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1.
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
2.
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
3.
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
4.
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
5.
Wiad Lek ; 73(8): 1700-1706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055337

RESUMO

OBJECTIVE: The aim: To assess the level of hepcidin in patients with AS, to determine its connection to the disease and various forms of anemia. PATIENTS AND METHODS: Materials and methods: 118 patients with ankylosing spondylitis were examined and hematological, biochemical, immunologic indicators of the general parameters of hematopoiesis and ferrokinetics, plasma levels of CRP, IL-6 and hepcidin were determined. RESULTS: Results: It was found that high levels of hepcidin are found in 25% of patients with AS, 50% are limiting and only 25% are optimal. The serum levels of hepcidin in patients with AS are independent of the age, sex, and duration of the disease, but are closely associated with the activity (ESR, CRP, IL-6, BASDAI, and ASDAS levels) of the disease. Close pathogenetic connection of hepcidin with the formation of anemic syndrome was established. Patients with ACD were characterized by the highest levels of hepcidin. CONCLUSION: Conclusions: Hepcidin plays an important role in the pathogenesis of ACD in patients with AS and can be used as a diagnostic marker for differential diagnosis.


Assuntos
Anemia , Espondilite Anquilosante , Anemia/etiologia , Diagnóstico Diferencial , Humanos , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico
6.
Clin Ter ; 171(5): e378-e380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901777

RESUMO

Hypophosphatemic rickets (HR) is a metabolic bone disease manifesting with a wide variety of musculoskeletal symptoms. Sometimes it can mimic rheumatic diseases; also, it can be seen in the course of rheumatic diseases. In this paper, a 35-years old female patient, previously undiagnosed case of HR presenting first as Ankylosing Spondylitis will be discussed.


Assuntos
Raquitismo Hipofosfatêmico/diagnóstico , Espondilite Anquilosante/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos
7.
FP Essent ; 494: 30-35, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32640152

RESUMO

Ankylosing spondylitis (AS) is a rare yet significant cause of back pain in young adults that often is overlooked. AS should be suspected if symptoms of inflammatory back pain are present or if the patient has a personal or family history of related conditions. X-rays are the initial imaging modality of choice. If suspicion of AS remains high but no sacroiliitis is present on x-ray, an HLA-B27 test should be obtained. The Assessment of SpondyloArthritis International Society (ASAS) criteria are helpful in the diagnosis of AS. Continuous use of nonsteroidal anti-inflammatory drugs is the first-line therapy, followed by tumor necrosis factor-alpha inhibitors, followed by slow-acting antirheumatic drugs (eg, methotrexate). Patients also should undergo physical therapy and, if applicable, should quit smoking and maintain a healthy weight. Patients with AS are at increased risk of complications, such as spinal fracture. Other conditions associated with AS include anterior uveitis, inflammatory bowel disease, and osteoporosis.


Assuntos
Doenças Inflamatórias Intestinais , Espondilite Anquilosante , Dor nas Costas , Antígeno HLA-B27 , Humanos , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Adulto Jovem
8.
Z Rheumatol ; 79(8): 729-736, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32696075

RESUMO

BACKGROUND: The often slow onset of ankylosing spondylitis (AS), the initially partially unspecific symptoms (back pain) and the scarcity of resources in rheumatological care are important factors leading to delayed diagnosis and treatment of these mostly young patients in Germany. Qualified nurses specialized in rheumatology might improve quality of care by providing medical services delegated by the rheumatologists. OBJECTIVE: The aim was to investigate whether qualified nurses specialized in rheumatology can interpret anamnestic and clinical findings such as rheumatologists in patients with chronic low back pain and still unclear diagnosis using a structured questionnaire. MATERIAL AND METHODS: In the multicenter PredAS study a structured anamnestic questionnaire was applied independently by qualified nurses specialized in rheumatology and rheumatologists to patients referred to rheumatology practices with the leading symptom of low back pain. The questionnaire covered basic demographic data, medical history and patient reported outcomes. Additionally, measurements of physical function using the Bath ankylosing spondylitis functional index (BASFI) and spinal mobility using the Bath ankylosing spondylitis metrology index (BASMI) were standardized. In order to test the possible facilitation by using digital media, the results of two patient groups were separately documented on paper-based report forms and on an i­pad. Concordance between documentation by qualified nurses specialized in rheumatology and rheumatologists was studied by calculating Cohen's kappa, intraclass correlation coefficients (ICC) and percentage agreement on an individual patient level. RESULTS: Nearly 75% of the 141 patients with chronic low back pain were identified as having the characteristics of inflammatory back pain. The concordance of the documentation for the anamnesis of back pain by qualified nurses specialized in rheumatology and physicians was higher than for the localization of the back pain. The results for the BASMI showed no differences between qualified nurses specialized in rheumatology and physicians (ICC 0.925, 95 % confidence interval, CI 0.879-0.953). The time taken for the structured documentation was 20 ± 6.7 min for physicians and 28.5 ± 13 min for qualified nurses specialized in rheumatology. CONCLUSION: The results indicate that well-trained qualified nurses specialized in rheumatology have a high potential to take over some of the workload from rheumatologists during documentation of the anamnesis and the initial physical examination in the diagnosis of ankylosing spondylitis.


Assuntos
Reumatologia , Espondilite Anquilosante , Alemanha , Humanos , Internet , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/enfermagem , Inquéritos e Questionários
9.
Galicia clin ; 81(3): 75-76, jul. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-199177

RESUMO

Se presentan 2 casos, separados por un intervalo de más de 2500 años, de Enfermedad de Forestier - Rotés-Querol, uno de ellos procedentes de un enterramiento de la Atenas de Pericles y el otro actual para ejemplificar su presencia continua en la historia de la patología humana. Se realiza una sucinta revisión histórica sobre su separación de las espondilopatías inflamatorias anquilosantes, se revisan sus posibles manifestaciones clínicas y radiológicas y se menciona su importante papel en el desarrollo de la última película de Pedro Almodóvar, Dolor y Gloria


We present two cases of Forestier-Rotés-Querol disease, separated by an interval of more than 2500 years, one of them coming from a burial in the Athens of Pericles and the other from the present. This exemplify its continuous presence in the history of human pathology. A brief historical review of their separation from ankylosing inflammatory spondylopathies is carried out their possible clinical and radiological manifestations are reviewed, and it is mentioned an important role in the development of the latest film by Pedro Almodóvar, Dolor y Gloria


Assuntos
Humanos , Masculino , Idoso , Hiperostose Esquelética Difusa Idiopática/complicações , Espondilite Anquilosante/diagnóstico , Estenose Esofágica/etiologia , Transtornos de Deglutição/etiologia , Hiperostose Esquelética Difusa Idiopática/epidemiologia , Hiperostose Esquelética Difusa Idiopática/história , Espondilite Anquilosante/história , Diagnóstico Diferencial , Rigidez Muscular/etiologia , Filmes Cinematográficos , Arqueologia
10.
Zhonghua Nei Ke Za Zhi ; 59(7): 511-518, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32594684

RESUMO

In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.


Assuntos
Espondilartrite , Espondilite Anquilosante , Humanos , Guias de Prática Clínica como Assunto , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
12.
Medicine (Baltimore) ; 99(18): e20111, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358402

RESUMO

RATIONALE: We report a rare case with ankylosing spondylitis (AS), thymoma, and membranous glomerulonephritis. The pathogenic mechanisms of these 3 diseases may be associated with each other. Here, we discuss the course of diagnosis and treatment. PATIENT CONCERNS: A 64-year-old woman with bilateral pain of the sacroiliac joints for 10 years and anasarca for 10 days. DIAGNOSES: A diagnosis of AS by HLA-B27 and pelvic X-ray tests, thymoma based on computed tomography and pathological diagnosis, and membranous glomerulonephritis based on renal biopsy. INTERVENTIONS: We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD, for a month. OUTCOMES: The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin/creatinine decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved, and the Bath Ankylosing Spondylitis Disease Activity Index score dropped to 4.0. LESSONS: Although the causal relationship between AS, thymoma, and membranous nephropathy in this patient still needs to be established, the pathogenesis between the 3 diseases may have some association. In clinical practice, patients with AS need to be screened for tumors and renal complications.


Assuntos
Glomerulonefrite Membranosa/complicações , Espondilite Anquilosante/complicações , Timoma/complicações , Neoplasias do Timo/complicações , Anti-Inflamatórios/uso terapêutico , Feminino , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/tratamento farmacológico , Antígeno HLA-B27/sangue , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Timoma/diagnóstico , Timoma/tratamento farmacológico , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/tratamento farmacológico
13.
Medicine (Baltimore) ; 99(19): e20019, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384461

RESUMO

This study aimed to assess the efficacy of needle-knife (NK) combined with etanercept (NKCE) in attenuating pain, inflammation, disease activity, and improving hip joint function in ankylosing spondylitis (AS) patients with hip joint involvement.Totally, 90 patients with active AS involving unilateral hip joint were enrolled and randomly assigned in 1:1:1 ratio to receive NKCE, NK or conventional drugs (control). The ESR, CRP, hip joint pain Visual Analogue Scale (VAS) score, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), modified Harris hip score (mHHS), and range of motion (ROM) of affected hip joint were assessed at baseline (W0), after 1-week treatment (W1) and after 24-week treatment (W24).ESR and CRP were decreased in NKCE group compared with NK and control groups, while was not attenuated in NK group compared with control group. Regrading pain and disease activity, NKCE group presented a reduction in hip pain VAS score and BASDAI compared with NK and control groups, and NK group showed a decrease in hip pain VAS score and BASDAI compared with control group. Besides, BASFI was lowered in NKCE and NK groups compared with control group, but similar between NKCE and NK groups. mHHS and hip ROM were raised in NKCE and NK groups compared with control group, but similar between NKCE and NK groups.NKCE decreases hip pain, inflammation, disease activity and improves hip joint function in AS patients with hip joint involvement.


Assuntos
Terapia por Acupuntura/métodos , Artralgia , Etanercepte/administração & dosagem , Articulação do Quadril , Espondilite Anquilosante , Adolescente , Adulto , Antirreumáticos/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/terapia , Feminino , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor/métodos , Gravidade do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/terapia , Resultado do Tratamento
14.
Ann Rheum Dis ; 79(5): 595-604, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32253184

RESUMO

OBJECTIVES: Bimekizumab selectively neutralises both interleukin (IL)-17A and IL-17F. We report efficacy and safety in a phase IIb dose-ranging study in patients with active ankylosing spondylitis (AS). METHODS: Adults with AS (fulfilling modified New York criteria) were randomised 1:1:1:1:1 to bimekizumab 16 mg, 64 mg, 160 mg, 320 mg or placebo every 4 weeks for 12 weeks (double-blind period). At week 12, patients receiving bimekizumab 16 mg, 64 mg or placebo were re-randomised 1:1 to bimekizumab 160 mg or 320 mg every 4 weeks to week 48; other patients continued on their initial dose (dose-blind period). The primary end point was Assessment of SpondyloArthritis international Society (ASAS) 40 response at week 12 (non-responder imputation (NRI) for missing data). RESULTS: 303 patients were randomised: bimekizumab 16 mg (n=61), 64 mg (n=61), 160 mg (n=60), 320 mg (n=61) or placebo (n=60). At week 12, significantly more bimekizumab-treated patients achieved ASAS40 vs placebo (NRI: 29.5%-46.7% vs 13.3%; p<0.05 all comparisons; OR vs placebo 2.6-5.5 (95% CI 1.0 to 12.9)). A significant dose-response was observed (p<0.001). The primary end point was supported by all secondary efficacy outcomes. At week 48, 58.6% and 62.3% of patients receiving bimekizumab 160 and 320 mg throughout the study achieved ASAS40, respectively (NRI); similar ASAS40 response rates were observed in re-randomised patients. During the double-blind period, treatment-emergent adverse events occurred in 26/60 (43.3%) patients receiving placebo and 92/243 (37.9%) receiving bimekizumab. CONCLUSIONS: Bimekizumab provided rapid and sustained improvements in key outcome measures in patients with active AS, with no unexpected safety findings versus previous studies. TRIAL REGISTRATION NUMBER: NCT02963506.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Interleucina-17/metabolismo , Espondilite Anquilosante/tratamento farmacológico , Adulto , Biomarcadores/metabolismo , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Europa (Continente) , Feminino , Seguimentos , Humanos , Internacionalidade , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Resultado do Tratamento , Estados Unidos
15.
Medicine (Baltimore) ; 99(15): e19806, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282746

RESUMO

RATIONALE: Acute lymphoblastic leukemia (ALL) has acute and severe onset characterized by fever, moderate to severe anemia, bone and joint pain, and sternal tenderness. It is easy to be misdiagnosed as rheumatic disease when joint pain is the first symptom. PATIENT CONCERNS: A male Han, 18 years of age was admitted on July 15th, 2016 for multi-joint swelling and pain with intermittent fever for half a year which had aggravated in the last 10 days. DIAGNOSIS: Based on symptoms, imaging, family history, and blood tests, he was first diagnosed with ankylosing spondylitis, but he was refractory to treatment. Bone marrow biopsy then revealed acute B-lymphoblastic leukemia (possibility Pro-B-ALL). INTERVENTIONS: The patient was transferred to the hematology department on July 23rd, 2016 for chemotherapy. OUTCOMES: No joint pain occurred during follow-up, which ended on November 4th, 2018. LESSONS: ALL may present with symptoms suggestive of rheumatic diseases like ankylosing spondylitis. Physicians should be aware of this possibility, especially in young patients.


Assuntos
Artralgia/etiologia , Leucemia Linfocítica Crônica de Células B/patologia , Espondilite Anquilosante/diagnóstico , Adolescente , Antineoplásicos/uso terapêutico , Artralgia/diagnóstico , Biópsia , Medula Óssea/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Febre/diagnóstico , Febre/etiologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/patologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Masculino , Espondilite Anquilosante/sangue , Espondilite Anquilosante/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Ann Rheum Dis ; 79(5): 566-572, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32161058

RESUMO

OBJECTIVES: To investigate whether tumour necrosis factor alpha inhibitors (TNFis) are associated with an increased risk of neuroinflammatory diseases among patients with arthritic diseases. METHODS: Cohorts of patients with rheumatoid arthritis (RA, n=25 796), psoriatic arthritis (PsA, n=8586) and ankylosing spondylitis (AS, n=9527) who initiated a TNFi treatment year 2000-2017 were identified from nationwide clinical rheumatology registers in Sweden and Denmark. Information on demyelinating disease and inflammatory neuropathy diagnoses was retrieved from prospective linkage to National Patients Register. A Cox proportional hazard model was used to estimate HRs and 95% CI comparing TNFi exposed and non-exposed, by disease and country. RESULTS: Among 111 455 patients with RA, we identified 270 (Sweden) and 51 (Denmark) events (all types of neuroinflammatory diseases combined), corresponding to crude incidence rates (per 1000 person-years) of 0.37 (Sweden) and 0.39 (Denmark) in TNFi-treated patients vs 0.39 (Sweden) and 0.28 (Denmark) in unexposed patients, and an age-sex-calendar-period-adjusted HR (95% CI) of 0.97 (0.72 to 1.33) (Sweden) and 1.45 (0.74 to 2.81) (Denmark) in TNFi exposed compared with non-exposed patients. For a total of 64 065 AS/PsA patients, the corresponding numbers were: 196 and 32 events, crude incidence rates of 0.59 and 0.87 in TNFi-treated patients vs 0.40 and 0.19 in unexposed patients, and HRs of 1.50 (1.07 to 2.11) and 3.41 (1.30 to 8.96), for Sweden and Denmark, respectively. For multiple sclerosis, the patterns of HRs were similar. CONCLUSIONS: Use of TNFi in AS/PsA, but not in RA, was associated with increased risk of incident neuroinflammatory disease, though the absolute risk was below one in 1000 patients/year.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Doenças Desmielinizantes/induzido quimicamente , Sistema de Registros , Espondilite Anquilosante/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Idoso , Artrite Psoriásica/diagnóstico , Artrite Reumatoide/diagnóstico , Estudos de Coortes , Doenças Desmielinizantes/epidemiologia , Dinamarca , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Espondilite Anquilosante/diagnóstico , Suécia , Inibidores do Fator de Necrose Tumoral/administração & dosagem , Fator de Necrose Tumoral alfa/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidores
17.
Zhonghua Nei Ke Za Zhi ; 59(3): 189-194, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32146744

RESUMO

Objective: To analyze the clinical characteristics of patients with ankylosing spondylitis (AS) with inflammation bowel disease (IBD). Methods: AS patients fulfilling the 1984 modified New York diagnostic criteria were recruited in Chinese AS Prospective Imaging Cohort (CASPIC) consecutively from April 2016 to June 2017 in Chinese People's Liberation Army General Hospital by using smart management system for spondyloarthritis (SpAMS). The diagnosis of IBD was confirmed by tissue pathology via ileocolonoscopy. Demographic, clinical and biochemical data were collected. Results: In total, 893 patients with AS were recruited with the mean age 30.8 years. The majority were men (739, 82.8%). There were 64 (7.2%) patients concomitant with IBD. The mean age [(34.5±7.5) years vs. (30.5±8.8) years, P<0.001] was older and the disease duration [(10.8±6.9) years vs. (8.1±5.9) years, P=0.001] was longer in patients with IBD than patients without. Compared with patients without IBD, patients with IBD had more frequent involvement of the cervical spine [(21.9% (14/64) vs. 10.5% (87/829), P=0.006) and thoracic spine [29.7% (19/64) vs. 12.3% (102/829), P<0.001]. Uveitis [28.1% (18/64) vs. 16.4% (136/829), P=0.017] and psoriasis [7.8% (5/64) vs. 2.3% (19/829), P=0.009] were also more common in patients concomitant with IBD. In addition, patients with IBD had significantly higher scores in BASDAI (3.3±2.1 vs. 2.4±1.8, P<0.001), BASFI [2.2 (1.0,3.3) vs. 1.1(0.2,2.4), P<0.001)] and ASAS HI (7.1±4.3 vs. 5.3±3.7, P= 0.001) than patients without IBD. Conclusions: Compared with patients without IBD, AS patients concomitant with IBD have more severe disease activity and organ dysfunction. Furthermore, the uveitis and psoriasis are more frequently accompanied in AS patients with IBD.


Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/fisiopatologia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Adulto , China , Feminino , Humanos , Masculino , Estudos Prospectivos , Psoríase , Índice de Gravidade de Doença , Espondilartrite , Uveíte
20.
PLoS One ; 15(2): e0229273, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084192

RESUMO

OBJECTIVE: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. The risk of serious mental illness, including deliberate self-harm (DSH), in these conditions is not well known. We aimed to determine if RA or AS independently increases the risk for DSH. METHODS: We conducted retrospective, population-based cohort studies using administrative health data for the province of Ontario, Canada between April 1, 2002 and March 31, 2014. Individuals with incident RA (N = 53,240) or AS (N = 13,964) were separately matched 1:4 by age, sex, and year with comparators without RA or AS. The outcome was a first DSH attempt identified using emergency department data. We estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for risk of DSH in RA and AS versus comparators, adjusting for demographic, clinical and health service utilization variables. RESULTS: Subjects with AS were significantly more likely to self-harm (crude incidence rate [IR] of 0.68/1,000 person years [PY] versus 0.32/1,000 PY in comparators), with an adjusted HR of 1.59 (95% CI 1.15 to 2.21). DSH was increased for RA subjects (IR 0.35/1,000 PY) versus comparators (IR 0.24/1,000 PY) only before (HR 1.43, 95% CI 1.16 to 1.74), but not after covariate adjustment (HR 1.07, 95% CI 0.86 to 1.33). CONCLUSIONS: AS carries an increased risk for DSH but no such risk was observed in RA. Further evaluation of at-risk AS subjects is needed, including the longitudinal effects of disease and arthritis therapies on self-harm behaviour. This will inform whether specific risk-reduction strategies for DSH in inflammatory arthritis are needed.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Comportamento Autodestrutivo/complicações , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Artrite Reumatoide/psicologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Espondilite Anquilosante/psicologia
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