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1.
Clin Rheumatol ; 39(12): 3529-3531, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33011932
2.
PLoS One ; 15(8): e0237219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764781

RESUMO

Many susceptibility genes of inflammatory bowel disease (IBD) are associated with ankylosing spondylitis (AS). Fucosyltransferase 2 (FUT2) and FUT3 genes are related to IBD. This study aimed to investigate whether these genes correlated with the susceptibility to AS. Questionnaires of 673 patients with AS, and peripheral blood specimens of the patients and 687 healthy controls were collected. FUT2 and FUT3 genes were genotyped using the SNPscan method. Frequency differences of the genes at different levels, haplotypes, and interactions were analyzed. No frequency differences were found between the cases and the controls in all the genotypes and the alleles of rs1047781, rs1800028, rs1800030, and rs812936. For rs28362459, a significant difference in allele frequencies was observed in the total participants between the groups [χ2 = 7.515, Pcorrected = 0.030; adjusted odds ratio (ORadjusted)G/T = 0.782; 95% confidence interval (CI), 0.650-0.941]. The frequencies of haplotypes TT (rs812936-rs28362459) (χ2 = 5.663, Ppermutation = 0.039) and TG (rs812936-rs28362459) (χ2 = 7.456, Ppermutation = 0.013) in the total participants, and TG (rs812936-rs28362459) in the female subgroup (χ2 = 5.624, Ppermutation = 0.047) showed significant differences between the cases and the controls. No frequency differences at the phenotypic level were found. Two-factor interactions were observed between rs28362459-TG and age, rs28362459-TG and sex, rs28362459 and rs1047781, and the Lewis and secretor status. Rs28362459-G was related to some aggravated symptoms of AS (all Pcorrected < 0.05). These findings indicated that FUT3 polymorphisms were associated with human predisposition to AS at the allele and haplotype level. Rs28362459-G might decrease the susceptibility to AS, but aggravate relevant symptoms.


Assuntos
Fucosiltransferases/genética , Polimorfismo de Nucleotídeo Único , Espondilite Anquilosante/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Espondilite Anquilosante/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(31): e21450, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756165

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a common progressive autoimmune inflammatory disease. Du moxibustion can effectively treat AS with few adverse reactions. The aim of this protocol is to systematically investigate the effectiveness and safety for management of AS with Du moxibustion. METHODS: Seven relevant databases, namely, PubMed, Cochrane Library, Embase, Chinese Biomedical Literatures Database (CBM), China National Knowledge Infrastructure (CNKI), WangFang Database (WF), Chinese Scientific Journal Database (VIP) will be searched from their inception until May 1st, 2020. All clinical randomized controlled trials containing eligible interventions(s) and outcome(s) will be included, regardless of blinding or publication types. Two reviewers will independently retrieval databases, extract data, and then assess the quality of studies. Data synthesis will be conducted by RevMan 5.3 software. We regard the effective rate, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analogue Scale (VAS) as the primary outcomes, and the secondary outcomes contain C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), finger-to-floor distance (FFD), occiput to wall distance (OWD), and side effects. The result about the curative effect and safety of Du moxibustion for AS will be presented as risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data. RESULTS: The finding will be presented in a journal or related conferences. CONCLUSIONS: This study expects to provide high-quality, evidence-based recommendations on further treatment for clinical guidance. PROSPERO REGISTRATION NUMBER: CRD42020158727.


Assuntos
Moxibustão/métodos , Espondilite Anquilosante/sangue , Espondilite Anquilosante/terapia , Sedimentação Sanguínea , Proteína C-Reativa/análise , Bases de Dados como Assunto , Humanos , Moxibustão/efeitos adversos , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Espondilite Anquilosante/epidemiologia , Resultado do Tratamento , Escala Visual Analógica
4.
PLoS One ; 15(8): e0237117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745130

RESUMO

OBJECTIVE: To describe fatigue in relation to disease-specific and socioeconomic factors and to test possible correlations between fatigue and work impairment, quality of life, pain, sleep, depression, and physical functioning in people with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS: A questionnaire-based cross-sectional survey collecting patient characteristics such as disease characteristics, socioeconomic factors and patient-reported outcomes (PROs) from patients with RA, PsA and axSpA in Denmark. PRO scales included the FACIT-Fatigue sub-scale, Work Productivity and Activity Impairment scale (WPAI), EuroQol (EQ-5D), Medical Outcomes Study Sleep Scale (MOS), Major Depression Inventory (MDI), and Health Assessment Questionnaire (HAQ). Respondents were recruited via routine visits to the outpatient rheumatology clinic; information on diagnosis, treatment and disease activity was collected from medical journals by trained nurses. RESULTS: 487 patients participated in the study. Fatigue was more present in women, experienced patients, and patients who changed medication in the past 12 months, who were unemployed, who had less education, and who had lower household income. There was no statistically significant difference between mean fatigue in the three diagnostic groups (p = 0.08). Fatigue correlated with all included PROs (Pearson correlation coefficients, p<0.0001). Stratifying for diagnosis and adjusting for socioeconomic factors did not change the conclusion. CONCLUSION: In a stable, representative group of patients with RA, PsA and axSpA, we found significant correlations between fatigue and work impairment, quality of life, pain, sleep, depression and physical functioning. Fatigue cannot be perceived as a single problem, but rather as a symptom that affects broadly.


Assuntos
Artrite Psoriásica/epidemiologia , Artrite Reumatoide/epidemiologia , Fadiga/epidemiologia , Espondilite Anquilosante/epidemiologia , Adolescente , Adulto , Idoso , Dinamarca , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
5.
Clin Rheumatol ; 39(11): 3195-3204, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32852623

RESUMO

INTRODUCTION: Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. METHOD: This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. RESULTS: A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to "Italian general population" (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various "connective tissue diseases" compared to "inflammatory arthritis group" (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011). CONCLUSIONS: The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points • Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients' increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement. • The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing. • Patients with "connective tissue diseases" show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to "inflammatory arthritis group". • Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.


Assuntos
Doenças Autoimunes/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/fisiopatologia , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/fisiopatologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Dermatomiosite/tratamento farmacológico , Dermatomiosite/epidemiologia , Dermatomiosite/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Itália/epidemiologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/fisiopatologia , Escleroderma Sistêmico/tratamento farmacológico , Escleroderma Sistêmico/epidemiologia , Escleroderma Sistêmico/fisiopatologia , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/epidemiologia , Síndrome de Sjogren/fisiopatologia , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/fisiopatologia , Doenças do Tecido Conjuntivo Indiferenciado/tratamento farmacológico , Doenças do Tecido Conjuntivo Indiferenciado/epidemiologia , Doenças do Tecido Conjuntivo Indiferenciado/fisiopatologia
6.
PLoS One ; 15(5): e0233781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32459816

RESUMO

OBJECTIVE: Cases of inflammatory bowel disease (IBD) during treatment with interleukin (IL)-17 antagonists have been reported from trials in psoriasis, psoriatic arthritis, and ankylosing spondylitis. The aim of this study was to assess the overall risk for development of IBD due to IL-17 inhibition. DESIGN: Systematic review and meta-analysis of studies conducted 2010-2018 of treatment with IL-17 antagonists in patients with psoriasis, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. We compared risk of IBD development in anti-IL-17 treated patients compared to placebo treatments. We also computed incident rates of IBD overall. A 'worst case scenario' defining subjects ambiguous for prevalent versus incident cases for the latter was also applied. RESULTS: Sixty-six studies of 14,390 patients exposed to induction and 19,380 patients exposed to induction and/or maintenance treatment were included. During induction, 11 incident cases of IBD were reported, whereas 33 cases were diagnosed during the entire treatment period. There was no difference in the pooled risk of new-onset IBD during induction studies for both the best-case [risk difference (RD) 0.0001 (95% CI: -0.0011, 0.0013)] and worst-case scenario [RD 0.0008 (95% CI: -0.0005, 0.0022)]. The risk of IBD was not different from placebo when including data from maintenance and long-term extension studies [RD 0.0007 (95% CI: -0.0023, 0.0036) and RD 0.0022 (95% CI: -0.0010, 0.0055), respectively]. CONCLUSIONS: The risk for development of IBD in patients treated with IL-17 antagonists is not elevated. Prospective surveillance of patients treated with IL-17 antagonists with symptom and biomarker assessments is warranted to assess for onset of IBD in these patients.


Assuntos
Anticorpos Monoclonais , Artrite Psoriásica , Artrite Reumatoide , Doenças Inflamatórias Intestinais , Interleucina-17/antagonistas & inibidores , Espondilite Anquilosante , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/imunologia , Artrite Psoriásica/patologia , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Artrite Reumatoide/patologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/induzido quimicamente , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/imunologia , Interleucina-17/imunologia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/patologia
8.
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
9.
Dent Med Probl ; 57(2): 171-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32104993

RESUMO

BACKGROUND: There are no studies evaluating the possible association between ankylosing spondylitis (AS) and apical periodontitis (AP). OBJECTIVES: The aim of the present cross-sectional study was to investigate the possible association between AS and AP. MATERIAL AND METHODS: Fifty patients diagnosed with AS, receiving treatment at the Rheumatology Clinic in Erzurum, Turkey, were included in the experimental group. Another 50 ageand gender-matched individuals without any history of systemic disease were included in the study as the control group. All patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients: the smoking habit, the number of teeth present, the number of teeth with AP, the number of root canal-treated (RCT) teeth, and the number of RCT teeth with AP. RESULTS: There were 1,283 teeth in the AS group and 1,305 in the control group. There was a significant association between teeth with AP and AS, as the prevalence of teeth with AP was significantly lower in the control group (1.3%) than in the AS group (2.9%) (OR (odds ratio) = 2.250; p = 0.005). There was no statistically significant difference between the groups in terms of the number of RCT teeth and RCT teeth with AP (p > 0.05). CONCLUSIONS: Ankylosing spondylitis is significantly associated with an increased prevalence of AP. It can be concluded that patients with AS can be more prone to develop AP. However, AS does not reduce the success rate of endodontic treatment, because there was no significant difference between the AS and control groups in terms of RCT teeth with AP.


Assuntos
Periodontite Periapical , Espondilite Anquilosante , Estudos Transversais , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/epidemiologia , Tratamento do Canal Radicular , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , Turquia
10.
BMC Musculoskelet Disord ; 21(1): 41, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954409

RESUMO

BACKGROUND: Studies on characteristic spinal deformities in Japanese patients with ankylosing spondylitis (AS) and data demonstrating a relationship between health-related quality of life (HRQOL) and spinopelvic alignment in these patients are lacking. METHODS: In this cross-sectional study, 50 patients with AS and without a surgical history, vertebral body fracture, or scoliosis as well as 30 control patients with degenerative lumbar kyphoscoliosis (DLKS) were included. Data collected included patient sex, age, spinopelvic parameters on sagittal full-spine standing radiographs, and HRQOL questionnaire responses. Student's t-test was used to compare the characteristics of spinopelvic parameters between the groups. A multiple regression analysis was performed to analyze correlations between spinopelvic parameters and HRQOL in the AS group. RESULTS: Global kyphosis (GK; T1-12 angle) was significantly greater in the AS group than in the DLKS group (P < 0.001), whereas the pelvic tilt (PT; posterior PT angle) was smaller in the AS group (P = 0.006). Radiographic parameters correlated with HRQOL in the AS group. Multiple regression analysis identified the sagittal vertical axis (SVA) and sacral slope (SS) as factors influencing the SRS-22 total score and SVA and GK as factors influencing Japanese Orthopaedic Association Back Pain Evaluation Questionnaire mental health (subdomain). CONCLUSIONS: Patients with AS did not use lumbar lordosis or posterior PT to compensate for their large thoracic kyphosis due to spinopelvic ankylosis. These patients showed a unique compensation pattern. The correlation/regression analysis revealed a correlation between radiographic parameters and HRQOL in patients with AS, with particular importance of SVA, SS, and GK for clinical results in AS.


Assuntos
Ossos Pélvicos/diagnóstico por imagem , Equilíbrio Postural/fisiologia , Qualidade de Vida , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/cirurgia
11.
Sci Rep ; 10(1): 1412, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996699

RESUMO

Lymphotoxin-a (LTA) may be associated with the pathogenesis of inflammatory diseases. To assess the association of the LTA rs909253 A/G polymorphism with plasma level and risk of ankylosing spondylitis (AS) in a Chinese Han population. Genotyping and LTA plasma were tested by mass spectroscopy and enzyme-linked immunosorbent assay (ELISA), respectively. The results showed that the average plasma level of LTA in AS was significantly lower than in the controls (P = 0.000). Our results also indicated that LTA rs909253 A/G was associated with a decreased risk of AS (G vs. A: P = 0.014). Significant differences were also found between the rs909253 A/G genotype and down-regulated plasma level in AS patients, compared with controls. After stratification analysis, a decreased risk of AS was associated with the LTA rs909253 G allele (G vs. A) among female patients, younger patients (Yr. < 30), HLA-B27-positive patients. In addition, In conclusion, LTA rs909253 A/G genotype has a significant relationship with decreased susceptibility to AS.


Assuntos
Linfotoxina-alfa/genética , Espondilite Anquilosante/genética , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Feminino , Técnicas de Genotipagem , Antígeno HLA-B27/sangue , Antígeno HLA-B27/imunologia , Humanos , Linfotoxina-alfa/sangue , Masculino , Polimorfismo de Nucleotídeo Único , Fatores Sexuais , Espondilite Anquilosante/sangue , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/imunologia , Adulto Jovem
12.
Expert Opin Biol Ther ; 20(2): 183-192, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31736377

RESUMO

Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.


Assuntos
Produtos Biológicos/uso terapêutico , Eficiência , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Absenteísmo , Adulto , Estudos de Coortes , República Tcheca/epidemiologia , Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Eficiência/efeitos dos fármacos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia
14.
Int J Rheum Dis ; 23(1): 101-105, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31713329

RESUMO

BACKGROUND: To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). METHODS: This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease-related medical treatment during pregnancy, as drug free, single medication or multiple medication. RESULTS: Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty-three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively). CONCLUSION: In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.


Assuntos
Complicações na Gravidez/epidemiologia , Medição de Risco , Espondilite Anquilosante/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Turquia/epidemiologia , Adulto Jovem
15.
J Clin Rheumatol ; 26(1): 1-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30028807

RESUMO

OBJECTIVE: The aim of this study was to determine the prevalence and associated factors for uveitis in ethnic Chinese patients with axial spondyloarthritis (SpA) and ankylosing spondylitis (AS). METHODS: This was a cross-sectional study. Patients fulfilling the Assessment of SpondyloArthritis international Society axial SpA criteria were recruited consecutively from 3 rheumatology centers in Hong Kong from March 2014 to July 2017. Clinical and biochemical parameters were collected. History of uveitis was inquired from both history and medical records. All patients received lumbosacral spine x-rays and whole-spine and sacroiliac joint magnetic resonance imaging. Patients were defined as axial SpA if they fulfilled the Assessment of SpondyloArthritis international Society criteria and AS if they fulfilled the modified New York criteria. Clinical and radiological findings were compared between patients with and without uveitis in the 2 groups. Factors associated with uveitis were identified with univariate analyses and multivariate logistic regression analyses. RESULTS: Among 252 patients, 67 patients (26.6%) had a history of uveitis. The male-to-female ratio was 55.4 to 44.6. Disease duration was 12.3 ± 11.7 years. In the axial SpA group, multivariate regression showed that older age (odds ratio [OR], 1.05; p = 0.01), human leukocyte antigen B27 positivity (OR, 11.79; p = 0.01), and history of inflammatory bowel disease (OR, 9.74; p = 0.04) were positively associated with uveitis. In the AS group, multivariate regression showed that back pain duration (OR, 1.05; p = 0.01) and male sex (OR, 3.46; p = 0.03) were associated with uveitis. CONCLUSIONS: Axial SpA represents a spectrum of diseases. Its clinical associations with uveitis should be distinguished from those of traditional AS.


Assuntos
Antirreumáticos/uso terapêutico , Espondilartrite/epidemiologia , Espondilite Anquilosante/epidemiologia , Uveíte/epidemiologia , Adulto , Fatores Etários , Análise de Variância , Comorbidade , Estudos Transversais , Diagnóstico Diferencial , Feminino , Hong Kong , Humanos , Incidência , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Espondilartrite/diagnóstico por imagem , Espondilartrite/tratamento farmacológico , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Uveíte/diagnóstico
16.
Gac Sanit ; 34(1): 83-86, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-30541679

RESUMO

OBJECTIVE: To illustrate some gender challenges and contributions which are more frequent in research and health care through a chronic disease such as spondyloarthritis. METHOD: Using two of the main identified gender biases in research and health care (de-contextualization of diseases, especially in women, and problem definition and knowledge production in women's health), a cross-sectional study was used with 96 men and 54 women with spondyloarthritis of the Rheumatology Department of the Alicante University General Hospital, whose sources of information were semi-structured patient interviews and clinical records. RESULTS: We show how the gender perspective can contribute to contextualise the differences by sex of functional alterations and other social and health indicators, and highlight inequalities in the socioeconomic repercussions between patients of both sexes. It can contribute towards re-conceptualizing diseases, especially of women, specifying the profile of differential diagnosis according to sex, and provide knowledge about methodological challenges related to diagnostic tests. CONCLUSIONS: Achieving scientific and professional excellence in health care is also a gender issue. Analysing from a gender perspective the history of the diseases, how their diagnosis criteria were established and the normality and abnormality cut-off points, especially identified diseases of men, such as spondyloarthritis, is a priority to re-conceptualize medicine; as well as providing information on how the gender norms and values of the context interact with the lives of those who suffer these diseases.


Assuntos
Fatores Sexuais , Espondilartrite/diagnóstico , Pesquisa Biomédica , Distribuição de Qui-Quadrado , Doença Crônica , Estudos Transversais , Diagnóstico Diferencial , Feminino , Identidade de Gênero , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Humanos , Relações Interpessoais , Masculino , Sexismo , Fatores Socioeconômicos , Espondilartrite/epidemiologia , Espondilartrite/fisiopatologia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Estatísticas não Paramétricas , Saúde da Mulher
17.
Scand J Rheumatol ; 49(1): 21-27, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31354008

RESUMO

Objective: To describe the incidence of ankylosing spondylitis (AS) and spondyloarthritis (SpA) in the Danish population in 2000-2013, at national and regional level, and to investigate any trends in incidence over time.Methods: From the Danish National Patient Registry (NPR), we identified patients diagnosed with AS (International Classification of Diseases, 10th revision: M45) or SpA (M46) from 1 January 2000 to 31 December 2013. Patients without a relevant contact in NPR at 12-24 months after initial diagnosis were excluded. Incidence rate ratios (IRRs) were calculated using the background population of men and women aged 18-45 years in 2000-2013 as a comparator. Variations in incidence between periods and the five Danish regions were evaluated.Results: In total, 3042 incident cases were identified (AS: 1849; SpA: 1193). AS incidence increased from 476 in 2000-2004 to 660 in 2010-2013; the IRR (95% confidence interval) increased from 1.49 (1.33-1.67) in 2005-2009 to 1.74 (1.53-1.97) in 2010-2013. SpA incidence increased from 156 in 2000-2004 to 707 in 2010-2013; the IRR increased from 2.45 (2.03-2.94) in 2005-2009 to 6.31 (5.27-7.55) in 2010-2013. The incidence of both AS and SpA increased in all five regions.Conclusion: The incidence of both AS and SpA in Denmark increased from 2000 to 2013. However, the proportion of patients diagnosed with SpA rather than AS was significantly higher in 2010-2013. This may be due to increased awareness of SpA and new treatment options, but possibly also misclassification of patients with SpA.


Assuntos
Vigilância da População/métodos , Sistema de Registros , Espondilartrite/epidemiologia , Espondilite Anquilosante/epidemiologia , Adolescente , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico , Adulto Jovem
18.
Arthritis Care Res (Hoboken) ; 72(6): 822-828, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31033231

RESUMO

OBJECTIVE: To evaluate the impact of comorbidities on physical function in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHODS: This was a cross-sectional analysis of the baseline visit from the Cardiovascular in Rheumatology study. Multivariate models with physical function as the dependent variable (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire for AS and PsA, respectively) were performed. Independent variables were a proxy for the Charlson Comorbidity Index (CCIp; range 0-27), sociodemographic data, disease activity (erythrocyte sedimentation rate [ESR] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] in AS; Disease Activity Score in 28 joints [DAS28] using the ESR in PsA), disease duration, radiographic damage, and treatments. Results were reported as beta coefficients, 95% confidence intervals (95% CIs), and P values. RESULTS: We included 738 patients with AS and 721 with PsA; 21% of patients had >1 comorbidity. Comorbidity burden (CCIp) was independently associated with worse adjusted physical function in patients with PsA (ß = 0.11). Also, female sex (ß = 0.14), disease duration (ß = 0.01), disease activity (DAS28-ESR; ß = 0.19), and the use of nonsteroidal antiinflammatory drugs (ß = 0.09), glucocorticoids (ß = 0.11), and biologics (ß = 0.15) were associated with worse function in patients with PsA. A higher education level was associated with less disability (ß = -0.14). In patients with AS, age (ß = 0.03), disease activity (BASDAI; ß = 0.81), radiographic damage (ß = 0.61), and the use of biologics (ß = 0.51) were independently associated with worse function on multivariate analyses, but CCIp was not. CONCLUSION: The presence of comorbidities in patients with PsA is independently associated with worse physical function. The detection and control of the comorbidities may yield an integral management of the disease.


Assuntos
Artrite Psoriásica/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Adulto , Idoso , Artrite Psoriásica/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Espondilite Anquilosante/epidemiologia
19.
Scand J Rheumatol ; 49(3): 210-213, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31682163

RESUMO

Objective: The aim of this study was to estimate the prevalence of ankylosing spondylitis (AS) in Spain.Method: This is a cross-sectional, population-based study of people aged 20 years or older in Spain. Randomly selected individuals were contacted by telephone and rheumatic disease screening was performed. If the first screening was positive, medical records were then reviewed and/or a telephone questionnaire was conducted by a rheumatologist, followed by an appointment if necessary. Cases had to fulfil the modified New York (mNY) criteria.Results: In total, 4916 individuals were included, of whom 355 had a positive screening result for AS. Of these, 11 were classified as AS. An additional individual who reported a prior diagnosis of rheumatoid arthritis had a diagnosis of AS confirmed on review of the medical records. Estimated prevalence was 0.26% (95% CI 0.14-0.49).Conclusion: EPISER2016 is the first population-based study to estimate the prevalence of AS in Spain, which has been estimated as being similar to that in other European countries.


Assuntos
Espondilite Anquilosante/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fumar/epidemiologia , Espanha/epidemiologia , Adulto Jovem
20.
Rheumatology (Oxford) ; 59(5): 1059-1065, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31535693

RESUMO

OBJECTIVES: To develop classification algorithms that accurately identify axial SpA (axSpA) patients in electronic health records, and compare the performance of algorithms incorporating free-text data against approaches using only International Classification of Diseases (ICD) codes. METHODS: An enriched cohort of 7853 eligible patients was created from electronic health records of two large hospitals using automated searches (⩾1 ICD codes combined with simple text searches). Key disease concepts from free-text data were extracted using NLP and combined with ICD codes to develop algorithms. We created both supervised regression-based algorithms-on a training set of 127 axSpA cases and 423 non-cases-and unsupervised algorithms to identify patients with high probability of having axSpA from the enriched cohort. Their performance was compared against classifications using ICD codes only. RESULTS: NLP extracted four disease concepts of high predictive value: ankylosing spondylitis, sacroiliitis, HLA-B27 and spondylitis. The unsupervised algorithm, incorporating both the NLP concept and ICD code for AS, identified the greatest number of patients. By setting the probability threshold to attain 80% positive predictive value, it identified 1509 axSpA patients (mean age 53 years, 71% male). Sensitivity was 0.78, specificity 0.94 and area under the curve 0.93. The two supervised algorithms performed similarly but identified fewer patients. All three outperformed traditional approaches using ICD codes alone (area under the curve 0.80-0.87). CONCLUSION: Algorithms incorporating free-text data can accurately identify axSpA patients in electronic health records. Large cohorts identified using these novel methods offer exciting opportunities for future clinical research.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Processamento de Linguagem Natural , Melhoria de Qualidade , Espondilartrite/classificação , Espondilite Anquilosante/classificação , Idoso , Algoritmos , Área Sob a Curva , Estudos de Coortes , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Espondilartrite/epidemiologia , Espondilite Anquilosante/epidemiologia
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