contamination of the affected area.
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Affiliation(s)
- Ioannis Papaioannou
- Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece.
| | - Georgia Pantazidou
- Public Health, Postgraduate MSc Program, University of Patras, Patras, Greece
| | - Thomas Repantis
- Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece
| | - Andreas Baikousis
- Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece
| | - Panagiotis Korovessis
- Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece
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Ma S, Zhou Z, Yu H, Wu C, Deng W, Cao K. Two-Level Pedicle Subtraction Osteotomy in Lateral Position for an Ankylosing Spondylitis Patient With Severe Thoracolumbar Kyphosis and Hip Flexion Contracture: A Case Report. Oper Neurosurg (Hagerstown) 2022; 23:e72-e76. [PMID: 35726950 DOI: 10.1227/ons.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Spinal osteotomy and total hip replacement (THR) are the most common surgical interventions for ankylosing spondylitis (AS). It is recommended that patients with AS with severe thoracolumbar kyphotic deformity (TLKD) and flexed hips receive spinal osteotomy before THR to reduce the risk of hip prosthesis dislocation after THR. Standardly, spinal osteotomy is performed in the prone position; however, it is impractical to place patients with AS with kyphosis and closed hips in a prone position. In this report, we present an AS case with severe TLKD and closed hips who underwent spinal osteotomy in a lateral position first, then THR in the second stage. CLINICAL PRESENTATION The patient with AS was a 40-year-old woamn with severe TLKD and a closed hip. Back pain, difficulty walking, and gaze loss are the chief complaints. In consideration of the infeasibility of adopting the prone position, the patient was placed in a lateral position and underwent 2-level pedicle subtraction osteotomy at L1 and L3 with a long instrumentation from T10 to S1 at the first stage. Then, THR was performed at the second stage. The patient achieved pain relief, horizontal gaze, and nearly normal ambulation after spinal deformity correction and THR. After 2-year follow-up, the spinal alignment remains good and hip function was satisfactory. DISCUSSION The sequence of spinal osteotomy and THR performed for AS patients with TLKD and hip flexion contracture remains inconclusive. According to previous studies, patients treated with THR under a sagittal malaligned spine may require revision of the acetabular component to accommodate to the re-orientated acetabula resulting from the subsequent spinal osteotomy and realignment. Thus, we believe it is more reasonable to perform spinal osteotomy first. For osteotomy in lateral position, one of the key points is that the operation table should be tilted away from the surgeon side at a certain angle. Another point is that contralateral cancellous bone should be removed as much as possible when performing osteotomy at the side of vertebral away from the table. The satisfactory outcomes of this case revealed the feasibility of osteotomy in a lateral position for such severe AS with closed hip. CONCLUSION Performing double-level spinal osteotomy in a lateral position first could be an alternative for patients with AS who cannot be placed in the prone position because of the severe deformity of the spine and hips.
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Affiliation(s)
- Shengbiao Ma
- The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Jiangxi, China
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Huang R, Yang H, Chen L, Su S, Wu X, Zhuang R, Liu Y. T2 mapping and fat quantification of lumbar paraspinal muscle in ankylosing spondylitis: a case control study. BMC Musculoskelet Disord 2022; 23:614. [PMID: 35761300 PMCID: PMC9235229 DOI: 10.1186/s12891-022-05570-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To compare changes in the composition of paraspinal muscles of patients with ankylosing spondylitis (AS) and matched healthy controls using T2 mapping and T2 IDEAL and correlate the quantitative magnetic resonance imaging (qMRI) results with clinical assessments of AS patients. METHOD In total, 37 AS patients and 37 healthy controls were enrolled in the case control study. T2 mapping with and without fat saturation and IDEAL imaging were used to assess the multifidus (MF) and erector spinae (ES) at the levels of L3/L4 and L4/L5 for all subjects. Mean T2non-fatsat, T2fat, T2fatsat, cross-sectional area (CSA), and fat fraction (FF) were compared between AS and healthy controls. Correlations of qMRI results with clinical assessments were analyzed in AS. RESULTS Significantly elevated mean T2non-fatsat values and the FF of the MF and ES at both levels were observed in AS and compared to the controls (p < 0.05). The mean T2fatsat values of ES and MF were significantly higher only at the level of L3/L4 in AS compared to healthy controls (p < 0.05). A loss of muscle CSA compatible with atrophy was present in MF and ES at both levels in AS compared to the controls (p < 0.05). Weak to moderate positive correlations were found between FF and age and disease duration in AS (r = 0.318-0.415, p < 0.05). However, such positive correlation was not observed between FF and disease duration after adjusting for age (p > 0.05). CONCLUSIONS Our findings indicate that using a combination of IDEAL and T2 mapping may provide deeper insights into the pathophysiological degeneration of paraspinal muscles in AS.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Hongwu Yang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Liujiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Xiaojia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
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Maksymowych WP, Østergaard M, Landewé R, Barchuk W, Liu K, Gilles L, Hendrikx T, Besuyen R, Baraliakos X. Filgotinib decreases both vertebral body and posterolateral spine inflammation in ankylosing spondylitis: results from the TORTUGA trial. Rheumatology (Oxford) 2022; 61:2388-2397. [PMID: 34647992 PMCID: PMC9157176 DOI: 10.1093/rheumatology/keab758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/28/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the effects of filgotinib on inflammatory and structural changes at various spinal locations, based on MRI measures in patients with active AS in the TORTUGA trial. METHODS In the TORTUGA trial, patients with AS received filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, spine MRIs were evaluated using the Canada-Denmark (CANDEN) MRI scoring system to assess changes from baseline to week 12 in total spine and subscores for inflammation, fat, erosion and new bone formation (NBF) at various anatomical locations. Correlations were assessed between CANDEN inflammation and clinical outcomes and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scores and between baseline CANDEN NBF and baseline BASFI and BASMI scores. RESULTS MRIs from 47 filgotinib- and 41 placebo-treated patients were evaluated. There were significantly larger reductions with filgotinib vs placebo in total spine inflammation score and most inflammation subscores, including posterolateral elements (costovertebral joints, transverse/spinous processes, soft tissues), facet joints and vertebral bodies. No significant differences were observed for corner or non-corner vertebral body inflammation subscores, spine fat lesion, bone erosion or NBF scores. In the filgotinib group, the change from baseline in the total inflammation score correlated positively with the SPARCC spine score. Baseline NBF scores correlated with baseline BASMI but not BASFI scores. CONCLUSIONS Compared with placebo, filgotinib treatment was associated with significant reductions in MRI measures of spinal inflammation, including in vertebral bodies, facet joints and posterolateral elements. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT03117270.
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Affiliation(s)
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert Landewé
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - William Barchuk
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | - Ke Liu
- Clinical Research, Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - Robin Besuyen
- Clinical Development, Galapagos BV, Leiden, Netherlands
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Liu L, Zhou Z, Hua S, Xue L, Zhu J, Liu R, Li Y. Detection of the disease activity with ankylosing spondylitis through intravoxel incoherent motion diffusion-weighted MR imaging of sacroiliac joint. Br J Radiol 2022; 95:20211074. [PMID: 35195441 PMCID: PMC10993985 DOI: 10.1259/bjr.20211074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the value of the quantitative parameter of intravoxel incoherent motion diffusion (IVIM-DWI) at 3.0 T MRI of the sacroiliac joint in differentiating different disease activity statuses of ankylosing spondylitis (AS) and to compare it with traditional diffusion-weighted imaging (DWI) and Spondyloarthritis Research Consortium of Canada (SPARCC) score. METHODS 56 AS patients (active group, inactive group) and 24 healthy controls were included. Clinical data, quantitative parameters of IVIM-DWI MR images and the SPARCC scores were collected. The Kruskal-Wallis test was used to compare the differences between the groups. Receiver operating characteristic (ROC) curve analysis of histogram data and the SPARCC scores identified the efficacy of the three groups. The Spearman correlation coefficients were used to analyse the correlation between the quantitative IVIIM-DWI parameters and the SPARCC score. RESULTS The f (10th percentile) and SPARCC score of the active group were significantly higher than those of the inactive group. The f (10th, 25th, 50th percentiles), Dslow (average, entropy, 10th ~ 90 th percentiles), Dfast (kurtosis, skewness), ADC (average, 10th ~ 90 th percentiles) and the SPARCC score of the active group were significantly higher than the control group (p < 0.05). The AUC of the SPARCC score was the highest (0.799) in the identification between the active and inactive groups, and the sensitivity and specificity were 69.23 and 82.35%, respectively, at the cut-off value of 12. The SPARCC score was positively correlated with each percentile and the average value. CONCLUSIONS Quantitative IVIIM-DWI parameters are helpful for the identification of different AS disease activity levels and are superior to traditional DWI. IVIM-DWI quantitative parameters had a good correlation with the SPARCC score. ADVANCES IN KNOWLEDGE A new MR technology-quantitative parameters of IVIM-DWI contribute to the identification of AS disease activity. IVIM-DWI quantitative parameters were well correlated with the SPARCC score.
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Affiliation(s)
- Li Liu
- Department of Imaging, Linyi Central Hospital,
Linyi, Shandong, China
| | - Zhimin Zhou
- Department of Radiology, The Second Affiliated Hospital of
Soochow University, Suzhou,
Jiangsu, China
| | - Sunyu Hua
- Department of Radiology, The Second Affiliated Hospital of
Soochow University, Suzhou,
Jiangsu, China
| | - Leixi Xue
- Department of Rheumatology and Immunology, The Second
Affiliated Hospital of Soochow University,
Suzhou, Jiangsu, China
| | - Jiangtao Zhu
- Department of Radiology, The Second Affiliated Hospital of
Soochow University, Suzhou,
Jiangsu, China
| | - Rong Liu
- Department of Radiology, The Second Affiliated Hospital of
Soochow University, Suzhou,
Jiangsu, China
| | - Yong Li
- Department of Radiology, The Second Affiliated Hospital of
Soochow University, Suzhou,
Jiangsu, China
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Li Y, Qian BP, Qiu Y, Zhao SZ, Zhong XL, Wang B. Influence of lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis-related thoracolumbar kyphosis following pedicle subtraction osteotomy. J Neurosurg Spine 2022; 36:624-631. [PMID: 34715648 DOI: 10.3171/2021.7.spine21114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the impact of the lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis and to evaluate the potential risk of prosthetic dislocation after total hip arthroplasty (THA) following pedicle subtraction osteotomy (PSO). METHODS Seventy-two patients with AS-related thoracolumbar kyphosis following spinal osteotomy were retrospectively reviewed, and 21 healthy volunteers were recruited as a control group. Pre- and postoperative 2D full-body images in standing and sitting positions were obtained to evaluate the anterior pelvic plane angle (APPA), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), proximal femur angle (PFA), and femoroacetabular flexion during postural changes. Patients with AS were categorized in either a lordotic or kyphotic group based on the lumbar sagittal profile. RESULTS Significant increases in the SS and decreases in the APPA, PT, and LL were observed postoperatively in both the standing and sitting positions (p < 0.001 for all). Significantly higher APPA, PT, LL, and ΔPT, and lower SS, ΔSS, and ΔSS+ΔPFA were observed in the kyphotic group (p < 0.05). After undergoing PSO, ΔPT and ΔSS significantly decreased while femoroacetabular flexion significantly increased in both AS groups (p < 0.05), and no significant difference was present between the two groups (p > 0.05). Bath Ankylosing Spondylitis Radiology Hip Index scores in the kyphotic group were significantly worse than those in the lordotic group pre- and postoperatively (p < 0.05). No significant difference in parameters concerning pelvic motion (ΔAPPA, ΔPT, and ΔSS) was found when PSO was performed in the thoracolumbar or lumbar spine. CONCLUSIONS Lumbar sagittal profiles greatly affect pelvic orientation and pelvic motion in AS. When THA is performed before PSO, AS patients with lumbar kyphosis are at higher risk of anterior prosthetic dislocation, while those with lordotic lumbar sagittal profiles are at higher risk of posterior dislocation. PSO should be performed prior to THA. After PSO, further decreased pelvic motion indicated a potential risk of posterior prosthetic dislocation after sequential THA, whereas theoretically patients with preoperative lumbar kyphosis are at higher risk of THA dislocation. The site where PSO was performed (thoracolumbar or lumbar spine) does not influence the risk of THA dislocation.
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Affiliation(s)
- Yao Li
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiu
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shi-Zhou Zhao
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao-Lin Zhong
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Affiliation(s)
- Tomoyuki Mukai
- Department of Immunology and Molecular Genetics, Kawasaki Medical School, Japan
- Department of Rheumatology, Kawasaki Medical School, Japan
- Department of Internal Medicine (Rheumatology), Fukuyama City Hospital, Japan
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Pai SN, Kailash K, Jayabalan V, Ganesan S. Andersson lesion in ankylosing spondylitis. BMJ Case Rep 2022; 15:e248542. [PMID: 35217558 PMCID: PMC8883225 DOI: 10.1136/bcr-2021-248542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Satvik N Pai
- Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Karthik Kailash
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vignesh Jayabalan
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sudhir Ganesan
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Jia H, Chen M, Cai Y, Luo X, Hou G, Li Y, Cai C, Chen J, Li Q, Miu KK, Fung SH, Wang Z, Huang R, Shen H, Lu L. A new and spontaneous animal model for ankylosing spondylitis is found in cynomolgus monkeys. Arthritis Res Ther 2022; 24:1. [PMID: 34980262 PMCID: PMC8722021 DOI: 10.1186/s13075-021-02679-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis is a progressive, disabling joint disease that affects millions worldwide. Given its unclear etiology, studies of ankylosing spondylitis relied heavily on drug-induced or transgenic rodent models which retain only partial clinical features. There is obviously a lack of a useful disease model to conduct comprehensive mechanistic studies. METHODS We followed a group of cynomolgus monkeys having joint lesions reported of spinal stiffness for 2 years by conducting hematological testing, radiographic examination, family aggregation analysis, pathological analysis, and genetic testing. RESULTS The results confirmed that these diseased animals suffered from spontaneous ankylosing spondylitis with clinical features recapitulating human ankylosing spondylitis disease progression, manifested by pathological changes and biochemical indicators similar to that of ankylosing spondylitis patients. CONCLUSION The study offers a promising non-human primate model for spontaneous ankylosing spondylitis which may serve as an excellent substitute for its pre-clinical research.
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Affiliation(s)
- Huanhuan Jia
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
- Guangdong Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Meili Chen
- Guangdong Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Yanzhen Cai
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaoling Luo
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
| | - Gang Hou
- Department of Orthopedics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yongfeng Li
- Guangzhou Blooming-Spring Biological Research Institute, Guangzhou, China
| | - Chunmei Cai
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jun Chen
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qingnan Li
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China
- Guangdong Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Kai-Kei Miu
- Developmental and Regenerative Biology Theme, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Sin-Hang Fung
- Developmental and Regenerative Biology Theme, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Zhangting Wang
- Developmental and Regenerative Biology Theme, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ren Huang
- Guangdong Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Huiyong Shen
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Lu
- School of Life Science and Biopharmacy, Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, China.
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Chekhonatsky VA, Dreval ON, Kuznetsov AV, Gorozhanin AV, Sidorenko VV. [Surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:71-76. [PMID: 35758081 DOI: 10.17116/neiro20228603171] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the features of diagnosis and surgical treatment of thoracic spine fracture in a patient with ankylosing spondylitis. MATERIAL AND METHODS We present a patient with ankylosing spondylitis, blunt thoracic spine trauma and Th10-Th11 fracture, spinal cord compression and contusion and moderate lower extremity paresis. Preoperative and postoperative CT and MRI (after 8 months) were performed for control of decompression. RESULTS The authors identified the main factors affecting the quality of life of patients with spine fractures following ankylosing spondylitis and formulated treatment algorithm. CONCLUSION Active strategy is advisable for spine fractures following ankylosing spondylitis: spinal cord decompression, creation of anatomical compliance in the damaged vertebral segment and its fixation by transpedicular system. A similar surgical treatment of spine fractures following ankylosing spondylitis makes it possible to achieve early activation of patients and reduce rehabilitation period.
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Affiliation(s)
- V A Chekhonatsky
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - O N Dreval
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - A V Kuznetsov
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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