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1.
Medicine (Baltimore) ; 99(8): e19229, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080122

RESUMO

OBJECTIVES: The aim of this meta-analysis is to investigate the comparative efficacy between supervised- and home-based programs in patients with ankylosing spondylitis (AS). METHOD: A systematic search in PubMed, Web of Science, EMBASE, and the Cochrane Library was electronically performed by 2 independent investigators in order to capture all potential studies comparing supervised- with home-based in patients with AS from inception to April 2018. After extracted essential information, apprised risk of bias, statistical analysis was performed with Review Manager (RevMan) software (version 5.3.0). The protocol was registered at PROSPERO platform with an identifier of CRD42018097046. RESULTS: A total of 7 studies comprising 271 patients were included finally. Meta-analyses showed that, compared to home-based program, supervised-based program was associated with reduced bath ankylosing spondylitis metrology index (BASMI) scores (mean difference [MD], -0.45; 95% confidence interval [CI], -0.73, -0.17), bath ankylosing spondylitis disease activity index (BASDAI) scores (MD, -0.48; 95% CI, -0.88, -0.08), and bath ankylosing spondylitis functional index (BASFI) scores (MD, -0.78; 95% CI, -1.19, -0.37). However, depression scores (standard mean difference, -0.22; 95% CI, -0.58, 0.14) between the 2 groups showed no significant defference. CONCLUSIONS: Both supervised- and home-based programs can benefit to reduce BASMI, BASDAI, and BASFI scores in AS patients. However, short-term, supervised exercise program may be more effective than home-based exercises at decreasing disease activity with AS.


Assuntos
Terapia por Exercício/métodos , Serviços de Assistência Domiciliar/organização & administração , Espondilite Anquilosante/reabilitação , Ensaios Clínicos como Assunto , Depressão/epidemiologia , Humanos , Índice de Gravidade de Doença , Espondilite Anquilosante/epidemiologia
2.
Medicine (Baltimore) ; 98(27): e15596, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277086

RESUMO

This study aimed to investigate the relationship between Mycoplasma pneumonia (MP) infection and new development of ankylosing spondylitis (AS).Using data from the Taiwan National Health Insurance Research Database, we included a total of 116,084 patients with newly diagnosed MP between 2000 and 2012. The control cohort consisted of patients who did not have MP, matched 1:4 by age, sex, and index year. The follow-up period was defined as the time from the initial diagnosis of MP to the date of diagnosis of AS, censoring, or 31 December 2013. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases by sex, age, and comorbidities, with hazard ratios (HRs) and 95% confidence intervals (CIs).The eligible study participants included 116,084 patients in the MP group and 464,336 patients in the comparison group. The incidence rates of AS in the MP group and comparison groups were 1.49 and 0.74 per 1,000,000-person years, respectively. The adjusted HR of AS for the MP group was 2.45 (95% CI = 1.02-5.90) compared to the control group after adjustment for age, sex, and all covariates.MP remained an independent risk factor for developing AS in terms of sex, age, and comorbidities.


Assuntos
Pneumonia por Mycoplasma/epidemiologia , Espondilite Anquilosante/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
3.
Int J Rheum Dis ; 22(9): 1686-1694, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31328410

RESUMO

AIM: Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. METHODS: This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. RESULTS: We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P < .001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P = .019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P < .001) and higher disease activity (OR 3.24-7.42, both P < .05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P = .036) and higher disease activity (OR 1.15, P = .004) were univariate associated factors. CONCLUSION: These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.


Assuntos
Artrite Psoriásica/epidemiologia , Artrite/epidemiologia , Doenças Cardiovasculares/epidemiologia , Pneumopatias/epidemiologia , Espondilite Anquilosante/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite/diagnóstico , Artrite Psoriásica/diagnóstico , Doenças Cardiovasculares/diagnóstico , China/epidemiologia , Progressão da Doença , Oftalmopatias/diagnóstico , Oftalmopatias/epidemiologia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Incidência , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Adulto Jovem
4.
Arch Med Res ; 50(1): 41-46, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-31101242

RESUMO

BACKGROUND: Gut inflammation is closely related to spondyloarthritis (SpA) pathophysiology. Fecal calprotectin has been used to measure the degree of gut inflammation. The phenotype of SpA may change according to studied population. AIM: To study the fecal calprotectin levels in a sample of SpA in Brazilian patients and its relationship with epidemiological, clinical and treatment variables as well as with the macro and microscopic degree of gut inflammation. METHODS: Eighty five SpA patients were studied for epidemiological and clinical features, functional and inflammatory indexes and fecal calprotectin levels measured using a ELISA kit. Colonoscopy with intestinal biopsies were performed in 39 of them. At time of colonoscopy a second calprotectin level was done after suspension of at least 3 weeks of used anti-inflammatory nonsteroidal drugs (NSAIDs). RESULTS: Fecal calprotectin levels were higher in Ankylosing Spondylitis (AS) patients (p <0.0001) and in those with axial involvement (p = 0.002). No relationship was found with SpA inflammatory and functional parameters (all p = ns). After suspension of NSAIDs, a drop in fecal calprotectin levels was observed (from median levels of 215.0-76.0 µg/g; p = 0.01). In the colonoscopy, 33.3% had macroscopic signs of inflammation and these patients had higher calprotectin (p = 0.009) than others. Microscopic examination showed that all patients had lymphoplasmacytic infiltrate and eosinophilic infiltrate; epithelial erosion was present in 27.2%. CONCLUSIONS: Patients with ankylosing spondylitis and axial forms of diseases have higher fecal calprotectin levels. Patients with all types of SpA have microscopic inflammatory changes in the gut.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Intestinos/patologia , Complexo Antígeno L1 Leucocitário/análise , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/patologia , Biomarcadores/análise , Brasil/epidemiologia , Colonoscopia , Ensaio de Imunoadsorção Enzimática , Fezes/química , Feminino , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/epidemiologia
5.
Expert Opin Pharmacother ; 20(12): 1483-1491, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31095430

RESUMO

Introduction: Spondyloarthritis (SpA) refers to a group of disorders sharing common clinical, genetic and imaging characteristics. Axial (ax) SpA corresponds to a subgroup that mainly affects the axial skeleton, leading to inflammatory back pain and progressive radiographic changes of the sacroiliac joints and the spine. axSpA are currently subdivided into two forms, namely the radiographic and nonradiographic form, and are associated with musculoskeletal pain, restriction of spinal mobility, specific extra-articular features and overall, altered quality of life. The therapeutic management of axSpA has considerably progressed and is now well standardized. Areas covered: Herein, the author reviews the pharmacological treatments that may be used in axSpA, including radiographic and nonradiographic forms in addition to the role of nonsteroidal anti-inflammatory drugs (NSAIDs), TNF alpha (TNFi), and IL-17A (IL-17Ai) inhibitors. Expert opinion: NSAIDs remain the mainstay of initial therapy and biological agents may be then envisaged. TNFi and IL-17Ai may be used in axSpA, but physicians have more experience with TNFi. Only TNFi are licensed for the treatment of nonradiographic axSpA. IL-17Ai may be used as first or second line biologic disease modifying antirheumatic drugs (bDMARDs) and further results are needed to better define their position in the therapeutic management of axSpA.


Assuntos
Antirreumáticos/classificação , Antirreumáticos/uso terapêutico , Espondilartrite/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Humanos , Interleucina-17/antagonistas & inibidores , Dor/tratamento farmacológico , Dor/epidemiologia , Qualidade de Vida , Espondilartrite/epidemiologia , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores
6.
Int J Rheum Dis ; 22(7): 1202-1208, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062501

RESUMO

AIM: Several studies have described sensorineural deafness in ankylosing spondylitis (AS) patients while conductive hearing loss has been reported to be rare. In our study we have studied the prevalence of hearing loss (HL) among AS patients and its association with non-steroidal anti-inflammatory drug (NSAID) intake. METHODS: We studied 100 AS patients and 40 controls. HL was defined as pure-tone thresholds greater than 20 dB (decibel) in at least two frequencies of the audiogram. Severity of HL was defined as given by World Health Organization. Clinical details and cumulative NSAID doses were noted. RESULTS: Ninety-six of the 100 patients were male with mean age of 32 ± 12 years and mean duration of illness of 8.2 ± 6 years. Median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and cumulative NSAID dose were 3.5 ± 2.2, 2.75 ± 2, 3.7 ± 2.6 and 1202 ± 1290, respectively. Of the 48 with HL, 28 patients had bilateral HL. Twenty-nine patients had pure conductive HL while 16 had mixed HL (components of both sensory and conductive) and 3 had pure sensorineural HL. HL was mild in 38 patients, and moderate to severe in 10 patients. The presence of HL was associated with higher age (P ≤ 0.05). Conductive HL was at low frequency (0.25, 0.5, 1 kHz) in 70% of cases. Sensorineural HL was at high frequency (4, 8 kHz) in 75% of cases. There was no association of HL with disease parameters such as BASMI, BASDI, BASFI or cumulative NSAID dose. CONCLUSION: HL is common in AS. Conductive HL is more common than sensorineural HL. It is usually mild and occurs at low frequencies.


Assuntos
Perda Auditiva Bilateral/epidemiologia , Perda Auditiva Condutiva/epidemiologia , Perda Auditiva Neurossensorial/epidemiologia , Audição , Espondilite Anquilosante/epidemiologia , Adulto , Fatores Etários , Anti-Inflamatórios não Esteroides/efeitos adversos , Audiometria de Tons Puros , Estudos de Casos e Controles , Estudos Transversais , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/fisiopatologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Adulto Jovem
7.
Biomed Res Int ; 2019: 2171475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931322

RESUMO

Objectives: Ankylosing spondylitis (AS) is a chronic disease that decreases mobility, function, and quality of life. This study introduced the "Smart-phone SpondyloArthritis Management System" (SpAMS), an interactive mobile health (mHealth) tool designed for AS/spondyloarthritis (SpA) disease management and used SpAMS data to evaluate clinical characteristics of Chinese patients with AS. Methods: SpAMS integrates patient's and physician's portals in a smart phone application. The Chinese Ankylosing Spondylitis Prospective Imaging Cohort was launched using SpAMS in April 2016. Patient self-assessments were completed online at baseline and at every subsequent clinic visit. Physician-reported assessments and treatments were recorded by rheumatologists during each visit. Results: In total, 1201 patients with AS [mean (SD) age, 30.6 (8.7) years; male, 82.6%] were recruited. Mean (SD) disease duration was 8.4 (6.1) years. Past or current symptoms of acute anterior uveitis (AAU), psoriasis, and inflammatory bowel disease (IBD) were observed in 21.0%, 3.7%, and 9.4% of patients, respectively. AAU and IBD occurred significantly more in patients with symptom duration > 10 years. The most commonly used medications at baseline were nonsteroidal anti-inflammatory drugs (98.2%). Patients using tumour necrosis factor inhibitors accounted for 20.8%, and 66.4% of patients used conventional synthetic disease-modifying antirheumatic drugs. At baseline, 57.2% of patients had inactive disease (ID)/low disease activity (LDA); this rate significantly improved to 79.2% after a mean follow-up of 13.3 (5.9) months. Compared with relapsed patients, new achievers of ID/LDA underwent more online patient assessments (P < .001). Problems solved in SpAMS caused 29.1% of clinic visits to a tertiary hospital unnecessary. SpAMS saved an average of 5.3 hours and 327.4 RMB per person on traffic expenses; these expenses equalled 16% of the Chinese monthly disposable personal income. Conclusions: SpAMS is a time- and cost-saving disease management tool that can help patients with AS perform self-management and provide valuable data to clinicians.


Assuntos
Gerenciamento Clínico , Smartphone , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/prevenção & controle , Adulto , Antirreumáticos/uso terapêutico , China/epidemiologia , Análise Custo-Benefício , Feminino , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Psoríase/epidemiologia , Psoríase/fisiopatologia , Psoríase/prevenção & controle , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/fisiopatologia , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/epidemiologia , Uveíte Anterior/fisiopatologia , Uveíte Anterior/prevenção & controle
8.
Reumatol. clín. (Barc.) ; 15(2): 90-96, mar.-abr. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184355

RESUMO

Objetivos: Describir la metodología del estudio de prevalencia de las enfermedades reumáticas en la población adulta en España, EPISER 2016, así como sus fortalezas y limitaciones. El objetivo del proyecto es estimar la prevalencia de artritis reumatoide (AR), artropatía psoriásica (APs), espondilitis anquilosante (EA), lupus eritematoso sistémico (LES), síndrome de Sjögren (SS), artrosis (de rodilla, cadera, manos, columna cervical y lumbar), fibromialgia, gota y fractura osteoporótica clínica. Material y método: Estudio transversal multicéntrico de base poblacional en el que participan 45 municipios de las 17 comunidades autónomas. La población de referencia está compuesta por adultos de 20 o más años residentes en España. La recogida de información se llevará a cabo mediante encuesta telefónica empleando el sistema Computer Assisted Telephone Interview (CATI). Las sospechas diagnósticas y los diagnósticos autorreferidos serán estudiadas por reumatólogos del hospital de referencia de los municipios seleccionados. Análisis estadístico: se calcularán las prevalencias de enfermedades reumáticas mediante estimadores y sus IC del 95%. Se calcularán factores de ponderación en función de la probabilidad de selección en cada una de las etapas del muestreo. Se tendrá en cuenta la distribución de la población en España según datos del Instituto Nacional de Estadística. Conclusiones: Los cambios sociodemográficos y en hábitos de vida durante los últimos 16 años justifican la realización de EPISER 2016. El estudio ofrecerá datos actualizados de prevalencia en AR, EA, APs, LES, SS, artrosis, fibromialgia, gota y fractura osteoporótica clínica. Los resultados permitirán comparar los datos con estudios de otros países y con el EPISER 2000


Aims: To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. Material and method: Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the participants will be studied by rheumatologists in the referral hospitals in the selected municipalities. Statistical analysis: the prevalence of the rheumatic diseases will be calculated using estimators and their 95% confidence intervals. Weights will be calculated in each of the sampling stages in accordance with the probability of selection. The distribution of the population in Spain will be obtained from the Spanish Statistics Institute. Conclusions: Sociodemographic and lifestyle changes over the last 16 years justify EPISER 2016. This study will provide current data about the prevalences of RA, AS, PsA, SLE, SS, osteoarthritis, fibromyalgia, gout and clinical osteoporotic fracture. The results will allow comparisons with studies from other countries and EPISER 2000


Assuntos
Humanos , Adulto , Doenças Reumáticas/epidemiologia , Gota/epidemiologia , Artropatias/epidemiologia , Síndrome de Sjogren/epidemiologia , Fibromialgia/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Artrite Reumatoide/epidemiologia , Espondilite Anquilosante/epidemiologia , Artrite Psoriásica/epidemiologia , Espanha/epidemiologia , Estudos Transversais/métodos
9.
Int J Rheum Dis ; 22(7): 1283-1288, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30816022

RESUMO

OBJECTIVE: To clarify the development of juvenile idiopathic arthritis (JIA) to adult-onset autoimmune diseases in a population-based study in Taiwan. METHODS: We analyzed data of 107 433 children born between 1990 and 1997 from the National Taiwan Health Insurance Database. There were 262 JIA patients and 107 171 individuals without JIA who were selected and followed up until December 2013 to investigate their outcomes of adult-onset autoimmune diseases after reaching 16 years of age. The adjusted hazard ratios (aHRs) including 95% confidence intervals (95% CI) of adult-onset autoimmune diseases were calculated using the Cox proportional regression model among different age groups. RESULTS: The incidence rate for patients with a history of JIA was 83.56 per 105 person-months for rheumatoid arthritis (RA), 16.61 for systemic lupus erythematosus (SLE), 58.39 for ankylosing spondylitis (AS), and 33.26 for psoriatic diseases. The aHRs were 29.60 for any autoimmune disease, 129.52 for RA, 10.01 for SLE, 49.62 for AS, and 8.20 for psoriatic diseases. Compared with non-JIA individuals, the aHRs of adult-onset autoimmune diseases were 34.87 (95% CI: 4.85-250.62) at the onset age of 3-5 years, 12.01 (95% CI: 2.99-48.26) at the age of 6-10 years, and 45.80 (95% CI: 29.69-70.64) at the age of 11-15 years. CONCLUSION: Children with JIA were at an increased risk of developing RA, AS, psoriatic disease, and SLE in adulthood.


Assuntos
Artrite Juvenil/epidemiologia , Artrite Reumatoide/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Psoríase/epidemiologia , Espondilite Anquilosante/epidemiologia , Adolescente , Idade de Início , Artrite Juvenil/diagnóstico , Artrite Juvenil/imunologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Psoríase/diagnóstico , Psoríase/imunologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/imunologia , Taiwan , Fatores de Tempo
10.
Dis Markers ; 2019: 4612370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30886655

RESUMO

Objective: The length ratio of the index finger (2D) to the ring finger (4D) (2D : 4D ratio) is considered a biomarker of prenatal sex hormone exposure. The 2D : 4D ratio is influenced by prenatal androgen and estrogen levels. Because ankylosing spondylitis (AS) influences men more frequently and severely than women, androgens are proposed to be related to AS pathogenesis. Estrogens have immune-modulating effects and reduce AS disease activity. The aim of this study was to assess the relationship between 2D : 4D ratio and AS disease activity. Material and Methods: In this study, 167 (43 female) patients diagnosed with AS were studied. The lengths of the second and fourth fingers were measured using a digital caliper. The 2D : 4D ratio was found by dividing the length of the second finger by the length of the fourth finger. AS disease activity was assessed with the Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). AS functional status was assessed with Bath Ankylosing Spondylitis Functional Index (BASFI). L-Schober, tragus to wall distance, finger to floor distance, and chest expansion were used to evaluate mobility. Results: In female patients, the right hand 2D : 4D ratios were higher than those in male patients. Biologic drug use was more frequent in males. The BASDAI scores were higher in female patients than in male patients. There were significant negative correlations between right and left hand 2D : 4D ratio and BASFI and BASDAI in female patients. There was no significant correlation between the 2D : 4D ratio and BASFI or BASDAI in male patients. We found a positive correlation between L-Schober and right hand 2D : 4D and a negative correlation between the left hand 2D : 4D ratio and finger to floor distance in female patients with AS. Conclusion: The 2D : 4D ratio of the right and left hand was low in female patients with high BASFI and BASDAI and low spinal mobility (L-Schober) was also linked to low female 2D : 4D. The lack of strong associations between 2D : 4D and AS in male patients may have resulted from their higher use of biologics.


Assuntos
Dedos/anatomia & histologia , Espondilite Anquilosante/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
PLoS One ; 14(2): e0211946, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768617

RESUMO

BACKGROUND: A hospitalized-based cohort study suggested that elevated C-reactive protein (CRP) levels are associated with radiographic sacroiliitis progression in ankylosing spondylitis (AS) patients. However, data from community-based populations are limited. OBJECTIVE: We sought to determine the association between elevated CRP levels and AS diagnosis in a prospective community-based study of 129,681 Chinese adults over a follow-up period of 8 years. METHODS: We measured the plasma CRP concentration at baseline and every 2 years thereafter with the high-sensitivity (hs)-CRP test. Incident AS cases were confirmed on the basis of modified New York diagnostic criteria after review of medical records. We used Cox proportional-hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for AS on the basis of hs-CRP concentrations, adjusting for age, sex, education, income, cigarette smoking, alcohol intake, physical activity, body mass index, blood-pressure status, blood glucose status, total cholesterol, history of cardiovascular disease, and use of antihypertensives, lipid-lowering agents, and aspirin. RESULTS: During 1,033,609 person-years (average 7.97 ± 1.36 years per person) of follow-up, we identified 55 incident AS cases. Baseline hs-CRP was positively associated with the risk of future AS. Compared with hs-CRP <1 mg/L, the HR was 1.28 (95% CI 0.54-3.08) for hs-CRP of 1.00-2.99 mg/L, 4.71 (95% CI 2.26-9.81) for hs-CRP of 3.00-9.99 mg/L, and 19.8 (95% CI 9.6-40.9) for hs-CRP ≥10.00 mg/L (P-trend <0.001) after adjustment for potential confounders. We found similar results after excluding AS cases that occurred in the first 2 years of follow-up, and using the cumulative average hs-CRP concentration as a predictor. CONCLUSION: This is the first study in a community-based cohort to demonstrate that CRP plasma concentrations predict the risk of future AS, thus providing a test that is easy to routinely perform in the clinic to assess for AS risk.


Assuntos
Proteína C-Reativa/metabolismo , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Regulação para Cima , Adulto , Idoso , Biomarcadores/sangue , China/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Espondilite Anquilosante/metabolismo
12.
Ann Rheum Dis ; 78(4): 480-485, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737222

RESUMO

BACKGROUND: Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), can be life threatening. An increased frequency of VTE has been found in inflammatory conditions. To date, evidence assessing whether this risk is also greater in patients with ankylosing spondylitis (AS) is scarce. METHODS: Using the provincial British Columbia, Canada healthcare database that encompasses all residents within the province, we conducted matched cohort analyses of incident PE, DVT and overall VTE among incident cases of AS and compared them with individuals randomly selected from the general population without AS. We calculated incidence rates (IRs) of VTE and multivariable analyses after adjusting for traditional risk factors using Cox models. RESULTS: Among 7190 incident cases of AS, 35 developed PE and 47 developed DVT. IRs of PE, DVT and overall VTE per 1000 person-years for patients with AS were 0.79, 1.06, 1.56 compared with 0.40, 0.50, 0.77 in the control cohort. Corresponding fully adjusted HRs (95% CI) of PE, DVT and VTE were 1.36 (0.92 to 1.99), 1.62 (1.16 to 2.26) and 1.53 (1.16 to 2.01), respectively. The risks of PE, DVT and VTE were highest in the first year of diagnosis with HR (95% CI) of 2.88 (0.87 to 9.62), 2.20 (0.80 to 6.03) and 2.10 (0.88 to 4.99), respectively. CONCLUSIONS: These findings demonstrate an increased risk of VTE in the general AS population. This risk appears the most prominent in the first year after diagnosis.


Assuntos
Espondilite Anquilosante/complicações , Tromboembolia Venosa/etiologia , Adulto , Idoso , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Medição de Risco/métodos , Espondilite Anquilosante/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
13.
PLoS One ; 14(2): e0211835, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726282

RESUMO

OBJECTIVES: There are limited studies describing the association between ankylosing spondylitis (AS) and osteoporosis. We conducted a nationwide retrospective cohort study to investigate this epidemiologic evidence. METHODS: Data were obtained from the Taiwan National Health Insurance Research Database (NHIRD). Of 10,290 participants, 2,058 patients with AS and 8,232 patients without AS were enrolled from the NHIRD between 2000 to 2013. Cumulative incidences of osteoporosis were compared between 2 groups. Cox regression model was used to estimate the hazard ratio (HR) of developing osteoporosis after controlling for demographic and other co-morbidities, and subgroup analyses were conducted to examine the risk factors for osteoporosis in AS patients. RESULTS: The incidence rate ratio (IRR) of osteoporosis in AS patients was 2.17 times higher than that non-AS group (95% confidence interval [CI], 1.83-2.57). The adjusted HRs of osteoporosis for AS patients after controlling for demographic characteristics and comorbid medical disorders was 1.99 (95% CI 1.68-2.36). Among AS group, after adjustment for major comorbidities, old age (≥65 years, HR 4.32, 95% CI 3.01-6.18), female sex (HR 2.48, 95% CI 1.87-3.28), dyslipidemia (HR 1.44, 95% CI 1.01-2.06) were risk factors associated with osteoporosis. CONCLUSIONS: This cohort study demonstrated that patients with AS had a higher risk of developing osteoporosis, especially in those aged over 65, female sex and with dyslipidemia in this patient group.


Assuntos
Bases de Dados Factuais , Osteoporose , Espondilite Anquilosante , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/etiologia , Fatores de Risco , Fatores Sexuais , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Taiwan/epidemiologia
14.
Rheumatol Int ; 39(4): 729-733, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30799529

RESUMO

The aim of the study is to analyze the characteristics of patients with rheumatic diseases applying for a Disability Certificate (DC). Every application for DC filed by patients of 16 years of age and older in the Health Secretariat of Junin, between 2012 and 2016, was analyzed regarding age, gender, rheumatic disease as the cause of disability, employment status, and health insurance coverage. Applications were examined as per two elements: inflammatory articular or systemic disease (IASD) versus degenerative diseases, regional or generalized pain syndromes (non-IASD). Based on the DCs accepted, a Disability Prevalence Rate (DPR) was estimated and the most common causes of disability were determined. Out of 400 applications, 68% belonged to women; applicants' median age was 61 years, only 27% were working, 42% were for DC renewal, and 46% were IASD. Overall, 83% of the applications submitted were accepted. Those patients with accepted DC applications were older (median age 62 vs 55; p < 0.001), had health insurance coverage (90% vs 65%; p <0.001), were applying for DC renewal (49% vs 12%; p < 0.001) and more frequently presented a IASD (52% vs 17%; p < 0.001). 48% of accepted DC applications had osteoarthritis (OA), 36% rheumatoid arthritis (RA), 6% psoriatic arthritis (PsA), 5% systemic lupus erythematosus (SLE) and 2% ankylosing spondylitis (AS). The DPR was 0.5%. Overall, the accepted applications for DC belong to older patients with health insurance coverage, who were submitting an application for DC renewal and suffer from a IASD. OA, RA, PsA, SLE and AS were the five most common causes of disability.


Assuntos
Artrite Reumatoide/epidemiologia , Avaliação da Deficiência , Osteoartrite/epidemiologia , Previdência Social , Adulto , Idoso , Argentina/epidemiologia , Artrite Psoriásica/epidemiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/epidemiologia , Espondilite Anquilosante/epidemiologia
15.
Hum Immunol ; 80(5): 339-343, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30794838

RESUMO

The objective of this case-control study was to evaluate the role of four single-nucleotide polymorphisms in the ERAP1 (rs2287987, rs30187, rs27044) and ERAP2 (rs2248374) genes and their haplotypes in predicting the risk for ankylosing spondylitis (AS) on a well-defined Polish population. Our study confirmed the strong association between the HLA-B*27 allele and the disease. For all tested ERAP1 SNPs we found significant differences in the minor allele and genotype distribution between patients and controls. The strongest association with AS was observed for rs30187. The minor T allele and homozygous TT genotype of this SNP significantly increased disease risk (OR = 1.56, 95%CI = 1.22-1.99, p = 0.0004 and OR = 2.52, 95%CI = 1.50-4.25, p = 0.001, respectively). In the case of rs2287987, minor C allele exerted a protective effect (OR = 0.64, 95%CI = 0.46-0.88, p = 0.008). In contrast to ERAP1, we observed no effect of rs2248374 in ERAP2 on the disease. We also carried out ERAP1-ERAP2 haplotype analysis to demonstrate a possible association of both genes with AS. Results showed that the haplotype H4, containing ERAP1 SNPs associated with high enzymatic activity, together with the presence of ERAP2 expression, significantly increased the risk of AS (OR = 1.97, 95% CI = 1.21-3.21, pcorr = 0.048). By contrast, the haplotype H5 coding for low activity of ERAP1 and the lack of ERAP2 expression was strongly protective (OR = 0.41, 95% CI = 0.23-0.72, pcorr = 0.008).


Assuntos
Aminopeptidases/genética , Predisposição Genética para Doença , Haplótipos , Antígenos de Histocompatibilidade Menor/genética , Espondilite Anquilosante/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminopeptidases/metabolismo , Biomarcadores , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética , Antígeno HLA-B27/genética , Antígeno HLA-B27/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Antígenos de Histocompatibilidade Menor/metabolismo , Razão de Chances , Polônia , Polimorfismo de Nucleotídeo Único , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Adulto Jovem
16.
PLoS One ; 14(1): e0210335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703142

RESUMO

Among a variety of comorbidities of ankylosing spondylitis (AS), the association between dementia and AS by using an extensive dataset from the Korean National Health Insurance System was evaluated in this study. We extracted 15,547 newly diagnosed AS subjects among the entire Korean population and excluded wash-out patients (n = 162) and patients that were inappropriate for cohort match (n = 1192). Finally, 14,193 subjects were chosen as the AS group, and through 1:5 age- and sex-stratified matching, 70,965 subjects were chosen as the control group. We evaluated patient demographics, household incomes, and comorbidities, including hypertension, diabetes, and dyslipidemia. The prevalence of overall dementia (1.37%) and Alzheimer's dementia (AD) (0.99%) in the AS group was significantly higher than in the control group (0.87% and 0.63%), respectively. The adjusted hazard ratio of the AS group for overall dementia (1.758) and AD (1.782) showed statistical significance also. On the other hand, the prevalence of vascular dementia did not differ significantly between the two groups. Subgroup analyses revealed the following risk factors for dementia in the AS group: male gender, greater than 65 years in age, fair income (household income greater than 20% of the median), urban residency, no diabetes, and no hypertension. From the nationwide, population-based, retrospective, longitudinal cohort study, AS patients showed a significantly higher prevalence of overall dementia and Alzheimer's dementia. Comprehensive patient assessment using our subgroup analysis could help to prevent dementia in patients suffering from AS.


Assuntos
Demência/epidemiologia , Espondilite Anquilosante/epidemiologia , Adulto , Idoso , Doença de Alzheimer/epidemiologia , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Demência Vascular/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
Curr Opin Rheumatol ; 31(2): 109-117, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30624284

RESUMO

PURPOSE OF REVIEW: Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures. RECENT FINDINGS: Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings. SUMMARY: The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.


Assuntos
Fatores Biológicos/uso terapêutico , Espondilite Anquilosante/terapia , Biomarcadores/sangue , Saúde Global , Humanos , Morbidade/tendências , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia
18.
Ann Rheum Dis ; 78(4): 473-479, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30674475

RESUMO

OBJECTIVES: Here, we present the reported incidence rates of inflammatory bowel disease (IBD) in patients receiving treatment with secukinumab for psoriasis (PsO), psoriatic arthritis (PsA) or ankylosing spondylitis (AS), in a pooled analysis of 21 clinical trials. METHODS: Data from all patients who had received at least one dose of secukinumab were included. Safety analyses were conducted to evaluate cumulative IBD rates as well as per-year rates, by indication. Crohn's disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU) events were analysed using exposure-adjusted incidence rates (patient incidence rates per 100 patient-years (PY)). RESULTS: A total of 7355 patients with a cumulative exposure of 16 226.9 PY were included in the pooled analysis. Among 5181 patients with PsO, there were 14 cases of UC, 5 cases of CD and 1 case of IBDU, with exposure adjusted incidence rates (EAIRs) of 0.13, 0.05 and 0.01, respectively. Of these 20 cases, 14 were new-onset. In 1380 patients with PsA, there were 3 cases of UC, 3 cases of CD and 2 cases of IBDU (EAIRs 0.08, 0.08 and 0.05); 7 of these represented new-onset cases. Among 794 patients with AS, there were 4 cases of UC, 8 cases of CD and 1 case of IBDU (EAIRs 0.2, 0.4 and 0.1); 9 were new-onset cases. In the per year analysis, the EAIRs for each indication did not increase over time with secukinumab treatment. CONCLUSIONS: In this pooled secukinumab safety analysis of 7355 patients across 21 clinical trials, cases of IBD events (including CD, UC and IBDU) were uncommon.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Produtos Biológicos/efeitos adversos , Doenças Inflamatórias Intestinais/induzido quimicamente , Psoríase/tratamento farmacológico , Espondilite Anquilosante/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Produtos Biológicos/uso terapêutico , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/epidemiologia , Doença de Crohn/induzido quimicamente , Doença de Crohn/epidemiologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Vigilância de Produtos Comercializados , Psoríase/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Espondilite Anquilosante/epidemiologia
19.
Clin Exp Rheumatol ; 37(5): 731-739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30620291

RESUMO

OBJECTIVES: To determine the incidence and risk factors of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD). METHODS: Analysis of data after 2.5 years of follow-up from the prospective study CARMA project, that includes patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and matched individuals without CIRD from 67 hospitals in Spain. CVE cumulative incidence per 1000 patients was calculated after 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate hazard ratio (HR) and 95% confidence interval (95% CI) of the risk factors. RESULTS: 2595 (89.1%) patients completed the 2.5 years of follow-up visit. Cumulative incidence of CVE in patients with CIRD was 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in the subgroup with AS; 22.03 (95% CI: 11.01-33.04). Patients with AS (HR: 4.11; 95% CI: 1.07-15.79), those with older age (HR: 1.09; 95% CI: 1.05-1.13), systolic hypertension (HR: 1.02; 95% CI: 1.00-1.04) and long duration of the disease (HR: 1.07; 95% CI: 1.03-1.12) were at higher risk of first CVE during the 2.5 years of follow-up. In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00). CONCLUSIONS: Among CIRD patients prospectively followed-up at rheumatology outpatient clinics, those with AS show higher risk of first CVE. Besides cardiovascular risk factors, such as hypertension, being a man and older as well as having a long disease duration increase the risk of CVE in patients with CIRD.


Assuntos
Artrite Psoriásica/epidemiologia , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Espondilite Anquilosante/epidemiologia , Idoso , Comorbidade , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Doenças Reumáticas/epidemiologia , Fatores de Risco , Espanha/epidemiologia
20.
Joint Bone Spine ; 86(2): 173-183, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29635017

RESUMO

OBJECTIVE: Obesity is a worldwide epidemic and a growing body of evidence suggests that it may affect the body's response to biologic agents. We investigated the influence of obesity on the efficacy of different biologic agents used to treat inflammatory diseases. METHODS: Medline, EMBASE and the Cochrane Database were searched using relevant MeSH and keyword terms for obesity and bDMARDs. Articles were selected if they reported a clinical response in obese subjects relative to other BMI categories. Response and remission outcomes were assessed using meta-analysis and all other reported outcomes were summarized. RESULTS: Among the 3850 records retrieved, 24 articles met the inclusion criteria, including 10 on rheumatoid arthritis (RA), 4 on axial spondyloarthritis (axSpA), 4 on Crohn's disease (CD), 4 on psoriasis (Ps) and 2 on psoriasic arthritis (PsA). Four biological disease-modifying anti-rheumatic drugs (bDMARDs) - anti-TNF agents, T cell co-stimulation inhibitor (abatacept), IL-6 inhibitor (tocilizumab), and B-cell depletion therapy (rituximab) - were involved. The meta-analysis showed that the odds to reach a good response or achieve remission were lower in obese (BMI>30kg/m2) than non-obese (BMI≤30kg/m2) patients who were treated with anti-TNF agents (good responder % in RA: OR 0.34, 95% CI 0.18-0.64; remission% in RA: OR 0.36, 95% CI 0.21-0.59; BASDAI50% in axSpA: OR 0.41, 95% CI 0.21-0.83), but no significant difference between obese and non-obese was found in patients treated with abatacept (good responder % in RA: OR 0.75, 95% CI 0.42-1.36; remission% in RA: OR 0.84, 95% CI 0.65-1.09) and tocilizumab (good responder % in RA: OR 1.08, 95% CI 0.44-2.63; remission% in RA: OR 0.91, 95% CI 0.50-1.66). CONCLUSION: Obesity hampered the effect of anti-TNF agents, but not those of abatacept and tocilizumab, suggesting that a personalized treatment strategy should be considered for obese patients with inflammatory diseases.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Inflamação/tratamento farmacológico , Obesidade/epidemiologia , Abatacepte/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/epidemiologia , Produtos Biológicos/farmacologia , Comorbidade , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Feminino , Humanos , Inflamação/epidemiologia , Masculino , Obesidade/diagnóstico , Prognóstico , Medição de Risco , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/epidemiologia , Resultado do Tratamento
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