Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis.

OBJECTIVE: To assess the frequency and characteristics of the oculographic findings and the usefulness of the clinical test of sensory integration and balance (CTSIB) for the evaluation of balance in patients with psoriatic arthritis (PsA) by comparing this test with the computerized dynamic posturography (CDP). STUDY DESIGN: A series of consecutive patients that fulfilled the Moll and Wright criteria for PsA and matched controls were studied. SETTING: The study was performed at the Otolaryngology Division of a tertiary reference center. INTERVENTION: Vestibular evaluation including CTSIB followed by CDP was performed to all patients and age, sex, and ethnically frequency-matched controls. MAIN OUTCOME MEASURE: Patterns of CTSIB and CDP (gold standard) were assessed and compared. PATIENTS: Sixty PsA patients (63.3% women) and 60 matched controls. RESULTS: PsA patients had higher frequency of abnormal oculocephalic response (13.3%) and abnormal caloric test (26.7%) than controls (0% in both cases) (p = 0.006 and p < 0.001, respectively). Benign paroxysmal positional vertigo (BPPV) was diagnosed in two (3.4%) patients and none of the controls (p = 1). Significantly increased frequency of abnormal CTSIB test with vestibular loss pattern (33.3%) in patients compared with controls (6%) was observed (p = 0.002). Significantly increased frequency of abnormal CDP was also observed in PsA patients (14 [23.3%] versus 0 [0%] of controls) (p < 0.001). CTSIB yielded 100% sensitivity, 73% specificity, 48% positive predictive value, and 100% negative predictive value. CONCLUSIONS: This study indicates that oculographic findings are common in PsA. CTSIB is useful for assessing balance disorder screening in the routine clinical practice in these patients.

Investigations into audiovestibular manifestations in patients with psoriatic arthritis.

OBJECTIVE: Although psoriatic arthritis (PsA) is a common chronic inflammatory rheumatic disease, little is known about audiovestibular impairment in this condition. We aimed to establish whether audiovestibular manifestations were present in patients with PsA. METHODS: A set of 60 consecutive patients who fulfilled the Moll and Wright criteria for PsA and 60 matched controls were studied. During the period of recruitment, individuals were excluded who had a history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere disease and other vestibular syndromes, infections involving the inner ear, barotrauma, or were in treatment with ototoxic drugs. RESULTS: Most patients with PsA were men (63%). The mean age at the time of our study was 52.9 years and the mean age at the onset of symptoms was 33 years. Thirty-six (60%) of the 60 patients showed abnormal hearing loss in the audiogram compared to only 5 (8.3%) of the 60 controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). The audiogram disclosed a bilateral and symmetrical sensorineural hearing loss (SNHL) in PsA with predominant pattern of high frequency SNHL in patients with PsA (46.7%) compared to controls (8.3%, p < 0.001). Patients with PsA exhibited abnormal vestibular tests more commonly than controls. A significantly increased frequency of abnormal computerized dynamic posturography with a predominant vestibular loss pattern was also observed in patients (23.3%) compared to controls (0%, p < 0.001). CONCLUSION: Our current study demonstrates strong evidence for inner ear damage in patients with PsA.

Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in ankylosing spondylitis.

OBJECTIVE: To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with ankylosing spondylitis (AS). STUDY DESIGN: A series of consecutive patients that fulfilled the modified New York diagnostic criteria for AS and matched controls were studied. SETTING: The study was performed at the Otolaryngology Division of a tertiary reference center. PATIENTS: Fifty-nine patients with AS (47 men [79.6%]) attending hospital outpatient rheumatology clinics between March and October 2008, and 46 controls (34 men [73.9%]) were studied. INTERVENTION: Dix-Hallpike and cephalic rotational tests and CTSIB were performed in AS patients and age-, sex-, and ethnically frequency-matched controls. MAIN OUTCOME MEASURE: Type and frequency of BPPV and CTSIB conditions were assessed. RESULTS: BPPV was diagnosed in 6 patients (10.1%) with AS and in 2 (4.3%) of the controls (p = 0.24). Abnormal caloric test was more commonly observed in patients with AS (n = 15 [25.4%]) than the controls (n = 0) (p < 0.001). Increased frequency of abnormal CTSIB also was observed in patients (19/59 [32%]) compared with the controls (3 [6.5%]) (odds ratio, 6.81 [95% confidence interval, 1.77-38.0]; p = 0.001). Among the abnormal CTSIB patterns, the vestibular loss was the most commonly observed in patients with AS (15/59 [25.4%]). CONCLUSION: The present study shows an increased frequency of abnormal postural control in CTSIB test of vestibular origin in patients with AS.

Audiovestibular manifestations in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin affecting up to 1% of the population. Little is known about audiovestibular impairment in patients with AS, especially the presence of cochleovestibular dysfunction in these patients. To investigate audiovestibular manifestations in AS, we studied a series of 50 consecutive patients who fulfilled the modified New York diagnostic criteria for AS and 44 matched controls. Individuals with history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. Most patients with AS were men (80%). The mean age at the time of study was 52.5 years, and mean age at the onset of symptoms was 34.4 years. Twenty-nine (58%) patients showed abnormal hearing loss in the audiogram compared to only 8 (18%) controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). It is noteworthy that the audiogram shape disclosed a predominant pattern of high-frequency sensorineural hearing loss in AS patients (50%) compared to controls (18%) (p = 0.002). Also, AS patients exhibited abnormal vestibular tests more commonly than controls. AS patients had an increased frequency of head-shaking nystagmus (20%) compared to controls (0%) (p < 0.001). Moreover, patients (26%) showed a significantly increased frequency of abnormal caloric test compared to controls (0%) (p < 0.001). Finally, a significantly increased frequency of abnormal clinical test of sensory integration and balance with a predominant vestibular loss pattern was observed in patients (36%) compared to controls (5%) (p < 0.001). In conclusion, the current study demonstrates strong evidence for inner ear compromise in patients with AS.

Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in systemic sclerosis.

OBJECTIVE: To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with systemic sclerosis (SSc). STUDY DESIGN: A series of consecutive patients diagnosed with SSc according to well-established classification criteria and matched controls were studied. SETTING: The study was performed at the otolaryngology division of a tertiary reference center. PATIENTS: Forty-two patients (35 with limited SSc [lSSc] and 7 with diffuse SSc [dSSc]) and 74 controls were studied between January and May 2007. INTERVENTION: Dix-Hallpike and cephalic rotational tests and CTSIB were performed in SSc patients and age-, sex-, and ethnically frequency-matched controls. MAIN OUTCOME MEASURE: Type and frequency of BPPV and CTSIB conditions were assessed. RESULTS: Seven patients (17%) fulfilled the diagnostic criteria for BPPV compared with none of the controls (p < 0.001). It was related to the involvement of the posterior semicircular canal in two lSSc patients and the horizontal semicircular canal in another three patients with lSSc and two with dSSc. A significantly increased frequency of abnormal CTSIB was also observed in SSc patients (20 [48%]) compared to controls (7 [10%]; p < 0.0001; odds ratio, 8.70; 95% confidence interval, 2.97-27.2). It was caused by a vestibular pattern in most patients (p < 0.0001). CONCLUSION: The present study shows an increased frequency of BPPV and a vestibular pattern in CTSIB in SSc patients.