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1.
Pan Afr Med J ; 38: 49, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33854678

RESUMO

Haglund´s syndrome is characterized by osterosuperior calcaneal exostosis which irritates the Achilles tendon and manifests mainly as posterior talalgia. We here report the case of a 28-year-old woman on follow up for ankylosing spondylitis. Her mother was on follow up for the same systemic disease, and one of her maternal aunts had undergone surgery due to Haglund's syndrome. Patient's delay led to incorrect diagnosis as talagia was considered by physicians as a consequence of her system disease. The patient did not improve under medical treatment. Surgery outcome was satisfactory. This study raises a hypothesis about the genetic and hereditary character of Haglund's syndrome and its relationship with treatment response.


Assuntos
Calcâneo/patologia , Exostose/diagnóstico , Espondilite Anquilosante/complicações , Tendão do Calcâneo/patologia , Adulto , Calcâneo/cirurgia , Exostose/cirurgia , Feminino , Humanos , Síndrome
2.
J Int Med Res ; 49(4): 3000605211004201, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33823632

RESUMO

OBJECTIVES: The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects various clinical outcomes. This study examined the real-world situation of patients with AS during diagnosis and treatment. METHODS: Data were obtained from 26 tertiary care hospitals in Korea using a self-report questionnaire. The questionnaire assessed symptoms, pain, extra-articular manifestations, the initial pattern of pain before diagnosis, factors leading to delayed referral to rheumatology, time until receiving an AS diagnosis, comorbid diseases, treatment status, and disease education needs. RESULTS: Between September and October 2019, 1012 patients with AS completed the survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median disease duration was 76 months. The median time to diagnosis with AS was 12 months. When pain occurred, the medical departments most frequently visited first were orthopedic (61.5%) and rheumatology (18.7%) departments. The likelihood of the first visit being to the orthopedic department and the frequency of biologics use increased with the disease duration. The rates of uveitis, depressed mood, and comorbid diseases were higher in the group with delayed diagnosis. CONCLUSIONS: Physicians should be aware of subtypes of AS that take longer to diagnose and comorbid diseases in the real-world clinical setting.


Assuntos
Autorrelato , Espondilite Anquilosante , Adulto , Feminino , Humanos , Masculino , República da Coreia/epidemiologia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Inquéritos e Questionários
3.
Medicine (Baltimore) ; 100(15): e25179, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847616

RESUMO

BACKGROUND: Ankylosing spondylitis is a complex and progressive autoimmune inflammatory disease with a worldwide prevalence ranging up to 0.9%. Several systematic reviews and meta-analyses of traditional Chinese medicine alternative therapies, such as acupuncture or moxibustion, have demonstrated the effectiveness of moxibustion and acupuncture in the treatment of ankylosing spondylitis. However, there is no relevant literature to comprehensively evaluate the evidence. The purpose of this overview is to synthesize and evaluate the reliability of evidence generated in the systematic review (SR) and meta-analysis of moxibustion and acupuncture as a primary or complementary therapy for patients with ankylosing spondylitis. METHODS: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched for systematic reviews and meta-analysis that review the efficacy of acupuncture or moxibustion as the primary treatment for patients with Ankylosing Spondylitis. The literature published before August 2020 will be selected. Additionally, the relevant SRs and meta-analyses that unpublished or ongoing will be searched in PROSPERO and INPLASY. The methodological guidelines for overviews will be used to review and extract data by 2 reviewers, and their will do it independently. Methodology quality will be analyzed by the assessment of multiple systematic reviews-2and the risk of bias by POBIS. For the included studies, we will adopt the following results as primary evaluation indicators: effective rate, visual analogue scale and bath AS disease activity index. Reviewers will assess the certainty of evidence by Grading of Recommendations Assessment, Development and Evaluation. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: This overview will provide comprehensive evidence of moxibustion and acupuncture for patients with Ankylosing Spondylitis.


Assuntos
Terapia por Acupuntura/métodos , Espondilite Anquilosante/terapia , Terapia por Acupuntura/efeitos adversos , Humanos , Metanálise como Assunto , Moxibustão/efeitos adversos , Moxibustão/métodos , Medição da Dor , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
Medicine (Baltimore) ; 100(13): e25051, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787586

RESUMO

ABSTRACT: Coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the same patient is often thought to be rare, and thus misdiagnosis is common. The aim of our study was to describe the main characteristics of RA coexisting with AS in patients with delayed diagnoses and improve awareness of the disease association.Between 2012 and 2018, data from 22 patients who had RA and AS (RA/AS) were retrospectively reviewed. All patients had a history of delayed diagnosis for RA or AS. The clinical features and radiographic changes of RA and AS patients were obtained at baseline and after 2 years. Disease activity score 28 (DAS28) or bath ankylosing spondylitis disease activity index (BASDAI) were used as outcome measures. The mean age at the time of diagnosis of RA/AS was 51.8 years, while the mean duration of diagnostic delay was 5.5 years. Middle-aged women were the most common subgroup among the RA/AS cohort. The common clinical manifestations were systemic, symmetric, peripheral, and axial arthritis. The erythrocyte sedimentation rate and C-reactive protein levels in RA/AS patients were elevated at the time diagnosis of RA/AS. The typical radiologic changes for the 2 diseases coexisted in RA/AS patients. The DAS28 and BASDAI scores at the 2-year follow-up evaluation were lower than the initial assessment.Coexisting RA and AS is often misdiagnosed for many years; a lack of recognition of RA and AS together is one of the most common reasons. Systemic, symmetric, peripheral, and axial arthritis in middle-aged women were the most frequent presentations at onset.


Assuntos
Artrite Reumatoide/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Espondilite Anquilosante/diagnóstico , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
5.
Medicine (Baltimore) ; 100(6): e24279, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578524

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a common infammatory rheumatic disease that affects the axial skeleton. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for AS. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of 7 electronic databases by December 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for AS. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. RESULTS: This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of AS. CONCLUSION: This study will generate evidence for different TCM nonpharmacological therapies for AS and provide a decision-making reference for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/FHD2U.


Assuntos
Medicina Tradicional Chinesa/métodos , Medição da Dor/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Espondilite Anquilosante/terapia , China/epidemiologia , Gerenciamento de Dados , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Metanálise em Rede , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Espondilite Anquilosante/patologia , Espondilite Anquilosante/psicologia , Resultado do Tratamento
6.
BMJ ; 372: m4447, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397652

RESUMO

Axial spondyloarthritis (axSpA) is an inflammatory disease of the axial skeleton associated with significant pain and disability. Previously, the diagnosis of ankylosing spondylitis required advanced changes on plain radiographs of the sacroiliac joints. Classification criteria released in 2009, however, identified a subset of patients, under the age of 45, with back pain for more than three months in the absence of radiographic sacroiliitis who were classified as axSpA based on a positive magnetic resonance imaging or HLAB27 positivity and specific clinical features. This subgroup was labeled non-radiographic (nr)-axSpA. These patients, compared with those identified by the older New York criteria, contained a larger percentage of women and demonstrated less structural damage. However, their clinical manifestations and response to biologics were similar to radiographic axSpA. The discovery of the interleukin (IL) IL-23/IL-17 pathway revealed key molecules involved in the pathophysiology of axSpA. This discovery propelled the generation of antibodies directed toward IL-17A, which are highly effective and demonstrate treatment responses in axSpA that are similar to those observed with anti-TNF agents. The finding that agents that block IL-23 were not effective in axSpA came as a surprise and the potential underlying mechanisms underlying this lack of response are discussed. New agents with dual inhibition of the IL-17A and F isoforms and some oral small molecule agents that target the Jak-STAT pathway, have also shown efficacy in axSpA.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia , Terapia por Exercício/métodos , Antígeno HLA-B27/sangue , Humanos , Interleucina-17 , Interleucinas , Imagem por Ressonância Magnética , Espondilite Anquilosante/classificação , Espondilite Anquilosante/fisiopatologia
7.
Clin Exp Rheumatol ; 39(2): 242-252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33506749

RESUMO

OBJECTIVES: Magnetic resonance imaging (MRI) is currently the most accurate imaging tool used in axial spondyloarthritis regarding its diagnostic approach. MRI of the spine and sacroiliac joints (SIJ) might be relevant in the follow-up of axial spondyloarthritis for difficult cases, provided that its validity and correlation with clinical, biological and functional outcomes is ascertained. The aim of this study was to assess the effect of TNF alpha inhibitors (TNFi) on MRI scoring of inflammation on spine and SIJ and to evaluate their correlation with the parameters used in daily practice. METHODS: A systematic review of the literature using PUBMED and the Cochrane library was performed until January 2016. All randomised controlled trials and controlled cohorts reporting the effect of TNFi on spine and SIJ MRI scores [Ankylosing Spondylitis spine MRI (ASspiMRI), Spondyloarthritis Research Consortium of Canada (SPARCC), and Berlin] were selected. The collected outcomes were: the change in scores between baseline and follow-up in TNFi and control groups, the correlation of these changes with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index/Functional Index (BASDAI/BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS), pain and morning stiffness. When appropriate, statistical analysis determined the pooled therapeutic effect of TNFi on MRI scores computed by meta-analysis. RESULTS: Of 39 screened references, 55 studies were included. In studies using ASspiMRI at 12-week and 2-year follow-up, and in those using SPARCC spine score at 12-week follow-up, a non-significant decrease in MRI score between the TNFi group and control group was reported (p=0.36; p=0.73; p=0.12, respectively). Only a significant decrease in the SPARCC SIJ score was reported at 12 weeks in the TNFi group versus control (p<0.0001). The correlation between MRI spine and SIJ scores on the one hand, and the clinical and biological data on the other was very heterogeneous across the different reports. However, an association was usually reported between the MRI scores and CRP, ESR and ASDAS. CONCLUSIONS: There is not sufficient evidence to distinguish the difference between changes in MRI inflammatory lesions of the spine and SIJ in patients with axial SpA related to TNF alpha inhibitor effects and those due to the natural course of the disease activity (alternating periods of flares and remission in axial SpA).


Assuntos
Espondilartrite , Espondilite Anquilosante , Canadá , Humanos , Imagem por Ressonância Magnética , Articulação Sacroilíaca/diagnóstico por imagem , Índice de Gravidade de Doença , Espondilartrite/diagnóstico por imagem , Espondilartrite/tratamento farmacológico , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa
8.
Osteoporos Int ; 32(5): 991-999, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33386877

RESUMO

Several studies have reported changes in body composition in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that body composition measurements obtained by absorptiometry were highly reproducible in patients suffering from these diseases. This study justifies the use of absorptiometry measurements in longitudinal studies in this population. PURPOSE: Our study aimed to assess the reproducibility of total and regional body composition in patients with rheumatoid arthritis (RA) and with ankylosing spondylitis (AS) and to compare them to healthy subjects. METHODS: The study enrolled 80 subjects including 32 healthy subjects, 31 RA patients, and 17 AS patients. Each subject had two scans in one day under the same standard conditions and none ate nor drunk before being repositioned on the table. The reproducibility was assessed through the coefficient of variation (CV), the least significant change (LSC), the intraclass correlation (ICC), and the smallest significant difference (SDD). RESULTS: Total body composition measurements obtained by dual-energy X-ray absorptiometry (DXA) were highly reproducible, and there was no statistically significant difference between reproducibility in healthy subjects, patients with RA, and patients with AS. For total body fat mass (FM), lean mass (LM), and bone mineral content (BMC) in the total population, CV values were 1.71%, 1.25%, and 1.74%, respectively; ICC values were 0.998, 0.996, and 0.993, respectively; LSC values were 4.88%, 3.7%, and 5.2%, respectively; and SDD values were ± 1.23 Kg, ± 1.47 Kg, and ± 126.0 g, respectively. For regional body FM, LM, and BMC in the total population, CV values in the arms were 8.46%, 4.17%, and 3.79%, respectively; in the legs 6.24%, 3.59%, and 2.04%, respectively, and in the trunk 5.02%, 2.92%, and 5.24%, respectively. CONCLUSION: Total body tissue mass, FM percentage, FM, LM, and BMC measurements obtained by DXA are highly reproducible in RA and AS.


Assuntos
Artrite Reumatoide , Espondilite Anquilosante , Absorciometria de Fóton , Artrite Reumatoide/diagnóstico por imagem , Composição Corporal , Densidade Óssea , Humanos , Reprodutibilidade dos Testes , Espondilite Anquilosante/diagnóstico por imagem
9.
Medicine (Baltimore) ; 100(1): e24116, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429781

RESUMO

BACKGROUND: Ankylosing spondylitis refers to a type of autoimmune disease, which is commonly characterized by joint pain and stiffness, since the disease progression can exhibit joint deformity and other activities limited symptoms. Has significantly impacts on people's work and life. Warm acupuncture as a traditional Chinese therapy, showing several advantages (eg, safety, economy, and less side effects), has been extensively used to treat ankylosing spondylitis. However, its curative effect is supported by limited evidence. Accordingly, the present study aims to comprehensively assess the reliability of warm acupuncture in ankylosing spondylitis treatment. METHODS: Randomized controlled trials were searched from the Chinese Biomedical Literature Database, Chongqing VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Wanfang, Web of Science, Cochrane Library, PubMed, and EMBASE, regardless of their publication status. The deadline was November 6th, 2020. Two experienced researchers adopted RevMan V.5.3 software for literature selection, data collection, data analysis, and synthesis, respectively. In addition, the quality of the trials involved in this study was measured with the Cochrane Bias risk assessment tool, regardless of language or publication status. RESULTS: The protocol will be used to assess the efficacy and safety of warm acupuncture in ankylosing spondylitis treatment. CONCLUSION: This review reliably evidences whether warm acupuncture is a reliable method for the intervention of ankylosing spondylitis. INPLASY REGISTRATION NUMBER: INPLASY2020110096.


Assuntos
Terapia por Acupuntura/normas , Protocolos Clínicos , Moxibustão/normas , Espondilite Anquilosante/terapia , Terapia por Acupuntura/métodos , Humanos , Metanálise como Assunto , Moxibustão/métodos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514619

RESUMO

We report the case of a 43-year-old man, suffering from ankylosing spondylitis and treated with Infliximab 5 mg/kg every 2 months, with an excellent disease control. During a follow-up consultation, an incipient renal insufficiency is detected. A urine analysis showed haematuria and proteinuria and a renal puncture-biopsy revealed an image of IgA nephropathy.Several cases of IgA nephropathy have been reported in the literature associated with ankylosing spondylitis. Some of them occur in patients treated with antitumour necrosis factor, but it is unclear whether this pathology is caused by the treatment or whether treatment failed to prevent its occurrence.Our clinical case highlights the importance of regular monitoring of renal function in patients with ankylosing spondylitis, as well as urinary spotting.The question of whether the disease itself, the treatment or other factors such as immune dysregulation could be held responsible for kidney disease will be addressed in the discussion.


Assuntos
Antirreumáticos/uso terapêutico , Glomerulonefrite por IGA/patologia , Infliximab/uso terapêutico , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Antirreumáticos/administração & dosagem , Biópsia , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/urina , Hematúria/diagnóstico , Humanos , Infliximab/administração & dosagem , Rim/patologia , Testes de Função Renal/normas , Masculino , Monitorização Fisiológica/normas , Proteinúria/diagnóstico , Remissão Espontânea , Espondilite Anquilosante/tratamento farmacológico
11.
Nat Rev Rheumatol ; 17(2): 109-118, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33361770

RESUMO

The axial spondyloarthritis (axSpA) disease concept has undergone substantial change from when the entity ankylosing spondylitis was defined by the modified New York criteria in 1984. Developments in imaging, therapy and genetics have all contributed to changing the concept of axSpA from one of erosions in the sacroiliac joints to a spectrum of disease with and without changes evident on plain radiographs. Changes to the previously held concept and construct of the disease have also necessitated new classification criteria. The use of MRI, primarily of the sacroiliac joints, has substantially altered the diagnosis and differential diagnosis of axSpA. Many in the axSpA community believe that the current classification criteria lack specificity, and the CLASSIC study is underway to examine this area. Although much about the evolving axSpA disease concept is universally agreed, there remains disagreement about operationalizing aspects of it, such as the requirement for the objective demonstration of axial inflammation for the classification of axSpA. New imaging technologies, biomarkers and genetics data will probably necessitate ongoing revision of axSpA classification criteria. Advances in our knowledge of the biology of axSpA will settle some differences in opinion as to how the disease concept is applied to the classification and diagnosis of patients.


Assuntos
Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/classificação , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico por imagem , Adulto , Biomarcadores/análise , Diagnóstico Diferencial , Feminino , Genética/instrumentação , Humanos , Inflamação/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Radiografia/métodos , Articulação Sacroilíaca/patologia , Espondilartrite/tratamento farmacológico , Espondilartrite/patologia
12.
Adv Rheumatol ; 61: 2, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1152742

RESUMO

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)


Assuntos
Humanos , Espondilartrite/epidemiologia , Prognóstico , Espondilite Anquilosante/epidemiologia , Artrite Psoriásica/epidemiologia , Demografia , Prevalência , Fatores de Risco , América Latina/epidemiologia
13.
Spine (Phila Pa 1976) ; 46(1): E31-E36, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065692

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: A retrospective study was conducted to clarify the prognostic factors of postoperative for cervical spine fractures patients with ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: Now the high probability of cervical fractures in patients with AS is unanimously recognized. Fractures mostly occur in the lower cervical spine and two-thirds of patients are accompanied by spinal cord injury. But there are few studies on treatment of AS patients with cervical fracture and it is unclear whether the surgical method, timing of surgery, basic treatment of AS, and different doses of steroids therapy have an impact on the prognosis. Thus, this study aims to evaluate the impact of perioperative factors on the prognosis of traumatic cervical fractures in surgical patients with AS. METHODS: Preoperative and postoperative spinal cord function were assessed according to the Japanese Orthopaedic Association (JOA) Scores and Improvement rate were calculated. The neck pain severity were rated using a visual analogue scale (VAS) score. The t test and v2-test were used for comparison of clinical data between the preoperative and postoperative groups. Logistic univariate and multivariate regression analysis were used to obtain adjusted odds ratios. Pearson correlation coefficients were used to evaluate the relationship between variables. RESULTS: The degree of fracture displacement in cervical spine fractures patients with AS was most common at the neck-chest junction (26.1%). Patients with degree of cervical fracture displacement less than 50% had significantly improved JOA scores after surgery (P = 0). The incidence of spinal cord injury (SCI) due to fracture was high (52.2%). Patients with combined anterior and posterior is helpful for neurological recovery (P = 0.01). Basic AS treating before injury would be benefit for neurological improvement (P = 0). CONCLUSION: Basic AS treatment, SCI, and surgical methods are independent factors that affect the prognosis of cervical spine fractures patients with AS. It is controversial to perform surgery and preoperative steroid application as soon as possible. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Fraturas Ósseas/cirurgia , Espondilite Anquilosante/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
14.
Int J Mol Sci ; 21(24)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348540

RESUMO

The strong association with the Major Histocompatibility Complex (MHC) class I genes represents a shared trait for a group of autoimmune/autoinflammatory disorders having in common immunopathogenetic basis as well as clinical features. Accordingly, the main risk factors for Ankylosing Spondylitis (AS), prototype of the Spondyloarthropathies (SpA), the Behçet's disease (BD), the Psoriasis (Ps) and the Birdshot Chorioretinopathy (BSCR) are HLA-B*27, HLA-B*51, HLA-C*06:02 and HLA-A*29:02, respectively. Despite the strength of the association, the HLA pathogenetic role in these diseases is far from being thoroughly understood. Furthermore, Genome-Wide Association Studies (GWAS) have highlighted other important susceptibility factors such as Endoplasmic Reticulum Aminopeptidase (ERAP) 1 and, less frequently, ERAP2 that refine the peptidome presented by HLA class I molecules to CD8+ T cells. Mass spectrometry analysis provided considerable knowledge of HLA-B*27, HLA-B*51, HLA-C*06:02 and HLA-A*29:02 immunopeptidome. However, the combined effect of several ERAP1 and ERAP2 allelic variants could generate an altered pool of peptides accounting for the "mis-immunopeptidome" that ranges from suboptimal to pathogenetic/harmful peptides able to induce non-canonical or autoreactive CD8+ T responses, activation of NK cells and/or garbling the classical functions of the HLA class I molecules. This review will focus on this class of epitopes as possible elicitors of atypical/harmful immune responses which can contribute to the pathogenesis of chronic inflammatory diseases.


Assuntos
Aminopeptidases/genética , Síndrome de Behçet/imunologia , Coriorretinopatia de Birdshot/imunologia , Genes MHC Classe I , Antígenos de Histocompatibilidade Classe I/genética , Imunidade/genética , Antígenos de Histocompatibilidade Menor/genética , Psoríase/imunologia , Espondilite Anquilosante/imunologia , Alelos , Linfócitos T CD8-Positivos/imunologia , Humanos , Polimorfismo de Nucleotídeo Único
15.
PLoS One ; 15(12): e0244184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347471

RESUMO

OBJECTIVES: To analyse the predictive values of inflammatory back pain (IBP), positive HLA B27 antigen, increased C-reactive protein (CRP), Spondyloarthritis (SpA) features, familial history (FH), magnetic resonance sacroiliac joints (MRI-SIJ) imaging and its weight in early SpA diagnosis. METHODS: 133 patients with back pain, aged <50, duration of the pain <2 years were included. Data such as IBP, HLA B27, increased CRP, SpA features, FH, SIJ´s radiography and MRI were collected for each patient. STIR sequences were classified as strongly positive bone morrow oedema (SPBME ≥2), clearly present and easily recognisable as positive according to the ASAS criterion, weakly positive (WPBME ≥2), suggestive, but not easily recognisable and, clearly negative none of those features. T1-weighted sequences were assessed as positive/negative for erosion, fat metaplasia, backfill and sclerosis, if ≥1, for each lesion was present. MRI images were read by three blinded readers. RESULTS: The average age was 38.9 years. 47 (35.3%) patients received SpA diagnosis according to the clinical opinion. IBP was highly specific, 0.81 and sensitive, 0.83. HLA B27 was positive in a half of the SpA patients. SPBME ≥2 provided a great specificity, 0.94 and an acceptable sensitivity, 0.79. Erosion was significantly more frequent in SpA patients (72% vs 7%), specificity 0.93. The addition of erosion ≥1 to the WPBME ≥2 noticeably improved specificity, 0.98, although slightly decreased sensitivity, 0.64. Fat metaplasia and backfill were highly specific, but poorly sensitive. Factors forecasting positive diagnosis were IBP, followed by SpA features and increased CRP. CONCLUSIONS: At the onset, IBP might be a good marker for selecting patients with suspicion of SpA. The addition of erosion to the ASAS criterion might be helpful for early diagnosis, especially in patients with doubtful STIR imaging where BME is present but it is hard to determinate whether the ASAS "highly suggestive" criterion is met.


Assuntos
Dor nas Costas/patologia , Proteína C-Reativa/análise , Antígeno HLA-B27/sangue , Imagem por Ressonância Magnética/normas , Espondilite Anquilosante/diagnóstico , Adulto , Biomarcadores/sangue , Proteína C-Reativa/normas , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
16.
Psychiatr Danub ; 32(3-4): 403-410, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370739

RESUMO

BACKGROUND: This study aims to investigate the influence of traditional Chinese music on the physical and psychological functions of hospitalized patients with ankylosing spondylitis (AS). SUBJECTS AND METHODS: A total of 120 patients with AS admitted to the People's Hospital of Anhui Province between March 2018 and March 2019 were randomly divided into experiment and control groups. The experiment group was a traditional music group composed of 56 patients, namely, 50 males and 6 females. The control group was further divided into a painting group and a routine treatment group with a total of 64 patients, namely, 48 males and 16 females. The physical and psychological functions of each group of patients before and after the intervention were assessed in terms of physical and psychological function dimensions obtained before and after the intervention. RESULTS: After 8 weeks of treatment, the score in terms of physical functions is the highest in the music group (P<0.05), and the difference in eating functions is statistically significant (P<0.001). This finding suggests that the music group is better than the painting group and the routine treatment group (P<0.05). In terms of the score in sexual functions, the following trend is observed: music group>painting group>routine treatment group. The difference in their psychological functions is statistically significant (P<0.001). In terms of the score in psychological functions, the following trend is obtained: music group>painting group>routine treatment group. The three groups significantly differ in their scores in mental tension, negative emotion, positive emotion, cognitive functions, and self-esteem. All of these dimensions show the following pattern: music group>painting group>routine treatment group. Cross-group comparisons between the three groups are also statistically significant (P<0.05). CONCLUSIONS: Traditional Chinese music therapy and painting therapy can promote the recovery of patients' physical and psychological functions. Traditional Chinese music intervention therapy is better than painting therapy and routine hospitalization in promoting the recovery of physical and psychological functions of hospitalized patients.


Assuntos
Saúde Mental , Musicoterapia , Música/psicologia , Espondilite Anquilosante/psicologia , Espondilite Anquilosante/terapia , Adolescente , Adulto , Cognição , Emoções , Feminino , Humanos , Masculino , Autoimagem , Espondilite Anquilosante/fisiopatologia , Adulto Jovem
17.
Int J Mol Sci ; 21(24)2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33317138

RESUMO

OBJECTIVE: Coagulation and fibrinolysis are interrelated with the expression of vascular endothelial growth factor (VEGF), which frequently is increased in axial spondyloarthritis (axSpA). We tested whether (i) α2-antiplasmin (A2AP) Arg6Trp, (ii) fibrinogen, factor XIII A-subunit or B-subunit genotypes are associated with VEGF levels and assessed whether the known association between elevated VEGF and radiographic spinal progression in axSpA depends on genetic background. METHODS: One hundred and eighty-six axSpA patients from the German Spondyloarthritis Inception Cohort were genotyped, characterized for VEGF levels, and statistically analyzed. The association between VEGF and radiographic spinal progression was assessed in dependence on genetic background in stratified analyses. RESULTS: A2AP 6Trp carriage was associated with VEGF elevation (OR: 2.37, 95% CI: 1.06-5.29) and VEGF levels (6Trp, 455 ± 334 pg/mL; 6Arg/Arg, 373 ± 293 pg/mL; p < 0.008). Association between elevated VEGF and radiographic spinal progression in axSpA (OR: 3.11, 95% CI: 1.02-8.82) depended remarkably on the fibrinogen (FGA) genotype. When considering axSpA patients with elevated VEGF, in FGA rs6050A>G wild types, 42.1% of patients (8 of 19) progressed, while in G-allele carriers, no radiographic progression happened (0 of 13) (p < 0.04). CONCLUSIONS: The A2AP Arg6Trp genotype seems to influence VEGF levels in axSpA. The predictive value of VEGF elevations in respect of radiographic spinal progression in axSpA depends on FGA genotypes.


Assuntos
Fibrinogênio/genética , Genótipo , Espondilite Anquilosante/genética , Fator A de Crescimento do Endotélio Vascular/genética , alfa 2-Antiplasmina/genética , Adulto , Fator VIII/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
18.
Medicine (Baltimore) ; 99(46): e23174, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181692

RESUMO

To determine the effects of ankylosing spondylitis (AS)-associated hip damages on the outcome measurements after total hip arthroplasty (THA).The medical records of 122 patients with AS (181 hips) who underwent THA were retrospectively reviewed. The mean follow-up was 43.9 (32-129) months. The types and degrees of hip damages were evaluated by preoperative hip X-rays. The patients were grouped according to the satisfaction degree after the operation. Univariable and multivariable statistical analyses were conducted.The intraclass correlation coefficients for the assessment between the 2 reviewers in the study were 0.86 to 0.97. Cox regression showed that femoral head erosion severity had an effect on the recovery time of independent walking without crutches postoperatively (odds ratio = 1.467, 95% confidence interval: 1.050-2.409, P = .025). The mean time to recover independent walking in the severe femoral head erosion group was 7.3 ±â€Š0.9 weeks, which was 4.6 ±â€Š0.4 weeks longer than in the non-severe femoral head erosion group, as confirmed by the log-rank (Mantel-Cox) test (Chi-squared = 11.684, P = .001). The multivariable analysis showed that higher acetabular sclerosis scores correlated with lower postoperative dissatisfaction risk (odds ratio = 0.322, 95% confidence interval: 0.136-0.764). The multiple linear regression analysis showed that postoperative range of motion (ROM) improvement was affected by preoperative ROM of the hip, space narrowing degree, and ceramic-ceramic material for the weight-bearing surface (F = 179.81, P < .001), with preoperative ROM of the hip having the greatest impact.Severe femoral head erosion prolongs the recovery time of independent walking after THA. Acetabular sclerosis is not associated with poor outcomes in patients with AS-associated hip damage undergoing THA.


Assuntos
Acetábulo , Artroplastia de Quadril , Cabeça do Fêmur , Osteoartrite do Quadril , Recuperação de Função Fisiológica , Espondilite Anquilosante , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Acetábulo/fisiopatologia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Artroplastia de Quadril/reabilitação , China/epidemiologia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Cabeça do Fêmur/fisiopatologia , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Radiografia/métodos , Amplitude de Movimento Articular , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Resultado do Tratamento , Caminhada , Suporte de Carga
19.
Clin Rheumatol ; 39(12): 3529-3531, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33011932
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