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Elsaman AM, Hamed A, Radwan AR. Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. Korean J Pain 2021; 34:114-123. [PMID: 33380574 PMCID: PMC7783858 DOI: 10.3344/kjp.2021.34.1.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Evaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients. METHODS A total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound-guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows: visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165. RESULTS There was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes. CONCLUSIONS Epidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.
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Affiliation(s)
- AM Elsaman
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt
| | - A Hamed
- Department of Rheumatology and Rehabilitation, Minia University Hospital, Elminia, Egypt
| | - AR Radwan
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt
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Maruiwa R, Watanabe K, Suzuki S, Nori S, Tsuji O, Nagoshi N, Okada E, Yagi M, Fujita N, Nakamura M, Matsumoto M. Chin on Chest Deformity Caused by Upper Cervical Kyphosis Associated With Ankylosing Spondylitis: A Case Report. Neurospine 2020; 17:666-671. [PMID: 33022171 PMCID: PMC7538344 DOI: 10.14245/ns.2040502.251] [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] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022] Open
Abstract
Chin on chest deformity caused by upper cervical kyphosis associated with ankylosing spondylitis is rare. A 66-year-old woman presented at our institute with chief complaints of difficulty in horizontal gaze and opening her mouth. Cervical radiographs showed a C0–2 angle of 1° on flexion and 7° on extension, and her chin-brow vertical angle was 49°. We planned fixation surgery at C0–5 posteriorly to prevent the progression of kyphosis, with slight correction of the kyphosis at C0–2. The correction was performed by pushing down the over lordotically contoured titanium rods connected to an occipital plate onto the C3–5 lateral mass screws, just like cantilever technique. No palpable cracking or loss of resistance was noticed during the correction. However, intraoperative radiographs revealed apparent anterior separation of the vertebral bodies between C3 and C4. Postoperative computed tomography images at the C3/4 level suggested hemorrhage from the fracture site. Tracheostomy was performed because of massive edema around the pharynx. To secure solid bone fusion, staged surgery to extend the fusion to T3 and to graft an additional iliac bone was performed. Fortunately, the C2–7 angle was corrected to 40°, and her chin-brow vertical angle was restored to 17° without any catastrophic complications. Although the patient finally obtained an ideal sagittal alignment, the surgeon should be aware that the technique had a higher perioperative risk for iatrogenic fracture, resulting in neurological and vascular injuries.
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Affiliation(s)
- Ryosuke Maruiwa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Fujita Medical University, Aichi, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig 2019; 16:565-574. [PMID: 31446684 PMCID: PMC6710421 DOI: 10.30773/pi.2019.06.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to provide a summary estimate of depression prevalence among people with ankylosing spondylitis (AS) in comparison to those without AS. A systematic literature search was conducted using PubMed, Embase, PsycINFO, Web of Science, the Cochrane database library, China National Knowledge Infrastructure, and Wanfang Database from their inception to December 2016. The results showed that thirty-one eligible studies involving 8,106 patients were analyzed. Fifteen methods of defining depression were reported. The overall pooled prevalence of depression was 35% (95% CI, 28-43%), with high between-study heterogeneity (I2=98.8%, p<0.001). The relative risk of depression among people with AS was 1.76 (95% CI: 1.21-2.55, eight studies, n=3,006) compared with people without AS. The depression score [standardized mean difference (SMD)=0.43, 95% CI: 0.19-0.67, seven studies, n=549] was higher in AS patients than in controls. The main influence on depression prevalence was the sample size and country of origin. In conclusion, one-third of people with AS experience symptoms of depression. Depression was more prevalent in AS patients than in controls. Further research is needed to identify effective strategies for preventing and treating depression among AS patients.
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Affiliation(s)
- Lijuan Zhang
- Department of Gastrointestinal Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaping Wu
- Department of Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguang Liu
- Department of Gastrointestinal Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Rahman P, Choquette D, Bensen WG, Khraishi M, Chow A, Zummer M, Shaikh S, Sheriff M, Dixit S, Sholter D, Psaradellis E, Sampalis JS, Letourneau V, Lehman AJ, Nantel F, Rampakakis E, Otawa S, Shawi M. Biologic Treatment Registry Across Canada (BioTRAC): a multicentre, prospective, observational study of patients treated with infliximab for ankylosing spondylitis. BMJ Open 2016; 6:e009661. [PMID: 27048632 PMCID: PMC4823435 DOI: 10.1136/bmjopen-2015-009661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the profile of patients with ankylosing spondylitis (AS) treated with infliximab in Canadian routine care and to assess the effectiveness and safety of infliximab in real world. SETTING 46 primary care rheumatology practices across Canada. PARTICIPANTS 303 biological-naïve patients with AS or patients previously treated with a biological for <6 months and who were eligible for infliximab treatment as per routine care within the Biologic Treatment Registry Across Canada (BioTRAC). INTERVENTION Not applicable (non-interventional study). PRIMARY AND SECONDARY OUTCOMES Effectiveness was assessed with changes in disease parameters (AS Disease Activity Score (ASDAS), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Health Assessment Questionnaire Disease Index (HAQ-DI), physician global assessment of disease activity (MDGA), patient global disease activity (PtGA), back pain, C-reactive protein, erythrocyte sedimentation rate (ESR), morning stiffness). Safety was assessed with the incidence of adverse events (AEs). RESULTS Of the 303 patients included, 44.6% were enrolled in 2005-2007 and 55.4% in 2008-2013. Patients enrolled in 2005-2007 had significantly higher MDGA and ESR at baseline while all other disease parameters examined were numerically higher with the exception of PtGA. Treatment with infliximab significantly (p<0.001) improved all disease parameters over time in both groups. At 6 months, 56% and 31% of patients achieved clinically important (change≥1.1) and major (change≥2.0) improvement in ASDAS, respectively; at 48 months, these proportions increased to 75% and 50%, respectively. Among patients unemployed due to disability at baseline, 12.1% returned to work (mean Kaplan-Meier (KM)-based time=38.8 months). The estimated retention rate at 12 and 24 months was 78.3% and 60.1%, respectively. The profile and incidence of AEs were comparable to data previously reported for tumour necrosis factor-α inhibitors. CONCLUSIONS Characteristics of patients with AS at infliximab initiation changed over time towards lower disease activity and shorter disease duration. Infliximab treatment significantly reduced disease activity independent of treatment initiation year, although patients enrolled in recent years achieved lower disease activity over 48 months. TRIAL REGISTRATION NUMBER NCT00741793.
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Affiliation(s)
- Proton Rahman
- Department of Medicine & Rheumatology, Memorial University, St. John's, Newfoundland, Canada
| | - Denis Choquette
- Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
| | - William G Bensen
- St. Joseph's Hospital, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Majed Khraishi
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrew Chow
- Credit Valley Rheumatology, Mississauga, Ontario, Canada
| | - Michel Zummer
- Université de Montréal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | - Maqbool Sheriff
- Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
| | | | | | - Eliofotisti Psaradellis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - John S Sampalis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Emmanouil Rampakakis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Susan Otawa
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
| | - May Shawi
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
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