1
|
Feng X, Wang C, Ji B, Qiao J, Xu Y, Zhu S, Ji Z, Zhou B, Tong W, Xu W. CD_99 G1 neutrophils modulate osteogenic differentiation of mesenchymal stem cells in the pathological process of ankylosing spondylitis. Ann Rheum Dis 2024; 83:324-334. [PMID: 37977819 PMCID: PMC10894850 DOI: 10.1136/ard-2023-224107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This study aimed to identify the types and heterogeneity of cells within the spinal enthesis and investigate the underlying mechanisms of osteogenesis. METHODS Single-cell RNA sequencing was used to identify cell populations and their gene signatures in the spinal enthesis of five patients with ankylosing spondylitis (AS) and three healthy individuals. The transcriptomes of 40 065 single cells were profiled and divided into 7 clusters: neutrophils, monocytic cells, granulomonocytic progenitor_erythroblasts, T cells, B cells, plasma cells and stromal cells. Real-time quantitative PCR, immunofluorescence, flow cytometry, osteogenesis induction, alizarin red staining, immunohistochemistry, short hairpin RNA and H&E staining were applied to validate the bioinformatics analysis. RESULTS Pseudo-time analysis showed two differentiation directions of stromal cells from the mesenchymal stem cell subpopulation MSC-C2 to two Cxcl12-abundant-reticular (CAR) cell subsets, Osteo-CAR and Adipo-CAR, within which three transcription factors, C-JUN, C-FOS and CAVIN1, were highly expressed in AS and regulated the osteogenesis of mesenchymal stem cells. A novel subcluster of early-stage neutrophils, CD99_G1, was elevated in AS. The proinflammatory characteristics of monocyte dendritic cell progenitor-recombinant adiponectin receptor 2 monocytic cells were explored. Interactions between Adipo-CAR cells, CD99_G1 neutrophils and other cell types were mapped by identifying ligand-receptor pairs, revealing the recruitment characteristics of CD99_G1 neutrophils by Adipo-CAR cells and the pathogenesis of osteogenesis induced in AS. CONCLUSIONS Our results revealed the dynamics of cell subpopulations, gene expression and intercellular interactions during AS pathogenesis. These findings provide new insights into the cellular and molecular mechanisms of osteogenesis and will benefit the development of novel therapeutic strategies.
Collapse
Affiliation(s)
- Xinzhe Feng
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chen Wang
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Boyao Ji
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Junjie Qiao
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yihong Xu
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shanbang Zhu
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhou Ji
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bole Zhou
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenwen Tong
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Weidong Xu
- Department of Joint Bone Disease Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
2
|
Jiang Y, Liu Q, Kong X, Zhao M, Liu Y, Gao P, Deng G, Cao Y, Ma L. Role of HLA class I and II alleles in susceptibility to ankylosing spondylitis in Chinese Han. J Clin Lab Anal 2023; 37:e24964. [PMID: 37747092 PMCID: PMC10623521 DOI: 10.1002/jcla.24964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE The objective of the study was to clarify the associations of HLA class I and II alleles with ankylosing spondylitis (AS) among Chinese Han. METHODS We performed HLA genotyping and Sanger sequencing for 68 HLA-B*27(-), 62 HLA-B*27(+) AS patients, and 70 controls. Case-control analyses and separate analyses of HLA-B*27(-) patients were performed. One-way ANOVA and Kruskal-Wallis multiple comparisons test were used to analyze the effects of HLA-A\B\C\DRB1\DQB1 alleles on clinical characteristics of HLA-B*27(-) and HLA-B*27(+) patients. RESULTS In the HLA-B*27(+) group, positive associations were seen with A*11:02, B*27:04, B*27:05, C*02:02, C*12:02, and DRB1*04:01 and negative associations were seen with A*33:03, B*07:02, B*57:01, and C*07:02. The age at onset was greater in HLA-B*27(-) patients than in HLA-B*27(+) patients (30.03 ± 15.15 vs. 23.08 ± 7.79 years). In the HLA-B*27(-) group, those with A*01:01, B*13:01, B*13:02, C*01:02, C*04:01, DQB1*02:01, DQB1*06:01, and DRB1*03:01 had an earlier onset than those without these alleles, while patients carrying B*40:02, C*07:02, C*12:02, C*15:02, DQB1*05:02, and DQB1*05:03 had a delayed onset. In the HLA-B*27(-) group, A*32:01(+), C*08:01(+), and DRB1*04:05(-) women were likely to develop AS. In the HLA-B*27(+) group, DQB1*03:02(+) women may be more likely to develop AS. DRB1*12:02 and HLA-B*27 interacted with the distribution of AS-affected sites. In the HLA-B*27(+) group, DRB1*12:02(+) patients were likely to have peripheral joint involvement. CONCLUSION HLA class I and II alleles other than HLA-B*27 contribute to AS predisposition and characteristics among Chinese Han patients.
Collapse
Affiliation(s)
- Yongwei Jiang
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Qian Liu
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Xiaomu Kong
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Meimei Zhao
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Yi Liu
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Peng Gao
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Guoxiong Deng
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Yongtong Cao
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| | - Liang Ma
- Clinical Laboratory, China‐Japan Friendship HospitalBeijingChina
| |
Collapse
|
3
|
Lorenzin M, Cozzi G, Scagnellato L, Ortolan A, Vio S, Striani G, Scapin V, De Conti G, Doria A, Ramonda R. Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study). Scand J Rheumatol 2023; 52:519-529. [PMID: 36847124 DOI: 10.1080/03009742.2023.2169990] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/15/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA). METHOD Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician's judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics. RESULTS Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males. CONCLUSION Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.
Collapse
Affiliation(s)
- M Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - G Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - L Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - A Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - S Vio
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G Striani
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - V Scapin
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G De Conti
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - A Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - R Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| |
Collapse
|
4
|
Sex Impacts Disease Activity But Not Symptoms or Quality of Life in Adults With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2022; 20:1729-1738.e1. [PMID: 34798333 DOI: 10.1016/j.cgh.2021.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eosinophilic esophagitis has a strong male predominance that appears at least partially due to genetic susceptibility. However, data regarding sex-related differences in patients with EoE are scarce. METHODS We analyzed prospectively collected data from adults enrolled into the Swiss Eosinophilic Esophagitis Cohort Study. Patients with and without dilation in the past 12 months completed patient-reported Eosinophilic Esophagitis Activity Index (EEsAI) and EoE-specific quality of life in adults (EoE-QoL-A) and underwent endoscopy with biopsies. We used linear regression with EEsAI or EoE-QoL-A as the outcome, eosinophils per high power field, rings and strictures, current therapy use, and disease duration as predictors. RESULTS A total of 266 patients (77% male, median age at diagnosis 35.8 years, median disease duration 10.4 years) were seen during 408 visits. Men had a longer diagnostic delay (62 months vs 36 months; P = .022), higher endoscopic disease activity (median endoscopic reference score 3.0 [interquartile range, 1.0-6.0] vs 2.0 [interquartile range, 0.0-4.0]; P = .010), more microabscesses (25% vs 13%; P = .025), and more often fibrosis of the lamina propria (mild/moderate 74.7% vs 61.5%, severe 9.1% vs 5.8%; P = .047) than women. When adjusting for objective measures of disease activity, disease duration, and current therapy use, we did not observe differences in EEsAI or EoE-QoL-A between women and men. CONCLUSIONS Male EoE patients had higher endoscopic and histologic disease activity than female patients. When adjusting for biologic activity and therapy use, we did not identify differences in symptom severity or EoE-QoL between male and female eosinophilic esophagitis patients.
Collapse
|
5
|
Baseline Characteristics and Treatment Response to Ixekizumab Categorised by Sex in Radiographic and Non-radiographic Axial Spondylarthritis Through 52 Weeks: Data from Three Phase III Randomised Controlled Trials. Adv Ther 2022; 39:2806-2819. [PMID: 35429281 PMCID: PMC9123018 DOI: 10.1007/s12325-022-02132-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 12/26/2022]
Abstract
Objectives Assess baseline characteristics and treatment response to ixekizumab (IXE) categorised by sex in patients with radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axSpA (nr-axSpA) up to 52 weeks. Methods Data were analysed from three randomised controlled trials of IXE through 52 weeks. Patients fulfilled ASAS classification criteria for r-axSpA or nr-axSpA and were randomised to receive 80 mg subcutaneous administration of IXE every 2 weeks (Q2W) or 4 weeks (Q4W), or placebo (16 weeks COAST-V/W; 52 weeks COAST-X). Baseline characteristics and treatment outcomes were assessed. Patients were categorised by sex; methods included non-responder imputation for categorical variables, and modified baseline observation carried forward for continuous efficacy variables. Results At presentation, female patients had higher disease burden as reflected by significantly higher spinal pain at night, fatigue scores and pain/swelling in joints other than the neck, back or hip. ASAS40 response rate with the approved label dose, IXEQ4W, was achieved in 39% of male patients with r-axSpA by week 16, and 44% by week 52. For female patients, 16.7% and 33.3% achieved ASAS40 at week 16 and 52, respectively. In nr-axSpA, 46% of male patients achieved ASAS40 at week 16 and 30% at week 52. In total, 23.9% of female patients achieved ASAS40 at week 16, and 30.4% at week 52. Conclusions This analysis demonstrates that for the axSpA disease spectrum, female patients present with higher disease burden. Following treatment with IXE, there is a higher proportion of male responders up to 16 weeks, while female patients show less robust responses for the first 16 weeks but larger responses from weeks 16 through 52. Trial Registration Numbers NCT02696785, NCT02696798 and NCT02757352. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02132-2.
Collapse
|
6
|
Cui H, Li Z, Chen S, Li X, Chen D, Wang J, Li Z, Hao W, Zhong F, Zhang K, Zheng Z, Zhan Z, Liu H. CXCL12/CXCR4-Rac1-mediated migration of osteogenic precursor cells contributes to pathological new bone formation in ankylosing spondylitis. SCIENCE ADVANCES 2022; 8:eabl8054. [PMID: 35385310 PMCID: PMC8986111 DOI: 10.1126/sciadv.abl8054] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/15/2022] [Indexed: 05/29/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by inflammatory back pain and spinal ankylosis due to pathological new bone formation. Here, we identified CXCL12 as a critical contributor to pathological new bone formation through recruitment of osteogenic precursor cells (OPCs). CXCL12 was found highly expressed in the regions that would potentially develop pathological new bone. OPCs were recruited to the regions where CXCL12 was up-regulated. Inhibition of CXCL12/CXCR4 axis with AMD3100 or conditional knockout of CXCR4 attenuated OPCs migration and subsequent pathological new bone formation in animal models of AS. By contrast, a genetically engineered animal model with CXCL12 overexpression developed a joint ankylosis phenotype. Furthermore, Rac1 was found essential for OPCs migration and pathological new bone formation. These findings ravel the novel role of CXCL12 in AS and indicate a potential strategy for targeting the CXCL12/CXCR4-Rac1 axis to prevent progression of axial skeleton ankylosis.
Collapse
Affiliation(s)
- Haowen Cui
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Zihao Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Siwen Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Xiang Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Dongying Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Wenjun Hao
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Fangling Zhong
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Kuibo Zhang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| | - Zhongping Zhan
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, 510080 Guangdong, China
| |
Collapse
|
7
|
Li LL, Fu J, Xu C, Ni M, Chai W, Hao LB, Zhou YG, Chen JY. Gender Differences in Ankylosing Spondylitis Patients with Advanced Hip Involvement: Results from A Matched Retrospective Cohort Study. Orthop Surg 2021; 14:405-410. [PMID: 34898026 PMCID: PMC8867405 DOI: 10.1111/os.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To determine the gender differences in ankylosing spondylitis (AS) patients with advanced hip involvement. Methods We retrospectively analyzed the 373 consecutive AS patients with advanced hip involvement from 2012 to 2017 and divided them into two groups by sex with 340 men and 33 women. Research data on hip involvement in the patients were obtained from medical records and radiographs. The severity of radiographic hip involvement was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI‐hip) scoring system. The data on clinical characteristics, radiographic hip involvement, and laboratory values were compared between the two groups. The comparison was performed again between the two groups after adjusting for the onset age and disease duration by propensity score matching (PSM). Results Men underwent total hip arthroplasty earlier than women in the patients, with a median age of 31 years (range, 19–67 years) vs 36 years (range, 23–67 years), respectively (P < 0.05). Hip involvement was found to be younger in men than that in women, with a median age of 18 years (range, 7–56 years) vs 23 years (range, 5–55 years) (P < 0.05), and men with bilateral onset in hips had a higher frequency than women with that (66.2% vs 39.4%) (P < 0.05). There was no gender difference in the proportion of bilateral advanced hip involvement (85.3% vs 72.7%) (P > 0.05). The proportion of the patients who had spinal involvement (89.1% vs 69.7%), flexion contracture in the hip (43.8% vs 24.2%), hip range of motion =0° (53.5% vs 30.3%), and an elevated level of C‐reactive protein (CRP) (69.1% vs 51.5%) was significantly higher in men than that in women (P < 0.05). After adjusting for the onset age and disease duration by PSM (1:1), men with bilateral onset in hips still had a higher frequency than women with that (76.7% vs 40.0%), and the proportion of the patients who had spinal involvement (90.0% vs 66.7%) and an elevated level of CRP (80.0% vs 53.3%) was significantly higher in men than that in women (P < 0.05). Conclusions The disease pattern of hip involvement in AS has gender differences, with bilateral onset being the dominant pattern in men and unilateral onset being more common in women. However, the frequency of bilateral advanced hip involvement has no gender difference eventually. The higher prevalence of spinal involvement in men with AS may be responsible for the more severe functional impairment compared with women.
Collapse
Affiliation(s)
- Liang-Liang 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, 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
| | - 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
| | - Li-Bo Hao
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yong-Gang Zhou
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ji-Ying Chen
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
8
|
A Pooled Analysis Reporting the Efficacy and Safety of Secukinumab in Male and Female Patients with Ankylosing Spondylitis. Rheumatol Ther 2021; 8:1775-1787. [PMID: 34618347 PMCID: PMC8572254 DOI: 10.1007/s40744-021-00380-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Despite of higher disease burden, lower efficacy to biologics has been reported in female compared to male patients with ankylosing spondylitis (AS). The aim of this study was to evaluate the efficacy and safety of secukinumab by sex in patients with active AS from five phase 3 studies (MEASURE 1–5) through 52 weeks. Methods Baseline demographics, disease characteristics and efficacy outcomes at Weeks 16 and 52 were summarized for males versus females. Baseline predictor analysis used multivariable logistic regression for binary outcome measures or generalized linear model for continuous outcome measures to assess the impact of sex as one of the independent variables on selected efficacy outcomes at Week 52. Results Overall, 1031 males and 396 females were included in this analysis. Smoking status, hs-CRP, prior exposure to TNF inhibitors, BASMI occiput-to-wall and tragus-to-wall distance (cm) were higher in males, whereas MASES was higher in females. Efficacy outcomes i.e., ASAS40 responses and BASDAI change from baseline at Weeks 16 and 52 were generally comparable between males and females. Response rates were found to be significantly higher in male patients when compared with female patients only for ASDAS-CRP inactive disease (ID) at Week 52. Conclusion Comparable efficacy and safety outcomes were observed between male and female patients with active AS treated with secukinumab over 52 weeks. Further, sex was not an independent predictor of treatment response to secukinumab as assessed by ASAS40 responder rates and BASDAI change from baseline; association of ASDAS-CRP ID responder rates with sex warrants further exploration. Trial registration ClinicalTrials.gov; NCT01358175, NCT01649375, NCT02008916, NCT02159053, and NCT02896127. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00380-2.
Collapse
|
9
|
Nordin J, Pettersson M, Rosenberg LH, Mathioudaki A, Karlsson Å, Murén E, Tandre K, Rönnblom L, Kastbom A, Cedergren J, Eriksson P, Söderkvist P, Lindblad-Toh K, Meadows JRS. Association of Protective HLA-A With HLA-B∗27 Positive Ankylosing Spondylitis. Front Genet 2021; 12:659042. [PMID: 34335681 PMCID: PMC8320510 DOI: 10.3389/fgene.2021.659042] [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: 01/26/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To further elucidate the role of the MHC in ankylosing spondylitis by typing 17 genes, searching for HLA-B∗27 independent associations and assessing the impact of sex on this male biased disease. Methods High-confidence two-field resolution genotyping was performed on 310 cases and 2196 controls using an n-1 concordance method. Protein-coding variants were called from next-generation sequencing reads using up to four software programs and the consensus result recorded. Logistic regression tests were applied to the dataset as a whole, and also in stratified sets based on sex or HLA-B∗27 status. The amino acids driving association were also examined. Results Twenty-five HLA protein-coding variants were significantly associated to disease in the population. Three novel protective associations were found in a HLA-B∗27 positive population, HLA-A∗24:02 (OR = 0.4, CI = 0.2–0.7), and HLA-A amino acids Leu95 and Gln156. We identified a key set of seven loci that were common to both sexes, and robust to change in sample size. Stratifying by sex uncovered three novel risk variants restricted to the female population (HLA-DQA1∗04.01, -DQB1∗04:02, -DRB1∗08:01; OR = 2.4–3.1). We also uncovered a set of neutral variants in the female population, which in turn conferred strong effects in the male set, highlighting how population composition can lead to the masking of true associations. Conclusion Population stratification allowed for a nuanced investigation into the tightly linked MHC region, revealing novel HLA-B∗27 signals as well as replicating previous HLA-B∗27 dependent results. This dissection of signals may help to elucidate sex biased disease predisposition and clinical progression.
Collapse
Affiliation(s)
- Jessika Nordin
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Mats Pettersson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Lina Hultin Rosenberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Argyri Mathioudaki
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Åsa Karlsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Eva Murén
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Karolina Tandre
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Rönnblom
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Alf Kastbom
- Department of Rheumatology, University Hospital Linköping, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jan Cedergren
- Department of Rheumatology, University Hospital Linköping, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Eriksson
- Department of Rheumatology, University Hospital Linköping, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Söderkvist
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Jennifer R S Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Lener S, Wipplinger C, Hartmann S, Rietzler A, Thomé C, Tschugg A. Gender-Specific Differences in Presentation and Management of Spinal Infection: A Single-Center Retrospective Study of 159 Cases. Global Spine J 2021; 11:430-436. [PMID: 32875875 PMCID: PMC8119926 DOI: 10.1177/2192568220905804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN A retrospective single-center analysis of 159 cases. OBJECTIVE To investigate differences between male and female patients, as spinal infection (SI) represents a life-threatening condition and numerous factors may facilitate the course and outcome of SI, including patients' age and comorbidities, as well as gender. To date, no comparative data investigating sex differences in SI is available. Thus, the purpose of the present retrospective trial was to investigate differences between male and female patients. METHODS A total of 159 patients who were treated for a spinal infection between 2010 and 2016 at our department were included in the analysis. The patients were categorized into 2 groups based on gender. Evaluation included magnetic resonance imaging, laboratory values, clinical outcome, and conservative/operative management. RESULTS Male patients suffered from SI significantly more often than female patients (n = 101, 63.5% vs n = 58, 36.5%, P = .001). However, female patients were initially affected more severely, as infection parameters were significantly higher (P = .032) and vertebral destruction was more serious (P = .018). Furthermore, women suffered from intraoperative complications more often (P = .024) and received erythrocyte concentrates more frequently (P = .01). Nevertheless, mortality rates and outcome were comparable. Pain scales were significantly higher in female patients at 12-month follow-up (P = .042). CONCLUSION Although male patients show a higher incidence for SI, the course of disease and the management is more challenging in female patients. Nevertheless, outcome after 12 months is comparably good. Underlying mechanisms may include a better immune response and dissimilar effects of antibiotic treatment in women. Pain management in female patients is still unsatisfactory after 12 months.
Collapse
Affiliation(s)
- Sara Lener
- Medical University of
Innsbruck, Innsbruck, Austria,Sara Lener, Clinical Department of
Neurosurgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck,
Austria.
| | | | | | | | | | - Anja Tschugg
- Medical University of
Innsbruck, Innsbruck, Austria
| |
Collapse
|
11
|
Cutolo M, Straub RH. Sex steroids and autoimmune rheumatic diseases: state of the art. Nat Rev Rheumatol 2020; 16:628-644. [PMID: 33009519 DOI: 10.1038/s41584-020-0503-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Abstract
In autoimmune rheumatic diseases, oestrogens can stimulate certain immune responses (including effects on B cells and innate immunity), but can also have dose-related anti-inflammatory effects on T cells, macrophages and other immune cells. By contrast, androgens and progesterone have predominantly immunosuppressive and anti-inflammatory effects. Hormone replacement therapies and oral contraception (and also pregnancy) enhance or decrease the severity of autoimmune rheumatic diseases at a genetic or epigenetic level. Serum androgen concentrations are often low in men and in women with autoimmune rheumatic diseases, suggesting that androgen-like compounds might be a promising therapeutic approach. However, androgen-to-oestrogen conversion (known as intracrinology) is enhanced in inflamed tissues, such as those present in patients with autoimmune rheumatic diseases. In addition, it is becoming evident that the gut microbiota differs between the sexes (known as the microgenderome) and leads to sex-dependent genetic and epigenetic changes in gastrointestinal inflammation, systemic immunity and, potentially, susceptibility to autoimmune or inflammatory rheumatic diseases. Future clinical research needs to focus on the therapeutic use of androgens and progestins or their downstream signalling cascades and on new oestrogenic compounds such as tissue-selective oestrogen complex to modulate altered immune responses.
Collapse
Affiliation(s)
- Maurizio Cutolo
- Research Laboratories and Academic Division of Clinical Rheumatology, Postgraduate School of Rheumatology, Department of Internal Medicine DIMI, University of Genova, IRCCS San Martino Polyclinic, Genoa, Italy.
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Division of Rheumatology, Department of Internal Medicine, University Hospital of Regensburg, Regensburg, Germany
| |
Collapse
|
12
|
Maguire S, O'Dwyer T, Mockler D, O'Shea F, Wilson F. Pregnancy in axial spondyloarthropathy: A systematic review & meta-analysis. Semin Arthritis Rheum 2020; 50:1269-1279. [PMID: 33065422 DOI: 10.1016/j.semarthrit.2020.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Axial spondyloarthropathy (axSpA) is an inflammatory arthritis which affects the sacroiliac joints and the spine. Many females affected are of childbearing age. Studies on effects of pregnancy on axSpA disease activity and medication use have been limited, with divergent conclusions. OBJECTIVE To review literature on axSpA in pregnancy to determine the effect of disease on pregnancy outcomes. METHODS A systematic review of case-control trials, observational studies, cross sectional studies and case series (n>5) on axSpA in pregnancy. EMBASE, Medline (OVID), CINAHL, Maternity and Infant Care (MIDIRS online), and Web of Science were searched for keywords. Two reviewers reviewed articles to determine suitability for inclusion. The Newcastle Ottawa Scale was used to assess risk of bias. Data extraction was performed using a standardized template to streamline data to allow comparison and meta-analysis. RESULTS Search strategy returned 884 records, 130 full text articles were assessed for eligibility. Eighteen studies with a total of 3,166 axSpA participants were eligible for inclusion. There was an increased prevalence of pre-eclampsia (OR 1.3, 95% CI 0.92-1.82) and IUGR (OR 1.17, 95% CI 0.26-5.17) and a statistically significant increase in cesarean sections (OR 1.85, 95% CI 1.46-2.30) in axSpA females, with an especially high prevalence of elective cesarean sections (OR 2.26, 95% CI 1.74, 2.93). There was a trend towards increased prevalence of fetal complications in axSpA pregnancies (LBW OR 1.47, 95% CI 0.98-2.21; SGA OR1.66, 95% CI 0.93-2.95; congenital abnormalities OR 1.34, 95% CI0.63-1.24; NICU admissions OR 1.55, 95% CI 0.96-2.51) which did not reach significance. CONCLUSION AxSpA females have an increased prevalence of cesarean sections compared to the general population. There is a trend towards increased prevalence of pre-eclampsia, IUGR and certain fetal complications. Ongoing development of national registries could help to better understand axSpA in pregnancy.
Collapse
Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James' Hospital, James' Street, Dublin, Ireland.
| | | | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, James' Street, Dublin, Ireland
| | - Fiona Wilson
- Discipline of Physiotherapy, Trinity College, Dublin, Ireland
| |
Collapse
|
13
|
Ursin K, Lydersen S, Skomsvoll JF, Salvesen KÅ, S S Koksvik H, Jakobsen B, Wallenius M. Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry-Based Multicenter Study. Arthritis Care Res (Hoboken) 2020; 73:1201-1209. [PMID: 32353185 DOI: 10.1002/acr.24233] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The present study was undertaken to study time to pregnancy (TTP) and factors associated with TTP in women with axial spondyloarthritis (SpA) compared to women with rheumatoid arthritis (RA). METHODS We included 274 women with axial SpA and 317 women with RA from the Norwegian nationwide registry RevNatus. For all the women, we had retrospectively collected data on TTP, and a subgroup also had prospectively collected data. We compared TTP in women with axial SpA to women with RA using Kaplan-Meier plots and a log rank test. To identify factors associated with TTP, we used Cox proportional hazards regression. RESULTS TTP exceeded 12 months in 21% of women with axial SpA. In the subgroup followed prospectively, 32% had TTP that exceeded 12 months. Longer TTP was associated with older age, nulliparity, and longer disease duration, with hazard ratios of 0.97 (95% confidence interval [95% CI] 0.94-1.00), 0.66 (95% CI 0.50-0.88), and 0.94 (95% CI 0.91-0.98), respectively. Disease activity, medication, and self-reported health-related quality of life were not associated with TTP. We found no statistically significant differences between axial SpA and RA in regard to TTP. CONCLUSION In women with axial SpA, longer TTP was associated with older age, nulliparity, and longer disease duration.
Collapse
Affiliation(s)
- Kristin Ursin
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan F Skomsvoll
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å Salvesen
- Norwegian University of Science and Technology and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege S S Koksvik
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bente Jakobsen
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
14
|
Zhao SS, Radner H, Siebert S, Duffield SJ, Thong D, Hughes DM, Moots RJ, Solomon DH, Goodson NJ. Comorbidity burden in axial spondyloarthritis: a cluster analysis. Rheumatology (Oxford) 2020; 58:1746-1754. [PMID: 31220322 DOI: 10.1093/rheumatology/kez119] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/03/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To examine how comorbidities cluster in axial spondyloarthritis (axSpA) and whether these clusters are associated with quality of life, global health and other outcome measures. METHODS We conducted a cross-sectional study of consecutive patients meeting ASAS criteria for axSpA in Liverpool, UK. Outcome measures included quality of life (EQ5D), global health and disease activity (BASDAI). We used hierarchical cluster analysis to group patients according to 38 pre-specified comorbidities. In multivariable linear models, the associations between distinct comorbidity clusters and each outcome measure were compared, using axSpA patients with no comorbidities as the reference group. Analyses were adjusted for age, gender, symptom duration, BMI, deprivation, NSAID-use and smoking. RESULTS We studied 419 patients (69% male, mean age 46 years). 255 patients (61%) had at least one comorbidity, among whom the median number was 1 (range 1-6). Common comorbidities were hypertension (19%) and depression (16%). Of 15 clusters identified, the most prevalent clusters were hypertension-coronary heart disease and depression-anxiety. Compared with patients with no comorbidities, the fibromyalgia-irritable bowel syndrome cluster was associated with adverse patient-reported outcome measures; these patients reported 1.5-unit poorer global health (95%CI 0.01, 2.9), reduced quality of life (0.25-unit lower EQ5D; 95%CI -0.37, -0.12) and 1.8-unit higher BASDAI (95% CI 0.4, 3.3). Similar effect estimates were found for patients in the depression-anxiety cluster. CONCLUSION Comorbidity is common among axSpA patients. The two most common comorbidities were hypertension and depression. Patients in the depression-anxiety and fibromyalgia-IBS clusters reported poorer health and increased axSpA severity.
Collapse
Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Helga Radner
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow
| | - Stephen J Duffield
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool
| | - Daniel Thong
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Robert J Moots
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicola J Goodson
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| |
Collapse
|
15
|
Prevalence of axial spondyloarthritis in Poland. Rheumatol Int 2019; 40:323-330. [DOI: 10.1007/s00296-019-04482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
|
16
|
Unal C, Fadiloglu E, Tanacan A, Zaim OC, Beksac MS. Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey. Int J Rheum Dis 2019; 23:101-105. [PMID: 31713329 DOI: 10.1111/1756-185x.13746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS). METHODS This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease-related medical treatment during pregnancy, as drug free, single medication or multiple medication. RESULTS Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty-three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively). CONCLUSION In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.
Collapse
Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Onur Can Zaim
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
17
|
Xiao M, Lv Q, Zhang Y, Tu L, Yang M, Lin Z, Liao Z, Jiang Y, Zheng X, Li X, Wei Q, Cao S, Gu J. Spondyloarthritis Patients Suffer Increased Risk of Renal Complications Compared With General Population: A Retrospective Observational Study. Front Pharmacol 2019; 10:1073. [PMID: 31620002 PMCID: PMC6759995 DOI: 10.3389/fphar.2019.01073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to identify the prevalence and risk factors of renal complications of spondyloarthritis (SpA) patients, and to assess increased risks compared to general people. We conducted a retrospective study enrolled with consecutive SpA patients from an inpatient department and age, sex-matched general population (GP). The renal disorders investigated in this study contained decreased estimated glomerular filtration rate (eGFR), hematuria, proteinuria and nephrolithiasis. A total of 350 admitted SpA patients with complete medical records and 323 age and sex-matched GP were enrolled. Most SpA patients were male (n = 283, 80.9%) and the mean age was 31.61 ± 10.73 years old. Among 350 SpA patients, 29 (8.8%) suffered from hematuria, six (1.8%) suffered from proteinuria, one (0.3%) had decreased eGFR, and 27 (13.0%) presented with nephrolithiasis. The relative risk (RR) of nephrolithiasis in SpA compared to the GP was 2.24 (95% CI, 1.00-4.98), and the RR of renal insufficiency was 2.04 (95% CI, 1.11-3.77). In a univariate analysis, nephrolithiasis was significantly associated with age, age of onset, smoking, extra-articular manifestation and a bamboo spine. Renal insufficiency was significantly associated with age, peripheral manifestation, serum albumin, C-reactive protein and erythrocyte sedimentation rate. In a multivariable analysis, only extra-articular manifestation (OR = 8.43, 95% CI, 1.65-43.06, p = 0.010) and bamboo spine (OR = 3.47, 95% CI, 1.01-12.06, p = 0.049) remained significantly associated with nephrolithiasis. However, no variable was recognized as an independent risk factor for renal insufficiency. Renal complications are more common in SpA patients, with more than two-fold increased risk compared with GP. Extra-articular manifestation and bamboo spine are independent risk factors of renal disease in SpA patients.
Collapse
Affiliation(s)
- Min Xiao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liudan Tu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiming Lin
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yutong Jiang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi Zheng
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Li
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
18
|
de Jong HMY, Paramarta JE, de Winter JJH, Baeten DLP, van de Sande MGH. Differences between females and males in axial spondyloarthritis: data from a real-life cross-sectional cohort. Scand J Rheumatol 2019; 49:28-32. [DOI: 10.1080/03009742.2019.1627410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- HMY de Jong
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - JE Paramarta
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - JJH de Winter
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - DLP Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - MGH van de Sande
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Nihad S, Nessrine A, Sofia Z, Salma G, Khadija EK, Taoufik H. Distinctive Features in Spondyloarthritis Between Women and Man in Moroccan Context: Disease Beginning, Clinical Manifestations, Disease Activity and Function Scores. Curr Rheumatol Rev 2019; 17:95-100. [PMID: 31241435 DOI: 10.2174/1573397115666190626113230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a common group of chronic rheumatic inflammatory diseases, which usually affects the axial skeleton, and are more frequently observed in males than in females. Several differences have been brought up in the clinical presentation of axSpA, according to the patient's gender. In fact; axSpA severity in women tends to be moderate, leading then, to an underdiagnosis in this category of patients. While male axSpA patients seem to set forth more spinal destructions on radiographs. OBJECTIVE As the main goal, our study aims to bring up the particularities of female axial spondyloarthritis, all the while comparing them with the male form. MATERIALS AND METHODS This is a cross-sectional study carried out in the period lying between January 2012 and December 2017, at a single rheumatology department in Morocco. All patients with an axial spondyloarthritis meeting the Assessment of SpondyloArthritis international Society (ASAS) classification criteria 2010, and who have been admitted in our department, during that period, were included. The data was recorded and analyzed using SPSS v20 univariate and bivariate analysis. A value of p <0.005 has been used to identify factors associated with axSpA in women. RESULTS A total of 277 patients were enrolled, of which 147 are female and 130 are male with a sex ratio of 1.1. Cervical stiffness was more common in men. On the other hand, women had more arthritis and enthesitis. However, no considerable divergences have been underscored between the two genders, neither in the prevalence of extra-articular manifestations, nor in disease activity BASDAI and BASFI. Men had more radiographic sacroiliitis compared to women (57.5% vs. 42.5%, p=0.01), more coxitis (66.7% vs. 33.3%, p = 0.0001). The Multivariate logistic regression analysis showed that female gender was associated with a greater age at the diagnosis onset (IC: 1.053-1.103, OR=1.07, p=0.001) and arthritis (IC: 2.37-4.26, OR=2.3, p=0.004). While the male sex was associated with a young age of onset (CI: 4.50-19.52, OR = 9.3), coxitis (CI: 2.53-4.23, OR = 3.3) and smoking (CI: 15.667-900.18, OR = 118.7). CONCLUSION The comparison between male and female patients suffering from axial spondyloarthritis found many differences and similarities as well, in the disease expression. This study showed actually that women had the less severe form of spondyloarthritis.
Collapse
Affiliation(s)
- Siar Nihad
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| | - Akasbi Nessrine
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| | - Zoukal Sofia
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| | - Ghazzali Salma
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| | - El Kohen Khadija
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| | - Harzy Taoufik
- Department of Rheumatology, 2Department of Epidemiology and Public Health, Hassan II University Medical Center, Fez, Morocco
| |
Collapse
|
20
|
van der Slik B, Spoorenberg A, Wink F, Bos R, Bootsma H, Maas F, Arends S. Although female patients with ankylosing spondylitis score worse on disease activity than male patients and improvement in disease activity is comparable, male patients show more radiographic progression during treatment with TNF-α inhibitors. Semin Arthritis Rheum 2019; 48:828-833. [DOI: 10.1016/j.semarthrit.2018.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
|
21
|
He Z, Wang M, Li H, Wen C. GC-MS-based fecal metabolomics reveals gender-attributed fecal signatures in ankylosing spondylitis. Sci Rep 2019; 9:3872. [PMID: 30846747 PMCID: PMC6405849 DOI: 10.1038/s41598-019-40351-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 02/14/2019] [Indexed: 01/12/2023] Open
Abstract
Ankylosing spondylitis (AS) has different clinical features in males and females. Fecal metabolites play significant roles in AS disorders. This study aimed to reveal gender-attributed fecal signatures of AS. Fecal samples from 87 cross-sectional individuals (healthy controls: 20 males, 18 females; AS patients: 26 males, 23 females) were analyzed by gas chromatography-mass spectroscopy (GC-MS). Partial least squares discriminant analysis (PLS-DA) was used to reveal differences in the fecal signatures of AS between males and females. Fecal signatures were defined by the significantly different fecal metabolites between AS patients and healthy individuals. Therefore, different fecal signatures of male and female AS patients were defined as gender-attributed fecal signatures. Male-specific fecal signatures in AS patients were steroid compounds, including cholestan-3-ol, tocopherol, stigmastan-3,5-diene, cholest-3-ene, cholest-4-en-6-one and 1-heptatriacotanol. Female-specific fecal signatures were ergost-5-en-3-ol, acetate and D-myo-Inositol. Gender-attributed fecal signatures of AS further reveal differences between males and females in terms of AS features.
Collapse
Affiliation(s)
- Zhixing He
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Mingzhu Wang
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Haichang Li
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Chengping Wen
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| |
Collapse
|
22
|
Akasbi N, Nihad S, Sofia Z, Khadija EK, Taoufik H. Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondyltis from a Single Rheumatology Hospital in Morocco. Curr Rheumatol Rev 2019; 16:240-244. [PMID: 30806321 DOI: 10.2174/1573397115666190222195923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND According to the new classification criteria developed by The Assessment of SpondyloArthritis International Society, patients with axial spondyloarthritis (axSpA) can be classified in 2 subgroups: Patients with radiographic axial spondyloarthritis: ankylosing spondylitis patients (AS) and those with non-radiographic axial spondyloarthritis (nr-axSpA). OBJECTIVE The aim of the present study is to describe and discuss the differences and similarities between the two subgroups. PATIENTS AND METHODS A cross-sectional study was conducted in a single rheumatology hospital in Morocco. These included patients diagnosed as having axial spondyloarthritis according to ASAS criteria 2010, during a period of 6 years. The AS and the nr-axSpA subgroups were compared for the various axSpA-related variables. RESULTS Of the 277 patients with a diagnosis of axial SpA who were included in this study, 160 had AS and 117 had nr-axSpA. AS and nr-ax-SpA shared a similar age at diagnosis, similar prevalence of low back pain, lumbar stiffness, extra-articular manifestations, BASDAI and BASFI. In the multivariate analysis, AS patients were mainly male with cervical stiffness, enthesitis, coxitis and high level of ESR (erythrocyte sedimentation rate). The females generally had a family history of SpA and arthritis and were associated to the nr-axSpA form in the univariate analysis. CONCLUSION This was the first study to characterise patients with AS and nr-axSpA in Morocco. Consistent with other studies published, this study showed that patients with nr-axSpA and patients with AS shared a comparable degree of disease burden.
Collapse
Affiliation(s)
- Nessrine Akasbi
- Rheumatology Department, Faculty of Medicine,University Sidi Mohamed Ben Abdellah, University Hospital Center Hassan II, Fez, Morocco
| | - Siar Nihad
- Rheumatology Department, Faculty of Medicine,University Sidi Mohamed Ben Abdellah, University Hospital Center Hassan II, Fez, Morocco
| | - Zoukal Sofia
- Department of Epidemiology and Public Health, Faculty of Medicine, University Sidi Mohamed Ben Abdellah, University Hospital Center Hassan II, Fez, Morocco
| | - El Kohen Khadija
- Rheumatology Department, Faculty of Medicine,University Sidi Mohamed Ben Abdellah, University Hospital Center Hassan II, Fez, Morocco
| | - Harzy Taoufik
- Rheumatology Department, Faculty of Medicine,University Sidi Mohamed Ben Abdellah, University Hospital Center Hassan II, Fez, Morocco
| |
Collapse
|
23
|
Abdolmohammadi K, Pakdel FD, Aghaei H, Assadiasl S, Fatahi Y, Rouzbahani NH, Rezaiemanesh A, Soleimani M, Tayebi L, Nicknam MH. Ankylosing spondylitis and mesenchymal stromal/stem cell therapy: a new therapeutic approach. Biomed Pharmacother 2018; 109:1196-1205. [PMID: 30551369 DOI: 10.1016/j.biopha.2018.10.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is an inflammatory rheumatoid disease categorized within spondyloarthropathies (SpA) and manifested by chronic spinal arthritis. Several innate and adaptive immune cells and secreted-mediators have been indicated to play a role in AS pathogenesis. Considering the limitations of current therapeutic approaches (NSAIDs, glucocorticoids, DMARDs and biologic drugs), finding new treatments with fewer side effects and high therapeutic potentials are required in AS. Mesenchymal stem cells (MSCs) with considerable immunomodulatory and regenerative properties could be able to attenuate the inflammatory responses and help tissue repair by cell-to-cell contact and secretion of soluble factors. Moreover, MSCs do not express HLA-DR, which renders them a favorable therapeutic choice for transplantation in immune-mediated disorders. In the present review, we describe immunopathogenesis and current treatments restrictions of AS. Afterwards, immunomodulatory properties and applications of MSCs in immune-mediated disorders, as well as recent findings of clinical trials involving mesenchymal stem cell therapy (MSCT) in ankylosing spondylitis, will be discussed in detail. Additional studies are required to investigate several features of MSCT such as cell origin, dosage, administration route and, specifically, the most suitable stage of disease for ideal intervention.
Collapse
Affiliation(s)
- Kamal Abdolmohammadi
- Department of Immunology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran
| | - Fatemeh Dadgar Pakdel
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Aghaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Assadiasl
- Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Fatahi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Hosseini Rouzbahani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran; Department of Immunology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Rezaiemanesh
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Soleimani
- Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran; Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Mohammad Hossein Nicknam
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
24
|
Are gender-specific approaches needed in diagnosing early axial spondyloarthritis? Data from the SPondyloArthritis Caught Early cohort. Arthritis Res Ther 2018; 20:218. [PMID: 30285842 PMCID: PMC6167860 DOI: 10.1186/s13075-018-1705-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background Although gender differences have been observed in the severity of axial spondyloarthritis (axSpA), gender differences in disease presentation of early axSpA have not been thoroughly investigated. In particular, their impact on the diagnostic process is unknown. Methods Baseline data from the SPondyloArthritis Caught Early cohort, which includes patients with chronic back pain (CBP; duration ≥ 3 months and ≤ 2 years, age of onset < 45 years), were analysed. Patients underwent a full diagnostic work-up, including MRI and radiograph of the sacroiliac joints (MRI-SIJ and X-SIJ), to establish a diagnosis of axSpA. Characteristics of male and female patients with a certain diagnosis of axSpA (confidence level by the physician ≥ 7 on a 0–10 rating scale) were compared. Regression models were built for: the whole CBP cohort stratified by gender, to study which SpA features were associated most with diagnosis in each gender; and for axSpA patients, to test whether gender was associated with imaging positivity (MRI-SIJ+ and/or X-SIJ+). Results Of the 719 CBP patients, 275 were male. With 146/275 males and 155/444 females diagnosed as axSpA, males were more likely to be diagnosed with axSpA (OR 2.1, 95% CI 1.5–2.9). Despite similar symptom duration, male axSpA patients were younger at diagnosis (27.4 ± 7.5 vs 29.5 ± 7.8 years; p = 0.02). Presence of SpA features was similar in male and female axSpA patients, except for HLA-B27 and imaging positivity that were more common in male axSpA patients (80% vs 60%; p < 0.01 and 78% vs 64%; p = 0.01). Nevertheless, these SpA features were still more prevalent in female axSpA patients than in no-axSpA patients, both females (HLA-B27+ 23%, positive imaging 7%) and males (HLAB27+ 34%, positive imaging 11%) (all p < 0.01). Moreover, in multivariable models with diagnosis of axSpA as outcome, HLA-B27 and imaging positivity were associated with the diagnosis in both sexes. In models with imaging positivity as outcome, male gender and HLA-B27 were both independently associated with MRI+ and/or X-SI+. Conclusions While our data show clear gender differences in early axSpA, they highlight that HLA-B27 and imaging are still key elements for diagnosis in both genders. Our study does not suggest that separate diagnostic strategies for men and women are required. Electronic supplementary material The online version of this article (10.1186/s13075-018-1705-x) contains supplementary material, which is available to authorized users.
Collapse
|
25
|
Deminger A, Klingberg E, Geijer M, Göthlin J, Hedberg M, Rehnberg E, Carlsten H, Jacobsson LT, Forsblad-d'Elia H. A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis. Arthritis Res Ther 2018; 20:162. [PMID: 30075808 PMCID: PMC6091099 DOI: 10.1186/s13075-018-1665-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex. Methods Swedish patients with AS, age (mean ± SD) 50 ± 13 years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples. Results Of 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9 ± 2.8 vs. 1.2 ± 3.3; p = 0.005) More men than women developed new syndesmophytes (30% vs. 12%; p = 0.007). Multivariate logistic regression analyses with progression ≥ 2 mSASSS units over 5 years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women. Conclusion This first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men. Trial registration ClinicalTrials.gov, NCT00858819. Registered on 9 March 2009. Last updated 28 May 2015.
Collapse
Affiliation(s)
- Anna Deminger
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - Mats Geijer
- Department of Radiology, Skåne University Hospital, 221 85, Lund, Sweden.,Faculty of Medicine, Lund University, Box 117, 221 00, Lund, Sweden
| | - Jan Göthlin
- Department of Radiology, Sahlgrenska University Hospital, Mölndal, 431 80, Mölndal, Sweden
| | - Martin Hedberg
- Section of Rheumatology, Södra Älvsborg Hospital, 501 82, Borås, Sweden
| | - Eva Rehnberg
- Section of Rheumatology, Alingsås Hospital, 441 33, Alingsås, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - Lennart T Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, 901 87 Umeå University, Umeå, Sweden
| |
Collapse
|
26
|
Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity during and after pregnancy in women with axial spondyloarthritis: a prospective multicentre study. Rheumatology (Oxford) 2018; 57:1064-1071. [PMID: 29554329 DOI: 10.1093/rheumatology/key047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 12/17/2022] Open
Abstract
Objective The aim was to study disease activity in women with axial spondyloarthritis (axSpA) during and after pregnancy. Methods The study included 179 pregnancies in 166 women with axSpA from a Norwegian nationwide register. Disease activity was assessed at seven time points before, throughout and after pregnancy with the DAS BASDAI. Scores assessed at each time point were analysed in a linear mixed model. The same statistical method was used to study self-reported physical functioning, pain and mental health. Results Altogether, disease activity was stable throughout the study period. We found the highest disease activity and worst self-reported pain in the second trimester, when 45% of the women had active disease. At this time point, disease activity was significantly higher than 6 weeks postpartum (mean BASDAI 3.97 vs 3.46, P = 0.005). Self-reported mental health was also stable, but significantly better 6 weeks postpartum than in the first trimester (mean RAND-36 mental health 79.3 vs 73.2, P < 0.001). Physical functioning was significantly worse in third trimester than postpartum (mean BASFI 3.6 vs 2.6, P < 0.001). Conclusion Studying women with axSpA, we found that disease activity was highest in the second trimester, but altogether low and stable in the period from planning pregnancy to 1 year after delivery.
Collapse
Affiliation(s)
- Kristin Ursin
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Fredrik Skomsvoll
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Wallenius
- National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
27
|
Park JS, Hong JY, Park YS, Han K, Suh SW. Trends in the prevalence and incidence of ankylosing spondylitis in South Korea, 2010-2015 and estimated differences according to income status. Sci Rep 2018; 8:7694. [PMID: 29769560 PMCID: PMC5955990 DOI: 10.1038/s41598-018-25933-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/30/2018] [Indexed: 01/13/2023] Open
Abstract
The aim of this study is to determine the prevalence and incidence of ankylosing spondylitis (AS) in South Korea, 2010–2015. This study was conducted using the Health Insurance Review Agency (HIRA) database, which includes information on every patient diagnosed with AS. The incidence and prevalence of AS were evaluated by age, sex, and income status. The prevalence increased linearly by 7.7% annually, i.e., 31.62 in 2010 to 52.30 in 2015 (per 100,000 persons). During the study period, the incidence was 6.34 per 100,000 person-years. The prevalence peaked for both men and women in the age range 30–39 years. Incidence peaked for men in the age range 20–29 years, but peaked for women between ages 70 and 89. AS was 3.6 times more prevalent in men than in women, and the incidence in men was 2.1 times greater than in women. With respect to income status, the prevalence and incidence of AS were 3 times greater and 5 times greater, respectively, in medical aid recipients compared to individuals with other income levels. The trend of increasing AS prevalence and the observation that 14.3% of all patients newly diagnosed with AS are medical aid recipients have significant implications for healthcare planning.
Collapse
Affiliation(s)
- Jin-Sung Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan-si, South Korea.
| | - Ye-Soo Park
- Department of Orthopedics, Hanyang University Guri Hospital, Guri-si, South Korea
| | - Kyungdo Han
- Department of Biostatistics, Biomedicine & Health Sciences, Catholic University, Seoul, South Korea
| | - Seung-Woo Suh
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
| |
Collapse
|
28
|
de Koning A, Schoones JW, van der Heijde D, van Gaalen FA. Pathophysiology of axial spondyloarthritis: Consensus and controversies. Eur J Clin Invest 2018; 48:e12913. [PMID: 29460306 DOI: 10.1111/eci.12913] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a common inflammatory arthritis of the sacroiliac joints and the spine. The best-known and most studied form of axSpA is ankylosing spondylitis. DESIGN In this review, we provide a brief overview of the pathophysiology of axSpA. In addition, we performed a quantitative text analysis of reviews on the pathogenesis of axSpA published in the last 10 years to establish the current consensus in various fields of research into the pathogenesis of axSpA. RESULTS There appears to be broad consensus on genetic risk factors and the involvement of the immune system in the initiation phase of the disease although little consensus was found on which specific immune cells drive disease. Moreover, despite relatively little data available, alterations in the microbiome are commonly thought to be involved in disease. Abnormal bone formation is the most prominent pathogenic factor thought to be involved in disease progression. CONCLUSION So, although the pathophysiology of axSpA remains incompletely understood, the progress in recent years in several fields of research in axSpA including genetics, diagnosis, imaging and therapeutics, hold great promise for the future.
Collapse
Affiliation(s)
- Anoek de Koning
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
29
|
Cheng BW, Lo FS, Wang AM, Hung CM, Huang CY, Ting WH, Yang MO, Lin CH, Chen CC, Lin CL, Wu YL, Lee YJ. Autoantibodies against islet cell antigens in children with type 1 diabetes mellitus. Oncotarget 2018; 9:16275-16283. [PMID: 29662644 PMCID: PMC5893239 DOI: 10.18632/oncotarget.24527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/13/2018] [Indexed: 12/21/2022] Open
Abstract
We investigated the prevalence of glutamic acid decarboxylase 65 autoantibody (GADA), insulinoma-associated protein 2 autoantibody (IA2A), and insulin autoantibody (IAA) in 750 children with type 1 diabetes (T1D) living in Taiwan. GADA, IA2A, and IAA were measured by radioimmunoassay. The data were assessed by χ2 test, binary logistic regression, and Spearman rank correlation. Of the 750 T1D patients, 66.3% had GADA, 65.3% IA2A, 35.7% IAA, and 17.2% no autoantibodies. The prevalence of GADA and IA2A significantly decreased along T1D duration. The positivity of either GADA or IA2A was 89.4% within the first year of disease and decreased to 36.7% after 9 years (P = 1.22 × 10–20). Female patients had significantly higher prevalence of GADA compared with male patients (72.3% vs. 59.7%, P = 0.00027). The patients diagnosed before 12 years of age had a positive rate of 92.2% for either GADA or IA2A. Patients diagnosed at age 12 or above had a significantly lower positive rate of 81.6% (P = 0.011). GADA and IA2A significantly correlated with each other (rs = 0.245, P = 1.09 × 10–11). We concluded that autoantibodies were detectable in 89.4% of T1D patients within one year after diagnosis. Their prevalence declined with disease duration. GADA was more prevalent in female patients. GADA and IA2A weakly correlated with each other.
Collapse
Affiliation(s)
- Bi-Wen Cheng
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital HsinChu Branch, HsinChu, Taiwan
| | - Fu-Sung Lo
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - An-Mei Wang
- Department of Nuclear Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, New Taipei City, Taiwan
| | - Chen-Mei Hung
- Department of Pediatrics, Hsinchu Cathay General Hospital, HsinChu, Taiwan
| | - Chi-Yu Huang
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, New Taipei City, Taiwan
| | - Wei-Hsin Ting
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, New Taipei City, Taiwan
| | - Mei-Ore Yang
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatrics, MacKay Memorial Hospital HsinChu Branch, HsinChu, Taiwan
| | - Chia-Ching Chen
- Department of Pediatrics, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chiung-Ling Lin
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yi-Lei Wu
- Department of Pediatric Endocrinology and Metabolism, Chuanghua Christian Children's Hospital, Chuanghua, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
30
|
Hebeisen M, Neuenschwander R, Scherer A, Exer P, Weber U, Tamborrini G, Micheroli R, Wildi LM, Zufferey P, Nissen MJ, Villiger PM, Bernhard J, Finckh A, van der Horst-Bruinsma IE, Sieper J, Landewé R, van der Heijde D, Ciurea A. Response to Tumor Necrosis Factor Inhibition in Male and Female Patients with Ankylosing Spondylitis: Data from a Swiss Cohort. J Rheumatol 2018; 45:506-512. [PMID: 29449504 DOI: 10.3899/jrheum.170166] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS). METHODS A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response. RESULTS Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed. CONCLUSION In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.
Collapse
Affiliation(s)
- Monika Hebeisen
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Regula Neuenschwander
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Almut Scherer
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Pascale Exer
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Ulrich Weber
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Giorgio Tamborrini
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Raphael Micheroli
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Lukas M Wildi
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Pascal Zufferey
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Michael J Nissen
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Peter M Villiger
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Jürg Bernhard
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Axel Finckh
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Irene E van der Horst-Bruinsma
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Joachim Sieper
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Robert Landewé
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Désirée van der Heijde
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital
| | - Adrian Ciurea
- From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. .,M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital.
| | | |
Collapse
|
31
|
Lubrano E, Perrotta FM, Manara M, D'Angelo S, Addimanda O, Ramonda R, Punzi L, Olivieri I, Salvarani C, Marchesoni A. The Sex Influence on Response to Tumor Necrosis Factor-α Inhibitors and Remission in Axial Spondyloarthritis. J Rheumatol 2017; 45:jrheum.17666. [PMID: 29142035 DOI: 10.3899/jrheum.17666] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of sex on response to treatment and disease remission in patients with axial spondyloarthritis (axSpA). METHODS In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria for axSpA, and treated with adalimumab, etanercept, golimumab, or infliximab, were studied. We compared clinical characteristics, patient-reported outcomes, disease activity, function, and response to treatment in male and female patients with this disease. RESULTS Three hundred forty patients with axSpA (270 with ankylosing spondylitis, 19 with psoriatic arthritis with axial involvement, and 51 with nonradiographic axSpA) were studied. Male subjects had a significantly higher prevalence of grade IV sacroiliitis, higher levels of serum C-reactive protein, lower Maastricht Ankylosing Spondylitis Enthesitis Score, and fatigue when compared with females. Further, Kaplan-Meier survival curves showed that the rate of partial remission, ASAS40 response, and Ankylosing Spondylitis Disease Activity Score (ASDAS) major improvement, but not ASDAS inactive disease, were significantly lower in female patients. CONCLUSION Our data suggest that female sex was associated with a lower rate of response to treatment and of disease remission in patients with axSpA treated with antitumor necrosis factor-α drugs.
Collapse
Affiliation(s)
- Ennio Lubrano
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Fabio Massimo Perrotta
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Maria Manara
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Salvatore D'Angelo
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Olga Addimanda
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Roberta Ramonda
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Leonardo Punzi
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Ignazio Olivieri
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Carlo Salvarani
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| | - Antonio Marchesoni
- From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: . Accepted for publication September 12, 2017
| |
Collapse
|
32
|
Ablin JN, Eshed I, Berman M, Aloush V, Wigler I, Caspi D, Likhter M, Wollman J, Paran D, Anouk M, Elkayam O. Prevalence of Axial Spondyloarthritis Among Patients With Fibromyalgia: A Magnetic Resonance Imaging Study With Application of the Assessment of SpondyloArthritis International Society Classification Criteria. Arthritis Care Res (Hoboken) 2017; 69:724-729. [PMID: 27390225 DOI: 10.1002/acr.22967] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/27/2016] [Accepted: 06/21/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the prevalence of sacroiliitis, the radiographic hallmark of inflammatory spondyloarthropathy, among patients diagnosed with fibromyalgia syndrome (FMS), using the current Assessment of SpondyloArthritis International Society (ASAS) criteria and magnetic resonance imaging. METHODS Patients experiencing FMS (American College of Rheumatology 1990 criteria) were interviewed regarding the presence of spondyloarthritis (SpA) features and underwent HLA-B27 testing, C-reactive protein (CRP) level measurement, and magnetic resonance imaging examinations of the sacroiliac joints. FMS severity was assessed by the Fibromyalgia Impact Questionnaire and the Short Form 36 health survey. SpA severity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index. RESULTS Sacroiliitis was demonstrated among 8 patients (8.1%) and ASAS criteria for diagnosis of axial SpA were met in 10 patients (10.2%). Imaging changes suggestive of inflammatory involvement (e.g., erosions and subchondral sclerosis) were demonstrated in 15 patients (17%) and 22 patients (25%), respectively. The diagnosis of axial SpA was positively correlated with increased CRP level and with physical role limitation at recruitment. CONCLUSION Imaging changes suggestive of axial SpA were common among patients with a diagnosis of FMS. These findings suggest that FMS may mask an underlying axial SpA, a diagnosis with important therapeutic implications. Physicians involved in the management of FMS should remain vigilant to the possibility of underlying inflammatory disorders and actively search for such comorbidities.
Collapse
Affiliation(s)
- Jacob N Ablin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- The Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Berman
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie Aloush
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irena Wigler
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Caspi
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Likhter
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Wollman
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Anouk
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
33
|
Jovaní V, Blasco-Blasco M, Ruiz-Cantero MT, Pascual E. Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis. J Rheumatol 2016; 44:174-183. [PMID: 27980009 DOI: 10.3899/jrheum.160825] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. METHODS A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. RESULTS The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4-10.1) for women and 6.5 (5.6-7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31-0.89), indicating that men were diagnosed 0.6 year (7 months) before women. CONCLUSION Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.
Collapse
Affiliation(s)
- Vega Jovaní
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain. .,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University.
| | - Mar Blasco-Blasco
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
| | - M Teresa Ruiz-Cantero
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
| | - Eliseo Pascual
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
| |
Collapse
|
34
|
Landi M, Maldonado-Ficco H, Perez-Alamino R, Maldonado-Cocco JA, Citera G, Arturi P, Sampaio-Barros PD, Flores Alvarado DE, Burgos-Vargas R, Santos E, Palleiro D, Gutiérrez MA, Vieyra-Sousa E, Pimentel-Santos F, Paira SO, Berman A, Barrezueta CV, Vazquez-Mellado J, Collantes-Estevez E. Gender differences among patients with primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease in an iberoamerican spondyloarthritis cohort. Medicine (Baltimore) 2016; 95:e5652. [PMID: 28002334 PMCID: PMC5181818 DOI: 10.1097/md.0000000000005652] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to compare clinical manifestations, disease activity, functional capacity, spinal mobility, and radiological findings between men and women from a multicenter, multiethnic Ibero-American cohort of patients with Spondyloarthritis (SpA).This observational cross-section study included 1264 consecutive SpA patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS). Demographic, clinical, and radiologic data were evaluated. Categorical data were compared by X or Fisher's exact tests and continuous variables by ANOVA with post-hoc tests.Primary AS was diagnosed in 1072 patients, psoriatic spondylitis in 147, and spondylitis associated to inflammatory bowel disease (IBD) in 45 patients. Overall, male patients were significantly younger, had longer diagnostic delay, lower disease activity, worse spinal mobility, better quality of life, and more severe radiologic damage. Dactylitis and enthesitis, as well as swollen joint count, were significantly more common among women. In primary AS, there was a marked male predominance (76.2%). Among patients with psoriatic spondylitis, male predominance was lower (57.8%), but was also associated with worse spinal mobility and more severe radiologic damage. In the total population, male patients with primary AS referred higher permanent work disability (13.2% vs 6.9%; P < 0.05), although no difference was observed in psoriatic or IBD spondylitis according to the gender.Among Ibero-American SpA patients, there are some differences in clinical and radiological manifestations, men showing more structural damage, whereas women more active disease. These data suggest that the phenotype of SpA differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.
Collapse
Affiliation(s)
| | | | | | | | | | - Pablo Arturi
- Former Fellow in Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | | | | | - Rubén Burgos-Vargas
- Hospital General de Mexico, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico DF, Mexico
| | - Elena Santos
- Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - Daniel Palleiro
- Instituto Nacional de Reumatología del Uruguay, Montevideo, Uruguay
| | - Miguel A. Gutiérrez
- Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elsa Vieyra-Sousa
- Serviço de Reumatologia e de Doencas Ósseas Metabólicas, Centro Hospitalar Lisboa Norte
| | - Fernando Pimentel-Santos
- Facultade de Ciencias Médicas da Universidade Nova de Lisboa and CHLO, Hospital de Egas Moniz, Lisbon, Portugal
| | | | - Alberto Berman
- Centro Médico Privado de Reumatología, Tucumán, Argentina
| | - Claudia Vera Barrezueta
- Hospital Luis Vernaza, Guayaquil, Profesora de Inmunología Clínica, Universidad Católica de Guayaquil, Guayaquil, Ecuador
| | - Janitzia Vazquez-Mellado
- Rheumatology Service, Hospital General de Mexico y Facultad de Medicina, UNAM, Mexico DF, Mexico
| | - Eduardo Collantes-Estevez
- Rheumatology Department, “Reina Sofía” University Hospital / IMIBIC, University of Cordoba, Cordoba, Spain
| |
Collapse
|
35
|
Kilic G, Kilic E, Ozgocmen S. Is there any gender-specific difference in the cut-off values of ankylosing spondylitis disease activity score in patients with axial spondyloarthritis? Int J Rheum Dis 2016; 20:1201-1211. [PMID: 27309497 DOI: 10.1111/1756-185x.12885] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To assess the validity of Assessment in Spondyloarthritis International Society (ASAS) endorsed Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein (-CRP) and ASDAS erythrocyte sedimentation rate (-ESR) in axial spondyloarthritis (axSpA) and to estimate the cut-off values for male and female patients with axSpA. METHODS Patients with axSpA were assessed for disease activity, functions, mobility and AS Quality of Life (ASQoL) and pain. The discriminant ability of ASDAS versions was assessed using standardized mean differences. Optimal cut-off values of ASDAS versions were calculated. RESULTS Patients with axSpA were included (196 AS, 164 non-radiographic axSpA). ASDAS versions and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) had good correlations with patient's global (PtG) and physician's global (PhG) assessment in both groups; however, men had relatively higher coefficients. Women had significantly higher pain, ASQoL, ASDAS-ESR, BASDAI item scores, PtG, PhG and ESR. Discriminant abilities of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in men and women regarding low and high disease activity. ASDAS cut-offs are quite similar in both genders and in accordance with predefined values. The cut-offs for ASDAS-ESR were relatively lower than ASDAS-CRP and women tend to have higher cut-offs than men. CONCLUSION The construct validity of ASDAS-CRP to discriminate low and high disease activity and cut-off values are similar in male and female patients with axSpA; however, cut-offs for ASDAS-ESR need to be defined.
Collapse
Affiliation(s)
- Gamze Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Erkan Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
36
|
Timur H, Tokmak A, Türkmen GG, Ali İnal H, Uygur D, Danışman N. Pregnancy outcome in patients with ankylosing spondylitis. J Matern Fetal Neonatal Med 2015; 29:2470-4. [DOI: 10.3109/14767058.2015.1089432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Webers C, Essers I, Ramiro S, Stolwijk C, Landewé R, van der Heijde D, van den Bosch F, Dougados M, van Tubergen A. Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. Rheumatology (Oxford) 2015; 55:419-28. [PMID: 26385369 DOI: 10.1093/rheumatology/kev340] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To investigate gender-attributable differences regarding clinical outcome [disease activity, physical function and quality of life (QoL)] and radiographic damage in patients with AS over time. METHODS Data from the Outcome in AS International Study were used. Disease activity was assessed by the BASDAI, ASDAS and CRP; physical function by BASFI; QoL by the Short Form-36, Ankylosing Spondylitis Quality of Life (ASQoL) score and European Quality Of Life scale; and radiographic damage by the modified Stoke AS Spine Score (mSASSS). Cross-sectional comparative analyses were done at baseline. Next, separate models were created to assess gender-attributable differences on each outcome measure over time using time-adjusted generalized estimating equations. RESULTS A total of 216 patients [154 (72.3%) males, mean age 43.6 years (s.d. 12.7), symptom duration 20.5 years (s.d. 11.8), mean follow-up duration 8.3 years (s.d. 4.1)] were included. At baseline, male compared with female patients had lower self-reported disease activity (BASDAI 3.2 vs 3.9, P = 0.03) but more radiographic damage (mSASSS 13.8 vs 6.5, P = 0.02). No significant gender-attributable differences in other clinical parameters were found. In multivariable analysis, male gender was significantly associated with a better ASQoL (B = -1.18, 95% CI: -2.17, -0.20, P = 0.02), and in a separate model with a higher mSASSS over time (B = 8.24, 95% CI: 4.38, 12.09, P < 0.01). CONCLUSION In this prospective cohort study, no gender-attributable differences in disease activity or physical function over time were found. However, radiographic damage was more severe in males. Furthermore, males had a better QoL over time.
Collapse
Affiliation(s)
- Casper Webers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht
| | - Ivette Essers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden
| | - Carmen Stolwijk
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Robert Landewé
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, Department of Rheumatology, Atrium Medical Center, Heerlen, The Netherlands
| | | | - Filip van den Bosch
- Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and INSERM (U1153); Epidemiologie Clinique et Biostatistiques, PRES Sorbonne Paris-Cité, Paris, France
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Care and Public Health Research Institute, Maastricht University, Maastricht,
| |
Collapse
|
38
|
Erkol İnal E, Demirci K, Doğru A, Şahin M. Ankylosing Spondylitis patients with Type D personality have worse clinical status. Mod Rheumatol 2015; 26:138-45. [PMID: 26011439 DOI: 10.3109/14397595.2015.1054098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Type D personality was identified as an important factor that can explain the differences in clinical outcomes in various diseases. The aim of this study is to clarify the relationships between Type D personality and clinical status of patients with Ankylosing Spondylitis (AS). METHODS The scores of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), the Bath Ankylosing Spondylitis Functional Index (BASFI), the 36-Item Short-Form Health Survey (SF-36), and 14-item Type D Scale (DS-14) were noted. RESULTS We found significantly higher levels of the BASDAI, the BASFI, and the SF-36 mental subscale scores in patients with Type D personalities compared to those who were Non-Type D (p < 0.05). The total DS-14 scores were found to be correlated with the scores of physical and mental subscales of SF-36, the BASDAI, the BASFI, ASDAS-CRP, and ESR (p < 0.05). In logistic regression analysis, the occurrence of Type D personality was found to be an independent predictor for disease activity of AS due to BASDAI and ASDAS-ESR (p = 0.016, OR, 95% CI = 2.98,1.23-7.22; p = 0.022, OR, 95% CI = 2.78,1.16-6.63 respectively). CONCLUSIONS Patients may over-rate self-reported measurements such as the BASDAI, BASFI, and SF-36 related to their interpersonal characteristics. Therefore, including the Type D personality, which is a stable construct in evaluating AS patients with brief and valid DS-14, may be noteworthy.
Collapse
Affiliation(s)
- Esra Erkol İnal
- a Süleyman Demirel University, Faculty of Medicine , Department of Physical Medicine and Rehabilitation , Isparta , Turkey
| | - Kadir Demirci
- b Süleyman Demirel University, Faculty of Medicine , Department of Psychiatry , Isparta , Turkey
| | - Atalay Doğru
- c Süleyman Demirel University, Faculty of Medicine , Department of Internal Medicine , Division of Rheumatology , Isparta , Turkey
| | - Mehmet Şahin
- c Süleyman Demirel University, Faculty of Medicine , Department of Internal Medicine , Division of Rheumatology , Isparta , Turkey
| |
Collapse
|
39
|
Arends S, Maas F, Wink F, Efde M, Bootsma H, van der Veer E, Brouwer E, Spoorenberg A. Male and female patients with axial spondyloarthritis experience disease activity, physical function and quality of life differently: results from the Groningen Leeuwarden Axial Spondyloarthritis cohort: Table 1. Rheumatology (Oxford) 2015; 54:1333-5. [DOI: 10.1093/rheumatology/kev119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
40
|
Neuenschwander R, Ciurea A. Gender differences in axial spondyloarthritis. World J Rheumatol 2014; 4:35-43. [DOI: 10.5499/wjr.v4.i3.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/18/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
Within the concept of axial spondyloarthritis (axSpA), relevant differences between men and women have been described for patients with the radiographic disease form [ankylosing spondylitis (AS)]. The subjective perception of disease activity (spinal and peripheral pain, fatigue, morning stiffness) has been shown to be higher in female than in male patients. Moreover, women experience more functional limitations and a lower quality of life, despite lower degrees of radiographic spinal damage. Peripheral clinical involvement (arthritis and enthesitis) is, additionally, more predominant in women. On the other hand, a higher level of objective signs of inflammation (C-reactive protein, erythrocyte sedimentation rate, magnetic resonance imaging of sacroiliac joints and spine) has been reported in men. Whether these differences might explain the better response to treatment with anti-tumor necrosis factor agents observed in male patients remains unclear. The underlying causes of the discrepancies are still unknown and genetic, environmental, cultural and/or societal factors may be involved. While AS is still more prevalent in men in a ratio of 2-3:1, the prevalence of males and females in patients with axSpA without radiographic sacroiliac damage is similar. Gender differences in this subgroup of patients have not been adequately addressed, and are particularly needed to further validate the Assessment of SpondyloArthritis international Society classification criteria.
Collapse
|
41
|
Kang KY, Kwok SK, Ju JH, Park KS, Park SH, Hong YS. The predictors of development of new syndesmophytes in female patients with ankylosing spondylitis. Scand J Rheumatol 2014; 44:125-8. [DOI: 10.3109/03009742.2014.938693] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
42
|
The burden of non-radiographic axial spondyloarthritis. Semin Arthritis Rheum 2014; 44:556-562. [PMID: 25532945 DOI: 10.1016/j.semarthrit.2014.10.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify patients earlier, new classification criteria have been introduced for axial spondyloarthritis (axSpA). Patients who satisfy the clinical or imaging criteria for axSpA in the absence of definite sacroiliac joint changes on pelvic x-rays are classified as having non-radiographic axSpA. Although the burden associated with radiographic axSpA (i.e., ankylosing spondylitis) has been extensively studied, the impact of non-radiographic disease is not well understood. The purpose of this review is to provide an overview of the burden of illness in non-radiographic axSpA, including epidemiology and effects on patients׳ functioning and health-related quality of life (HR-QoL). METHODS A PubMed search was performed using relevant key words (e.g., "spondyloarthritis," "ankylosing spondylitis," "epidemiology," and "quality of life") to examine literature published from 2003 to 2013. RESULTS Studies conducted to date suggest that radiographic progression is detected in approximately 10% of patients with non-radiographic axSpA over 2 years. Differences between patients with non-radiographic and radiographic axSpA were found in age, symptom duration, and gender distribution. Although less inflammation (i.e., lower C-reactive protein levels and less spinal inflammation on MRI) and less impairment in spinal mobility are observed in non-radiographic than in radiographic axSpA, the 2 conditions pose a similar burden in terms of disease activity, physical function, HR-QoL impairment. CONCLUSIONS Patients with non-radiographic axSpA are more frequently female. Although patients with non-radiographic axSpA have shorter disease duration and lack radiological changes, they demonstrate a substantial burden of illness, with self-reported disease activity and functional impairments comparable to those found in patients with radiographic disease.
Collapse
|
43
|
Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
Collapse
Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
| | | | | | | | | | | |
Collapse
|
44
|
Xiong J, Chen J, Tu J, Ye W, Zhang Z, Liu Q, Zhu X. Association of HLA-B27 status and gender with sacroiliitis in patients with ankylosing spondylitis. Pak J Med Sci 2014; 30:22-7. [PMID: 24639824 PMCID: PMC3955535 DOI: 10.12669/pjms.301.3896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 11/23/2013] [Accepted: 11/26/2013] [Indexed: 01/18/2023] Open
Abstract
Objective: To observe the influence of human leucocyte antigen B27 (HLA-B27) status and gender on sacroiliitis on computed tomography (CT) in ankylosingspondylitis (AS). Methods: We reviewed the archived medical records of the AS inpatients admitted in the Rheumatology Department of the First Affiliated Hospital of Wenzhou Medical University during the period from January 2007 through January 2013 and finally 386 patients were included in the study. The severity of sacroiliitis on CT was evaluated according to the grading used in the modified New York criteria for AS. Two-way classification analysis of variance (ANOVA) was employed to examine the effect of HLA-B27 status and gender on age at disease onset. The impact of HLA-B27 and gender on sacroiliitis on CT was tested by univariate and multivariate logistic regression analyses. Results: There were 350 HLA-B27 positive patients (90.7%) and 36 HLA-B27 negative patients (9.3%). The ANOVA test indicated that HLA-B27 positive patients and male patients respectively had an earlier age at disease onset than HLA-B27 negative patients and female patients. The logistic regression analysis indicated that positive HLA-B27 status (OR 2.601, p=0.004) and male gender (OR 1.923, p=0.004) were significant predictors of worse sacroiliitis. In addition, elevated ESR (OR 2.181, p=0.013) and longer disease duration (OR 1.100, p<0.001) contributed to worse sacroiliitis likewise. Conclusion: Positive HLA-B27 status and male gender are associated with worse sacroiliitis on CT, acting as predictors of sacroiliitis. Elevated ESR and longer disease duration also contribute to worse sacroiliitis. Meanwhile, positive HLA-B27 status and male gender are associated with earlier age at disease onset.
Collapse
Affiliation(s)
- Jiangbiao Xiong
- Jiangbiao Xiong, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Jing Chen
- Jing Chen, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Jianxin Tu
- Jianxin Tu, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Wenjing Ye
- Wenjing Ye, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Zhiyong Zhang
- Zhiyong Zhang, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Qiaoqiong Liu
- Qiaoqiong Liu, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Xiaochun Zhu
- Xiaochun Zhu, Department of Rheumatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| |
Collapse
|
45
|
Marinović I, Pivalica D, Aljinović J, Vlak T, Škorić E, Martinović Kaliterna D. Extremely rare coincidence of non-radiographic axial spondyloarthropathy HLA-B27 positive and Stiff Person Syndrome--rheumatologist point of view. Mod Rheumatol 2013; 26:278-80. [PMID: 24289195 DOI: 10.3109/14397595.2013.857837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive stiffness and rigidity of truncal muscles accompanied with co-contraction of agonist-antagonist muscles. Our 51-year-old female patient was presented for the first time to physiatrists in 2006 and diagnosed with axial-spondyloarthropathy (SpA) HLA-B27 positive. SPS was diagnosed 7 years after initial symptoms. SPS should be taken into consideration in HLA-B27 positive patients if stiffness of paravertebral and abdominal muscles progresses during SpA therapy.
Collapse
Affiliation(s)
- Ivanka Marinović
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Dinko Pivalica
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Jure Aljinović
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Tonko Vlak
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Ela Škorić
- a Department of Rehabilitation Medicine and Rheumatology , University Hospital Split, School of Medicine in Split , Split , Croatia
| | - Dušanka Martinović Kaliterna
- b Department of Rheumatology and Clinical Immunology , University Hospital Split, School of Medicine in Split , Split , Croatia
| |
Collapse
|
46
|
Shahlaee A, Mahmoudi M, Nicknam MH, Farhadi E, Fallahi S, Jamshidi AR. Gender differences in Iranian patients with ankylosing spondylitis. Clin Rheumatol 2013; 34:285-93. [PMID: 24288047 DOI: 10.1007/s10067-013-2439-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/18/2013] [Accepted: 11/10/2013] [Indexed: 11/25/2022]
Abstract
Inequalities in features and severity of ankylosing spondylitis (AS) have been noticed between men and women, suggesting a possible influence of gender on disease phenotypes. Comparing disease features and characterization of gender differences in clinical features and medications could help elucidate the potential influence of gender on the severity of AS in patients. This study aims to assess the influence of gender on disease patterns in Iranian patients with AS. Three hundred and twenty patients diagnosed with primary AS were assessed for demographic variables, clinical manifestations, HLA status, disease severity, functional capacities, quality of life, and treatment status. Sixty-seven women and 253 men were included corresponding to a male to female ratio of 3.78:1. Both groups were similar regarding ethnicity, positive family history, and juvenile onset AS. HLA-B27 was more frequent among males (78.3 vs. 55.2%; p < 0.001). There was a higher proportion of female patients with overall enthesitis (p < 0.05). Extra-articular manifestations and treatment modalities presented similar frequencies in both genders. No difference in gender-associated diagnostic delays was observed. Female disease was at least as severe as male disease, and in some aspects, females presented with more severe disease. Despite a relatively similar disease profile, we observed a higher rate of enthesitis among women. Together with the equally high rate of disease activity indices in both genders, these findings indicate an overall longer delay to diagnosis in our country. Early detection and specialized care would be of great practical importance.
Collapse
Affiliation(s)
- Abtin Shahlaee
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, P.O. Box 1411713137, Kargar Ave., Tehran, Iran
| | | | | | | | | | | |
Collapse
|
47
|
Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, Dougados M, Soubrier M. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken) 2013; 65:1482-9. [PMID: 23463610 DOI: 10.1002/acr.22001] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 02/21/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To clarify sex differences in early axial spondyloarthritis (SpA). METHODS In total, 475 patients included in the Devenir des Spondylarthropathies Indifférenciées Récentes (Outcome of Recent Undifferentiated Spondylarthropathies) cohort, a prospective multicenter French cohort of patients with early inflammatory back pain suggestive of SpA, and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA were studied. The clinical and imaging features were compared between sexes and according to the clinical or imaging arm of the ASAS criteria using univariate and multivariate analysis. RESULTS Comparisons between the 239 men and 236 women showed that women had higher disease activity when measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Patient Global Score and higher fatigue and functional scores despite having less radiographic sacroiliitis and magnetic resonance imaging (MRI) inflammation of sacroiliac joints and the spine than men. Disease activity measured by the C-reactive protein (CRP)-based Ankylosing Spondylitis Disease Activity Score was not different between men and women. In contrast to patients classified with the clinical arm, disease activity and functional scores did not differ between women and men with sacroiliitis on imaging scans, except for fatigue and the Ankylosing Spondylitis Quality of Life questionnaire. Women with sacroiliitis had more peripheral involvement and more family history, whereas HLA-B27 positivity, elevated CRP, and MRI inflammation of the spine were associated with male sex. CONCLUSION Women with early axial SpA according to the ASAS criteria had greater disease activity when measured by the BASDAI and worse functioning despite fewer radiologic abnormalities than men. The differences in disease expression may be confounding factors to establish the diagnosis of SpA and to assess disease activity in women, suggesting that the imaging arm is a pivotal measure in the ASAS criteria.
Collapse
Affiliation(s)
- A Tournadre
- Centre Hospitalier Universitaire Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Berntson L, Nordal E, Aalto K, Peltoniemi S, Herlin T, Zak M, Nielsen S, Rygg M. HLA-B27 predicts a more chronic disease course in an 8-year followup cohort of patients with juvenile idiopathic arthritis. J Rheumatol 2013; 40:725-31. [PMID: 23547219 DOI: 10.3899/jrheum.121257] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated associations of HLA-B27 with clinical manifestations and longterm outcome in a near population-based setting among patients with juvenile idiopathic arthritis (JIA). METHODS We studied clinical and serological data from 410 patients with HLA-B27 results among 440 prospectively collected patients with JIA with 8-year followup data in a Nordic database. The study was structured to be as close to a population-based study as possible. RESULTS HLA-B27 was analyzed in 93% of patients, and was positive in 21% of the cohort, in 18.4% of the girls and in 25.9% of the boys. Boys who were HLA-B27-positive had significantly higher age at onset compared to HLA-B27-negative boys and compared to both HLA-B27-negative and positive girls. This difference in onset age in relation to HLA-B27 was not found in girls. HLA-B27 was associated with clinical signs of sacroiliitis, enthesitis, and tenosynovitis in boys, but not in girls. After 8 years of disease, 46 children (11.2%) were classified as having enthesitis-related arthritis (ERA). Boys with ERA had clinical signs of sacroiliitis more often than girls with ERA. HLA-B27-positive children, as well as children with clinical signs of sacroiliitis, enthesitis, and hip arthritis, had higher odds of not being in remission off medication after 8 years of disease. CONCLUSION In this near population-based Nordic JIA cohort we found significant differences between HLA-B27-positive boys and girls in age at disease onset, clinical signs of sacroiliitis, and ERA classification. HLA-B27 was negatively associated with longterm remission status, possibly because of its association with clinical disease characteristics, such as sacroiliitis, rather than being a general marker of persistent disease.
Collapse
Affiliation(s)
- Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Sex and gender differences in frequent diseases are more widespread than one may assume. In addition, they have significant yet frequently underestimated consequences on the daily practice of medicine, on outcomes and effects of therapies. Gender medicine is a novel medical discipline that takes into account the effects of sex and gender on the health of women and men. The major goal is to improve health and health care for both, for women as well as for men. We give in this chapter an overview on sex and gender differences in a number of clinical areas, in cardiovascular diseases, pulmonary diseases, gastroenterology and hepatology, in nephrology, autoimmune diseases, endocrinology, hematology, neurology. We discuss the preferential use of male animals in drug development, the underrepresentation of women in early and cardiovascular clinical trials, sex and gender differences in pharmacology, in pharmacokinetics and pharmacodynamics, in management and drug use. Most guidelines do not include even well-known sex and gender differences. European guidelines for the management of cardiovascular diseases in pregnancy have only recently been published. Personalized medicine cannot replace gender-based medicine. Large databases reveal that gender remains an independent risk factor after ethnicity, age, comorbidities, and scored risk factors have been taken into account. Some genetic variants carry a different risk in women and men. The sociocultural dimension of gender integrating lifestyle, environment, stress, and other variables cannot be replaced by a sum of biological parameters. Because of this prominent role of gender, clinical care algorithms must include gender-based assessment.
Collapse
|
50
|
van der Horst-Bruinsma IE, Zack DJ, Szumski A, Koenig AS. Female patients with ankylosing spondylitis: analysis of the impact of gender across treatment studies. Ann Rheum Dis 2012; 72:1221-4. [PMID: 23264358 DOI: 10.1136/annrheumdis-2012-202431] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine the impact (if any) of gender on the clinical, functional and patient-reported outcomes of treatment using data pooled from four controlled clinical trials. METHODS Study data were pooled from four clinical control trials in which 1283 adult patients with active ankylosing spondylitis (AS) were treated with etanercept, sulfasalazine or placebo. Patients were stratified by gender and analysed for differences/similarities in baseline demographics, disease characteristics, and efficacy in AS outcome measures and safety and discontinuation rates after 12 weeks of therapy. RESULTS Significant baseline differences were observed between 326 female patients compared with 957 male patients. Female patients had an older mean age of disease onset (35.0 vs 31.2 years; p<0.001), shorter mean time of disease duration (7.4 vs 9.5 years; p<0.001) and lower mean baseline C-reactive protein (13.1 vs 20.9 mg/l; p<0.001); a lower proportion was HLA-B27 positive (76.3% vs 85.2%; p<0.001) compared with male patients. Women had significantly (p<0.001) smaller differences in all week 12 efficacy assessments including AS disease activity score (0.87 vs -1.08), Bath AS disease activity index (-19.22 vs -23.41) and Bath AS functional index (-13.89 vs -16.88) relative to men. A similar relationship was observed between women and men in the adjusted mean difference of nocturnal back pain (4.04, 95% CI 0.77 to 7.32; p<0.05), total back pain (3.80, 95% CI 0.77 to 7.32; p<0.05) and patient global assessment (4.79, 95% CI 1.51 to 8.08; p<0.01). CONCLUSIONS Women had a higher burden of disease and less improvement in AS outcome measures compared with men. This was observed despite women having a later disease onset of shorter duration; the mechanism behind this observation is unclear. Additional research is necessary to better understand female patients with AS and the burden of disease in this population.
Collapse
|