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Recent studies found the intrusion and retention of exogenous fine particles into joints, but epidemiological data for long- and intermediate-term exposure associations are scare. Here, all urban working, retired employee, and rural residents (16.78 million) in Beijing from January 1, 2011 to December 31, 2019 were included to investigate the effects of long- and intermediate-term ambient particulate exposure on development of osteoarthritis. We identified 1,742,067 participants as first-visit patients with osteoarthritis. For each interquartile range increase in annual PM2.5 (23.32 µg/m3) and PM10 (23.92 µg/m3) exposure concentration, the pooled hazard ratios were respectively 1.238 (95% CI: 1.228, 1.249) and 1.178 (95% CI: 1.168, 1.189) for first osteoarthritis outpatient visits. Moreover, age at first osteoarthritis outpatient visits significantly decreased by 4.52 (95% CI: 3.45 to 5.40) days per µg/m3 for annual PM2.5 exposure at below 67.85 µg/m3. Finally, among the six constituents analyzed, black carbon appears to be the most important component associated with the association between PM2.5 exposure and the three osteoarthritis-related outcomes.
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Osteoartritis , Material Particulado , Humanos , Osteoartritis/epidemiología , Estudios Prospectivos , Contaminación del Aire , Masculino , Contaminantes Atmosféricos , Femenino , Exposición a Riesgos Ambientales , Persona de Mediana Edad , Factores de Riesgo , Beijing/epidemiología , AncianoRESUMEN
BACKGROUND AND AIMS: This study aims to investigate the association of Chinese visceral adiposity index (CVAI) with incident hyperuricemia (HUA). METHODS AND RESULTS: We included 5186 adults aged ≥45 years from China Health and Retirement Longitudinal Study. Modified Poisson regression model was used to estimate the relative risks (RRs) of incident HUA associated with baseline CVAI, and logistic model was used to estimate the odds ratios (ORs) of HUA for CVAI change. Restricted cubic splines analysis was adopted to model the dose-response associations. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the predictive value of CVAI. During 4-year follow-up, a total of 510 (9.8%) HUA cases were identified. The RRs (95%CIs) of incident HUA were 3.75 (2.85-4.93) for quartile 4 versus quartile 1 and 1.56 (1.45-1.69) for per-standard deviation increase in baseline CVAI. For the analyses of CVAI change, compared with stable group, participants in decreased group had 34% lower risk (OR 0.66, 95%CI 0.49-0.87) and those in increased group had 35% (1.35, 1.03-1.78) higher risk of HUA. Linear associations of baseline CVAI and its change with HUA were observed (Pnonlinear >0.05). Besides, the AUC value for HUA was 0.654 (0.629-0.679), which was higher than other five obesity indices. CONCLUSIONS: Our study found linear associations between baseline CVAI and its change and risk of HUA. CVAI had the best predictive performance in predicting incident HUA. These findings suggest CVAI as a reliable obesity index to identify individuals with higher HUA risk.
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OBJECTIVES: To determine the frequency of symptoms meeting Rome IV functional bowel disorder (FBD) in patients with ankylosing spondylitis (AS), investigate factors associated with FBD symptoms, and assess whether having FBD symptoms might influence AS disease activity. METHODS: In this cross-sectional study, we enrolled 153 AS patients without known colonic ulcers and 56 sex- and age-matched controls to evaluate FBD (or its subtypes) symptoms. Disease characteristics were also evaluated in the AS group. RESULTS: Sixty (39.2%) of 153 AS patients had FBD symptoms, which were more prevalent than controls (23.2%). Besides, symptoms compatible with irritable bowel syndrome (IBS) and chronic diarrhoea were detected in 18 and 43 AS patients, respectively. For the AS group, multivariable logistic regression analyses showed that symptoms of FBD, IBS, and chronic diarrhoea were negatively associated with using non-steroidal anti-inflammatory drugs and positively associated with comorbid fibromyalgia, respectively. In exploration about the effects of FBD (or its subtypes) symptoms on AS disease activity by multivariable linear regression analyses, FBD symptoms and chronic diarrhoea had universal positive associations with assessments of AS disease characteristics, respectively. CONCLUSIONS: Patients with AS had frequent symptoms compatible with FBD, IBS, and chronic diarrhoea, proportions of which were lower in those with non-steroidal anti-inflammatory drug use. The improvement of FBD symptoms and chronic diarrhoea might be conducive to the disease status of AS patients.
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Enfermedades Gastrointestinales , Síndrome del Colon Irritable , Espondilitis Anquilosante , Humanos , Síndrome del Colon Irritable/complicaciones , Síndrome del Colon Irritable/diagnóstico , Estudios Transversales , Ciudad de Roma , Espondilitis Anquilosante/complicaciones , Enfermedades Gastrointestinales/diagnóstico , Diarrea/complicaciones , Antiinflamatorios no Esteroideos/uso terapéutico , Encuestas y CuestionariosRESUMEN
BACKGROUND: To measure volumetric bone mineral density (vBMD) with quantitative computed tomography (QCT) in the proximal femur of ankylosing spondylitis (AS) patients with hip involvement and analyze their correlations with radiographic and clinical parameters. METHODS: Sixty-five AS inpatients were enrolled in this study. The bone mineral density was measured by QCT and dual-energy x-ray absorptiometry (DXA), respectively. The morphological parameters of the proximal femur were measured on digital anteroposterior (AP) radiographs of the pelvis. The correlations between them were analyzed by SPSS software. RESULTS: The average trabecular vBMD measured at the femoral neck was 136.38 ± 25.58 mg/cm3. According to the BASRI-Hip score, group A consisted of 39 hips (0-2 score) and group B consisted of 26 hips (3-4 score). There were significant differences regarding trabecular CTXA equivalent T-score between group A and B at the femoral neck (p = 0.004); intertrochanteric region (p < 0.001) and greater trochanter (p = 0.001). The trabecular CTXA equivalent T-score at femoral neck had a negative correlation with disease duration (r = - 0.311, p = 0.012) and with CBR (r = - 0.319, p = 0.010). CONCLUSIONS: The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. Meanwhile, it had a correlation with hip function status although we failed to confirm a significant relationship between hip vBMD and disease activity.
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Densidad Ósea , Espondilitis Anquilosante , Absorciometría de Fotón , Fémur/diagnóstico por imagen , Cuello Femoral , Humanos , Espondilitis Anquilosante/diagnóstico por imagenRESUMEN
BACKGROUND Limited clinical data are available on bone loss in ankylosing spondylitis (AS) patients with hip involvement, especially for bone strength. The purpose of this study was to analyze bone strength and bone turnover markers in AS patients with hip involvement. MATERIAL AND METHODS The stiffness index (SI) calculated by quantitative ultrasound (QUS) was used to compare the bone strength between patients with AS with radiographic hip involvement (RHI-AS, BASRI-hip ≥2) and those without radiographic hip involvement (WORHI-AS, BASRI-hip ≤1). The Spearman correlation test was used to evaluate the association between SI and bone turnover markers [TP1NP, OC, ß-CTx, 25(OH)VD3, and PTH]. RESULTS RHI-AS (BASRI-hip ≥2) patients accounted for 52.2% (177/339) of all patients. There was no significant difference in most of the basic clinical features between RHI-AS and WORHI-AS patients, except for age and BMI. After adjusting for confounding factors (age and BMI), the stiffness index (SI) of RHI-AS patients was significantly lower than that of WORHI-AS patients (ORadj=0.982, 95% CIadj=0.968~0.997, Padj=0.017). The Z scores calculated by SI were lower in RHI-AS patients (ORadj=0.802, 95% CIadj=0.679~0.949, Padj=0.01). Among the 5 bone turnover markers in the RHI-AS patients, only 25(OH)VD3 had a correlation with SI (rho=0.279, P=0.001). CONCLUSIONS AS patients have lower bone strength once the disease progresses to include radiologic hip involvement. Treatment of vitamin D deficiency may be an effective way to improve bone strength in AS patients with hip involvement.
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Remodelación Ósea/fisiología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Radiografía/métodos , Espondilitis Anquilosante/fisiopatología , Adulto , Beijing , Densidad Ósea/fisiología , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: To systematically review the effects of Tai Chi exercise as a nonpharmacological therapeutic strategy on the physical and mental health in individuals with knee osteoarthritis. DATA SOURCES: A systematic literature retrieval has been conducted in PubMed, Web of Science, EMbase, CENTRAL, OVID, CINAHL, Physiotherapy Evidence Database, Chinese Biomedical Database and China National Knowledge Infrastructure up to June 2020 to identify the relevant randomised controlled trials (RCTs). METHODS: Two authors assessed independently the risk of bias using the Cochrane Collaboration's tool. Standardised mean difference (SMD) and 95% CI were calculated and data were combined using the fixed or random-effect model. The strength of evidence was rated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: A total of 16 RCTs involving 986 patients with knee osteoarthritis met the established inclusion criteria. The strength of evidence for the main outcomes was low or moderate. The systematic review illustrated the efficacy of Tai Chi exercise in treating and managing knee osteoarthritis. Patients' outcomes practising Tai Chi exercise were improved significantly, including pain (SMD = â0.69, 95%CI: â0.95 to â0.44, P < 0.001), stiffness (SMD = â0.59, 95%CI: â0.91 to â0.27, P < 0.001), physical function (SMD = â0.92, 95%CI: -1.16 to â0.69, P < 0.001), dynamic balance (SMD = 0.69, 95%CI: 0.38 to 0.99, P < 0.001), physiological and psychological health (SF-36 PCS: SMD = 0.48, 95%CI: 0.28 to 0.68, P < 0.001; SF-36 MCS: SMD = 0.26, 95%CI: 0.06 to 0.45, P = 0.01). No adverse events associated with Tai Chi exercise were reported. CONCLUSION: Tai Chi exercise was beneficial for ameliorating physical and mental health of patients with knee osteoarthritis and should be available as an alternative non-pharmacological therapy in rehabilitation programmes.
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Osteoartritis de la Rodilla/rehabilitación , Taichi Chuan , Ejercicio Físico , Humanos , Salud Mental , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/psicologíaRESUMEN
BACKGROUND: This study aimed to test the reliability and validity of the Hip Inflammation MRI Scoring System (HIMRISS) in assessing hip involvement of AS patients with AS at different stages of the bath ankylosing spondylitis radiology index (BASRI-hip) scoring system. METHODS: Fifty-two outpatients with ankylosing spondylitis (AS) were included in this study. The subjects' data includes demographics, clinical characteristics, disease activity score, and functional index. Based on the Harris hip scoring (HHS) of involved hip and BASRI-hip score, we devided these patients into no hip involvement group((HHS ≥ 80 and BASRI ≤ 1) (Group A), mild hip involvement subgroup (BASRI = 2 or BASRI ≤ 1 and HHS ≤ 79) (Group B), and moderate to advanced hip involvement subgroup (BASRI ≥ 3) (Group C). Data was analyzed statistically by SPSS software. RESULTS: In total of 44 patients (88 hips), group A consisted of 21 hips, group B consisted of 42 hips and group C consisted of 25 hips. The test-retest intraclass correlation coefficients (ICCs) in four raters were 0.955 ~ 0.977 and interrater ICC was 0.993. HIMRISS correlated moderately with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (r = 0.540, p < 0.001), the Bath ankylosing spondylitis functional index (BASFI) (r = 0.540, p < 0.001), the Bath Ankylosing Spondylitis Functional Index (BASFI) (r = 0.581, p < 0.001), ASDAS-ESR (r = 0.604, p < 0.001), and Ankylosing Spondylitis Disease Activity Score (ASDAS)-C reactive protein (CRP) (r = 0.575, p < 0.001). HIMRISS in groups B and C was significantly higher than that in group A: 29.38 (17.00, 40.94) vs. 14.50 (11.38, 22.25), p = 0.009; 38 (31.13, 64.38) vs 14.50 (11.38, 22.25), p < 0.001. CONCLUSIONS: HIMRISS applied to patients with AS demonstrated a satisfactory reliability, meaning it is a reliable quantitive assessment tool for evaluating early hip involvement in patients with AS.
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Espondilitis Anquilosante , Humanos , Inflamación , Imagen por Resonancia Magnética , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/diagnóstico por imagenRESUMEN
BACKGROUND The aim of this study was to investigate the effects of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) on patients with ankylosing spondylitis (AS) using real-world data, and to analyze patients' choices of csDMARDs and reasons for discontinuation. MATERIAL AND METHODS This observational study included 320 patients satisfying the modified New York criteria for AS. Patients were grouped according to medication: Group 1: 122 patients receiving non-steroidal anti-inflammatory drug (NSAID) monotherapy; Group 2: 198 patients receiving csDMARDs and NSAIDs. Patients were followed for 18 months at 6-month intervals. The change in AS Disease Activity Score and C-reactive protein (ASDAS-CRP) at each visit was the primary outcome. Secondary outcomes were based on validated disease activity questionnaires, clinical assessment, and acute-phase biomarkers (CRP and erythrocyte sedimentation rate [ESR]). Inter-group relationships were assessed across the 18-month follow-up period using generalized additive mixed models. RESULTS Sulfasalazine and thalidomide were the most commonly used csDMARDs, with cumulative use times of 8.9±4.1 months and 9.1±4.7 months, respectively. In Group 2, 56 patients discontinued or switched csDMARDs during the follow-up period, with lack of efficacy being the primary reason. The ASDAS-CRP was found to decrease significantly in both groups; however, improvements in many parameters (including ASDAS-CRP, disease activity questionnaires and ESR) were greater in Group 2. CONCLUSIONS Use of csDMARDs can improve disease activity in terms of ASDAS-CRP. The addition of csDMARDs may provide increased benefits compared with NSAID monotherapy, particularly in the reduction of AS disease activity, in the Chinese population.
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Antirreumáticos/uso terapéutico , Espondilitis Anquilosante/tratamiento farmacológico , Adulto , Biomarcadores/sangre , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , China/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/metabolismo , Sulfasalazina/uso terapéutico , Encuestas y Cuestionarios , Talidomida/uso terapéutico , Resultado del TratamientoRESUMEN
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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Radiología , Espondilitis Anquilosante , Humanos , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/diagnóstico por imagen , Diagnóstico Tardío , Sacro , RadiografíaRESUMEN
OBJECTIVES: A subset of gout patients developed persistent joint pain after flares. Analysis of this clinical phenomenon may shed further light on the factors related to worsening gout and even provide clues to its pathogenesis. METHODS: We analyzed the clinical, laboratory, and ultrasound data of gout patients to explore the associations of these data with persistent joint pain after gout flares. RESULTS: A total of 1029 gout patients were included: 182 (17.7%) patients with persistent joint pain and 847 (82.3%) patients with nonpersistent joint pain. Patients with persistent joint pain had more total involved joints, more gout flares in the past year, and more joints with simultaneous gout flares (P<0.01). Among the ultrasound-detected lesions, patients with persistent joint pain had a higher incidence of tophus (36.4% vs. 21.1%) and bone erosion (18.6% vs. 8.6%) (P<0.05). Higher UA and lower TBil were found in patients with persistent joint pain (P<0.001). Hypertension (54.9% vs. 38.7%) and metabolic syndrome (58.8% vs. 46.4%) were both more frequent in patients with persistent joint pain (P<0.05). TBil was negatively correlated with the incidence of persistent joint pain (P<0.001, r=-0.190), UA values (P<0.001, r=-0.125), and metabolic syndrome scores (P<0.001, r=-0.192). A correlation curve was fitted using LOESS (locally weighted region). CONCLUSION: Persistent joint pain after gout flares is a marker of increased disease burden in gout. The significance of the level of total bilirubin for the exacerbation of gout deserves further study.
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Artralgia , Gota , Brote de los Síntomas , Humanos , Gota/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Artralgia/etiología , Anciano , Adulto , Estudios Retrospectivos , UltrasonografíaRESUMEN
Hip involvement in ankylosing spondylitis (AS) is associated with severe functional impairment, and early diagnosis can improve the disease prognosis. We investigated gluteal muscle cross-sectional area (CSA) and radiodensity at different stages of hip involvement and their associations with AS-related clinical and laboratory parameters. This cross-sectional study included 83 patients with AS and 83 age- and sex-matched controls. Patients with AS were divided into three groups according to the Bath Ankylosing Spondylitis Radiology Hip Index system. The CSA and radiodensity of the gluteus maximus, medius, and minimus muscles were measured using computed tomography images. Muscle parameters were compared, and their relationships with clinical and laboratory parameters were evaluated. For the gluteus maximus, patients with AS had a lower CSA than controls, regardless of the degree of hip involvement. For the gluteus medius and minimus, patients with moderate/advanced hip involvement had significantly lower CSA and radiodensity than those with mild to no hip involvement. The severity of hip involvement was negatively associated with muscle parameters. CSA of the gluteus maximus decreased in early-stage hip involvement without any changes in radiographs, while radiodensity decreased in the later stages. Muscle parameters on computed tomography may be a more sensitive indicator than radiographic findings.
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BACKGROUND: The transfusion rate is relatively high in patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA). However, relevant studies focusing on the predisposing factors for transfusion with a large sample size are lacking. This study aimed to investigate the incidence of and risk factors for allogeneic blood transfusion in patients with AS undergoing primary unilateral THA. METHODS: This retrospective study included 331 patients with AS who underwent primary unilateral THA between 2011 and 2021. Relevant parameters were collected through a chart review. Multivariate logistic regression analysis was conducted to identify possible factors associated with perioperative allogeneic blood transfusion. RESULTS: A total of 113 (34.1%) patients received perioperative allogeneic blood transfusions. Factors related to receiving an allogeneic blood transfusion included prolonged operative duration (odds ratio [OR] per 10 min = 1.139, P = 0.047), increased estimated intraoperative blood loss (OR per 100 mL = 1.348, P < 0.001), and increased postoperative drainage volume (OR per 100 mL = 1.235, P = 0.024). A higher body mass index (BMI) (OR = 0.914, P = 0.012), perioperative tranexamic acid (TXA) use (OR = 0.166, P < 0.001), and a higher preoperative hemoglobin level (OR per 1 g/dL = 0.744, P = 0.004) decreased the risk of transfusion. CONCLUSIONS: In patients with AS undergoing THA, prolonged operative duration, increased estimated intraoperative blood loss, and increased postoperative drainage volume were found to be risk factors for transfusion, whereas a higher BMI, perioperative TXA use, and a higher preoperative hemoglobin level were protective factors. These results may aid in developing a better perioperative management strategy, ultimately reducing the need for transfusion.
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Antifibrinolíticos , Artroplastia de Reemplazo de Cadera , Trasplante de Células Madre Hematopoyéticas , Espondilitis Anquilosante , Ácido Tranexámico , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Estudios Retrospectivos , Pérdida de Sangre Quirúrgica , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/cirugía , Transfusión Sanguínea , Factores de Riesgo , HemoglobinasRESUMEN
Previous studies have suggested that gamma-delta T cells play an important role in the pathogenesis of ankylosing spondylitis (AS). In this pilot study, the peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS) and healthy volunteers were stained and analyzed by flow cytometry to distinguish gamma-delta T cells and its subtypes, and then to report the distribution of gamma-delta T cells and iyts subtypes and their correlation with ankylosing spondylitis. A total of 17 patients with active AS and 10 age- and gender- matched healthy volunteers were enrolled in this study, and their peripheral blood were drawn to collect mononuclear cells (PBMCs). Flow cytometry was used to analyze gamma-delta T cell subpopulations by measuring the surface and intracellular expressions of phenotypic markers. Serum levels of inflammatory and bone turnover markers were measured, and their correlations with subpopulations of gamma-delta T cells were evaluated. In patients with AS, the Vdelta2 fractions within gamma-delta T cells and CD3+ T cells decreased significantly, in particular, the proportions of CD27+ Vdelta2 T cells, CD86+CD80+ Vdelta1 T cells, and IL17A-secreting and TNFalpha-secreting Vdelta1 T cells within the parental cells decreased significantly. gamma-delta T cells/PBMCs, Vdelta2 cells/gamma-delta T cells, and Vdelta2 cells/CD3+ T cells were negatively correlated with CRP, whereas Vdelta1 cells/CD3+ T cells were negatively correlated with ESR. Vdelta1 cells/gamma-delta T cells were positively correlated with CRP, gamma-deltaT cells/PBMCs were positively correlated with beta-CTx, CD69+CD25+ and IL-17A-secreting Vdelta1 cells were positively correlated with TP1NP, and CD69+CD25+ Vdelta1 and Vdelta2 cells were positively correlated with osteocalcin. Decreases in peripheral Vdelta2, CD27+ Vdelta2, CD86+CD80+ Vdelta1, and IL17A or TNFalpha-secreting Vdelta1 T cells are associated with AS. The correlations between gamma-delta T cell subpopulations and CRP and the CD69+CD25+ subpopulation with TP1NP or osteocalcin suggest that an imbalance in peripheral gamma-delta T cell subpopulations contributes to the pathogenesis of AS.
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Espondilitis Anquilosante , Humanos , Proyectos Piloto , Citometría de Flujo , Espondilitis Anquilosante/diagnóstico , Leucocitos Mononucleares , Factor de Necrosis Tumoral alfa , OsteocalcinaRESUMEN
Objective: Acupuncture has been used by rehabilitation specialists as an adjunctive treatment for the symptomatic treatment of rheumatoid arthritis (RA). This meta-analysis aims to evaluate the efficacy of acupuncture in treating patients with RA. Methods: A comprehensive search was conducted in CBM, CNKI, PubMed, CENTRAL, Web of Science, and Embase from their inception up to March 2022. All randomized controlled trials (RCTs) without the language restriction, concerning the patients with RA treated with acupuncture, were included. Two reviewers independently assessed the risk of bias with the Cochrane Risk of Bias Assessment tool. Weight mean difference (MD) and 95% CI were calculated, and data were pooled with random effects model. Results: A total of eleven RCTs involving 796 patients with RA met the established inclusion criteria. This systematic review indicated the efficacy of acupuncture as an adjunctive treatment for patients with RA. Invasive acupuncture could reduce significantly in pain (MD = -1.00, 95% CI: -1.96 to -0.05, P=0.040), health assessment questionnaire (HAQ, MD = -0.20, 95% CI: -0.30 to -0.11, P < 0.001), physician global assessment (PhGA, MD = -0.98, 95% CI: -1.23 to -0.72, P < 0.001), tender joint count (TJC, MD = -1.24, 95% CI: -2.11 to -0.37, P=0.005), C-reactive protein (CRP, MD = -1.81, 95% CI: -3.32 to -0.29, P=0.019), and erythrocyte sedimentation rate (ESR, MD = -3.03, 95% CI: -5.80 to -0.26, P=0.032), while compared to control group. Laser acupuncture could reduce HAQ (MD = -0.15, 95% CI: -0.28 to -0.01, P=0.034), the RA quality of life questionnaire (RAQoL, MD = -2.32, 95% CI: -4.40 to -0.25, P=0.028), CRP (MD = -35.24, 95% CI: -36.49 to -33.99, P < 0.001), and interleukin-6 (IL-6, MD = -29.63, 95% CI: -49.34 to -9.92, P=0.003), while compared to control group. No adverse events associated with acupuncture were reported. Conclusion: Available evidence suggests that acupuncture is beneficial for relieving pain and ameliorating quality of life and health index in patients with RA; thereby, it should be available as an adjunctive nonpharmacological treatment in rehabilitation programmes.
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INTRODUCTION: Studies on adherence to exercise therapy of patients with ankylosing spondylitis (AS) are rare, and the criteria for adherence to exercise are inconsistent. This study aimed to quantify patient-reported adherence to exercise therapy of Chinese outpatients with AS and investigate the factors related to poor adherence. METHODS: The subjects' sociodemographic, disease-related, radiographic, and laboratory parameters were collected. Patients' adherence to exercise therapy was assessed using the Exercise Attitude Questionnaire (EAQ) with a 4-point Likert scale. All cases were grouped as good adherence and poor adherence using a cutoff score of 60, according to a previous study. Univariate analysis was conducted to assess the intergroup differences. Then, we built a multivariate logistic regression model to identify possible significant factors related to poor adherence to exercise therapy. RESULTS: A total of 185 outpatients completed the questionnaire. The mean EAQ score was 49.4 (IQR, 40.7-59.3) and 146 patients (78.9%) were considered to have poor adherence, and 39 patients (21.1%) were considered to have good adherence. The rates of current nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor-α inhibitor (TNF-i) use were significantly higher in the poor adherence group (p=0.001, p=0.027, p=0.018, respectively). Our multivariate logistic regression model revealed that the only significant associated factor was current use of NSAIDs (OR=3.517; p=0.016; 95% CI, 1.259-9.827). CONCLUSIONS: Outpatients with AS had an unacceptable level of adherence to exercise therapy, and current use of NSAIDs was a significantly associated factor. Key Points ⢠Outpatients with AS had an unacceptable level of adherence to exercise therapy. ⢠Current use of NSAIDs exerted a negative impact on patients' adherence to exercise therapy.
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Antirreumáticos , Cooperación del Paciente , Espondilitis Anquilosante , Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Ejercicio Físico , Humanos , Cooperación del Paciente/estadística & datos numéricos , Espondilitis Anquilosante/tratamiento farmacológicoRESUMEN
Objective: To assess the midterm follow-up outcomes of total hip arthroplasty (THA) for the treatment of patients with juvenile-onset ankylosing spondylitis (JAS). Methods: The clinical data of 81 patients (127 hips) with JAS (age≤16 years, JAS group) and 267 patients (391 hips) with adult onset ankylosing spondylitis (AAS) (age>16 years, AAS group) between January 2004 and March 2018 were retrospectively analysed. The baseline demographics, clinical, radiographic, and laboratory parameters were collected. Before operation and at last follow-up, the overall disease activity [Bath ankylosing spondylitis disease activity index (BASDAI)] and function status [Bath ankylosing spondylitis functional index (BASFI)], hip subjective score [Harris hip score (HHS)] and objective score [12-item short form health survey (SF-12), including physical component score (PCS) and mental component score (MCS)], and patient satisfaction for THA were reviewed. The major orthopedic complications, including periprosthetic infection, dislocation, periprosthetic fractures, and poor incision healing, were also recorded during the follow-up period. Results: The comparison of preoperative baseline parameters showed that the body mass, body mass index, age of onset, age of surgery, disease duration, and the proportion of combined smoking history in the JAS group were significantly lower than those in the AAS group ( P<0.05), the proportion of bilateral surgeries, proportion of uveitis, proportion of combined family history, C-reactive protein, albumin, and preoperative BASFI were significantly higher than those in the AAS group ( P<0.05). Both groups were followed up. The follow-up time in the JAS group was 29-199 months, with an average of 113 months; in the AAS group was 35-199 months, with an average of 98 months. Incisions in both groups healed by first intention. During the follow-up period, there were 1 case of periprosthetic fracture, 1 case of dislocation, and 1 case of ceramic fragmentation in the JAS group, 1 case of periprosthetic infection and 6 cases of periprosthetic fracture in the AAS group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At last follow-up, the BASDAI, BASFI, SF-12 MCS, SF-12 PCS, and HHS score of the two groups were significantly improved when compared with those before operation ( P<0.05); but there was no significan difference in the difference of the above parameters before and after operation and the patient satisfaction between the two groups ( P>0.05). Conclusion: The midterm follow-up outcomes of THA for the treatment of JAS patients were reliable. A low age at disease onset did not exert a significant negative effect on THA reconstruction for the treatment of ankylosing spondylitis.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Luxaciones Articulares , Fracturas Periprotésicas , Espondilitis Anquilosante , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Seguimiento , Articulación de la Cadera/cirugía , Humanos , Luxaciones Articulares/cirugía , Fracturas Periprotésicas/cirugía , Estudios Retrospectivos , Espondilitis Anquilosante/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs). METHODS: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto odds ratio (OR) for infections in biologics-treated patients vs. placebo patients. The risk of bias on the included RCTs was assessed by using the Cochrane Risk of Bias Tool. RESULTS: In total, 62 studies were included in this meta-analysis. Overall, the risk of infection (Peto OR: 1.16, 95% confidence interval [CI]: 1.07-1.26, Pâ<â0.001), serious infection (Peto OR: 1.65, 95% CI: 1.26-2.17, Pâ<â0.001), upper respiratory tract infection (URTI) (Peto OR: 1.17, 95% CI: 1.04-1.32, Pâ=â0.008), nasopharyngitis (Peto OR: 1.25, 95% CI: 1.10-1.42, Pâ<â0.001), and Candida infection (Peto OR: 2.64, 95% CI: 1.48-4.71, Pâ =â0.001) were increased in SpA patients treated with biologics compared with placebo. Sensitivity analysis based on biologics classes was conducted, and results demonstrated that compared with placebo, there was a higher risk of infection for tumor necrosis factor (TNF)-a inhibitors (Peto OR: 1.38, 95% CI: 1.13-1.68, Pâ =â0.001) and interleukin (IL)-17 inhibitors (Peto OR: 1.55, 95% CI: 1.08-2.22, Pâ =â0.018) in axial SpA, and for Janus kinase inhibitors in peripheral SpA (Peto OR: 1.39, 95% CI: 1.14-1.69, Pâ =â0.001); higher risk of serious infection for IL-17 inhibitors in peripheral SpA (Peto OR: 3.46, 95% CI: 1.26-9.55, Pâ=â0.016) and axial SpA (Peto OR: 2.01, 95% CI: 1.38-2.91, Pâ<â0.001); higher risk of URTI for TNF-a inhibitors in axial SpA (Peto OR: 1.37, 95% CI: 1.05-1.78, Pâ=â0.019), and for apremilast in peripheral SpA (Peto OR: 1.60, 95% CI: 1.08-2.36, Pâ=â0.018); higher risk of nasopharyngitis for TNF-a inhibitors in axial SpA (Peto OR: 1.41, 95% CI: 1.05-1.90, Pâ=â0.022) and peripheral SpA (Peto OR: 1.49, 95% CI: 1.09-2.05, Pâ=â0.013), and for IL-17 inhibitors in axial SpA (Peto OR: 1.35, 95% CI: 1.01-1.82, Pâ=â0.044); higher risk of herpes zoster for Janus kinase inhibitors in peripheral SpA (Peto OR: 2.18, 95% CI: 1.03-4.62, Pâ=â0.043); higher risk of Candida infection for IL-17 inhibitors in peripheral SpA (Peto OR: 2.52, 95% CI: 1.31-4.84, Pâ=â0.006). CONCLUSIONS: This meta-analysis shows that biological therapy in patients with SpA may increase the risk of infections, including serious infections, URTI, nasopharyngitis, and Candida infection, which should be paid attention to in our clinical practice.
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Productos Biológicos , Candidiasis , Inhibidores de las Cinasas Janus , Nasofaringitis , Espondiloartritis , Productos Biológicos/uso terapéutico , Humanos , Interleucina-17 , Nasofaringitis/inducido químicamente , Nasofaringitis/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Espondiloartritis/inducido químicamente , Espondiloartritis/tratamiento farmacológico , Factor de Necrosis Tumoral alfaRESUMEN
BACKGROUND: Concerns exist regarding the potential development of tuberculosis in patients with rheumatoid arthritis (RA) treated with biological and targeted drugs. We assessed systematically whether biological therapy increased the risk of tuberculosis in patients with RA by meta-analysis of randomized controlled trials (RCTs). METHODS: A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, and China Biology Medicine disc for RCTs evaluating biological therapy in patients with RA from inception through August 2021. Traditional meta-analysis and network meta-analysis were performed to compare the risk of tuberculosis for each biologics class in patients with RA. Peto odds ratio (Peto OR) and its 95% confidence interval (CI) were calculated as the primary effect measure. RESULTS: In total, 39 studies with 20,354 patients were included in this meta-analysis, and 82 patients developed tuberculosis. The risk of tuberculosis was increased in patients treated with biologics compared with non-biologics (Peto OR: 3.86, 95% CI: 2.36-6.32, Pâ<â0.001). Also, tumor necrosis factor-α (TNF-α) inhibitors had a higher probability of developing tuberculosis than placebo (Peto OR: 3.98, 95% CI: 2.30-6.88, Pâ<â0.001). However, network meta-analysis demonstrated that there was no significant difference in the risk of tuberculosis for each biologics class in patients with RA. Noticeably, tuberculosis was significantly more common in patients treated with a high dose compared with patients receiving a low dose of tofacitinib (Peto OR: 7.39, 95% CI: 2.00-27.31, Pâ=â0.003). CONCLUSION: This meta-analysis demonstrates the evidence of an elevated risk of tuberculosis in patients with RA treated with TNF-α inhibitors, and a dose-dependent elevated risk of tuberculosis in patients treated with tofacitinib.
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Antirreumáticos , Artritis Reumatoide , Preparaciones Farmacéuticas , Tuberculosis , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Tuberculosis/tratamiento farmacológicoRESUMEN
INTRODUCTION: The relationship between tophaceous gout and metabolic markers is not well understood. The aim of this study was to compare the correlations between different metabolic markers and tophi and evaluate their potential predictive values for tophus. METHOD: We analysed the data of gout patients in Beijing Jishuitan Hospital from 2013 to 2020. Ten laboratory indicators (UA, eGFR, underexcretion, GLU, TRIG, HDL-C, ALT, TBIL, γ-GT and UPH) were included to evaluate the relationship between tophaceous gout and metabolic markers. RESULTS: Tophi was present in 14.7% (119/808) of gout patients. UA, eGFR, ALT and γ-GT were independently related to the development of tophi; UA and γ-GT were positively correlated. The γ-GT/ALT ratio and UA/eGFR ratio showed a positive correlation with tophi, with (rho, P) of (0.305, < 0.001) and (0.195, < 0.001), respectively. The γ-GT/ALT ratio showed the best classificatory performance (AUC = 0.749, P < 0.001) for tophi among the four positive correlation indicators. With increasing integer γ-GT/ALT ratio, the incidence of tophi (4.9%, 9.7%, 22.3% and 38.4%, P < 0.001), chronic kidney disease (2.5%, 5.2%, 12.3% and 19.2%, P < 0.001) and hyperuricemia over 10 years (6.6%, 10.7%, 18.5% and 26.4%, P < 0.001) showed a progressive increase. The γ-GT/ALT ratio was positively correlated with the number of tophi and duration of hyperuricemia, negatively correlated with eGFR. CONCLUSIONS: UA, eGFR, γ-GT and ALT were independently associated with tophi. The γ-GT/ALT ratio may be used as a predictor or monitor of tophi.
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Gota , Hiperuricemia , Tasa de Filtración Glomerular , Gota/complicaciones , Humanos , Ácido ÚricoRESUMEN
Objective: Concerns exist regarding the potential development of malignancy and tuberculosis in patients with spondyloarthritis (SpA) treated with biologics. We assessed the extent to which biologic therapy may increase the risk of malignancy and tuberculosis in patients with SpA by meta-analysis to derive estimates of sparse harmful events occurring in Randomized Controlled Trials (RCTs). Methods: A systematic literature search was conducted in PubMed, EMbase, Web of Science, the Cochrane Library, and China Biology Medicine disc for RCTs evaluating the risk of sparse harmful events of biologic therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto OR for malignancy and tuberculosis in biologics-treated patients vs. placebo patients. The risk of bias on the included RCTs was assessed by using Cochrane Risk of Bias tool. Results: In total, 63 studies were included in this meta-analysis, and 83 patients and 7 patients developed malignancy and tuberculosis, respectively. Overall, the risk of malignancy and tuberculosis was increased in SpA patients treated with biologics compared to placebo (malignancy: Peto OR: 2.49, 95%CI: 1.61-3.87, p < 0.001; tuberculosis: Peto OR: 5.98, 95%CI: 1.29-27.76, p = 0.022). Remarkably, compared to placebo, there was higher risk of malignancy for IL-17 inhibitors (Peto OR: 3.68, 95%CI: 1.20-11.30, p = 0.023) and small molecule targeted drugs (Peto OR: 3.08, 95%CI: 1.37-6.90, p = 0.043) in peripheral SpA, and for TNF receptor-Fc fusion protein in axial SpA (Peto OR: 7.18, 95%CI: 1.21-42.69, p = 0.030). Besides, the risk of tuberculosis was higher for anti-TNFα antibody in axial SpA (Peto OR: 6.17, 95%CI: 1.03-37.13, p = 0.046). Conclusion: This meta-analysis showed an elevated risk of malignancy in patients with peripheral SpA treated with biologics, especially for IL-17 inhibitors, and small molecule targeted drugs, a slightly increased risk of malignancy in TNF receptor-Fc fusion protein in axial SpA, and increased risk of tuberculosis in patients with axial SpA treated with anti-TNFα antibody. These findings need to be validated by studies with larger population and longer follow-up.