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Ferreira Azevedo S, Mazeda C, Barcelos A. Hip involvement in axial spondylarthritis patients: Comparison between ankylosing spondylitis and non-radiographic axial spondylarthritis - A retrospective study. Joint Bone Spine 2024; 91:105694. [PMID: 38295983 DOI: 10.1016/j.jbspin.2024.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/17/2023] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Sofia Ferreira Azevedo
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, rua Artur Navarra, 3814-501 Aveiro, Portugal; Centro Académico Clínico Egas Moniz, Health Alliance, Aveiro, Portugal.
| | - Carolina Mazeda
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, rua Artur Navarra, 3814-501 Aveiro, Portugal; Centro Académico Clínico Egas Moniz, Health Alliance, Aveiro, Portugal; EpiDoc Unit, Nova Medical School, NOVA University Lisbon, Lisboa, Portugal
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, rua Artur Navarra, 3814-501 Aveiro, Portugal; Centro Académico Clínico Egas Moniz, Health Alliance, Aveiro, Portugal; EpiDoc Unit, Nova Medical School, NOVA University Lisbon, Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
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2
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Song C, Wang K, Qian B, Lu J, Qiao M, Qiu Y, Wang B, Yu Y. Nrf-2/ROS/NF-κB pathway is modulated by cynarin in human mesenchymal stem cells in vitro from ankylosing spondylitis. Clin Transl Sci 2024; 17:e13748. [PMID: 38450992 PMCID: PMC10918724 DOI: 10.1111/cts.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Ankylosing spondylitis (AS) is an immune chronic inflammatory disease, resulting in back pain, stiffness, and thoracolumbar kyphotic deformity. Based on the reported anti-inflammatory and antioxidant capacities of cynarin (Cyn), this study explored its protective role and molecular mechanisms in mesenchymal stem cells (MSCs) from AS. The target pathways and genes were verified using Western blotting, quantitative real-time polymerase chain reaction, and immunofluorescent staining, while molecular docking analysis was conducted. In AS-MSCs, we found that the expression levels of p-NF-κB, IL-6, IL-1β, and TNF-α were higher and IκB-α, Nrf-2, and HO-1 were lower compared with healthy control (HC)-MSCs. With molecular docking analysis, the biding affinities between Cyn and Keap1-Nrf-2 and p65-IκB-α were predicted. The mRNA and protein expression of p-NF-κB, IL-6, IL-1β, and TNF-α and the reactive oxygen species (ROS) generation were downregulated following Cyn administration. Meanwhile, the expression level of IκB-α, Nrf-2, and HO-1 were significantly increased after Cyn pretreatment. The results suggested that the protective mechanisms of Cyn in AS-MSCs were based on enhancing the antioxidation and suppression of excessive inflammatory responses via Nrf-2/ROS/NF-κB axis. Our findings demonstrate that Cyn is a potential candidate for alleviating inflammation in AS.
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Affiliation(s)
- Chenyu Song
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Kaiyang Wang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Bangping Qian
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Jingshun Lu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Mu Qiao
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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3
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Liu Z, Cai M, Ke H, Deng H, Ye W, Wang T, Chen Q, Cen S. Fibroblast Insights into the Pathogenesis of Ankylosing Spondylitis. J Inflamm Res 2023; 16:6301-6317. [PMID: 38149115 PMCID: PMC10750494 DOI: 10.2147/jir.s439604] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose of the Review Emerging evidence has shown that ankylosing spondylitis fibroblasts (ASFs) act as crucial participants in inflammation and abnormal ossification in ankylosing spondylitis (AS). This review examines the investigations into ASFs and their pathological behavior, which contributes to inflammatory microenvironments and abnormal bone formation. The review spans the period from 2000 to 2023, with a primary focus on the most recent decade. Additionally, the review provides an in-depth discussion on studies on ASF ossification at the cellular level. Recent Findings ASFs organize immune functions by recruiting immune cells and influencing their differentiation and activation, thus mediate the inflammatory response in the early phase of disease. ASFs promote joint destruction at sites of cartilage and actively promote abnormal ossification by recruiting osteoblasts, differentiation into myofibroblasts or ossification directly. Many signaling pathways and cytokines such as Wnt signaling and BMP/TGF-β signaling are involved in ASF ossification. Summary ASFs play a key role in AS inflammation and osteogenesis. Further studies are required to elucidate molecular mechanisms behind that and provide new targets and directions for AS diagnosis and treatment from a new perspective of fibroblasts.
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Affiliation(s)
- Zhenhua Liu
- Department of Spinal Surgery, Orthopedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Mingxi Cai
- The Second Clinical School, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Haoteng Ke
- The Second Clinical School, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Huazong Deng
- The Second Clinical School, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Weijia Ye
- The Second Clinical School, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Tao Wang
- Department of Spinal Surgery, Orthopedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Qifan Chen
- Department of Spinal Surgery, Orthopedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
| | - Shuizhong Cen
- Department of Spinal Surgery, Orthopedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, People’s Republic of China
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Mauro D, Gandolfo S, Tirri E, Schett G, Maksymowych WP, Ciccia F. The bone marrow side of axial spondyloarthritis. Nat Rev Rheumatol 2023:10.1038/s41584-023-00986-6. [PMID: 37407716 DOI: 10.1038/s41584-023-00986-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Enrico Tirri
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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5
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Zheng G, Peng X, Zhang Y, Wang P, Xie Z, Li J, Liu W, Ye G, Lin Y, Li G, Liu H, Zeng C, Li L, Wu Y, Shen H. A novel Anti-ROS osteoblast-specific delivery system for ankylosing spondylitis treatment via suppression of both inflammation and pathological new bone formation. J Nanobiotechnology 2023; 21:168. [PMID: 37231465 DOI: 10.1186/s12951-023-01906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Ankylosing spondylitis (AS) is a common rheumatic disorder distinguished by chronic inflammation and heterotopic ossification at local entheses sites. Currently available medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and TNF inhibitors, are limited by side effects, high costs and unclear inhibitory effects on heterotopic ossification. Herein, we developed manganese ferrite nanoparticles modified by the aptamer CH6 (CH6-MF NPs) that can efficiently scavenge ROS and actively deliver siRNA into hMSCs and osteoblasts in vivo for effective AS treatment. CH6-MF NPs loaded with BMP2 siRNA (CH6-MF-Si NPs) effectively suppressed abnormal osteogenic differentiation under inflammatory conditions in vitro. During their circulation and passive accumulation in inflamed joints in the Zap70mut mouse model, CH6-MF-Si NPs attenuated local inflammation and rescued heterotopic ossification in the entheses. Thus, CH6-MF NPs may be an effective inflammation reliever and osteoblast-specific delivery system, and CH6-MF-Si NPs have potential for the dual treatment of chronic inflammation and heterotopic ossification in AS.
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Affiliation(s)
- Guan Zheng
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Xiaoshuai Peng
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Yunhui Zhang
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Peng Wang
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Zhongyu Xie
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Jinteng Li
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Wenjie Liu
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Guiwen Ye
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Yucong Lin
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Guojian Li
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Huatao Liu
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Chenying Zeng
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China
| | - Lihua Li
- Department of Applied Physics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, P.R. China.
- Future Technology Research Institute, South China Normal University, 55 Zhongshan Dadao, Tianhe District, Guangzhou, P.R. China.
| | - Yanfeng Wu
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China.
| | - Huiyong Shen
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025# Shennan Road, Shenzhen, P.R. China.
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6
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Han Y, Yang H, Hua Z, Nie S, Xu S, Zhou C, Chen F, Li M, Yu Q, Sun Y, Wei Y, Wang X. Rotating Magnetic Field Mitigates Ankylosing Spondylitis Targeting Osteocytes and Chondrocytes via Ameliorating Immune Dysfunctions. Cells 2023; 12:cells12070972. [PMID: 37048045 PMCID: PMC10093245 DOI: 10.3390/cells12070972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
Ankylosing spondylitis (AS) is clinically characterized by bone fusion that is induced by the pathological formation of extra bone. Unfortunately, the fundamental mechanism and related therapies remain unclear. The loss of SHP-2 (encoded by Ptpn11) in CD4-Cre;Ptpn11f/f mice resulted in the induction of AS-like pathological characteristics, including spontaneous cartilage and bone lesions, kyphosis, and arthritis. Hence, this mouse was utilized as an AS model in this study. As one of the basic physical fields, the magnetic field (MF) has been proven to be an effective treatment method for articular cartilage degeneration. In this study, the effects of a rotating magnetic field (RMF; 0.2 T, 4 Hz) on an AS-like mouse model were investigated. The RMF treatment (2 h/d, 0.2 T, 4 Hz) was performed on AS mice from two months after birth until the day before sampling. The murine specimens were subjected to transcriptomics, immunomics, and metabolomics analyses, combined with molecular and pathological experiments. The results demonstrated that the mitigation of inflammatory deterioration resulted in an increase in functional osteogenesis and a decrease in dysfunctional osteolysis due to the maintenance of bone homeostasis via the RANKL/RANK/OPG signaling pathway. Additionally, by regulating the ratio of CD4+ and CD8+ T-cells, RMF treatment rebalanced the immune microenvironment in skeletal tissue. It has been observed that RMF interventions have the potential to alleviate AS, including by decreasing pathogenicity and preventing disease initiation. Consequently, RMF, as a moderately physical therapeutic strategy, could be considered to alleviate the degradation of cartilage and bone tissue in AS and as a potential option to halt the progression of AS.
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Affiliation(s)
- Yu Han
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Hua Yang
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Zhongke Hua
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Shenglan Nie
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Shuling Xu
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Cai Zhou
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Fengyi Chen
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Mengqing Li
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Qinyao Yu
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Yang Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Biotechnology and Pharmaceutical Sciences, School of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Yunpeng Wei
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
| | - Xiaomei Wang
- Magnetobiology Group, Department of Physiology, Shenzhen University Health Science Center, Xili Campus of Shenzhen University, Shenzhen 518055, China
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7
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Are There Signs of Enthesitis in Nail Psoriasis? An Immunohistological Study of Nail Psoriasis With and Without Psoriatic Arthritis. Am J Dermatopathol 2023; 45:40-46. [PMID: 36484605 DOI: 10.1097/dad.0000000000002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The concept of nail psoriasis as an entheseal-driven disease has essentially been formulated on the basis of radiological findings because it is usually not possible to obtain the tissue directly from the joints. The aim of this retrospective study was to evaluate the histological features of isolated nail psoriasis with and without distal interphalangeal psoriatic arthritis (PsA), focusing on the question as to whether the fascia and adipose tissue surrounding the apex of the nail unit genuinely show an inflammatory infiltrate. In support of the nail-enthesitis theory, an ongoing inflammatory infiltrate could be expected. An immunohistochemical study was performed to evaluate the distribution and phenotype of the inflammatory infiltrate in nail psoriasis with and without PsA. This study did not show an inflammatory infiltrate in the fascia connecting the nail to the extensor tendon. CD8 and CD4 subsets were present in equal number in the nail dermis of nail psoriasis with or without PsA, which is a similar distribution to that seen in psoriatic synovium while skin psoriasis is characterized by a dermal predominance of CD4 T lymphocytes. Because of this study and recent microanatomic studies of the normal nail unit, it is possible to move away from a purely anatomic explanation of the strong association between nail psoriasis and PsA and to propose immunological factors as contributory. This study provides support for the hypothesis that CD8+ T cells play a crucial role in the pathogenesis of nail psoriasis through a pathogenic pathway similar to that of PsA and contrasting with that of the skin.
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Zheng Y, Bai C, Zhang K, Han Q, Guan Q, Liu Y, Zheng Z, Xia Y, Zhu P. Deep-learning based quantification model for hip bone marrow edema and synovitis in patients with spondyloarthritis based on magnetic resonance images. Front Physiol 2023; 14:1132214. [PMID: 36935744 PMCID: PMC10020192 DOI: 10.3389/fphys.2023.1132214] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: Hip inflammation is one of the most common complications in patients with spondyloarthritis (SpA). Herein, we employed use of a deep learning-based magnetic resonance imaging (MRI) evaluation model to identify irregular and multiple inflammatory lesions of the hip. Methods: All of the SpA patients were enrolled at the Xijing Hospital. The erythrocyte sediment rate (ESR), C-reactive protein (CRP), hip function Harris score, and disease activity were evaluated by clinicians. Manual MRI annotations including bone marrow edema (BME) and effusion/synovitis, and a hip MRI scoring system (HIMRISS) assessment was performed by experienced musculoskeletal radiologists. The segmentation accuracies of four deep learning models, including U-Net, UNet++, Attention-Unet, and HRNet, were compared using five-fold cross-validation. The clinical agreement of U-Net was evaluated with clinical symptoms and HIMRISS results. Results: A total of 1945 MRI slices of STIR/T2WI sequences were obtained from 195 SpA patients with hip involvement. After the five-fold cross-validation, U-Net achieved an average segmentation accuracy of 88.48% for the femoral head and 69.36% for inflammatory lesions, which are higher than those obtained by the other three models. The UNet-score, which was calculated based on the same MRI slices as HIMRISS, was significantly correlated with the HIMRISS scores and disease activity indexes (p values <0.05). Conclusion: This deep-learning based automatic MRI evaluation model could achieve similar quantification performance as an expert radiologist, and it has the potential to improve the accuracy and efficiency of clinical diagnosis for SpA patients with hip involvement.
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Affiliation(s)
- Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- National Translational Science Center for Molecular Medicine, Xi’an, China
| | - Chao Bai
- National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi’an, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- National Translational Science Center for Molecular Medicine, Xi’an, China
| | - Qing Han
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- National Translational Science Center for Molecular Medicine, Xi’an, China
| | - Qingbiao Guan
- National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi’an, China
| | - Ying Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- National Translational Science Center for Molecular Medicine, Xi’an, China
| | - Yong Xia
- National Engineering Laboratory for Integrated Aero-Space-Ground-Ocean Big Data Application Technology, School of Computer Science and Engineering, Northwestern Polytechnical University, Xi’an, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- National Translational Science Center for Molecular Medicine, Xi’an, China
- *Correspondence: Ping Zhu,
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9
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Dubinin AO, Khramov AE, Dubinina TV, Ilinykh EV, Bialik EI. Intraoperative picture of hip joint lesion in ankylosing spondylitis: data from a retrospective analysis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-594-598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In population of Russian patients with ankylosing spondylitis (AS), the frequency of clinical manifestations (pain and limitation of functions) of coxitis reaches 56%. Total hip arthroplasty (THA) can be considered as the only alternative that can relieve the suffering of the patient. Radiography and magnetic resonance imaging are widely used methods for assessing structural damage to the hip joint in AS. However, at the moment these methods can’t allow us to fully describe the lifetime changes of these joints. The aim of the study: to analyze the external changes of the femoral heads (HF) and acetabulums during the THA in patients with AS. Materials and methods. The retrospective study included 170 patients with a reliable diagnosis of AS, who met the modified New York criteria of 1984, who were treated in the traumatological and orthopedic department of the V.A. Nasonova Research Institute of Rheumatology in the period from 1998 to 2020, all patients underwent THA as planned. Most of them were male (80.6%). The average age of patients was 38.1±11.3 years and the average duration of the disease since the onset of the first symptoms was 17.0±8.5 years. The duration of pain in hip joints before performing THA is 7.4±4.8 years. The assessment of macroscopic changes in the FH and acetabulum was performed intraoperatively. Results and discussion. Acetabulum protrusion was detected in 108 (63.5%) patients, bone cysts – in 65 (38.2%). Filling of acetabulum with granulation tissue was recorded in 155 (91.2%) patients, presence of osteophytes on its edges – in 153 (90%). Cartilage in the acetabulum was completely absent in 122 (71.8%) patients. FH deformation was detected in 98.2% of cases, erosion in 46.4%. Cartilage on FH was completely absent in 130 (76.5%) patients. In 119 (70%) patients, macroscopic signs of osteonecrosis of FH were found. 79 (46.4%) patients had ankylosis of the hip joint, including fibrous ankylosis – in 77.2% of patients and bone ankylosis – in 22.8%. Conclusion. In patients with AS, the necessity for THA occurs on average after 7.4±4.8 years from the moment of the appearance of first clinical signs of coxitis. In 70% of cases, the macroscopic picture of hip joint lesion was characterized by the development of Avascular necrosis of the femur head (AVNFH), in most patients there was no cartilage in the most loaded segments of acetabulum and FH, in almost half of cases – ankylosis of hip joint and mainly fibrous (77.2%).
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Affiliation(s)
| | | | | | | | - E. I. Bialik
- V.A. Nasonova Research Institute of Rheumatology
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10
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Wu F, Han X, Liu J, Zhang Z, Yan K, Wang B, Yang L, Zou H, Yang C, Huang W, Jin L, Wang J, Qian F, Niu Z. An ankylosing spondylitis risk variant alters osteoclast differentiation. Rheumatology (Oxford) 2022; 62:1980-1987. [PMID: 36124946 DOI: 10.1093/rheumatology/keac542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore whether the variants in non-MHC proteasome gene is associated with ankylosing spondylitis and explain the role of the variant in the disease. METHODS Case-control analysis to identify ankylosing spondylitis predisposition genes; dual-luciferase reporter assay, immunoblot analysis and osteoclastogenesis assays to detect the function of the positive variant. Affected individuals was diagnosed according to the modified New York Criteria by at least two experienced rheumatologists, and rechecked by another rheumatologist. RESULTS The study included 1037 AS patients and 1014 no rheumatic and arthritis disease controls. The main age of AS onset is between 16 and 35 years old. HLA-B27-positive subjects comprised 90.0% of patients. A nonsynonymous SNP rs12717 in proteasome gene PSMB1 significantly associated with ankylosing spondylitis. Individuals with CC genotype had a higher onset risk compared with those with GG/GC genotypes (OR = 1.89, p= 0.0047). We also discovered that PSMB1 regulates the receptor activator of nuclear factor-κB (RANK)/RANK ligand (RANKL) signalling pathway and the disease-associated variant PSMB1-Pro11 significantly inhibits RANKL-induced NF-κB pathway in osteoclast differentiation via the degradation of IKK-β compared with PSMB1-Ala11. RANKL induced osteoclast differentiation was significantly lower in primary monocyte osteoclast precursor from individuals with genotype PSMB131C/31C compared with individuals with genotype PSMB131G/31G. CONCLUSIONS These results reveal a novel understanding of the bone formation and reabsorbing imbalance in AS. The new bone formation phenotype can be attributed to the inhibition of osteoclast differentiation by a more functional PSMB1 gene.
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Affiliation(s)
- Fangyi Wu
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China
| | - Xuling Han
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China
| | - Jing Liu
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China
| | - Zhenghua Zhang
- Division of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kexiang Yan
- Division of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Beilan Wang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies; Shanghai, China
| | - Lin Yang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies; Shanghai, China
| | - Hejian Zou
- Division of Rheumatology, Huashan Hospital, Fudan University; Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Shanghai, China
| | - Wei Huang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies; Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China
| | - Feng Qian
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China.,Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Zhenmin Niu
- State Key Laboratory of Genetic Engineering, Shanghai Public Health Clinical Center, Human Phenome Institute, Zhangjiang Fudan International Innovation Center and School of Life Sciences, Fudan University; Shanghai, China.,Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies; Shanghai, China
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11
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Guo C, Zheng K, Ye Q, Lu Z, Xie Z, Li X, Zhao Y. Intravoxel Incoherent Motion Imaging on Sacroiliitis in Patients With Axial Spondyloarthritis: Correlation With Perfusion Characteristics Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Front Med (Lausanne) 2022; 8:798845. [PMID: 35155474 PMCID: PMC8826054 DOI: 10.3389/fmed.2021.798845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To prospectively explore the relationship between intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) parameters of sacroiliitis in patients with axial spondyloarthritis (axSpA). METHODS Patients with initially diagnosed axSpA prospectively underwent on 3.0 T MRI of sacroiliac joint (SIJ). The IVIM parameters (D, f, D *) were calculated using biexponential analysis. K trans, K ep, V e, and V p from DCE-MRI were obtained in SIJ. The uni-variable and multi-variable linear regression analyses were used to evaluate the correlation between the parameters from these two imaging methods after controlling confounders, such as bone marrow edema (BME), age, agenda, scopes, and localization of lesions, and course of the disease. Then, their correlations were measured by calculating the Pearson's correlation coefficient (r). RESULTS The study eventually enrolled 234 patients (178 men, 56 women; mean age, 28.51 ± 9.50 years) with axSpA. With controlling confounders, D was independently related to K trans (regression coefficient [b] = 27.593, p < 0.001), K ep (b = -6.707, p = 0.021), and V e (b = 131.074, p = 0.003), whereas f and D * had no independent correlation with the parameters from DCE MRI. The correlations above were exhibited with Pearson's correlation coefficients (r) (r = 0.662, -0.408, and 0.396, respectively, all p < 0.001). CONCLUSION There were independent correlations between D derived from IVIM DWI and K trans, K ep, and V e derived from DCE-MRI. The factors which affect their correlations mainly included BME, gender, and scopes of lesions.
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Affiliation(s)
- Chang Guo
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Kai Zheng
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Ye
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Zixiao Lu
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Zhuoyao Xie
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Xin Li
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Yinghua Zhao
- Department of Radiology, Academy of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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12
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Perrin C. Focal Synovial Inflammation Versus Enthesitis Theory in Distal Psoriatic Arthritis: A Pioneer Histopathologic Study. Am J Dermatopathol 2021; 43:898-902. [PMID: 33795559 DOI: 10.1097/dad.0000000000001947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this analysis was to re-examine the classical concept of distal interphalangeal joint (DIP) psoriatic arthritis (PsA) as an entheseal-driven disease. Two cadaveric fingers with severe psoriatic arthritis were analyzed. Our results demonstrate that inflammation of DIP PsA is multifocal without interconnection between entheses and articular cartilage of the DIP. We found a clear association between synovitis and focal loss of articular cartilage at the head of the intermediate phalanx. By contrast, the articular cartilage adjacent to the zone of severe enthesitis did not show notable damage. Fibrocartilaginous destructions of enthesis were characterized by either a multifocal lymphocytic inflammation, accompanied by osteoclastic resorption, beginning on the interface between the uncalcified and calcified fibrocartilage and then extending into the bone or a subchondral bone inflammation which insidiously destroyed first the bone and then the fibrocartilage. Some sections well showed an inflammation either mild or prominent starting at the level of vascular foramina of flexor enthesis, with secondary invading into the interface between bone and enthesis. The different anatomic sites examined showed a slight predominance of CD8+ T cells over CD4+ T cells: 52% up to 63% for CD8+ T cells vs. to 36% up to 48% for CD4+ T cells. Sparse interspersed CD1a+cells and PS100+cells were also seen with a predominance of PS100+ cells on CD1a+ cells. CD20+ B cells, plasmocytes, neutrophils, and mastocytes were absent or rare. CD123 positive cells were not observed. In DIP PsA, 3 findings predominate: (1) cartilage invasion by the thin pannus offers a more rational explanation for the focal joint destruction than does inflammation of the enthesis which is independent from articular cartilage, (2) the thick ventral plate and to a lesser extend the thin dorsal plate constitute a barrier between the inflamed entheses and the articular cartilage, and (3) an unusual form of minute vascular foramen contributes to the early stage of enthesitis. This small study suggests that DIP PsA is a complex disease. It affects anatomical micro sites which, although close, are in fact relatively independent of each other. Further studies are needed to test this hypothesis.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central d'Anatomie Pathologique, Hôpital L. Pasteur, University of Nice, Nice, France
- Nail's Dermatology Consultations, Cannes, France
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13
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Targeting chondrocytes for arresting bony fusion in ankylosing spondylitis. Nat Commun 2021; 12:6540. [PMID: 34764263 PMCID: PMC8585952 DOI: 10.1038/s41467-021-26750-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/21/2021] [Indexed: 12/17/2022] Open
Abstract
Bony fusion caused by pathological new bone formation manifests the clinical feature of ankylosing spondylitis (AS). However, the underlying mechanism remains elusive. Here we discovered spontaneous kyphosis, arthritis and bony fusion in mature CD4-Cre;Ptpn11f/f mice, which present the pathophysiological features of AS. A population of CD4-Cre-expressing proliferating chondrocytes was SHP2 deficient, which could differentiate into pre-hypertrophic and hypertrophic chondrocytes. Functionally, SHP2 deficiency in chondrocytes impeded the fusion of epiphyseal plate and promoted chondrogenesis in joint cavity and enthesis. Mechanistically, aberrant chondrocytes promoted ectopic new bone formation through BMP6/pSmad1/5 signaling. It is worth emphasizing that such pathological thickness of growth plates was evident in adolescent humans with enthesitis-related arthritis, which could progress to AS in adulthood. Targeting dysfunctional chondrogenesis with Smo inhibitor sonidegib significantly alleviated the AS-like bone disease in mice. These findings suggest that blockade of chondrogenesis by sonidegib would be a drug repurposing strategy for AS treatment. Current treatments cannot significantly alleviate the radiographic progression in ankylosing spondylitis (AS), which results in joints stiffness and bony fusion of AS. Smo inhibitor sonidegib retards the pathological new bone formation in AS through targeting dysfunctional chondrogenesis.
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14
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Kaaij MH, Rip J, Jeucken KCM, Kan YY, van Rooijen CCN, Saris J, Pots D, Frey S, Grootjans J, Schett G, van Duivenvoorde LM, Nolte MA, Hendriks RW, Corneth OBJ, van Hamburg JP, Baeten DLP, Tas SW. Overexpression of Transmembrane TNF Drives Development of Ectopic Lymphoid Structures in the Bone Marrow and B Cell Lineage Alterations in Experimental Spondyloarthritis. THE JOURNAL OF IMMUNOLOGY 2021; 207:2337-2346. [PMID: 34561228 DOI: 10.4049/jimmunol.2100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/22/2021] [Indexed: 12/23/2022]
Abstract
TNF is important in immune-mediated inflammatory diseases, including spondyloarthritis (SpA). Transgenic (tg) mice overexpressing transmembrane TNF (tmTNF) develop features resembling human SpA. Furthermore, both tmTNF tg mice and SpA patients develop ectopic lymphoid aggregates, but it is unclear whether these contribute to pathology. Therefore, we characterized the lymphoid aggregates in detail and studied potential alterations in the B and T cell lineage in tmTNF tg mice. Lymphoid aggregates developed in bone marrow (BM) of vertebrae and near the ankle joints prior to the first SpA features and displayed characteristics of ectopic lymphoid structures (ELS) including presence of B cells, T cells, germinal centers, and high endothelial venules. Detailed flow cytometric analyses demonstrated more germinal center B cells with increased CD80 and CD86 expression, along with significantly more T follicular helper, T follicular regulatory, and T regulatory cells in tmTNF tg BM compared with non-tg controls. Furthermore, tmTNF tg mice exhibited increased IgA serum levels and significantly more IgA+ plasma cells in the BM, whereas IgA+ plasma cells in the gut were not significantly increased. In tmTNF tg × TNF-RI-/- mice, ELS were absent, consistent with reduced disease symptoms, whereas in tmTNF tg × TNF-RII-/- mice, ELS and clinical symptoms were still present. Collectively, these data show that tmTNF overexpression in mice results in osteitis and ELS formation in BM, which may account for the increased serum IgA levels that are also observed in human SpA. These effects are mainly dependent on TNF-RI signaling and may underlie important aspects of SpA pathology.
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Affiliation(s)
- Merlijn H Kaaij
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; .,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jasper Rip
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kim C M Jeucken
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yik Y Kan
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Charlotte C N van Rooijen
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Job Saris
- Department of Gastroenterology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Tytgat Institute for Intestinal and Liver Research, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Desiree Pots
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Silke Frey
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; and
| | - Joep Grootjans
- Department of Gastroenterology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Tytgat Institute for Intestinal and Liver Research, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; and
| | - Leonie M van Duivenvoorde
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn A Nolte
- Department of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rudi W Hendriks
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Odilia B J Corneth
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan Piet van Hamburg
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dominique L P Baeten
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; .,Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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15
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Zhang K, Zheng Y, Han Q, Liu Y, Wang W, Ding J, Wang Y, Zhang B, Jia J, Zheng M, Zheng Z, Zhu P. The Clinical and MRI Effect of TNF-α Inhibitors in Spondyloarthritis Patients With Hip Involvement: A Real-World Observational Clinical Study. Front Immunol 2021; 12:740980. [PMID: 34659233 PMCID: PMC8511713 DOI: 10.3389/fimmu.2021.740980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Hip involvement is an important cause of disability and poor prognosis in patients with spondyloarthritis (SpA). Tumor necrosis factor (TNF)-α inhibitor treatment has been demonstrated to be effective in SpA patients with hip arthritis; however, quantitative assessment using MRI in long-term follow-up needs further application and observation. Methods A total of 239 patients were involved in this study. Methotrexate and sulfasalazine were given as basic treatment. In total, 165 patients received TNF-α inhibitors plus basic treatment, and 74 received basic treatment only, as controls. Clinical symptoms were assessed at baseline and at weeks 12, 24, and 52. MRI performances of hip arthritis, including bone marrow edema (BME) and synovitis, were quantitatively assessed using the Hip Inflammation MRI Scoring System (HIMRISS). Results The clinical values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Harris hip score, and Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR in both groups showed significant clinical remission at week 52 (p < 0.001). However, the change in disease activity levels at week 52 in the control group was significantly worse than in the TNF-α inhibitor group. At week 52, MRI showed a significant remission trend in the TNF-α inhibitor group versus baseline, and total HIMRISS scores were significantly decreased (26.49 ± 10.37 vs. 20.59 ± 9.41, p < 0.001); the control group only had slight improvement (p < 0.05). Conclusions TNF-α inhibitors could significantly improve clinical and MRI manifestations of hip involvement in patients with SpA. Quantitative MRI assessment combined with clinical assessment can be used to accurately evaluate the treatment effect of TNF-α in SpA patients with hip involvement to help guide targeted treatment.
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Affiliation(s)
- Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Qing Han
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ying Liu
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Weitao Wang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Jin Ding
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Yan Wang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Bei Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,National Translational Science Center for Molecular Medicine, Xi'an, China
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16
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Coxitis in axial spondyloarthritis: the unmeasured, yet functionally most important, radiographic progression. Chin Med J (Engl) 2021; 134:2550-2552. [PMID: 34593699 PMCID: PMC8577678 DOI: 10.1097/cm9.0000000000001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Man S, Zhang L, Bian T, Li H, Ma Z, Zhou Y. Assessment of hip involvement in patients with ankylosing spondylitis: reliability and validity of the Hip Inflammation MRI Scoring System. BMC Musculoskelet Disord 2021; 22:705. [PMID: 34404369 PMCID: PMC8371884 DOI: 10.1186/s12891-021-04502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to test the reliability and validity of the Hip Inflammation MRI Scoring System (HIMRISS) in assessing hip involvement of AS patients with AS at different stages of the bath ankylosing spondylitis radiology index (BASRI-hip) scoring system. Methods Fifty-two outpatients with ankylosing spondylitis (AS) were included in this study. The subjects’ data includes demographics, clinical characteristics, disease activity score, and functional index. Based on the Harris hip scoring (HHS) of involved hip and BASRI-hip score, we devided these patients into no hip involvement group((HHS ≥ 80 and BASRI ≤ 1) (Group A), mild hip involvement subgroup (BASRI = 2 or BASRI ≤ 1 and HHS ≤ 79) (Group B), and moderate to advanced hip involvement subgroup (BASRI ≥ 3) (Group C). Data was analyzed statistically by SPSS software. Results In total of 44 patients (88 hips), group A consisted of 21 hips, group B consisted of 42 hips and group C consisted of 25 hips. The test–retest intraclass correlation coefficients (ICCs) in four raters were 0.955 ~ 0.977 and interrater ICC was 0.993. HIMRISS correlated moderately with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (r = 0.540, p < 0.001), the Bath ankylosing spondylitis functional index (BASFI) (r = 0.540, p < 0.001), the Bath Ankylosing Spondylitis Functional Index (BASFI) (r = 0.581, p < 0.001), ASDAS-ESR (r = 0.604, p < 0.001), and Ankylosing Spondylitis Disease Activity Score (ASDAS)-C reactive protein (CRP) (r = 0.575, p < 0.001). HIMRISS in groups B and C was significantly higher than that in group A: 29.38 (17.00, 40.94) vs. 14.50 (11.38, 22.25), p = 0.009; 38 (31.13, 64.38) vs 14.50 (11.38, 22.25), p < 0.001. Conclusions HIMRISS applied to patients with AS demonstrated a satisfactory reliability, meaning it is a reliable quantitive assessment tool for evaluating early hip involvement in patients with AS.
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Affiliation(s)
- Siliang Man
- Department of Rheumatology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China
| | - Liang Zhang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China
| | - Tao Bian
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China
| | - Hongchao Li
- Department of Rheumatology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China
| | - Zhuyi Ma
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035, Beijing, China.
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18
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Yu T, Zhang J, Zhu W, Wang X, Bai Y, Feng B, Zhuang Q, Han C, Wang S, Hu Q, An S, Wan M, Dong S, Xu J, Weng X, Cao X. Chondrogenesis mediates progression of ankylosing spondylitis through heterotopic ossification. Bone Res 2021; 9:19. [PMID: 33731675 PMCID: PMC7969928 DOI: 10.1038/s41413-021-00140-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/17/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is chronic inflammatory arthritis with a progressive fusion of axial joints. Anti-inflammatory treatments such as anti-TNF-α antibody therapy suppress inflammation but do not effectively halt the progression of spine fusion in AS patients. Here we report that the autoimmune inflammation of AS generates a microenvironment that promotes chondrogenesis in spine ligaments as the process of spine fusion. Chondrocyte differentiation was observed in the ligaments of patients with early-stage AS, and cartilage formation was followed by calcification. Moreover, a large number of giant osteoclasts were found in the inflammatory environment of ligaments and on bony surfaces of calcified cartilage. Resorption activity by these giant osteoclasts generated marrow with high levels of active TGF-β, which induced new bone formation in the ligaments. Notably, no Osterix+ osteoprogenitors were found in osteoclast resorption areas, indicating uncoupled bone resorption and formation. Even at the late and maturation stages, the uncoupled osteoclast resorption in bony interspinous ligament activates TGF-β to induce the progression of ossification in AS patients. Osteoclast resorption of calcified cartilage-initiated ossification in the progression of AS is a similar pathologic process of acquired heterotopic ossification (HO). Our finding of cartilage formation in the ligaments of AS patients revealed that the pathogenesis of spinal fusion is a process of HO and explained why anti-inflammatory treatments do not slow ankylosing once there is new bone formation in spinal soft tissues. Thus, inhibition of HO formation, such as osteoclast activity, cartilage formation, or TGF-β activity could be a potential therapy for AS.
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Affiliation(s)
- Tao Yu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Xiao Wang
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yun Bai
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Qianyu Zhuang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Chang Han
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Qimiao Hu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Senbo An
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Shiwu Dong
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730, Beijing, China.
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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19
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Liu L, Yuan Y, Zhang S, Xu J, Zou J. Osteoimmunological insights into the pathogenesis of ankylosing spondylitis. J Cell Physiol 2021; 236:6090-6100. [PMID: 33559242 DOI: 10.1002/jcp.30313] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022]
Abstract
Ankylosing spondylitis (AS) is inflammatory arthritis predominantly affecting the spine, which is involved in the disorders of both immune and skeletal systems. The exact pathogenesis of AS is not fully understood. Osteoimmunology is a new subject of study in inflammatory arthritis, in particular the pathogenic events involved in the cross-regulation of both skeletal and immune systems. In this review, we discuss osteoimmunological and pathological changes of AS in the spine that are characterized by altered osteogenesis and osteolytic bone destruction, accompanied by the changes of the immune system. It was revealed that bone cells like mesenchymal stem cells, osteoblast, and osteoclast in crossing talking with immune cells such as T cells, B cells coregulate to the pathogenesis of AS. Further, an array of cytokines and molecules expressed by both skeletal and immune systems contribute to these complex interplays. Understanding the cellular and molecular mechanisms underlying the pathogenesis of AS will lay a foundation for the exploration of the potential new treatment to AS.
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Affiliation(s)
- Lifei Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation, The People's Hospital of Liaoning Province, Shenyang, China
| | - Yu Yuan
- School of Sport and Health, Guangzhou Sport University, Guangzhou, China
| | - Shihua Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jiake Xu
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jun Zou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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20
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Ma M, Yang W, Cai Z, Wang P, Li H, Mi R, Jiang Y, Xie Z, Sui P, Wu Y, Shen H. SMAD-specific E3 ubiquitin ligase 2 promotes angiogenesis by facilitating PTX3 degradation in MSCs from patients with ankylosing spondylitis. STEM CELLS (DAYTON, OHIO) 2021; 39:581-599. [PMID: 33547700 PMCID: PMC8248389 DOI: 10.1002/stem.3332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/18/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Dysregulated angiogenesis of mesenchymal stem cells (MSCs) is closely related to inflammation and disrupted bone metabolism in patients with various autoimmune diseases. However, the role of MSCs in the development of abnormal angiogenesis in patients with ankylosing spondylitis (AS) remains unclear. In this study, we cultured human umbilical vein endothelial cells (HUVECs) with bone marrow-derived MSCs from patients with AS (ASMSCs) or healthy donors (HDMSCs) in vitro. Then, the cocultured HUVECs were assayed using a cell counting kit-8 (CCK-8) to evaluate the cell proliferation. A wound healing assay was performed to investigate cell migration, and a tube formation assay was conducted to determine the angiogenesis efficiency. ASMSCs exhibited increased angiogenesis, and increased expression of SMAD-specific E3 ubiquitin ligase 2 (Smurf2) in MSCs was the main cause of abnormal angiogenesis in patients with AS. Downregulation of Smurf2 in ASMSCs blocked angiogenesis, whereas overexpression of Smurf2 in HDMSCs promoted angiogenesis. The pro-angiogenic effect of Smurf2 was confirmed by the results of a Matrigel plug assay in vivo. By functioning as an E3 ubiquitin ligase in MSCs, Smurf2 regulated the levels of pentraxin 3 (PTX3), which has been shown to suppress angiogenesis through the PTX3-fibroblast growth factor 2 pathway. Moreover, Smurf2 transcription was regulated by activating transcription factor 4-induced endoplasmic reticulum stress. In conclusion, these results identify novel roles of Smurf2 in negatively regulating PTX3 stability and promoting angiogenesis in ASMSCs.
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Affiliation(s)
- Mengjun Ma
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Wen Yang
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Zhaopeng Cai
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Peng Wang
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Hongyu Li
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Rujia Mi
- Center for Biotherapy, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Yuhang Jiang
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Zhongyu Xie
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Pengfei Sui
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Yanfeng Wu
- Center for Biotherapy, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Huiyong Shen
- Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China.,Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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21
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Li L, Fu J, Xu C, Guan H, Ni M, Chai W, Hao L, Zhou Y, Chen J. Factors associated with blood loss in ankylosing spondylitis patients with hip involvement undergoing primary total hip arthroplasty: a cross-sectional retrospective study of 243 patients. J Orthop Surg Res 2020; 15:541. [PMID: 33208176 PMCID: PMC7672842 DOI: 10.1186/s13018-020-02064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Total hip arthroplasty (THA) can cause considerable blood loss and perioperative transfusion in ankylosing spondylitis (AS) patients. This study aimed to identify the factors related to blood loss in AS patients with hip involvement undergoing THA. Methods We analyzed 243 AS patients with advanced hip involvement undergoing primary THA from 2012 to 2017. Bilateral THA was performed by a one-stage operation during one general anesthesia session. The patients were divided into three groups according to the grade of blood loss, as determined by the Advanced Trauma Life Support hypovolemic shock classification system. Ordinal logistic regression was used to identify factors associated with blood loss in the patients. Results The proportion of patients who were male, underwent bilateral THA, had a hip range of motion (ROM) = 0°, had a BASRI-hip score of 4, underwent iliopsoas and adductor release, and underwent autologous or allogenic transfusion increased significantly with the grade of blood loss, while that of the patients who received tranexamic acid (TXA) decreased significantly (P < 0.05). The preoperative hemoglobin (Hb) level, hematocrit level, and operating time also increased significantly with the grade of blood loss (P < 0.05). The ordinal logistic regression results identified the factors related to blood loss during THA in AS patients with hip involvement to be the male sex (odds ratio [OR] = 3.287; 95% confidence interval [CI] 1.022, 10.567), bilateral THA (OR = 13.896; 95% CI 4.950, 39.011), hip ROM = 0° (OR = 2.513; 95% CI 1.277, 4.946), an elevated erythrocyte sedimentation rate (ESR) level (OR = 3.042; 95% CI 1.320, 7.014), an elevated preoperative Hb level (OR = 1.043; 95% CI 1.017, 1.070), a long operating time (OR = 1.009; 95% CI 1.003, 1.016), and the administration of TXA (OR = 0.252; 95% CI 0.134, 0.472). Conclusions The male sex, bilateral THA, a hip ROM = 0°, an elevated ESR level, a high preoperative Hb level, and a long operating time are risk factors associated with blood loss in AS patients with hip involvement undergoing THA, while the administration of TXA is a protective factor. These results might help determine the risk of bleeding in the perioperative assessment and develop more efficient blood management strategies for THA in AS patients with hip involvement.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jun Fu
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chi Xu
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Haitao Guan
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ming Ni
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Chai
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Libo Hao
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Yonggang Zhou
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiying Chen
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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22
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Abrar DB, Schleich C, Tsiami S, Müller-Lutz A, Radke KL, Holthausen N, Frenken M, Boschheidgen M, Antoch G, Mucke J, Sewerin P, Braun J, Nebelung S, Baraliakos X. Functional MR imaging beyond structure and inflammation-radiographic axial spondyloarthritis is associated with proteoglycan depletion of the lumbar spine. Arthritis Res Ther 2020; 22:219. [PMID: 32943084 PMCID: PMC7499866 DOI: 10.1186/s13075-020-02312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the glycosaminoglycan (GAG) content of lumbar intervertebral disks (IVDs) of patients with ankylosing spondylitis (AS) and healthy volunteers and to investigate the association of GAG depletion and disease-related clinical and imaging features. METHODS Lumbar spines of 50 AS patients (mean age 50 ± 10.5 years) and 30 age-matched volunteers were studied with 3-T magnetic resonance imaging (MRI) and conventional radiographs (CR). The MRI protocol included high-resolution morphological sequences and the compositional GAG chemical exchange saturation transfer imaging technique (gagCEST). Morphological images were analyzed by three raters for inflammatory activity, fat deposition, disk degeneration, and structural changes on CR. Clinical and serological measures included the Bath AS Disease Activity (BASDAI) and Bath AS Function (BASFI) Indices and C-reactive protein (CRP) levels. GagCEST values of both groups were compared using a linear mixed model. Kendall-Tau correlation analyses were performed. RESULTS GagCEST values were significantly lower in AS patients (2.0 ± 1.7%) vs. healthy volunteers (2.4 ± 1.8%), p = 0.001. Small, yet significant correlations were found between gagCEST values and CRP levels (τ = - 0.14, p = 0.007), BASFI (τ = - 0.18, p < 0.001) and presence of syndesmophytes (τ = - 0.17, p = 0.001). No significant correlations were found with BASDAI, inflammation, and fat deposition MRI scores. CONCLUSIONS Lumbar spines of r-AS patients undergo significant GAG depletion, independently associated with syndesmophyte formation, functional disability, and increased serological inflammation markers. Beyond establishing a pathophysiological role of the cartilage in AS, these findings suggest that gagCEST imaging may have an adjunct confirmatory role in the assessment of disease-related pathological MRI findings in axial spondyloarthritis. TRIAL REGISTRATION 3980 ( https://studienregister.med.uni-duesseldorf.de ).
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Affiliation(s)
- Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany.
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Neela Holthausen
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Johanna Mucke
- Policlinic and Hiller Research Unit of Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Sewerin
- Policlinic and Hiller Research Unit of Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, 40225, Düsseldorf, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, 44649, Herne, Germany
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23
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Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 45:355-363. [PMID: 32248264 DOI: 10.1007/s00264-020-04546-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Cartilage lesions are usually accompanied by subchondral bone alterations or bone marrow lesions (BMLs). BML associated with joint degeneration and cartilage lesions are considered to be predictors of rapidly progressing OA. Currently no existing treatment can fully halt OA progression. One of the approaches is an autologous, biological treatment based on the use of platelet rich plasma (PRP) injections. The purpose of this study is to assess the short-term effectiveness of intraosseous PRP injections, within the BML of individuals affected by OA, in ameliorating pain and improving knee functionality. MATERIALS AND METHODS The study involved 17 patients with an average age of 41.7 ± 14.3 years old. OA stage was determined using the Kellgren-Lawrence grading system by performing radiographic scanning of the knee joint before surgical intervention. Patients with K-L grade 3 knee joint OA prevailed. Patient OA history varied between one and nine years (average 5.2 ± 4.5 years). Clinical and functional state of the knee were assessed by pain visual analogue scale (VAS) score, the Western Ontario and McMaster Universities Score (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) which were filled out by patients previous to the surgical procedure at one, three, six and 12 months post-operatively. Before surgery, in addition to standard blood tests, serum cartilage oligomeric matrix protein (COMP) levels were tested for all patients. RESULTS Evaluation of preliminary results revealed a statistically significant reduction of pain based on the VAS score. A significant improvement was also observed in the patients' WOMAC score and in the overall KOOS score. Serum marker levels were initially elevated in our experimental patient group compared to the same marker in healthy control respondents, and continued to rise one month and three months following surgery, at six and 12 month the level was similar as at three months. CONCLUSIONS In our opinion, first COMP increasing can be caused by injection of platelet rich plasma. It is not adequate to interpret this growth in COMP levels as increased osteochondral degeneration. One year follow-up period showed good quality of life improvement, significant pain reduction, and essential MRI changes. The long-term observation of these cohort of patients combined with an analysis of MRI images is still ongoing.
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24
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Watad A, Bridgewood C, Russell T, Marzo-Ortega H, Cuthbert R, McGonagle D. The Early Phases of Ankylosing Spondylitis: Emerging Insights From Clinical and Basic Science. Front Immunol 2018; 9:2668. [PMID: 30505307 PMCID: PMC6250731 DOI: 10.3389/fimmu.2018.02668] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
In our paper, we discuss how the early phases of ankylosing spondylitis (AS) are linked to peri-firbocartilagenous osteitis in the sacroiliac joint and entheseal bone related anchoring sites. This skeletal proclivity is linked to an abnormal immunological response to skeletal biomechanical stress and associated microdamage. A key event in the early stages of AS appears to be the association with subclinical Crohn's-like colitis with this gut inflammation being pivotal to the osteitis reaction. Whether this osteitis is consequent to non-specific intestinal innate immune activation or adaptive immune responses against specific microbiotal or self-antigens is unknown. Recurrent iritis is an HLA-B27 associated feature that may predate AS and pursues a course independent of joint involvement, and points toward the pivotal role of organ specific immunology over generalized systemic immune responses in disease expression. Human genetics and animal model studies strongly incriminate the IL23/17 axis and TNF-α in disease pathogenesis. Preliminary work shows a strong convergence of innate immune cells including type 3 innate lymphoid-cells (ILC3) and γδ T-cells in skin, gut, entheseal, and eye inflammation. Despite the HLA-B27 association, the role of adaptive immunity, especially CD8+ T-cells mediated responses remains unproven and alternative theories have been proposed. The emerging non-dependence of axial inflammation on IL-23 but dependence on IL-17A is an unexpected new twist that awaits full explanation. In this mini-review, we discuss the key events in the early stages of human AS from clinical and basic science aspects, which could be crucial for attempted disease prevention studies in at risk subjects.
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Affiliation(s)
- Abdulla Watad
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Tobias Russell
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Richard Cuthbert
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
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25
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Caparbo VF, Saad CGS, Moraes JC, de Brum-Fernandes AJ, Pereira RMR. Monocytes from male patients with ankylosing spondylitis display decreased osteoclastogenesis and decreased RANKL/OPG ratio. Osteoporos Int 2018; 29:2565-2573. [PMID: 30006885 DOI: 10.1007/s00198-018-4629-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/02/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED The present study investigates the osteoclastogenic capacity of peripheral blood mononuclear cells (PBMCs) in male patients with ankylosing spondylitis (AS). We demonstrated that monocytes from these patients display a lower capacity to generate osteoclasts compared to cells from healthy controls, and osteoclastogenesis was negatively correlated with disease duration. INTRODUCTION Ankylosing spondylitis (AS) is a disease characterized by new bone growth that leads to syndesmophyte formation but AS patients frequently present with low bone mineral density/fractures. Osteoclastogenesis in AS patients is poorly studied and controversial. The aim of this study is to determine if the osteoclastogenic capacity of PBMCs is different in AS patients compared to controls and the relationship between osteoclastogenesis and clinical/laboratory parameters. METHODS PBMCs from 85 male AS patients and 59 controls were tested for CD16+ cells and induced to differentiate into osteoclasts over 3 weeks in vitro. Serum levels of RANKL, osteoprotegerin (OPG), C-terminal telopeptide of type I collagen (CTX), and amino-terminal pro-peptide of type I collagen (P1NP) were also evaluated. RESULTS PBMCs from AS patients had fewer CD16+ cells and produced fewer osteoclasts compared to controls. Apoptosis occurred less frequently in osteoclasts obtained from AS patients than in osteoclasts from the controls. A lower RANKL/OPG and CTX/P1NP were observed in AS patients compared to controls. AS patients taking NSAIDs presented no difference regarding the number of OCs produced and the percentage of CD16+ cells compared to controls. However, patients taking TNF inhibitors (TNFi) presented lower OC numbers than controls. A negative correlation was demonstrated between the number of osteoclasts generated from PBMCs of AS patients and disease duration. CONCLUSION Monocytes from male AS patients display a lower capacity to generate osteoclasts in vitro compared to cells from controls. Osteoclastogenesis was negatively correlated with disease duration. This finding supports the idea that osteoclasts play a role in the physiopathology of bone disease in AS patients.
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Affiliation(s)
- V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - C G S Saad
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - J C Moraes
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - A J de Brum-Fernandes
- Département de médecine, Service de Rhumatologie, Faculté de médecine et des sciences de la santé Université de Sherbrooke, Sherbrooke, Canada
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil.
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26
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Wang DM, Lin L, Peng JH, Gong Y, Hou ZD, Chen SB, Xiao ZY. Pannus inflammation in sacroiliitis following immune pathological injury and radiological structural damage: a study of 193 patients with spondyloarthritis. Arthritis Res Ther 2018; 20:120. [PMID: 29884210 PMCID: PMC5994024 DOI: 10.1186/s13075-018-1594-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 04/17/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The pathogenesis of sacroiliitis is unclear; therefore, we aimed to systematically study the immunopathology of sacroiliitis in patients with axial spondyloarthritis (axSpA), and explore the relationship between pannus formation, inflammation, and the structural damage caused by sacroiliitis. METHODS Fine needle aspiration biopsy of the sacroiliac joint (SIJ) was performed in 193 patients with axSpA. Clinical, laboratory, and imaging data were collected at baseline and during the follow up. Immunohistochemistry analysis was performed to detect CD34+ microvessels, CD68+ osteoclasts/macrophages, vascular endothelial growth factor (VEGF), metalloproteinase-3 (MMP-3), tumor necrosis factor-α (TNF-α), and caspase-3. Autopsy subjects were used as controls. RESULTS In early sacroiliitis (grade 0-1) all pathological features could be observed, with the most common being subchondral pannus formation. Among the 193 patients, 98 were followed up for 1-13 years (mean 3.6 years); 63.3% had radiological progression at the endpoint. Multiple regression analysis showed that cartilage pannus invasion (OR 2.99, P = 0.010) and endochondral ossification (OR 3.97, P = 0.049) at baseline were risk factors for radiological structural damage. Compared to SIJ controls, the subchondral microvessel density, number of CD68+ multinuclear osteoclasts, and the levels of VEGF, caspase-3, MMP-3, and TNF-α expressed at the interface of the bone and cartilage were significantly higher in patients with sacroiliitis. CONCLUSIONS Subchondral fibrovascular tissue formation is the most important pathological feature in early sacroiliitis. The existence of cartilage pannus invasion or endochondral ossification at baseline can predict radiological structural damage during the follow up.
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Affiliation(s)
- Dan min Wang
- Department of Rheumatology, the first Affiliated Hospital of Shantou University Medical College, No.57 Chang ping Road, Shantou, 515041 Guangdong Province China
| | - Ling Lin
- Department of Rheumatology, the first Affiliated Hospital of Shantou University Medical College, No.57 Chang ping Road, Shantou, 515041 Guangdong Province China
| | - Jian hua Peng
- Department of Rheumatology, the first Affiliated Hospital of Shantou University Medical College, No.57 Chang ping Road, Shantou, 515041 Guangdong Province China
| | - Yao Gong
- Department of Rheumatology of Shantou University Medical College, No.22 Xin Ling Road, Shantou, 515041 Guangdong Province China
| | - Zhi duo Hou
- Department of Rheumatology, the first Affiliated Hospital of Shantou University Medical College, No.57 Chang ping Road, Shantou, 515041 Guangdong Province China
| | - Su biao Chen
- Department of Rheumatology of Shantou University Medical College, No.22 Xin Ling Road, Shantou, 515041 Guangdong Province China
| | - Zheng yu Xiao
- Department of Rheumatology, the first Affiliated Hospital of Shantou University Medical College, No.57 Chang ping Road, Shantou, 515041 Guangdong Province China
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Mihara T, Tanishima S, Tanida A, Teshima R, Nagashima H. Histological Evaluation of Lumbar Spine Changes in Rats with Collagen-induced Arthritis. Yonago Acta Med 2018. [DOI: 10.33160/yam.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Tokumitsu Mihara
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Atsushi Tanida
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Ryota Teshima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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28
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Weber A, Chan PMB, Wen C. Do immune cells lead the way in subchondral bone disturbance in osteoarthritis? PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 148:21-31. [PMID: 29277342 DOI: 10.1016/j.pbiomolbio.2017.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 01/06/2023]
Abstract
Osteoarthritis (OA) is a whole-joint disorder, and non-cartilage articular pathologies, e.g. subchondral bone disturbance, contribute substantially to the onset and progression of the disease. In the early stage of OA, abnormal mechanical loading leads to micro-cracks or micro-fractures that trigger a reparative process with angiogenesis and inflammatory response. With the progression of disease, cystic lesion, sclerosis and osteophytosis occur at tissue level, and osteoblast dysfunction at cellular level. Osteoblasts derived from OA sclerotic bone produce increased amount of type I collagen with aberrant Col1A1/A2 ratio and poor mineralization capability. The coupling mechanism of bone resorption with formation is also impaired with elevated osteoclastic activities. All these suggest a view that OA subchondral bone presents a defective fracture repair process in a chronic course. It has been found that T and B cells, the major effectors in the adaptive immunity, take part in the hard callus formation at fracture site in addition to the initial phase of haematoma and inflammation. Infiltration of lymphocytes could interplay with osteoclasts and osteoblasts via a direct physical cell-to-cell contact. Several lines of evidence have consistently shown the involvement of T and B cells in osteoclastogenesis and bone erosion in arthritic joints. Yet the biological link between immune cells and osteoblastic function remains ambiguous. This review will discuss the current knowledge regarding the role of immune cells in bone remodelling, and address its implications in emerging basic and clinical investigations into the pathogenesis and management of subchondral bone pathologies in OA.
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Affiliation(s)
- Adrian Weber
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Pok Man Boris Chan
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chunyi Wen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Song R, Chung SW, Lee SH. Radiographic Evidence of Hip Joint Recovery in Patients with Ankylosing Spondylitis after Treatment with Anti-tumor Necrosis Factor Agents: A Case Series. J Rheumatol 2017; 44:1759-1760. [PMID: 29093078 DOI: 10.3899/jrheum.161401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ran Song
- School of Medicine, Kyung Hee University, Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Sang Wan Chung
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Sang-Hoon Lee
- School of Medicine, Kyung Hee University, Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
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30
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Jo S, Koo BS, Lee B, Kwon E, Lee YL, Chung H, Sung IH, Park YS, Kim TH. A novel role for bone-derived cells in ankylosing spondylitis: Focus on IL-23. Biochem Biophys Res Commun 2017; 491:787-793. [DOI: 10.1016/j.bbrc.2017.07.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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31
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Goldring SR. Differential mechanisms of de-regulated bone formation in rheumatoid arthritis and spondyloarthritis. Rheumatology (Oxford) 2017; 55:ii56-ii60. [PMID: 27856661 DOI: 10.1093/rheumatology/kew345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
The inflammatory arthropathies share in common their tendency to produce marked alterations in skeletal remodelling and architecture. This review will focus on RA and the seronegative spondyloarthopathies (SpA), which share common features with respect to their tendency to produce localized bone destruction at sites of articular and peri-articular inflammation. However, there are significant differences in the skeletal pathology in these conditions, which include the unique involvement of the axial skeleton and the presence of inflammation in the extra-articular entheses in SpA. There also are differences in the pattern of bone formation and repair associated with the articular and peri-articular inflammation. This review will highlight the molecular and cellular processes that are involved in the pathogenesis of the skeletal pathology in these two forms of inflammatory arthritis with specific focus on the pathogenic mechanisms underlying the differential patterns of bone formation and repair.
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Affiliation(s)
- Steven R Goldring
- The Hospital for Special Surgery, Weill College Medical College, New York, NY, USA
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32
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Neve A, Maruotti N, Corrado A, Cantatore FP. Pathogenesis of ligaments ossification in spondyloarthritis: insights and doubts. Ann Med 2017; 49:196-205. [PMID: 27685190 DOI: 10.1080/07853890.2016.1243802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite intensive research in spondyloarthritis pathogenesis, some important questions still remain unanswered, particularly concerning enthesis new bone formation. Several evidences suggest that it prevalently occurs by endochondral ossification, however it remains to identify factors that can induce and influence its initiation and progression. Recent progress, achieved in animal models and in vitro and genetic association studies, has led us to hypothesize that several systemic factors (adipokines and gut hormones) and local factors (BMP and Wnt signaling) as well as angiogenesis and mechanical stress are involved. We critically review and summarize the available data and delineate the possible mechanisms involved in enthesis ossification, particularly at spinal ligament level. KEY MESSAGES Complete understanding of spondyloarthritis pathophysiology requires insights into inflammation, bone destruction and bone formation, which are all located in entheses and lead all together to ankylosis and functional disability. Several factors probably play a role in the pathogenesis of bone formation in entheses including not only cytokines but also several systemic factors such as adipokines and gut hormones, and local factors, such as BMP and Wnt signaling, as well as angiogenesis and mechanical stress. Data available about pathophysiology of new bone formation in spondyloarthritis are limited and often conflicting and future studies are needed to better delineate it and to develop new therapeutic approaches.
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Affiliation(s)
- Anna Neve
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Nicola Maruotti
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Addolorata Corrado
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
| | - Francesco Paolo Cantatore
- a Rheumatology Clinic, Department of Medical and Surgical Sciences , University of Foggia Medical School , Foggia , Italy
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33
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He D, Zhu Q, Zhou Q, Qi Q, Sun H, Zachariah LM, Wang G, Reveille JD, Guan Y, Zhou X. Correlation of serum MMP3 and other biomarkers with clinical outcomes in patients with ankylosing spondylitis: a pilot study. Clin Rheumatol 2017; 36:1819-1826. [PMID: 28432524 DOI: 10.1007/s10067-017-3624-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
Abstract
The studies aimed to assess a set of biomarkers for their correlations with disease activity/severity of patients with ankylosing spondylitis (AS). A total of 24 AS patients were treated with etanercept and prospectively followed for 12 weeks. Serum levels of TNF-α, IFN-γ, TGF-β, IL6, IL15, IL17, MMP3, and MICA were measured at baseline and after treatment. The change of these biomarkers was analyzed for correlations with MRI indices for joint inflammation, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, AS Disease Activity Score, serum CRP, and ESR. The Wilcoxon rank sum test was used to compare the biomarker levels between pre- and post-treatment and between pre-treatment and controls. Both step-wise procedures based on the Akaike information criterion (AIC) and least absolute shrinkage and selection operator with fivefold cross-validation were used to select the best model for pairwise correlations between the above clinical measures and the serum biomarkers. Serum levels of both MMP3 and IL6 were significantly higher in AS patients at baseline. After treatment, the levels of MMP3 decreased, but TGF-β and TNF-α increased significantly. The changes of serum MMP3 and MICA were significantly associated with MRI sacroiliac joint (SIJ) scores. CRP was positively correlated with serum MMP3 and IL6. The pattern of combined changes of serum MICA, MMP3, TGF-β, IL17, TNF-α, and IFN-γ predicted the MRI score of SIJ by logistic regression analysis. Specific serum biomarkers were significantly associated with clinical measures of AS. Most prominently, serum MMP3 level was found to have a positive correlation with the MRI score of SIJ and CRP. Serum MICA level negatively correlated with disease remission.
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Affiliation(s)
- Dongyi He
- Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai, China
| | - Qi Zhu
- Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai, China
| | - Quan Zhou
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Graduate Program in Structural and Computational Biology & Molecular Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Qing Qi
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Dermatology, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongmei Sun
- Department of Radiology, Shanghai Guanghua Hospital, Shanghai, China
| | - Liza M Zachariah
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Grace Wang
- Washington University, St. Louis, MO, USA
| | - John D Reveille
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yongtao Guan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Graduate Program in Structural and Computational Biology & Molecular Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Xiaodong Zhou
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Liu JM, Cui YZ, Zhang GL, Zhou XY, Pang JX, Wang XZ, Han JX. Association Between Dentin Matrix Protein 1 (rs10019009) Polymorphism and Ankylosing Spondylitis in a Chinese Han Population from Shandong Province. Chin Med J (Engl) 2017; 129:657-64. [PMID: 26960368 PMCID: PMC4804411 DOI: 10.4103/0366-6999.177972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Ankylosing spondylitis (AS) is the most common rheumatic condition that is slowly progressive and predominantly affects adolescents. Pathological bone formation associated with AS is an important cause of disability. The aim of the study was to investigate the possible involvement of the genes related to endochondral ossification and ectopia ossification in genetic susceptibility to AS in a Chinese Han population. Methods: Sixty-eight single nucleotide polymorphisms (SNPs) from 13 genes were genotyped in discovery cohorts including 300 AS patients and 180 healthy controls. The rs10019009 in dentin matrix protein 1 (DMP1) gene shown as association with AS after multiple testing corrections in discovery cohorts was replicated in a validation independent cohort of 620 AS patients and 683 healthy controls. The rs10019009 was assessed with bioinformatics including phylogenetic context, F-SNP and FastSNP functional predictions, secondary structure prediction, and molecular modeling. We performed a functional analysis of rs10019009 via reverse transcription-polymerase chain reaction, alkaline phosphatase (ALP) activity in human osteosarcoma U2OS cells. Results: Interestingly, the SNP rs10019009 was associated with AS in both the discovery cohort (P = 0.0012) and validation cohort (P = 0.0349), as well as overall (P = 0.0004) in genetic case–control association analysis. After a multivariate logistic regression analysis, the effect of this genetic variant was observed to be independent of linkage disequilibrium. Via bioinformatics analysis, it was found that the amino acid change of the rs10019009 led to changes of SNP function, secondary structure, tertiary conformation, and splice mode. Finally, functional analysis of rs10019009 in U2OS cells demonstrated that the risk T allele of the rs10019009 increased enzymatic activity of ALP, compared to that of the nonrisk allele (P = 0.0080). Conclusions: These results suggested that the DMP1 gene seems to be involved in genetic predisposition to AS, which may contribute to the ectopic mineralization or ossification in AS. In addition, DMP1 gene may be a promising intervention target for AS in the future.
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Affiliation(s)
| | | | | | | | | | | | - Jin-Xiang Han
- National Laboratory for Bio Drugs of Ministry of Health, Provincial Laboratory for Modern Medicine and Technology of Shandong, Research Center for Medicinal Biotechnology, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
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Huang ZG, Chen XL, Shi KN, Yan R, Chen H, Yang MX, Gao BX, Chan Q, Wang GC. The application of T2W SPIR-FLAIR in the diagnosis of hip synovitis in patients with spondyloarthritis. Br J Radiol 2016; 89:20160566. [PMID: 27662536 DOI: 10.1259/bjr.20160566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and accuracy of T2 weighted spectral pre-saturation inversion recovery combined with fluid-attenuated inversion recovery (T2W SPIR-FLAIR) in the diagnosis of hip synovitis in patients with spondyloarthritis (SpA). METHODS 10 volunteers underwent a T2W SPIR and 4 T2W SPIR-FLAIR sequence scans with different inversion times (TIs) to determine the optimum TI that could effectively suppress the intra-articular fluid signals. Hip MRI including T2W SPIR-FLAIR and enhanced T1 weighted (T1W) SPIR sequences was performed in 45 patients with SpA and totally 90 hips were evaluated. McNemar's test and Kappa test were used to compare the diagnostic results of synovitis between T2W SPIR-FLAIR and enhanced T1W SPIR. RESULTS A TI of 2100 ms was selected as the optimum TI. 32 hips from 17 patients exhibited high signal intensity within the articular cavity on both T2W SPIR-FLAIR and enhanced T1W SPIR sequences, while only 3 hips showed high signals within the articular cavity on T2W SPIR-FLAIR. The remaining 55 hips did not show high signals within the articular cavity on both sequences. The T2W SPIR-FLAIR and enhanced T1W SPIR sequences had similar values in the diagnosis of hip synovitis (p = 0.25) and a high degree of diagnostic consistency (Kappa = 0.929). CONCLUSION T2W SPIR-FLAIR can effectively suppress the intra-articular fluid signals, while retaining the signals of thickened synovial membranes and can be used for the diagnosis of hip synovitis in patients with SpA. Advances in knowledge: The enhanced T1W SPIR is a classic sequence for synovitis diagnosis, but it requires the injection of contrast agents. The T2W SPIR-FLAIR and enhanced T1W SPIR sequences had similar values in the diagnosis of hip synovitis (p = 0.25) and a high degree of diagnostic consistency (Kappa = 0.929).
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Affiliation(s)
- Zhen-Guo Huang
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Liang Chen
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Kai-Ning Shi
- 2 Philips Healthcare, World Profit Center, Beijing, China
| | - Ran Yan
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - He Chen
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Min-Xing Yang
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bao-Xiang Gao
- 1 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | | | - Guo-Chun Wang
- 4 Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
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36
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Radenska-Lopovok SG. [Immunomorphological characteristics of the synovial membrane in rheumatic diseases]. Arkh Patol 2016; 78:64-68. [PMID: 27600785 DOI: 10.17116/patol201678464-68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The synovial membrane is frequently a target in rheumatic diseases. A search for diagnostic criteria and determination of changes in the pathological process necessitate standardized biopsy diagnostic techniques and quantification of morphological changes using digital imaging methods. The paper considers main methods for obtaining synovial membrane samples. It presents major morphological and immunohistochemical variations in synovitis in the presence of rheumatoid arthritis, ankylosing spondylitis, and osteoarthrosis. It shows different immunological and autoinflammatory mechanisms of these diseases. Synovial membrane inflammation in rheumatoid arthritis, ankylosing spondylitis, and osteoarthrosis is characterized by different components of morphogenesis, which is proven by the expression of different cell markers. Rheumatoid synovitis is an autoinflammatory process; synovitis in ankylosing spondylitis is characterized by autoinflammatory processes; biomechanical factors as joint inflammation triggers are leading in osteoarthrosis.
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Affiliation(s)
- S G Radenska-Lopovok
- A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Moscow, Russia, Department of Pathological Anatomy, Russian Medical Academy of Postgraduate Education, Moscow, Russia
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37
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González-Chávez SA, Quiñonez-Flores CM, Pacheco-Tena C. Molecular mechanisms of bone formation in spondyloarthritis. Joint Bone Spine 2016; 83:394-400. [DOI: 10.1016/j.jbspin.2015.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/20/2015] [Indexed: 12/17/2022]
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38
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Is There any Correlation Between Pathological Profile of Facet Joints and Clinical Feature in Patients With Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis?: An Immunohistochemical Investigation. Spine (Phila Pa 1976) 2016; 41:E512-8. [PMID: 26630414 DOI: 10.1097/brs.0000000000001294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An immunohistochemical analysis. OBJECTIVE The aim of this study was to systematically and extensively evaluate the immunopathology of the facet joints in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA The facet joints may be predominantly involved in the process of spinal inflammation in AS. Thus, a detailed investigation of the immunopathology at sites of facet joints is of crucial importance in understanding the pathogenesis of AS. METHODS The facet joints were obtained from 30 AS patients and 23 age- and gender-matched controls (patients with fresh thoracolumbar fracture). The facet joints were assessed immunohistochemically by analyzing the number of infiltrating T cells (CD3, CD4, CD8), B cells (CD20), microvessel density (CD34), osteoblasts (CD56), bone marrow macrophages (CD68), and osteoclasts (CD68) per high-power field (hpf). According to the presence or absence of persistent inflammation, AS patients were divided into 2 groups: A (patients with persistent inflammation) and B (patients without persistent inflammation). Lumbar spinal mobility was assessed using the modified Schober index (MSI). RESULTS Two or more CD3+ T cell aggregates were found in the facet joints from 18 of 30 AS patients, whereas 1 CD3+ T cell aggregate was noted in 5 of 23 patients with thoracolumbar fracture. The levels of T cells (CD4+ and CD8+), CD20+B cells, CD56+ osteoblasts, and CD34+ microvessel density were significantly higher in AS patients than in the controls (all P < 0.01). Notably, the MSI score in group A was significantly higher than that in group B (P < 0.01). CONCLUSION Active spinal inflammation is frequently observed in AS patients with thoracolumbar kyphosis. In addition, persistent inflammation in facet joints may further contribute to the loss of spinal mobility in the later stages of AS. These findings indicate that careful monitoring of disease activity is mandatory for AS patients in its advanced stage. LEVEL OF EVIDENCE 4.
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39
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Nossent JC, Johnsen S, Bakland G. The influence of ERAP1 gene variants on clinical phenotype in ankylosing spondylitis. Scand J Rheumatol 2016; 45:474-479. [DOI: 10.3109/03009742.2016.1150507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- JC Nossent
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Clinical Medicine, The Arctic University, Tromsø, Norway
| | - S Johnsen
- Norwegian University of Life Sciences, Aars, Norway
| | - G Bakland
- Department of Clinical Medicine, The Arctic University, Tromsø, Norway
- University Hospital of North Norway (UNN), Tromsø, Norway
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40
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Utility of DXA scanning and risk factors for osteoporosis in ankylosing spondylitis-A prospective study. Semin Arthritis Rheum 2016; 46:88-94. [PMID: 27162010 DOI: 10.1016/j.semarthrit.2016.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/02/2016] [Accepted: 03/07/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Conventional DXA imaging of spine and hip to measure bone mineral density (BMD) has limitations in patients with ankylosing spondylitis (AS). We investigated the correlation of hip and spine BMD measurements in patients with AS to determine if hip DXA will prove clinically useful while avoiding the confounding effect of spinal disease. Also, we studied risk factors for osteoporosis (OP) and osteopenia in AS. METHODS We randomly identified patients from our validated AS registry ≥18 years of age who met the Modified New York Classification criteria for AS. BMD was measured and interpreted using ISCD 2007 guidelines and diagnosis of OP was based on WHO criteria. ESR, CRP, urinary N-telopeptide, and 25-hydroxy vitamin D were also measured. Correlation between the BMD (total hip and/or femoral neck) and lumbar spine was calculated. Statistical comparisons between the 2 sites, lumbar spine (AP) and hip (total hip and or femoral neck) were made using Bowker's test for symmetry and kappa statistics. Chi-square and odds ratio using logistic regression were used to assess the association of the purported risk factors for OP in these patients. RESULTS Frequency of OP among AS patients ≥50 years of age was 23%, and that of osteopenia was 41%. Among patients <50 years of age, the frequency of low bone mass for expected age (Z-score ≤-2.0) was 14.7%. There was moderate correlation (ρ = 0.59) and a fair agreement (κ = 0.26; 95% CI: 0.10-0.42) between the lowest T-values of hip and lumbar spine (AP view). OP was significantly associated with elevated CRP level [OR = 4.2 (95% CI: 1.13-15.9), p < 0.03] and African American race [OR = 7.2 (95% CI: 1.18-44.99), p < 0.03]. CONCLUSION Our results demonstrated a moderate correlation and fair agreement between the T-scores of hip and the lumbar spine (AP view) in patients with AS, suggesting that DXA of the hip and the lumbar spine (AP view) may both be useful for OP and osteopenia screening in patients with AS without fused spines. We confirm the previous reports of an association of elevated CRP level with an increased risk of OP in patients with AS, but this is the first study to demonstrate that African American patients with AS may be at a higher risk of developing OP compared to Caucasians.
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Chen D, Yuan S, Zhan Z, Xiao Y, Li H, Liang L, Yang X. Early-stage hip involvement in patients with ankylosing spondylitis: A Chinese study based on magnetic resonance imaging. Mod Rheumatol 2016; 26:933-939. [PMID: 26872512 DOI: 10.3109/14397595.2016.1153232] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Dongying Chen
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
| | - Shiwen Yuan
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongping Zhan
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
| | - Youjun Xiao
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
| | - Hao Li
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
| | - Liuqin Liang
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
| | - Xiuyan Yang
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China and
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Geurts J, Patel A, Hirschmann MT, Pagenstert GI, Müller-Gerbl M, Valderrabano V, Hügle T. Elevated marrow inflammatory cells and osteoclasts in subchondral osteosclerosis in human knee osteoarthritis. J Orthop Res 2016; 34:262-9. [PMID: 26250062 DOI: 10.1002/jor.23009] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/31/2015] [Indexed: 02/04/2023]
Abstract
Subchondral osteosclerosis, characterized by an increase of hypomineralized bone material, is a pathological hallmark of osteoarthritis. The cellular components in the subchondral marrow compartment that participate in this aberrant bone remodeling process remain to be elucidated. This study assessed the presence of marrow inflammatory cells and their relative abundance between nonsclerotic and sclerotic tissues in knee osteoarthritis. Bone samples from osteoarthritic knee tibial plateaus were stratified for histological analyses using computed tomography osteoabsorptiometry. Immunohistological analysis revealed the presence of CD20 (B-lymphocyte) and CD68 (macrophage), but not CD3 (T-lymphocyte) immunoreactive mononuclear cells in subchondral marrow tissues and their relative abundance was significantly increased in sclerotic compared with nonsclerotic bone samples. Multinucleated osteoclasts that stained positive for CD68 and tartrate-resistant acid phosphatase, predominantly associated with CD34-positive blood vessels and their abundance was strongly increased in sclerotic samples. Bone-specific alkaline phosphatase activity in outgrowth osteoblasts was induced by conditioned medium from nonsclerotic, but not sclerotic, bone pieces. These results suggest that an interaction between bone-resident cells and marrow inflammatory cells might play a role in aberrant bone remodeling leading to subchondral osteosclerosis. Elevated osteoclast activity in sclerotic bone suggests that bone formation and resorption activities are increased, yet uncoupled, in human knee osteoarthritis.
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Affiliation(s)
- Jeroen Geurts
- Osteoarthritis Research Center Basel, Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Amit Patel
- Institute of Anatomy, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4104 Bruderholz, Switzerland
| | - Geert I Pagenstert
- Osteoarthritis Research Center Basel, Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Victor Valderrabano
- Osteoarthritis Research Center Basel, Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Thomas Hügle
- Osteoarthritis Research Center Basel, Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Tseng HW, Pitt ME, Glant TT, McRae AF, Kenna TJ, Brown MA, Pettit AR, Thomas GP. Inflammation-driven bone formation in a mouse model of ankylosing spondylitis: sequential not parallel processes. Arthritis Res Ther 2016; 18:35. [PMID: 26831337 PMCID: PMC4734853 DOI: 10.1186/s13075-015-0805-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 01/21/2023] Open
Abstract
Background Ankylosing spondylitis (AS) is an immune-mediated arthritis particularly targeting the spine and pelvis and is characterised by inflammation, osteoproliferation and frequently ankylosis. Current treatments that predominately target inflammatory pathways have disappointing efficacy in slowing disease progression. Thus, a better understanding of the causal association and pathological progression from inflammation to bone formation, particularly whether inflammation directly initiates osteoproliferation, is required. Methods The proteoglycan-induced spondylitis (PGISp) mouse model of AS was used to histopathologically map the progressive axial disease events, assess molecular changes during disease progression and define disease progression using unbiased clustering of semi-quantitative histology. PGISp mice were followed over a 24-week time course. Spinal disease was assessed using a novel semi-quantitative histological scoring system that independently evaluated the breadth of pathological features associated with PGISp axial disease, including inflammation, joint destruction and excessive tissue formation (osteoproliferation). Matrix components were identified using immunohistochemistry. Results Disease initiated with inflammation at the periphery of the intervertebral disc (IVD) adjacent to the longitudinal ligament, reminiscent of enthesitis, and was associated with upregulated tumor necrosis factor and metalloproteinases. After a lag phase, established inflammation was temporospatially associated with destruction of IVDs, cartilage and bone. At later time points, advanced disease was characterised by substantially reduced inflammation, excessive tissue formation and ectopic chondrocyte expansion. These distinct features differentiated affected mice into early, intermediate and advanced disease stages. Excessive tissue formation was observed in vertebral joints only if the IVD was destroyed as a consequence of the early inflammation. Ectopic excessive tissue was predominantly chondroidal with chondrocyte-like cells embedded within collagen type II- and X-rich matrix. This corresponded with upregulation of mRNA for cartilage markers Col2a1, sox9 and Comp. Osteophytes, though infrequent, were more prevalent in later disease. Conclusions The inflammation-driven IVD destruction was shown to be a prerequisite for axial disease progression to osteoproliferation in the PGISp mouse. Osteoproliferation led to vertebral body deformity and fusion but was never seen concurrent with persistent inflammation, suggesting a sequential process. The findings support that early intervention with anti-inflammatory therapies will be needed to limit destructive processes and consequently prevent progression of AS. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0805-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hsu-Wen Tseng
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Miranda E Pitt
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Tibor T Glant
- Section of Molecular Medicine, Department of Orthopedic Surgery, Rush University Medical Center, 1735 W. Harrison Street, Cohn Research Building, Chicago, IL, 60612, USA.
| | - Allan F McRae
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia. .,The University of Queensland, Queensland Brain Institute, QBI Building, St Lucia, QLD, 4072, Australia.
| | - Tony J Kenna
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Matthew A Brown
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Allison R Pettit
- The University of Queensland-Mater Research Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Gethin P Thomas
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
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Park R, Kim TH, Ji JD. Gene Expression Profile in Patients with Axial Spondyloarthritis: Meta-analysis of Publicly Accessible Microarray Datasets. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.6.363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Robin Park
- Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Tae-Hwan Kim
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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45
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Eriksen EF. Treatment of bone marrow lesions (bone marrow edema). BONEKEY REPORTS 2015; 4:755. [PMID: 26644910 PMCID: PMC4662576 DOI: 10.1038/bonekey.2015.124] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/07/2015] [Indexed: 11/09/2022]
Abstract
Bone marrow lesions (BMLs) or using older terminology 'Bone marrow edema' is characterised by excessive water signals in the marrow space on magnetic resonance imaging or ultrasound; BMLs constitute a central component of a wide variety of inflammatory and non-inflammatory rheumatologic conditions affecting the musculoskeletal system: BMLs are not only considered significant sources of pain but also linked to increased disease activity in many musculoskeletal conditions (for example, osteoarthritis, rheumatoid arthritis). The purpose of this review is to summarise current knowledge about the treatment of BMLs, with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.
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Affiliation(s)
- Erik F Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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46
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Kim H, Lee J, Ahn JK, Hwang J, Park EJ, Jeong H, Cha HS, Koh EM. Predictive factors of radiographic progression in ankylosing spondylitis. Korean J Intern Med 2015; 30:391-7. [PMID: 25995670 PMCID: PMC4438294 DOI: 10.3904/kjim.2015.30.3.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/28/2013] [Accepted: 07/23/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.
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Affiliation(s)
- Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwon Hwang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Jung Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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47
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Haibel H, Sieper J. [Enthesitis in connection with spondyloarthritides]. DER ORTHOPADE 2015; 44:395-406. [PMID: 25920504 DOI: 10.1007/s00132-015-3114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Enthesitis is a frequent manifestation in spondyloarthritis (SpA) and psoriatic arthritis (PsA) and can be found in up to 40% of patients with SpA. Because of the pathognomonic relevance the classification criteria for SpA and PsA use enthesitis as an entrance or secondary criterion. Enthesitis is most frequently localized at the heel but it can occur at any insertion of an enthesis into the bone. When diagnosing enthesitis differential diagnoses should be considered, mechanical-degenerative causes and fibromyalgia in particular should be excluded. The imaging techniques power Doppler ultrasound (PDUS) and magnetic resonance imaging (MRI) are most helpful in making the diagnosis. The therapeutic options for enthesitis are limited. Nonsteroidal antirheumatic drugs (NSARD) and local injections of corticosteroids are recommended. In small clinical trials no efficacy of disease modifying antirheumatic drugs (DMARD) could be demonstrated. In contrast, tumor necrosis factor alpha (TNF-alpha) blockers were shown to be highly effective in randomized controlled trials for SpA and PsA but they are not currently approved for enthesitis only.
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Affiliation(s)
- H Haibel
- Rheumatologie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland,
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48
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Appel H, Sieper J. Analysis of bone samples from patients with spondyloarthritides-identifying causes of new bone formation in axial spondyloarthritis. J Rheumatol 2015; 42:561-3. [PMID: 25834238 DOI: 10.3899/jrheum.150046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Heiner Appel
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Berlin, Germany.
| | - Joachim Sieper
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Berlin, Germany
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49
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Zhang Y, Hu X, Zhang C, Zhou Y, Chu TW. Suppression subtractive hybridization reveals differentially expressed genes in supraspinous ligaments of patients with ankylosing spondylitis. Mol Med Rep 2015; 11:4482-8. [PMID: 25632965 DOI: 10.3892/mmr.2015.3272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 12/12/2014] [Indexed: 11/06/2022] Open
Abstract
Ankylosing spondylitis (AS) is a severe chronic inflammatory disease that may ultimately result in the development of a 'bamboo‑like' spine. Although the pathological changes that occur in AS have been extensively investigated, the mechanism underlying spinal fusion during AS remains elusive. Differentially expressed genes (DEGs) in paraspinal tissues from patients with AS compared with those from healthy controls were therefore investigated. Polymerase chain reaction (PCR)‑based suppression subtractive hybridization was performed using total mRNA from the supraspinal ligaments of three patients with AS and three patients with spinal fractures as controls. From this, 27 genes were identified in all of the three independent forward libraries, which were defined as DEGs associated with AS. Reverse transcription‑quantitative PCR demonstrated that six DEGs were overexpressed in the tissues from patients with AS compared with those from individuals in the control group, including those encoding transforming growth factor β types I and III receptor, vascular endothelial growth factor, matrix metalloproteinase‑3, core‑binding factor α1 and bone morphogenetic protein 2. Western blot analysis showed increased expression in all six of these proteins in the samples from patients with AS compared with those in the control groups. These findings suggested that changes in the expression of these genes and proteins are associated with the development of spinal fusion during the pathogenesis of AS. Furthermore, these genes may be novel markers of the risk of developing AS, in addition to being targets for the treatment of this disease.
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Affiliation(s)
- Ying Zhang
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Xu Hu
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Chao Zhang
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Tong-Wei Chu
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
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50
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Abstract
Enthesitis is a frequent manifestation in spondyloarthritis (SpA) and psoriatic arthritis (PsA) and can be found in up to 40 % of patients with SpA. Because of the pathognomonic relevance the classification criteria for SpA and PsA use enthesitis as an entrance or secondary criterion. Enthesitis is most frequently localized at the heel but it can occur at any insertion of an enthesis into the bone. When diagnosing enthesitis differential diagnoses should be considered, mechanical-degenerative causes and fibromyalgia in particular should be excluded. The imaging techniques power Doppler ultrasound (PDUS) and magnetic resonance imaging (MRI) are most helpful in making the diagnosis. The therapeutic options for enthesitis are limited. Nonsteroidal antirheumatic drugs (NSARD) and local injections of corticosteroids are recommended. In small clinical trials no efficacy of disease modifying antirheumatic drugs (DMARD) could be demonstrated. In contrast, tumor necrosis factor alpha (TNF-alpha) blockers were shown to be highly effective in randomized controlled trials for SpA and PsA but they are not currently approved for enthesitis only.
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