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Ahısha BŞ, Kesiktaş FN. Prevalence of temporomandibular joint dysfunction in patients with ankylosing spondylitis and comparison of the findings with healthy controls. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240807. [PMID: 39356963 DOI: 10.1590/1806-9282.20240807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE This study aimed to assess the prevalence of temporomandibular dysfunction in ankylosing spondylitis patients and healthy controls, examining the relationship between temporomandibular dysfunction and disease activity in ankylosing spondylitis patients, as well as associations with psychosocial factors. METHODS The study included 113 ankylosing spondylitis patients and 110 healthy individuals aged 18-75. Temporomandibular dysfunction presence was evaluated using Diagnostic Criteria for Temporomandibular Disorders Axis I. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index. RESULTS Among healthy individuals, 60.9% did not receive a temporomandibular dysfunction diagnosis, while 39.1% received at least one diagnosis. In contrast, 69.9% of the 113 ankylosing spondylitis patients received at least one temporomandibular dysfunction diagnosis, and only 30.1% were not included in any diagnosis group (p<0.001). Joint (p=0.001) and pain disorders (p=0.008) were significantly more common in the ankylosing spondylitis group than in the healthy controls. Significant associations emerged between Bath Ankylosing Spondylitis Disease Activity Index (p<0.001) and Bath Ankylosing Spondylitis Functional Index (p=0.005) scores and pain disorders. CONCLUSION Temporomandibular dysfunction is more prevalent in ankylosing spondylitis patients than in healthy individuals, linked to increased joint issues and pain associated with disease activity. CLINICALTRIALS.GOV ID NCT05839925.
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Affiliation(s)
- Büşra Şirin Ahısha
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Hospital - İstanbul, Turkey
| | - Fatma Nur Kesiktaş
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Hospital - İstanbul, Turkey
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Kojima I, Nogami S, Hitachi S, Shimada Y, Ezoe Y, Yokoyama-Sato Y, Iikubo M. Temporomandibular joint ankylosis suspected to be associated with ankylosing spondylitis based on cervical computed tomography images: A pictorial essay. Imaging Sci Dent 2024; 54:201-206. [PMID: 38948191 PMCID: PMC11211022 DOI: 10.5624/isd.20230243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 07/02/2024] Open
Abstract
This report showed a case of temporomandibular joint (TMJ) ankylosis suspected to be associated with ankylosing spondylitis based on the observation of bony ankylosis of the cervical spine on computed tomography (CT) images. A 53-year-old man presented with a chief complaint of difficulty in opening his mouth. His medical history indicated that in his 20s, he became aware of the difficulty in moving his neck. CT revealed marked osteoarthritic changes in the right mandibular condyle, suggesting fibrotic TMJ ankylosis. In addition, bony ankylosis of the cervical vertebral body and facet joints from the axis (C2) to C5 in continuity was observed. CT of the entire spine also showed bony deformity of the sacroiliac joints and bony ankylosis. Based on these findings, ankylosing spondylitis was suspected. The possibility of an ankylosing spondylitis complication should be considered in cases of TMJ ankylosis if bony ankylosis of the cervical spine is observed.
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Affiliation(s)
- Ikuho Kojima
- Department of Oral and Maxillofacial Radiology, Tohoku University Hospital, Sendai, Japan
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shinnosuke Nogami
- Department of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shin Hitachi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Yusuke Shimada
- Department of Oral and Maxillofacial Radiology, Tohoku University Hospital, Sendai, Japan
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yushi Ezoe
- Department of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yuka Yokoyama-Sato
- Department of Oral and Maxillofacial Radiology, Tohoku University Hospital, Sendai, Japan
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masahiro Iikubo
- Department of Oral and Maxillofacial Radiology, Tohoku University Hospital, Sendai, Japan
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Ismah N, Bachtiar EW, Purwanegara MK, Tanti I, Mardiati E. Evaluation of IL-1β and CRP mRNA expression levels by RT-PCR in postorthodontic treatment patients with temporomandibular joint disorders: a cross-sectional Study. J Int Soc Prev Community Dent 2024; 14:98-104. [PMID: 38827355 PMCID: PMC11141896 DOI: 10.4103/jispcd.jispcd_197_23] [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: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 06/04/2024] Open
Abstract
Aim Temporomandibular joint disorder (TMD), which affects the masticatory muscles, temporomandibular joint, and surrounding tissues, can manifest as inflammation. This study aims to explore the expression levels of the inflammatory biomarkers, interleukin (IL)-1β and C-reactive protein (CRP), in TMD patients who have undergone orthodontic treatment. Materials and Methods Buccal swabs from 105 postorthodontic treatment patients were analyzed using real-time polymerase chain reaction to assess the expression levels of IL-1β and CRP in each group after messenger ribonucleic acid extraction. Patients were also examined using the Diagnostic Criteria for TMD (DC/TMD) to determine if they met the criteria for a TMD diagnosis. The TMD group was subdivided into three categories based on the DC/TMD. Results The study included 37 patients who did not develop TMD (group 0) and 68 participants who developed TMD after orthodontic treatment, including 17 with pain-related TMDs (group 1), 29 with intra-articular TMDs (Group 2), and 22 with combined pain-related and intra-articular TMDs (group 3). CRP expression was higher than IL-1β in groups 1 and 2, and IL-1β expression was higher than CRP in group 3. The Kruskal-Wallis test showed that IL-1β and CRP expression levels in groups 1, 2, and 3 were not statistically different. Sex and adult age had considerable effects on the occurrence of TMD in patients after orthodontic treatment. Conclusions Higher IL-1β expression was found in postorthodontic treatment patients with more complex TMD. This study strengthens the evidence of inflammation through IL-1β and CRP expression in individuals with TMD, especially after orthodontic treatment.
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Affiliation(s)
- Nada Ismah
- Department of Orthodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Ira Tanti
- Department of Prosthodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Endah Mardiati
- Department of Orthodontics, Faculty of Dentistry, Universitas Padjajaran, Bandung, Indonesia
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Gençosmanoğlu H, Ünlüer NÖ, Akın ME, Demir P, Aydın G. An investigation of biomechanics, muscle performance, and disability level of craniocervical region of individuals with temporomandibular disorder. Cranio 2024; 42:232-242. [PMID: 34128775 DOI: 10.1080/08869634.2021.1938854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate biomechanics, muscle performance, and disability of the craniocervical region in temporomandibular disorder (TMD) patients and compare them with controls. METHODS Craniocervical posture was evaluated using lateral photography and radiography. Range of motion, muscle performance, disability, and TMD severity were assessed using an inclinometer, Functional Strength Testing of Cervical Spine, Neck Disability Index, and Fonseca Anamnestic Index, respectively. RESULTS Compared to the control group, the TMD group demonstrated higher cervical flexion angle (p=0.005) and neck disability (p<0.001) as well as lower cervical extension (p=0.040), right cervical rotation (p=0.005), left cervical rotation (p<0.001), and tragus-C7-horizontal (p=0.048) angles, and reduced muscle performances (p≤0.001). Most patients had higher than normal craniocervical angle (p<0.001). Muscle performance in each cervical motion (p<0.005) and disability (p<0.001) were associated with TMD severity in the TMD group. CONCLUSION Biomechanics, muscle performance, and disability of craniocervical region were altered in the TMD group.
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Affiliation(s)
- Harun Gençosmanoğlu
- Department of Physiotherapy & Rehabilitation, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
| | - Nezehat Özgül Ünlüer
- Department of Physiotherapy & Rehabilitation, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Emre Akın
- Department of Radiology, Yenimahalle Training & Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Pervin Demir
- Department of Biostatistics & Medical Informatics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Gülümser Aydın
- Department of Physical Medicine & Rehabilitation, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
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Syrmou V, Grammatikopoulou MG, Bogdanos DP, Mitsimponas KT. Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know? Reumatologia 2023; 61:375-388. [PMID: 37970123 PMCID: PMC10634408 DOI: 10.5114/reum/173078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023] Open
Abstract
Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.
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Affiliation(s)
- Vasiliki Syrmou
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
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de Holanda GA, de Holanda TA, Boscato N, Casarin M. Temporomandibular joint involvement in individuals with ankylosing spondylitis: A scoping review. Arch Oral Biol 2023; 146:105609. [PMID: 36565536 DOI: 10.1016/j.archoralbio.2022.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This scoping review aimed to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in individuals with ankylosing spondylitis (AS). DESIGN Systematic literature searches were performed on PubMed, Embase, and Web of Science databases (up to April 2022). Studies with signs and symptoms of temporomandibular joint disorder (TMD) in adults with AS were included. TMJ outcomes were extracted and analyzed qualitatively. RESULTS From 527 potentially eligible studies, 22 were included. A total of 4309 individuals with AS were evaluated, aged between 18 and 80 years, being males approximately 65% of the sample. Signs and symptoms of pain, tenderness to palpation on TMJ and masticatory muscles, joint noises (i.e., clicking or crepitus), limited mouth opening, disc displacement, and radiographic changes were often observed. CONCLUSION The available evidence shows that different signs and symptoms of TMD co-occur with AS disease, with a higher prevalence of TMD observed in individuals with AS than in individuals without AS. Indeed, it seems that individuals suffering from AS disease have an increased risk of developing TMD.
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Affiliation(s)
| | | | - Noéli Boscato
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil.
| | - Maísa Casarin
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil.
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Souza RC, de Sousa ET, Sousa D, Sales M, Dos Santos Oliveira R, Mariano MH, Rushansky E, Amorim Gomes AC, Silva E. Prevalence of Temporomandibular Joint Disorders in Patients with Ankylosing Spondylitis: A Cross-Sectional Study. Clin Cosmet Investig Dent 2021; 13:469-478. [PMID: 34795532 PMCID: PMC8593348 DOI: 10.2147/ccide.s320537] [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: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022] Open
Abstract
Background This study sought to investigate which temporomandibular disorders (TMD) can be expected in patients with ankylosing spondylitis (AS) and to determine the combined impact of these conditions on the psychological status, chronic pain, and functional disability. Material and Methods A cross-sectional study composed of 30 patients between 18 and 65 years with ankylosing spondylitis was performed. The research protocol considered the evaluation of outcomes related to the ankylosing spondylitis (HLA-B27 antigen, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire – Spondylitis (HAQ-S)) and temporomandibular disorders (axis I and II of the Research Diagnostic Criteria for Temporomandibular Disorders – RDC/TMD). Descriptive analyses were applied to express the results. Results The sample presented both AS and TMD, most of them (24) were diagnosed with conventional AS (HLA-B27 positive). The BASDAI was scored as 7.70 (2.30) (high activity of AS disease). Functional disability represented by high scores of BASFI [7.00 (2.63)] and HAQ-S [1.79 (0.62)] demonstrates the severe impact of the disease on the daily routine and quality of life. According to RDC/TMD diagnostic criteria, 17 (57%) share the three groups of TMD, and 9 (30%) share two groups of TMD (Group I and III). Over 73% of the volunteers scored high levels of chronic pain (Grade III and IV) associated with a high depression scale score. The sample scored the somatization scale (with and without pain) as severe. Conclusion Patients with ankylosing spondylitis presented a high prevalence of temporomandibular disorder, most of them having the degenerative forms of TMJ disease. AS and TMD cause moderate to severe chronic pain and a negative impact on psychological status and functional capacities.
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Affiliation(s)
- Rebeca Cecília Souza
- Department of Oral Surgery, Dental School, Pernambuco University, Recife, Pernambuco, Brazil
| | - Emerson Tavares de Sousa
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - David Sousa
- Center of Medical Sciences, Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil
| | - Marcelo Sales
- Department of Clinical and Community Dentistry, Dental School, Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil
| | | | - Maria Helena Mariano
- Department of Rheumatology, Oswaldo Cruz University Hospital, Medical School, Pernambuco University, Recife, Pernambuco, Brazil
| | - Eliézer Rushansky
- Brazilian Society of Rheumatology, Department of Rheumatology, Oswaldo Cruz University Hospital, Medical School, Pernambuco University, Recife, Pernambuco, Brazil
| | - Ana Cláudia Amorim Gomes
- Department of Oral and Maxillofacial Surgery, Oswaldo Cruz University Hospital, Dental School, Pernambuco University, Recife, Pernambuco, Brazil
| | - Emanuel Silva
- Department of Oral and Maxillofacial Surgery, Oswaldo Cruz University Hospital, Dental School, Pernambuco University, Recife, Pernambuco, Brazil
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Huang YF, Chang CT, Muo CH, Chiu KM, Tsai CH, Liu SP. Bidirectional relationship between temporomandibular disorder and ankylosing spondylitis: a population-based cohort study. Clin Oral Investig 2021; 25:6377-6384. [PMID: 33855657 DOI: 10.1007/s00784-021-03938-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/05/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study aimed to determine the relation between temporomandibular disorder (TMD) and ankylosing spondylitis (AS) bidirectionally and ascertain the important comorbidities for AS occurrence in TMD patients. MATERIALS AND METHODS We conducted this population-based cohort study through Longitudinal Health Insurance Database, Taiwan. Study 1 investigated the risk of TMD in AS patients. Study 2 assessed the risk of AS in TMD patients. RESULTS In total, 3204 AS patients and 12,816 age-matched and gender-matched comparisons were enrolled in study 1. The TMD incidence in the AS cohort was 2.88-fold higher when compared with the comparisons (1.54 vs. 0.53 per 10,000 person-years). After adjusting for age, gender, and comorbidity, the AS cohort had a 2.66-fold (95% CI = 1.79-3.97) increased risk of TMD occurrence (P < 0.0001). The second study recruited 4998 TMD patients and 19,991 age-matched and gender-matched comparisons. Both TMD and comparison cohorts showed similar AS risk (HR = 1.49, 95% CI = 0.91-2.43, P = 0.1108) in the adjusted model. Study 2 identified a 3.66-fold increased risk of AS occurrence in TMD patients with comorbidity, including parapsoriasis, rheumatoid arthritis, osteoporosis, Cushing's syndrome, and climacteric arthritis (P < 0.012). CONCLUSIONS AS appears to significantly impact the occurrence of TMD. TMD might play a synergic role in AS development. CLINICAL RELEVANCE Clinicians have to be vigilant about the increased risk of TMD in AS patients and take care of AS disease activity and prognosis. The symptoms and signs of TMD could be a predictor of AS in patients with the aforementioned comorbidities.
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Affiliation(s)
- Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan.,School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan.,Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Chung-Ta Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan. .,Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 22056, Taiwan. .,Graduate Institute of Medicine, Yuan Ze University, Taoyuan, 32003, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, 22056, Taiwan.,Department of Nursing, Oriental Institute of Technology, New Taipei City, 22056, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan.,Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Shih-Ping Liu
- Program for Aging, College of Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Center for Translational Medicine, China Medical University and Hospital, Taichung, 40402, Taiwan. .,Department of Social Work, Asia University, Taichung, 41354, Taiwan.
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Akyol A, Kocyigit BF. Ankylosing spondylitis rehabilitation publications and the global productivity: a Web of Science-based bibliometric analysis (2000-2019). Rheumatol Int 2021; 41:2007-2014. [PMID: 33797569 DOI: 10.1007/s00296-021-04836-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
Rehabilitation programs have an important place in the treatment of ankylosing spondylitis (AS), but there is no comprehensive bibliometric research that assesses publications on AS rehabilitation in a holistic way. The aim of this study was to investigate the quantity and quality of articles related to AS rehabilitation and to reveal the features of global productivity in this topic. This bibliometric study was conducted utilizing the Web of Science (WoS) database with the keywords 'ankylosing spondylitis rehabilitation', 'ankylosing spondylitis exercise', 'ankylosing spondylitis physical therapy' and 'ankylosing spondylitis physiotherapy'. The number of articles, citations, and main active countries were determined and trend analyses were performed. A total of 792 articles were reviewed. The articles originated from 51 different countries, 22 of which met the main active country criteria. A significant increase trend was detected in the number of articles between 2000 and 2019 (p < 0.001). The five most productive countries were Germany (n = 111; 14.02%), Turkey (n = 98; 12.37%), the United States (n = 71; 8.96%), the United Kingdom (n = 53; 6.69%) and the Netherlands (n = 53; 6.69%). The highest values in number of articles per million population were calculated in Norway, the Netherlands and Austria, respectively. In the analysis according to GDP, Norway, the Netherlands and Turkey were ranked as the first three. The top three countries for the average citation count were France, Netherlands and Germany. This bibliometric study can be considered as an assessment and summary of worldwide scientific production on AS rehabilitation. The data demonstrate an increasing trend in research productivity since 2000. European countries were seen to be at the forefront both quantitatively and qualitatively in this area.
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Affiliation(s)
- Ahmet Akyol
- Physiotherapy and Rehabilitation Application and Research Center, Hasan Kalyoncu University, Gaziantep, Turkey.
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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