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Saravanan A, Bai J, Bajaj P, Sterner E, Rajagopal M, Sanders S, Luckose A, Kushnick M, Starkweather A. Composite Biomarkers, Behavioral Symptoms, and Comorbidities in Axial Low Back Pain: A Systematic Review. Biol Res Nurs 2023; 25:571-585. [PMID: 37139992 DOI: 10.1177/10998004231171146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Proinflammatory cytokines play a critical role in chronic inflammation and pain and contribute to behavioral symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and comorbidities (diabetes, cardiac diseases, cancer). Evidence is lacking on the specific proinflammatory cytokines associated with these behavioral symptoms/comorbidities co-occurring with axial low back pain (aLBP). This review aimed to systematically analyze the following: (1) specific proinflammatory cytokines associated with aLBP in adults, (2) associations among proinflammatory cytokines and behavioral symptoms in aLBP, and (3) relationships among proinflammatory cytokines and comorbidities in aLBP, to develop a new clinical framework for future diagnostic and intervention targets for patients with aLBP. METHODS Electronic databases, including PubMed/MEDLINE, ProQuest Nursing & Allied Health Source, and CINAHL Complete (EBSCO) were searched for the period January 2012 to February 2023. Eligible studies included cross-sectional, case-control, longitudinal, and cohort studies in which proinflammatory cytokines were reported in adults above 18 years with aLBP. Intervention studies and randomized controlled trails were excluded. The Joanna Briggs Institute (JBI) criteria were used for quality evaluation. RESULTS Findings from 11 studies showed 3 proinflammatory cytokines associated with pain intensity in adult patients with aLBP: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), and Interleukin (IL-6). Some studies assessed associations between proinflammatory cytokines and depressive symptoms; none explored the association of proinflammatory cytokines with fatigue, anxiety, sleep disturbance, or comorbidities (diabetes, cardiac diseases, and cancer) in aLBP. CONCLUSIONS Proinflammatory cytokines in aLBP can serve as composite biomarkers for pain, associated symptoms, and comorbidities and may serve as a target for future interventions. There is need for well-designed studies assessing associations among chronic inflammation, behavioral symptoms, and comorbidities.
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Affiliation(s)
- Anitha Saravanan
- School of Nursing, Northern Illinois University, DeKalb, IL, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Prempreet Bajaj
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | | | - Michael Kushnick
- College of Health and Human Sciences, Northern Illinois University, DeKalb, IL, USA
| | - Angela Starkweather
- School of Nursing, Northern Illinois University, DeKalb, IL, USA
- College of Nursing, University of Florida, Gainesville, FL, USA
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2
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Reveille JD, Ridley LK. Spondyloarthritis. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Weisman MH, Stens O, Kim HS, Hou JK, Miller FW, Dillon CF. Axial Pain and Arthritis in Diagnosed Inflammatory Bowel Disease: US National Health and Nutrition Examination Survey Data. Mayo Clin Proc Innov Qual Outcomes 2022; 6:443-449. [PMID: 36147868 PMCID: PMC9485826 DOI: 10.1016/j.mayocpiqo.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To estimate the nationally representative prevalence of chronic axial pain, inflammatory back pain (IBP), axial spondyloarthritis (axSpA), and peripheral arthritis in persons diagnosed with inflammatory bowel disease (IBD). Patients and Methods US National Health and Nutrition Examination Survey (NHANES) data from the 1976-1980 and 2009-2010 survey cycles. Results In NHANES 1976-1980, the chronic axial pain prevalence in participants with diagnosed ulcerative colitis (UC) was 19.5% vs 7.2% in the general population (P<.01). Neck or upper back, lower back, and Amor criteria-based axial pain were also significantly increased (11.2%, 14.5%, and 13.0%, respectively, vs 3%-5% in the general population (P<.01). In those with diagnosed UC, 40% had axial pain onset at an age older than 45 years; 30.2% reported peripheral arthralgias, and 12.2% reported peripheral arthritis. Arthritis findings on examination were uncommon. In NHANES 2009-2010, axial pain in those diagnosed with IBD had similar patterns. Conclusion Despite high rates of chronic axial pain in those with IBD, few cases met the IBP and axSpA classification criteria. This apparent discrepancy is unexplained. However, in IBD, axial pain onset at an age older than 45 years is common; and these may not meet IBP and axSpA age criteria. Also, neck pain was increased in those with IBD but is not included in most IBP and axSpA criteria. Peripheral arthralgias and chronic arthritis symptoms were common, but examination findings were not, suggesting that tenosynovitis or enthesitis is more likely than frank arthritis to occur in patients with UC.
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Affiliation(s)
- Michael H. Weisman
- School of Medicine, Stanford University Medical Center, Palo Alto, CA
- Correspondence: Address to Michael H. Weisman, MD, School of Medicine, Stanford University Medical Center, Palo Alto, CA 90024.
| | | | - Hyun-Seok Kim
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jason K. Hou
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Section of Gastroenterology, Baylor College of Medicine, Houston, TX
| | - Frederick W. Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Charles F. Dillon
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
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van der Meer R, Arends S, Kruidhof S, Bos R, Bootsma H, Wink F, Spoorenberg A. Extra-skeletal manifestations in axial spondyloarthritis are associated with worse clinical outcome despite the use of TNF blocking therapy. J Rheumatol 2021; 49:157-164. [PMID: 34393101 DOI: 10.3899/jrheum.210308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the prevalence and 4-year incidence of acute anterior uveitis (AAU), inflammatory bowel disease (IBD) and psoriasis, and to explore associations of newly developed extra-skeletal manifestations (ESMs) with clinical disease outcome in a large cohort of axial spondyloarthritis (SpA) patients. METHODS All consecutive patients included in the Groningen Leeuwarden Axial SpA (GLAS) cohort between 2004 and 2011 were analysed. History of ESMs at baseline and newly developed ESMs during 4-year follow-up were only recorded when diagnosis by an ophthalmologist, gastroenterologist or dermatologist was present. RESULTS Of the 414 included axial SpA patients, 31.5% had a positive history of one or more ESMs: 24.9% AAU, 9.4% IBD, and 4.4% psoriasis. History of psoriasis was significantly associated with more radiographic damage, especially of the cervical spine. Of the 362 patients with 4-year follow-up data, 15.7% patients developed an ESM: 13.3% patients with AAU, of which 3.6% had a first episode and 9.7% had recurrent AAU, 1.9% developed IBD, and 0.8% developed psoriasis. Patients who newly developed ESMs (without history of ESMs) had worse ASQoL score (mean 10.0 vs. 5.9, p=0.001), larger occiput to wall distance (median 6.3 vs. 2.0, p=0.021) and more limited modified Schober test (mean 12.6 vs. 13.6, p=0.014) after 4 years of follow-up. The majority of patients developing an ESM used anti-TNF therapy. CONCLUSION History of ESMs was present at baseline in one-third of axial SpA patients. The 4-year incidence of ESMs was relatively low, but patients who developed a new ESM reported worse quality of life.
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Affiliation(s)
- Rienk van der Meer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Sandra Kruidhof
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Reinhard Bos
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Freke Wink
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
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Vucemilovic AS, Puljak L. Outcome domains and measures for pain in psoriasis used in registered trials: analysis of studies on ClinicalTrials.gov. J Comp Eff Res 2021; 10:909-915. [PMID: 34111965 DOI: 10.2217/cer-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Psoriasis includes unpleasant symptoms such as pain. This study aimed to investigate whether clinical trials have domains related to pain in their study designs. Materials and methods: We analyzed all clinical trials about interventions for psoriasis treatment registered on ClinicalTrials.gov and the frequency of pain-related outcomes. Results: Our analysis included 1033 registered clinical trials. They had 1329 primary outcomes and 5457 secondary outcomes. The pain was used in six (0.6%) protocols as a primary outcome and 68 (6.5%) protocols as a secondary outcome. Conclusion: Pain as an outcome was used in few registered clinical trial protocols for the treatment of psoriatic conditions. Future studies should investigate why the trialists do not include pain among primary or secondary outcomes.
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Affiliation(s)
| | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
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Liew DFL, Dau J, Robinson PC. Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond. Curr Rheumatol Rep 2021; 23:36. [PMID: 33909169 DOI: 10.1007/s11926-021-01003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs. RECENT FINDINGS There are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and medication tapering may be appropriate. Increasing the value of the care we provide to patients can occur across domains and directly and indirectly improves patient outcomes. Taking the time to integrate principles of VBHC into our practice will allow us to justifiably gain and maintain access to diagnostic and therapeutic advances for the benefit of all our patients.
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Affiliation(s)
- David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Dau
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, 4006, Australia. .,Department of Rheumatology, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Bowen Bridge Road, Herston, Queensland, 4006, Australia.
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Kodumudi V, Rajput K. Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems. Curr Pain Headache Rep 2021; 25:36. [PMID: 33821380 DOI: 10.1007/s11916-021-00952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Psoriasis and psoriatic arthropathy are inflammatory autoimmune conditions that can lead to profound emotional distress, social stigmatization, isolation, disfigurement, pain, disability, unemployment, and decreased quality of life. Thus, this disease has immense psychological, social, and economic implications as the pain experienced is closely associated with the primary disease burden. This review focuses on discussing the primary disease burden of psoriasis and psoriatic arthropathy, as well as management of different types of pain in these patients. RECENT FINDINGS Pain affects over 40% of patients with psoriasis, ranging from neuropathic to nociceptive. Treatment of pain largely focuses on treating the underlying disease with mild topical steroids and non-steroidal medications including vitamin D analogs followed by systemic immunomodulatory agents for more severe disease. Interventional options such as corticosteroid injections are available for select cases (conditional recommendation). Psoriasis and psoriatic arthropathy have been associated with underreporting and resultant undertreatment of pain. Pain control in these conditions is complex and requires a multidisciplinary approach. More research and guidelines are needed in the areas of reporting of psoriatic disease, associated pain, psoriatic nociception, and optimal clinical management.
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Affiliation(s)
- Vijay Kodumudi
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA
| | - Kanishka Rajput
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA.
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Shridharmurthy D, Zhao D, Lapane KL, Baek J, Kay J, Liu SH. Disease Burden and Health-Related Quality of Life Among Women and Men with Spondyloarthritis: An Exploratory Analysis of a Population-Based Sample. J Womens Health (Larchmt) 2021; 30:1637-1644. [PMID: 33450162 DOI: 10.1089/jwh.2020.8763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objectives: We described the burden of illness and health-related quality of life (HRQoL) in adults with spondyloarthritis (SpA) using a nationally representative sample. Materials and Methods: We identified participants with SpA using the Amor classification criteria (probable: score 5 or definite: ≥6) and complete data on HRQoL from the 2009 to 2010 National Health and Nutrition Examination Survey (n = 231). HRQoL was measured using the Healthy Days Measures including self-rated health status (excellent/very good, good, fair/poor), number of activity-restricted days, and number of unhealthy mental and physical health days in the past month (range: 0-30). Other domains including clinical assessments, comorbidities, physical functioning, and medication use were also explored. Results: Only 39% of the sample met the Amor criteria for definite SpA. Although 58% of those with definite SpA had seen a doctor >3 times in the past year, 2.5% women and 4.1% men had ever been told by a physician that they have ankylosing spondylitis. Among those with definite SpA, racial/ethnic diversity was observed in women (13.6% non-Hispanic Black, 23.2% Hispanic) and men (11.6% non-Hispanic Black, 11.2% Hispanic). Overall, 41.6% women and 49.7% men rated their health as fair/poor. For other HRQoL measures, 25.4% women and 20.4% men reported ≥15 activity-restricted days and 39.7% women and 41.4% men reported ≥15 physically unhealthy days. Conclusion: Both men and women rank health as poor with indications that it affects QoL. Although our small sample size limits definitive statements, we observed trends that warrant further confirmation in larger population-based samples.
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Affiliation(s)
- Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Danni Zhao
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Abstract
INTRODUCTION Psoriasis is a common chronic skin inflammatory disease. Its presentation, apart from affected skin areas, involves other unpleasant symptoms, such as pain. Pain deteriorates the patient's quality of life, impairing their daily behaviour and functioning. Therefore, the alleviation of pain in patients with psoriasis should be one of the most desired outcomes of successful treatment. The aim of this study is to summarise available evidence about pain in patients with psoriasis using systematic scoping review methodology in order to map the relevant literature. METHODS AND ANALYSES Our scoping systematic review will provide evidence synthesis of the literature, both quantitative and qualitative, about the pain associated with psoriasis, including pain associated with psoriatic arthritis. Any types of studies will be eligible for inclusion, and we will not have any time, language or publication status restrictions. We will search MEDLINE, Embase and PsycINFO via OVID, as well as Cochrane Central Register of Clinical Trials, Cochrane Database of Systematic Reviews via Cochrane Library, CINAHL via EBSCO, OpenGrey and ProQuest Dissertations and Theses Global. All databases will be searched from the date of their inception. Retrieved bibliographic records and potentially relevant full texts will be screened by two authors independently. Two researchers will extract data independently. Any discrepancies will be resolved via discussion or consultation of the third author, if necessary. To appraise studies, we will use a Mixed Methods Appraisal Tool, AMSTAR 2, Cochrane risk of bias tool and ROBINS. Our findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION The proposed study will not be conducted with human participants. We will only use published data and therefore ethics approval is not required. Our findings will be disseminated via peer-reviewed manuscript and conference reports.
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Affiliation(s)
| | - Danijela Nujic
- Department of Public Health, Josip Juraj Strossmayer University of Osijek School of Medicine, Osijek, Osijek-Baranja, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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10
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STANHOPE J, WEINSTEIN P. Why do we need to investigate non-classical musicians to reduce the burden of musicians' musculoskeletal symptoms? INDUSTRIAL HEALTH 2020; 58:212-223. [PMID: 31588069 PMCID: PMC7286715 DOI: 10.2486/indhealth.2019-0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
Musculoskeletal symptoms (MSSs) are common among professional musicians; however, most of the research has focused on orchestral/classical musicians. In some countries orchestral and classical musicians are in the minority; hence targeting research towards these specific sub-groups of musicians is unlikely to address the overall burden of musicians' MSSs, unless the research is generalizable to other types of musicians. This multidisciplinary narrative review seeks to answer the question: "why do we need to examine the MSSs of non-classical groups of performing musicians in order to reduce the burden of musicians' MSSs?". There are differences in the education, posture, tasks (e.g. military training for military band musicians, dancing for those in musical theatre), venues and management of MSSs for different types of musicians. Future research should compare classical and non-classical musicians in order to determine which specific sub-groups (e.g. military band musicians) have the greatest MSS burden, such that further research into the risk factors of and interventions for MSSs can be targeted towards the sub-groups of musicians with the greatest MSS burden. In doing so, we maximise the likelihood of being able to introduce interventions, policies and practice that reduce the burden of musicians' MSSs.
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Affiliation(s)
| | - Philip WEINSTEIN
- School of Biological Sciences, The University of Adelaide,
Australia
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11
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Rida MA, Chandran V. Challenges in the clinical diagnosis of psoriatic arthritis. Clin Immunol 2020; 214:108390. [PMID: 32200113 DOI: 10.1016/j.clim.2020.108390] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/17/2020] [Indexed: 01/15/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.
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Affiliation(s)
- Mohamad Ali Rida
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vinod Chandran
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
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Stanhope J, Pisaniello D, Tooher R, Weinstein P. How do we assess musicians' musculoskeletal symptoms?: a review of outcomes and tools used. INDUSTRIAL HEALTH 2019; 57:454-494. [PMID: 30555103 PMCID: PMC6685794 DOI: 10.2486/indhealth.2018-0065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Recent reviews of musicians' musculoskeletal symptoms (MSS) have reported heterogeneity in the outcomes reported and data collection tools used, making it difficult to compare and synthesise findings. The purpose of this present review was to improve the consistency of future research, by documenting the outcomes reported in recent studies of musicians' MSS and the data collection tools used. All English language, peer-reviewed studies, published 2007-2016 that reported musicians' self-reported MSS outcomes were identified. Details of the types of outcomes reported and the tools used were extracted, and synthesised descriptively. A range of MSS outcomes were reported, including MSS with a temporal relationship to activities performed, and the consequences of symptoms. Only 24% of studies used standardised questionnaires, with the Nordic Musculoskeletal Questionnaire (NMQ) being the most commonly used. To improve the homogeneity of outcomes and data collection tools when investigating musicians' MSS, we recommend using the NMQ, where appropriate. Recall periods of 12-months and 7-d are the most appropriate for prevalence, and 7-d recall periods for ratings. Importantly, outcomes and the tools used to collect data should be reported in sufficient detail to ensure that the study can be replicated, critiqued, and accurately interpreted.
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Affiliation(s)
| | - Dino Pisaniello
- School of Public Health, The University of Adelaide, Australia
| | - Rebecca Tooher
- School of Public Health, The University of Adelaide, Australia
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, Australia
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13
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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Abstract
PURPOSE OF REVIEW To provide an update of the prevalence and incidence of axial spondyloarthritis in the general population and in patients with spondyloarthritis-related conditions, environmental risk factors for ankylosing spondylitis, progression from nonradiographic axial spondyloarthritis to ankylosing spondylitis, mortality, and risks for cardiovascular events in patients with ankylosing spondylitis. RECENT FINDINGS Increasingly, administrative healthcare data have been used to study disease frequency and outcomes. The prevalence of ankylosing spondylitis ranged from 9 to 30 per 10 000 persons, which are lower than previous estimates. Data on whether childhood infections influence the risk of ankylosing spondylitis were equivocal, while having been breast-fed may be protective. Progression of patients with nonradiographic axial spondyloarthritis to ankylosing spondylitis is slow, with estimates of 5.1% in 5 years and 19% in 10 years. Risk of mortality is slightly increased in ankylosing spondylitis. Risks for cardiovascular events in ankylosing spondylitis were either not different from, or only slightly higher than in controls. No studies have examined these outcomes in the broader group of patients with axial spondyloarthritis. SUMMARY Expanded use of administrative and registry data has facilitated studies of the epidemiology of ankylosing spondylitis, but lack of specific diagnostic codes limits use of these resources for studying axial spondyloarthritis in general.
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Lindström U, Bremander A, Haglund E, Bergman S, Petersson IF, Jacobsson LTH. Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study. BMC Musculoskelet Disord 2016; 17:106. [PMID: 26922375 PMCID: PMC4769824 DOI: 10.1186/s12891-016-0960-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/23/2016] [Indexed: 01/25/2023] Open
Abstract
Background In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP. Methods Five-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003–2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain ≥3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs). Results The frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree. Conclusion The proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0960-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulf Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - Ann Bremander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden. .,School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden. .,Spenshult Research and Development Center, Halmstad, Sweden.
| | - Emma Haglund
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden. .,School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden. .,Spenshult Research and Development Center, Halmstad, Sweden.
| | - Stefan Bergman
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden. .,Spenshult Research and Development Center, Halmstad, Sweden. .,Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ingemar F Petersson
- Department of Clinical Sciences, Section of Orthopedics, Lund University, Lund, Sweden.
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden. .,Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
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Looking into the new ASAS classification criteria for axial spondyloarthritis through the other side of the glass. Curr Rheumatol Rep 2016; 17:515. [PMID: 25921789 DOI: 10.1007/s11926-015-0515-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The new concept of axial spondylitis (axSpA) and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA have induced new clinical research that has broadened our understanding of spondyloarthritis (SpA) and has had indeed a positive impact on earlier diagnosis and treatment of patients with axSpA who have not yet developed radiographic sacroiliitis. The primary goal of any valid classification criteria for any disease is to provide a homogeneous study population with a common etiopathogenesis, similar prognosis, and similar response to identical treatment. Without such a homogeneous study population, robust clinical and basic science research in any subtype of SpA is not possible. All criteria are dynamic concepts that need updating as our knowledge advances and our review of the ASAS classification criteria of axSpA indicates that complex multi-selection design and unclear (not mutually exclusive) definitions of the imaging and clinical arms of the criteria results in patient heterogeneity across study populations. Therefore, there is a need to improve the validity of the ASAS criteria for axSpA. It is our opinion that in the meantime, the clinically well-established entity of AS, as defined by the modified New York (mNY) criteria, should be preserved for the most accurate comparison of the new research studies with those conducted over the last three decades, and that the use of the ASAS criteria should be restricted to patients with nr-axSpA, who are not recognized by the mNY criteria.
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Nakashima Y, Ohishi M, Okazaki K, Fukushi JI, Oyamada A, Hara D, Doi T, Akasaki Y, Yamada H, Iwamoto Y. Delayed diagnosis of ankylosing spondylitis in a Japanese population. Mod Rheumatol 2015; 26:421-5. [PMID: 26382224 DOI: 10.3109/14397595.2015.1088679] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the period from symptom onset to diagnosis of ankylosing spondylitis (AS) in Japanese patients and to examine possible reasons for delayed diagnosis. METHODS Seventy-two consecutive patients with AS were studied. Diagnostic delay was defined as the gap between the first spondyloarthropathic symptom and diagnosis of AS according to the modified New York criteria. RESULTS The mean patient ages at disease onset and diagnosis were 25.6 ± 11.3 and 33.3 ± 13.2 years old, respectively, resulting in diagnostic delay of 6.7 years. The number of medical institutions to which patients were referred before diagnosis was 2.4, and orthopedic surgeons were most commonly visited (62%). Non-specific low back pain or lumbar spondylitis (33%) and degenerative arthritis (28%) were the primary diagnoses preceding that of AS. Absence of articular symptoms significantly correlated with diagnostic delay. The patients with disease onset on year 2000 or later had significantly shorter periods until diagnosis than those before 2000 (3.6 vs. 7.5 years). CONCLUSIONS The present study showed a marked diagnostic delay among Japanese patients with AS. Although it has been improved, continuing medical education focusing on inflammatory back pain in adolescent is required for early diagnosis of AS.
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Affiliation(s)
- Yasuharu Nakashima
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Masanobu Ohishi
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Ken Okazaki
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Jun-Ichi Fukushi
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Akiko Oyamada
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Daisuke Hara
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Toshio Doi
- b Department of Orthopaedic Surgery , Kyushu University Beppu Hospital , Beppu, Oita , Japan
| | - Yukio Akasaki
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Hisakata Yamada
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
| | - Yukihide Iwamoto
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku, Fukuoka , Japan and
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Screening and referral for axial spondyloarthritis—need of the hour. Clin Rheumatol 2015; 34:987-93. [DOI: 10.1007/s10067-015-2958-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/12/2015] [Indexed: 01/17/2023]
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Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis. J Med Life 2015; 8:319-25. [PMID: 26351533 PMCID: PMC4556912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/18/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Spondyloarthritis (SpA) is associated with an array of peripheral manifestations. Our study aims to evaluate extra-articular manifestations of SpA in a Romanian academic clinical setting and to observe their associations with different disease measures. METHODS The study was designed to note the extra-articular manifestations of SpA patients in a cross-sectional and retrospective manner. Records included demographics, inflammation markers, SpA clinical characteristics, treatment regimes, associated osteoporosis and cardiovascular morbidity. Data were assessed by using appropriate non-parametric tests. RESULTS A total of 126 SpA patients were included. The most common extra-articular manifestations were skin involvement in the form of psoriasis (34.1%), eye involvement in the form of acute anterior uveitis (8.7%) and dactylitis (7.2%). Compared to patients with no record of uveitis, uveitis-affected cases were more frequently males, more frequently diagnosed with ankylosing spondylitis, but less frequently dyslipidemic and diagnosed with psoriasis. Psoriasis-affected patients were older and had a higher prevalence of peripheral SpA diagnosis, but a lower prevalence of radiographic sacroiliitis. CONCLUSIONS Acute anterior uveitis in SpA predominantly affects males with AS. This is relevant both to clinical and fundamental science, since its management requires both ophthalmology and rheumatology clinical settings. Psoriasis was associated more frequently with peripheral SpA. ABBREVIATIONS AHT = arterial hypertension, AS = ankylosing spondylitis, ASAS = Assessment in SpondyloArthritis international Society, aSpA = axial spondyloarthritis, BASFI = Bath Ankylosing Spondylitis Functional Index, BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, DM2 = type 2 diabetes mellitus, HLA = human leukocyte antigen, IBD = inflammatory bowel disease, MRI = magnetic resonance imaging, mSpA = mixed (peripheral and axial) spondyloarthritis, NSAIDs = non-steroidal anti-inflammatory drugs, pSpA = peripheral spondyloarthritis, PsA = psoriatic arthritis, ReA = reactive arthritis, SD = standard deviation, SI = sacroiliitis, SpA = spondyloarthritis, UDSpA = undifferentiated spondyloarthritis.
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