Bone mineral density improves during 2 years of treatment with bisphosphonates in patients with ankylosing spondylitis.

AIMS: To evaluate whether 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements has an effect on lumbar spine and hip bone mineral density (BMD) in ankylosing spondylitis (AS) patients starting tumour necrosis factor-α inhibitors or receiving conventional treatment. Secondly, to explore the development of radiographic vertebral fractures. METHODS: Patients from the Groningen Leeuwarden AS cohort receiving bisphosphonates based on clinical indication and available 2-year follow-up BMD measurements were included. BMD of lumbar spine (L1-L4) and hip (total proximal femur) were measured using dual-energy X-ray absorptiometry. Spinal radiographs (Th4-L4) were scored for vertebral fractures according to the Genant method. RESULTS: In the 20 included patients (median 52 years, 14 males), lumbar spine and hip BMD Z-scores increased significantly; median from -1.5 (interquartile range [IQR] -2.2 to 0.4) to 0.1 (IQR -1.5 to 1.0); P < .001 and median from -1.0 (IQR -1.6 to -0.7) to -0.8 (IQR -1.2 to 0.0); P = .006 over 2 years, respectively. In patients also treated with tumour necrosis factor-α inhibitors (n = 11), lumbar spine and hip BMD increased significantly (median 2-year change +8.6% [IQR 2.4 to 19.6; P = .009] and +3.6% [IQR 0.7-9.0; P = .007]). In patients on conventional treatment (n = 9), lumbar spine BMD increased significantly (median 2-year change +3.6%; IQR 0.7 to 9.0; P = .011) and no improvement was seen in hip BMD (median -0.6%; IQR -3.1 to 5.1; P = .61). Overall, younger AS males with limited spinal radiographic damage showed most improvement in lumbar spine BMD. Four mild radiographic vertebral fractures developed in 3 patients and 1 fracture increased from mild to moderate over 2 years in postmenopausal women and middle-aged men. CONCLUSION: This explorative observational cohort study in AS showed that 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements significantly improves lumbar spine BMD. Mild radiographic vertebral fractures still occurred.

Randomized, Controlled Trial: Efficacy of Ultrasound and Exercise in Patients With Ankylosing Spondylitis.

CONTEXT: The aim in treating ankylosing spondylitis (AS) is to reduce patients' symptoms, including pain, stiffness, and fatigue; to correct their posture; and to improve their quality of life. Currently, no definitive therapy is available for treating AS. Previous studies have reported positive results regarding the efficacy of exercise. OBJECTIVE: This study aimed to assess the efficacy of ultrasound, combined with exercise, in patients with AS. DESIGN: The research team designed a randomized, double-blind, 2-arm parallel-group, placebo-controlled trial. SETTING: The study took place at the Affiliated Hongqi Hospital of Mudanjiang Medical University (Mudanjiang, China). PARTICIPANTS: Participants were 62 individuals with AS who were patients at the hospital. INTERVENTION: Participants were randomly assigned to one of 2 groups: (1) the intervention group, who received exercise and ultrasound therapy; or (2) the control group, who received exercise and placebo ultrasound therapy, without an active probe, both for 8 wk. OUTCOME MEASURES: The outcome measures included (1) the numerical rating scale (NRS), (2) the Bath ankylosing spondylitis metrology index (BASMI), (3) the Bath ankylosing spondylitis disease activity index (BASDAI), (4) the Bath ankylosing spondylitis functional index (BASFI), and (5) the ankylosing spondylitis quality of life (ASQoL) questionnaire. All outcomes were measured at baseline and at the end of 4 and 8 wk of treatment. RESULT: Fifty-seven patients fulfilled the requirements of the study. Ultrasound and exercise therapy showed greater efficacy than the placebo ultrasound and exercise in decreasing the scores for the NRS, daily and at night; the BASMI; the BASDAI; the BASFI; and the ASQoL, at the end of both 4 and 8 wk of treatment. No adverse events were noted in either group. CONCLUSIONS: The study demonstrated that 8 wk of ultrasound and exercise therapy was efficacious in patients with AS.

Uncommon case of ankylosing spondylitis associated with spontaneous occurring hypoparathyroidism.

Hypoparathyroidism and ankylosing spondylitis are two conditions with distinctive features which allow their differentiation. Hypoparathyroidism can be responsible for clinical and radiological changes resembling those seen in patients with ankylosing spondylitis. We report an exceptional case of a patient with an association between ankylosing spondylitis and a severe idiopathic hypoparathyroidism with difficulties in diagnosis. To our knowledge, this is the first case of such an occurrence.

[Rheumatological complications of dialysis]. / Les complications rhumatologiques des dialysés.

The articular complications observed in dialysed chronic renal failure failures, whose incidence increases with the duration of dialysis, are closely correlated with the development of beta 2-microglobulin amyloidosis, responsible for nerve tunnel syndromes, arthralgia and chronic joint swelling with frequently multiple subchondral cysts on x-rays. Microcrystalline pathology is dominated by apatite deposits, which may also be involved in the pathogenesis of destructive arthropathy. Articular complications with destruction of the large joints or involvement of the first carpometacarpal joint interfere with the functional prognosis. Sepsis must be excluded in cases of destructive cervical spondyloarthropathies. The pathogenesis of destructive arthropathies is probably multifactorial, consisting of apatite and amyloid deposits, secondary hyperparathyroidism and aluminium poisoning.

Atypical presentation of ankylosing spondylitis: a case study.

Ankylosing spondylitis (Marie Strumpell's disease) is a chronic inflammatory disease which principally affects the axial skeleton. The earliest radiographic sign in 90% of the patients with ankylosing spondylitis is a bilateral sacroiliitis. Up to 3% of the patients with ankylosing spondylitis will not present with the initial sacroiliitis. A case is reported of a patient with an atypical presentation. The patient's radiographic presentation consisted of syndesmophytosis without sacroiliac involvement. However, due to the patient's symptoms, radiographic appearance, and laboratory studies, the diagnosis of an atypical ankylosing spondylitis was chosen.

Ankylosing spondylitis: a review and clinical update.

A review of literature and a presentation of the clinical aspects of ankylosing spondylitis reveal the symptom complex demonstrated in the female may differ from the clinical picture of a male with ankylosing spondylitis. It is suggested in recent literature that the occurrence may be equally distributed among the sexes, however, the ratio of diagnosis male to female remains at approximately 10:1. In the interest of ruling out AS, range of motion testing of the lumbar and sacral articulations should be performed on all patients with either axial or peripheral joint pain. Any compromise of mobility should be noted. Testing for the antigen HLA B27 should not be considered an absolute diagnostic criteria. Final diagnosis may rest on clinical presentation and the presence of a radiographically demonstrable sacroilitis.

Radionuclide joint imaging in the seronegative spondyloarthropathies.

Radionuclide joint imaging (RJI) of the peripheral and axial skeleton is a recent advance in the detection of early articular inflammation and has proven useful in establishing the extent and pattern of this involvement. The bone-seeking agents--the radiophosphates--are the radiopharmaceuticals presently favored for RJI in adults. They are more sensitive than the clinical examination in detecting inflammatory joint disease in all peripheral joints with the exception of the shoulders, elbows and knees. Radiophosphate may also be used to evaluate the axial skeletion for inflammatory involvement. The sacroiliac joints may be evaluated by a new technique, quantitative saroiliac scintigraphy (QSS). Studies to date have demonstrated that QSS is most sensitive in early sacroiliitis, a time when conventional radiography is normal or shows equivocal abnormalities. While extremely sensitive as a screening procedure for inflammatory articular disease, RJI is nonspecific diagnostically. Radiophosphate uptake by bone occurs in metabolic bone disease, osteoarthritis, trauma and juxta-articular bony abnormalities such as osteomyelitis and bone infraction. The results obtained by radionuclide joint imaging must be supplemented by the clinical findings and conventional investigations to establish a specific diagnosis.