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Moses J, Hach S, Mason J, Treacher A. Defining and measuring objective and subjective spinal stiffness: a scoping review. Disabil Rehabil 2023; 45:4489-4502. [PMID: 36516462 DOI: 10.1080/09638288.2022.2152878] [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: 09/25/2020] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications. METHODS A scoping review was conducted to determine what is known about definitions and measures of the specific term of spinal stiffness. Following the framework by Arksey and O'Malley, eligible peer-reviewed studies identified using PubMed, Ebsco health, and Scopus were included if they reported definitions or measures of spinal stiffness. Using a data abstraction form, the studies were classified into four themes: biomechanical, surgical, pathophysiological, and segmental spinal assessment. To identify similarities and differences between studies, sixteen categories were generated. RESULTS In total, 2426 records were identified, and 410 met the eligibility criteria. There were 350 measures (132 subjective; 218 objective measures) and 93 indicators of spinal stiffness. The majority of studies (n = 69%) did not define stiffness. CONCLUSION This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There is no consensus regarding a standardised definition of stiffness in the reviewed literature.
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Affiliation(s)
- Joel Moses
- Private Practice, Cambridge, New Zealand
| | - Sylvia Hach
- School of Community Studies, Unitec Institute of Technology, Auckland, New Zealand
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2
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Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol 2022; 18:657-669. [DOI: 10.1038/s41584-022-00833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/08/2022]
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3
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Avril V, Davergne T. In response to the recent recommendations on the assessment of patients with spondyloarthritis, a translation is needed for health professionals. Comment on : “Data to be collected for an optimal management of axial spondyloarthritis in daily practice: Proposal from evidence-based and consensual approaches” by Baillet et al. Joint Bone Spine 2020;87:405‑11. Joint Bone Spine 2022; 89:105355. [DOI: 10.1016/j.jbspin.2022.105355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
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4
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Disorders of the Neck and Back. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Winger J. Disorders of the Neck and Back. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Raybone K, Family H, Sengupta R, Jordan A. (Un)Spoken realities of living with axial spondyloarthritis: a qualitative study focused on couple experiences. BMJ Open 2019; 9:e025261. [PMID: 31272972 PMCID: PMC6615774 DOI: 10.1136/bmjopen-2018-025261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Axial spondyloarthritis is a long-term rheumatic condition. The symptoms, including pain, can impact on the daily life routines and psychological well-being of individuals that are diagnosed with axial spondyloarthritis (axSpA). Partners are often a main source of support for individuals who manage a long-term condition and they can also be affected by the illness experience, often themselves reporting elevated levels of emotional distress. Few qualitative studies have explored the impact of axSpA on partner relationships. This study addresses the social context of axSpA by investigating the experiences for both individuals with axSpA and their partners. DESIGN Semistructured individual telephone interviews analysed using thematic analysis at a dyadic partner level. SETTING Participants were recruited from the social media pages of a UK-based axSpA-specific charity. PARTICIPANTS Nine heterosexual partner dyads (23-65 years), who were currently cohabiting, comprising nine individuals diagnosed with axSpA (n=6 females) and nine partners (n=3 females). RESULTS Three themes 'Perceived relational closeness', 'Playing third wheel to axSpA' and 'Tensions surrounding a carer-type role' were identified. The findings illustrate how living with axSpA can influence closeness between partners and dominate daily decisions, particularly surrounding leisure activities. Partners commonly adopted a carer-type role, despite many individuals with axSpA expressing desire for a greater sense of autonomy. CONCLUSIONS This study provides an important insight into the lived experiences of both individuals with axSpA and their partners. Findings highlight the social context of managing a long-term condition and suggest the need for including partners within consultations, and the need for support provision for partners.
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Affiliation(s)
| | - Hannah Family
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Raj Sengupta
- The Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Abbie Jordan
- Psychology, Centre for Pain Research, University of Bath, Bath, UK
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Wang Y, Xue C, Song K, Wang T, Hu W, Hu F, Hao Y, Zhang Z, Wang C, Yang X, Fan T, Zheng G, Wang Z, Wang Y, Zhang X. Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up. J Orthop Surg Res 2019; 14:137. [PMID: 31097011 PMCID: PMC6521496 DOI: 10.1186/s13018-019-1170-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pedicle subtraction osteotomy (PSO) and vertebral column decancellation (VCD) are frequently used methods for correction of thoracolumbar kyphosis resulting from ankylosing spondylitis (AS). However, there are limited reports performed to evaluate the difference of loss of correction and the effectiveness of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. Objective To retrospectively estimate the effectiveness of correction and loss of correction of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. Methods We performed a retrospective review of 61 consecutive AS kyphosis patients undergoing PSO or VCD surgery from March 2012 to April 2015. The patients were divided into PSO group (n = 25) and VCD group (n = 36) according to the types of osteotomies. Measurement of the radiographic parameters was performed and the change was analyzed. Results Mean loss of correction in the global kyphosis was 2.31° in the PSO group and 2.29° in VCD group at the last follow-up, respectively, with no significant difference. Progressive junctional kyphosis occurred in both groups. VCD obtained a significantly larger correction than PSO while sharing a similar incidence of complications. No serious complications were observed in the two groups. Conclusion The PSO osteotomy and VCD osteotomy are both safe and effective methods in treating thoracolumbar kyphosis secondary to AS. Mild loss of correction mainly occurred in the global kyphosis in both techniques with no significant difference.
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Affiliation(s)
- Yao Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Chao Xue
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Kai Song
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Tianhao Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Wenhao Hu
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Fanqi Hu
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Yongyu Hao
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Zhifa Zhang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Chunguo Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Xiaoxi Yang
- Peking University 3rd Hospital, No 49. North Garden Street, Beijing, China
| | - Tianqi Fan
- Peking University 3rd Hospital, No 49. North Garden Street, Beijing, China
| | - Guoquan Zheng
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Zheng Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Yan Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Xuesong Zhang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China.
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Li Z, Fu T, Wang Y, Dong C, Shao X, Li L, Gu Z. Sleep disturbances in ankylosing spondylitis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2019; 24:911-924. [PMID: 31012756 DOI: 10.1080/13548506.2019.1574357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this meta-analysis was to compare sleep outcomes of AS patients and controls. Six electronic databases were searched: PubMed, Embase, IndMed, Cochrane Library, CNKI and Web of Science. Statistical analyses were executed using Revman 5.3 software. Nine studies and a total of 3169 participants were included in the meta-analysis. When sleep was assessed using PSQI, significant differences were observed in subjective sleep quality, sleep latency, sleep efficiency, sleep disorders, sleep medication use and total PSQI between patients with AS and controls, and subjective sleep quality was most severely affected. In PSG, eight variables of sleep quality (stage I sleep, stage II sleep, slow wave sleep, rapid eye movement, arousal index, periodic leg movement index, sleep latency, sleep efficiency) were lower in AS patients than in controls. Three variables of sleep quality assessed by USI (estimated sleep time, sleep sufficiency index, number of awakenings per night) and two variables of sleep quality assessed by MOS sleep scale (sleep disturbance scale, sleep problem index II) were lower in AS patients than in controls. It indicated that AS patients experience more serious sleep disorders. Early recognition and appropriate interventions are essential to improve patients' sleep quality.
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Affiliation(s)
- Zhenyu Li
- a Research Center of Gerontology and Longevity , Affiliated Hospital of Nantong University , Nantong , China.,b Department of Nursing , Affiliated Hospital of Nantong University , Nantong , China
| | - Ting Fu
- a Research Center of Gerontology and Longevity , Affiliated Hospital of Nantong University , Nantong , China
| | - Yilin Wang
- d Medical School of Nantong University , Nantong , China
| | - Chen Dong
- d Medical School of Nantong University , Nantong , China
| | - Xiaoyi Shao
- e Department of Immunology , Medical College of Nantong University , Nantong , China
| | - Liren Li
- d Medical School of Nantong University , Nantong , China
| | - Zhifeng Gu
- c Research Center of Clinical Medicine , Affiliated Hospital of Nantong University , Nantong , China.,f Department of Rheumatology , Affiliated Hospital of Nantong University , Nantong , China
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Wang T, Zheng G, Wang Y, Zhang X, Hu F, Wang Y. Comparison of 2 Surgeries in Correction of Severe Kyphotic Deformity Caused by Ankylosing Spondylitis: Vertebral Column Decancellation and Pedicle Subtraction Osteotomy. World Neurosurg 2019; 127:e972-e978. [PMID: 30965170 DOI: 10.1016/j.wneu.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the treatment results between 1-level vertebral column decancellation (VCD) and pedicle subtraction osteotomy (PSO) for correcting severe kyphotic deformity in ankylosing spondylitis (AS). VCD and PSO have been used to correct AS-related kyphotic deformity, but the differences on correcting results between VCD and PSO are not clear. METHODS Between 2013 and 2015, 57 patients underwent 1-level spinal osteotomy (VCD: n = 30; PSO: n = 27) for correcting kyphotic deformity. Sagittal parameters, fusion results, surgical information, and clinical outcomes were documented and compared. All data were obtained before and 1 week after surgery, 6 months after surgery, and at final follow-up (at least 2 years). RESULTS VCD provided significantly greater osteotomy angle (50.8° ± 9.7°) than PSO (38.5° ± 6.1°). In the VCD group, the change of the anterior column was 5.0 ± 1.3 mm, which was larger than the PSO group. The middle column was shortened by 9.9 ± 2.0 mm and 19.1 ± 3.3 mm in the VCD group and PSO group, respectively. There was no significant difference in operating time and blood loss between the 2 groups. All cases had solid fusion. Between the 2 groups, Scoliosis Research Society Outcomes Instrument-22 scores were similar at the final follow-up. No major acute complications occurred in both groups. CONCLUSIONS VCD is a safe and effective method in treating rigid kyphotic deformity secondary to AS. VCD provides a larger correction angle in one segment and preserves more height of osteotomized vertebrae than PSO.
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Affiliation(s)
- Tianhao Wang
- Southwest Hospital, Third Military Medical University, Chongqing, China; Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Guoquan Zheng
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Yao Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xuesong Zhang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Fanqi Hu
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Yan Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China.
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10
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Wang T, Zhao Y, Zheng G, Wang Y, Wang C, Wang Z, Wang Y. Can pelvic tilt be restored by spinal osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis? A minimum follow-up of 2 years. J Orthop Surg Res 2018; 13:172. [PMID: 29986732 PMCID: PMC6038279 DOI: 10.1186/s13018-018-0874-2] [Citation(s) in RCA: 4] [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] [Received: 04/11/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Defining the postoperative pelvic tilt (PT) individually can help to reconstruct sagittal balance. However, the postoperative actual PT is hardly restored to theoretical value. Some cases with theoretical postoperative PT was overcorrected and still did not have normal horizontal visual field after surgery. The objective of this study is to describe the pelvic tilt change after spinal osteotomy in ankylosing spondylitis (AS) kyphotic deformity and evaluate the effect on clinical outcomes. Methods Twenty-three AS patients including 21 men and two women with thoracolumbar kyphosis, who underwent spinal osteotomy from 2013 to 2015 in our center, were retrospectively reviewed. A series of parameters including sacral slop (SS), pelvic incidence (PI), PT, and sagittal vertical axis (SVA) measured on preoperative and postoperative standing radiographs were analyzed. The theoretical postoperative PT (tPT) was calculated by the formula tPT = 0.37 × PI − 7. The radiographic measurements were compared before surgery, 2 weeks and at least 2 years postoperatively. Clinical outcomes were performed with the Oswestry disability index and Scoliosis Research Society-22 surveys. Results Mean age of the patients (2 women, 21 men) was 39.8 ± 9.1 years. Mean follow-up was 27.4 ± 3.8 months, at least 24 months. After spinal osteotomy, SS and SVA were corrected from 11.9° ± 11.2° and 18.0 ± 7.6 mm preoperatively to 25.8° ± 8.1° and 9.6 ± 6.3 mm postoperatively, respectively (p < 0.001). PT reduced from 37.6° ± 12.1° to 21.8° ± 9.8° postoperatively (p < 0.001). The tPT was different from postoperative actual PT significantly (p < 0.001). The clinical evaluations were not correlated with postoperative PT. Conclusion The abnormal PT is corrected by spinal osteotomy but is hard to restore to theoretical normal value. PT is a helpful parameter in making surgery plan. But pursuing postoperative PT being totally equal to tPT is undesirable and even may cause for overcorrection.
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Affiliation(s)
- Tianhao Wang
- Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.,Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Yongfei Zhao
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Guoquan Zheng
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Yao Wang
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Chunguo Wang
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Zheng Wang
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China
| | - Yan Wang
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
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11
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Does the preoperative lumbar sagittal profile affect the selection of osteotomy level in pedicle subtraction osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis? Clin Neurol Neurosurg 2018; 172:39-45. [PMID: 29966933 DOI: 10.1016/j.clineuro.2018.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the different preoperative lumbar sagittal profiles of ankylosing spondylitis (AS) patients and the selection of osteotomy level for one-level pedicle subtraction osteotomy (PSO) for the correction of thoracolumbar kyphosis. PATIENTS AND METHODS Seventy-one consecutive AS patients with an average age of 35.3 years and a mean follow-up time of 35.9 months who underwent one-level PSO for thoracolumbar kyphosis were divided into 2 groups based on their preoperative lumbar sagittal profiles as follows: group A, lordotic lumbar sagittal profiles; and group B, kyphotic lumbar sagittal profiles. The following radiological parameters were measured and compared: chin-brow vertical angle (CBVA), global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Clinical evaluation included Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). Perioperative and mid-term complications were reviewed. RESULTS There were 28 patients in group A and 43 in group B. The preoperative LL was -21.0° in group A and 2.3° in group B (P < 0.05). The preoperative SVA was 122.5 mm in group A and 184.3 mm in group B (P < 0.05). All the patients in group A (100%) underwent PSO at L1/L2, while 90% of group B patients underwent PSO at L2/L3, with no significant difference of postoperative GK, LL and SVA between the 2 groups (P > 0.05). No obvious loss of correction was observed in either group at the final follow-up. The correction of LL and SVA showed a strong but not statistically significant increasing trend as the PSO level descended from L1 to L3 (P > 0.05). The postoperative ODI was significantly lower in patients underwent PSO at L1 or L2 (P < 0.05). CONCLUSIONS Patients in group B had significantly worse preoperative sagittal alignments compared to group A. The distribution of osteotomy levels varied between the 2 groups due to the different lumbar profiles; however, satisfactory correction was achieved in both groups. The preoperative lumbar profiles need to be considered in selecting the optimal osteotomy level. Patients with kyphotic lumbar profiles are suitable candidates for PSO at L2/L3, while L1/L2 PSO is appropriate for patients with lordotic lumbar profiles.
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12
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Bautista-Molano W, van der Heijde D, Landewé R, Lafaurie GI, de Ávila J, Valle-Oñate R, Romero-Sanchez C. Is there a relationship between spondyloarthritis and periodontitis? A case-control study. RMD Open 2017; 3:e000547. [PMID: 29299339 PMCID: PMC5729302 DOI: 10.1136/rmdopen-2017-000547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/21/2023] Open
Abstract
Objective To compare the frequency and severity of periodontitis in patients with spondyloarthritis (SpA) with healthy control individuals, through the evaluation of clinical, serological and microbiological periodontal condition. Methods Patients with a diagnosis of SpA (n=78) and biological disease-modifying antirheumatic drug (bDMARD) naive fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria as well as 156 healthy controls matched for age/gender were included. Two trained and calibrated periodontologists performed the periodontal clinical assessment. The presence of periodontitis and its severity were determined according to the criteria established by the Centers for Disease Control and Prevention-American Academy of Periodontology. The clinical periodontal variables, IgG1/IgG2 antibodies against Porphyromonas gingivalis andperiodontopathic bacterial identification, were also established. Comparisons of periodontal characteristics between the patients with SpA and the control group were performed using univariable analyses. A logistic regression analyses was performed to calculate the OR (95% CI) for diagnosis of periodontitis in patients with SpA and matched controls. Results A diagnosis of periodontitis was established in 56% in patients with SpA versus 69% of healthy controls (P≤ 0.01). Severe periodontitis was found in 3% versus 12% in SpA versus healthy controls, respectively (P≤ 0.01). There was no significant increase of frequency of any periodontal variable, IgG1/IgG2 antibodies against P. gingivalis or the presence of periodontopathic bacteria between patients with SpA and control group. Periodontitis was not positively associated with a diagnosis of SpA (OR: 0.57, 95% CI 0.32 to 1.00, P=0.05) in the logistic regression analyses. Conclusions We found a lower rather than a higher frequency and severity of periodontitis in patients with SpA in comparison with healthy control individuals. Our findings suggest that there is no positive association between SpA and periodontitis in Colombian patients.
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Affiliation(s)
- Wilson Bautista-Molano
- Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia.,Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | | | - Robert Landewé
- Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, The Netherlands.,Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Gloria I Lafaurie
- Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Juliette de Ávila
- Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Rafael Valle-Oñate
- Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia
| | - Consuelo Romero-Sanchez
- Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia.,Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
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13
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Lacout A, Carlier RY, El Hajjam M, Marcy PY. VEGF inhibition as possible therapy in spondyloarthritis patients: Targeting bone remodelling. Med Hypotheses 2017; 101:52-54. [PMID: 28351491 DOI: 10.1016/j.mehy.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 01/26/2017] [Accepted: 02/25/2017] [Indexed: 11/18/2022]
Abstract
Spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases that predominantly affects the axial skeleton, causing pain and stiffness. Human bone is highly dynamic organ that interacts with a wide array cells and tissues. Process of bone remodelling relies on a delicate balance between bone formation and bone resorption, orchestrated by osteoblasts and osteoclasts. Disruption of this homeostatic balance of bone removal and replacement can manifest as inappropriate new bone formation found in spondylarthritis. We hypothesize that VEGF may promote bone remodelling, stimulate angiogenesis, and both osteoclastic and osteoblastic activity. Anti VEGF may be tested as a dedicated therapy to prevent bone remodelling in spondyloarthritis patients, namely in cases of aggressive disease. Bone remodelling could be monitored by using [18F]Fluoride PET scan.
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Affiliation(s)
- Alexis Lacout
- Centre d'imagerie Médicale, 47, Boulevard du Pont Rouge, 15000 Aurillac, France.
| | - Robert Yves Carlier
- Service de Radiologie, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
| | - Mostafa El Hajjam
- Service de Radiologie, Hôpital Ambroise pare (APHP), 9, Avenue Charles De Gaulle, 92100 Boulogne Billancourt, France.
| | - Pierre Yves Marcy
- Radiodiagnostic and Interventional Radiology Department, Polyclinique Les Fleurs, Quartier Quiez, 83190 Ollioules, France.
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14
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Disorders of the Neck and Back. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Leverment S, Clarke E, Wadeley A, Sengupta R. Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review. Rheumatol Int 2016; 37:257-271. [PMID: 27796520 DOI: 10.1007/s00296-016-3589-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022]
Abstract
This review explores the prevalence and factors associated with disturbed sleep for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis in order to clarify consistent findings in this otherwise disparate research field. The association of physical, demographic and psychological factors correlating with poor sleep was explored, and the effectiveness of interventions assessed. Ten electronic databases were searched: AMED, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, OpenGrey and BASE. Following application of inclusion and exclusion criteria, 29 articles were critically assessed on the basis of methodology, experimental design, ethics and quality of sleep data, leading to the selection of 15 studies for final review. Poor sleep was reported in 35-90% of patients with axial spondyloarthritis and is more prevalent within this clinical population compared to healthy control subjects. Disturbed sleep is an important aspect of disease for patients and reflects the severity of disease activity, pain, fatigue and functional disability. However, the direction of this relationship is undetermined. Associations with age, gender, years spent in education, quality of life and depression have also been demonstrated. Anti-TNF medication is effective in reducing poor sleep, and exercise has also produced beneficial results. Future research into poor sleep should take account of its multifactorial nature. There is also a current lack of research investigating non-pharmacological interventions or combination therapies. A standardised, validated measurement of poor sleep, appropriate for regular patient screening, would be a useful first step for future research.
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Affiliation(s)
| | - Emily Clarke
- Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK.
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16
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Abstract
Axial spondyloarthritis (axSpA), a subtype of spondyloarthritis, is a debilitating inflammatory condition involving the spinal and sacroiliac joints, contributing to a significant diminution in quality of life. Historically, characterization of patient outcomes in axSpA has been a challenge due to the lack of data from longitudinal epidemiologic studies and the nonspecific nature of inflammatory laboratory markers to monitor disease activity. In this review, measures developed to address these clinical domains are discussed and compared, of which 3 are commonly used in diagnosis and therapeutic planning. Provider data regarding utilization of these measures are also included to clarify current clinical practice trends.
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Affiliation(s)
- Derek T Nhan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Liron Caplan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
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Chest Expansion and Modified Schober Measurement Values in a Healthy, Adult Population. Arch Rheumatol 2016; 31:145-150. [PMID: 29900960 DOI: 10.5606/archrheumatol.2016.5765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/03/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to demonstrate chest expansion and lumbar mobility using modified Schober measurement values in healthy male and female populations aged 15 and over, and to identify factors affecting these measurements. Patients and methods The prospective study included 444 volunteers (195 males, 249 females; mean age 47.13 years; range 15 to 88 years) from among patients presenting to the Akdeniz University Faculty of Medicine Hospital Physical Medicine and Rehabilitation Clinic. Participants were divided into seven 10-year age groups: group 1: 15-24 years, group 2: 25-34, group 3: 35-44, group 4: 45-54, group 5: 55-64, group 6: 65-74, and group 7: over 75. Exclusion criteria comprised factors potentially influencing spinal mobility and chest expansion. All volunteers' chest measurements were performed in three planes (circumferential with a tape measure, and anteroposteriorly and transversely with calipers) and lumbar mobility was measured using the modified Schober method. The same physician performed the measurements. Results Chest expansion measurements using tape and calipers varied considerably in all age groups and in both sexes. While there was no difference between males and females in circumferential chest expansion measurement, there was a significant difference decrease in both sexes from group 3 and onward. The only difference between the sexes in terms of modified Schober measurement was in group 4, in favor of male sex. Age-related change in both sexes was higher at age 55 and above compared to the young age groups. Conclusion We may conclude that chest expansion measurement in the circumferential plane is sufficient when appropriate conditions are established and provides the most accurate result by permitting measurement in all planes.
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Pan T, Qian BP, Qiu Y. Comparison of Sagittal Spinopelvic Alignment in Patients With Ankylosing Spondylitis and Thoracolumbar Fracture. Medicine (Baltimore) 2016; 95:e2585. [PMID: 26825904 PMCID: PMC5291574 DOI: 10.1097/md.0000000000002585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This article is a comparative study. The aim of the study is to investigate the difference of sagittal alignment of the pelvis and spine between patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) and thoracolumbar fracture, and to evaluate the role of sacropelvic component in AS patients' adaption to the changes in sagittal alignment. Advanced stages of AS are often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology, whereas thoracolumbar fractures may lead to major kyphosis with a potential compromise of the spinal canal, which can cause an abnormal spinopelvic balance. Until now, the comparison of that sagittal alignment between AS and thoracolumbar fracture is not found in the literature. This study included 30 cases of AS and 30 cases of thoracolumbar fracture. Sagittal spinal and pelvic parameters were measured from the standing lateral radiograph, and the following 11 radiological parameters were measured, including global kyphosis (GK), thoracic kyphosis (TK), C7 tilt (C7T), sagittal vertical axis (SVA), spino-pelvic angle (SSA), lumbar lordosis (LL), upper arc of lumbar lordosis (ULL), lower arc of lumbar lordosis (LLL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT), and T9 tilt (T9T). Analysis of variance was used in the comparison of each dependent variable between the 2 cohorts. The relationship between sagittal spinal alignment and pelvic morphology of AS patients was determined via Pearson correlation coefficient (r). Compared with the thoracolumbar fracture group, AS patients had significantly lower C7T, SSA, LL, LLL and SS (78.3° ± 9.3° vs 88.0° ± 2.7°, P < 0.001 for C7T; 91.6° ± 22.7° vs 119.1° ± 9.0°, P < 0.001 for SSA; 20.7° ± 21.0° vs 36.3° ± 16.8°, P = 0.001 for LL; 18.1° ± 11.9° vs 29.0° ± 9.7°, P < 0.001 for LLL; and 18.1° ± 11.9° vs 29.0° ± 9.7°, P < 0.001 for SS), whereas in terms of SVA and PT, AS patients had an obviously higher value than those of thoracolumbar fracture patients (94.5 mm ± 58.4 mm vs 8.0 mm ± 23.3 mm, P < 0.001 for SVA; and 26.5° ± 10.3° vs 17.5° ± 6.6°, P < 0.001 for PT). In AS patients, SS were found to be significantly correlated with SVA, SSA, and LL (r = -0.312, P < 0.05 for SVA; r = 0.475, P < 0.05 for SSA; r = 0.809, P < 0.001 for LL). In our study, there were significant differences in sagittal alignment of the pelvis and spine between patients with AS and thoracolumbar fracture, and changes in pelvic morphology compensated more in AS patients for a thoracolumbar kyphosis. These findings may be helpful for better understanding of sagittal alignment in patients with thoracolumbar kyphosis secondary to AS.
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Affiliation(s)
- Tao Pan
- From the Medical School of Southeast University (TP); and Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China (B-PQ, YQ)
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Ghasemi-rad M, Attaya H, Lesha E, Vegh A, Maleki-Miandoab T, Nosair E, Sepehrvand N, Davarian A, Rajebi H, Pakniat A, Fazeli SA, Mohammadi A. Ankylosing spondylitis: A state of the art factual backbone. World J Radiol 2015; 7:236-252. [PMID: 26435775 PMCID: PMC4585948 DOI: 10.4329/wjr.v7.i9.236] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/04/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.
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The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity. Best Pract Res Clin Rheumatol 2015; 29:512-23. [PMID: 26612245 DOI: 10.1016/j.berh.2015.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory condition that has a significant impact on the quality of life and work productivity. New classification criteria have enabled earlier diagnosis of this condition. However, work productivity is an important issue that is still often overlooked during clinical assessments and consultations. This article focusses on the relationship between axial spondyloarthritis (axial SpA) and work productivity. It summarises the impact of this condition on work productivity, and it highlights the tools available to assess this. It also highlights the increasing role and potential of employers, health professionals and new treatments for enhancing work productivity for people with this condition.
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Performance of ultrasound to monitor Achilles enthesitis in patients with ankylosing spondylitis during TNF-a antagonist therapy. Clin Rheumatol 2015; 34:1073-8. [DOI: 10.1007/s10067-015-2939-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 03/24/2015] [Accepted: 04/11/2015] [Indexed: 01/26/2023]
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Disorders of the Neck and Back. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Migliore A, Bizzi E, Bernardi M, Picchianti Diamanti A, Laganà B, Petrella L. Indirect Comparison Between Subcutaneous Biologic Agents in Ankylosing Spondylitis. Clin Drug Investig 2014; 35:23-9. [DOI: 10.1007/s40261-014-0246-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gyurcsik Z, Bodnár N, Szekanecz Z, Szántó S. Treatment of ankylosing spondylitis with biologics and targeted physical therapy: positive effect on chest pain, diminished chest mobility, and respiratory function. Z Rheumatol 2014; 72:997-1004. [PMID: 23929243 DOI: 10.1007/s00393-013-1240-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Biologics are highly effective in ankylosing spondylitis (AS). In this self-controlled study, we assessed the additive value of complex physiotherapy in decreasing chest pain and tenderness and improving respiratory function in AS patients treated with tumor necrosis factor α (TNF-α) inhibitors. PATIENTS AND METHODS The trial consisted of 2 parts. In study I, clinical data of AS patients with (n=55) or without biological therapy (n=20) were retrospectively analyzed and compared. Anthropometrical data, duration since diagnosis and patient assessment of disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. In study II, 10 voluntary patients (6 men and 4 women, age 52.4 ± 13.6 years) with definite AS and receiving anti-TNF therapy were recruited. It was a prospective, non-randomized physiotherapeutic trial. BASFI (Bath Ankylosing Spondylitis Functional Index), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), modified Schober Index, occiput-to-wall distance, and fingertip-to-floor distance were evaluated. Forced vital capacity, forced 1-s expiratory volume, peak expiratory flow, and maximum voluntary ventilation were recorded. Furthermore, typical tender points were recorded. A targeted physiotherapy program was conducted twice a week for 12 weeks and all above parameters were recorded at baseline and after 12 weeks. RESULTS Differences in patient assessment of disease activity (p=0.019) and pain intensity (p=0.017) were found in study I. Pain and tenderness of the thoracic spine were observed in both groups. Back pain without biologic therapy was slightly higher than other group. In study II, we found that patient assessment of disease activity and pain intensity significantly improved after the physical therapy program (p=0.002 and p<0.001). BASFI and BASDAI increased after treatment (p=0.004 and p<0.001). The finger-to-floor distance, chest expansion, and modified Schober index increased (p=0.008, p<0.001, and p=0.031, respectively). The respiratory functional parameters showed a tendency towards improvement. CONCLUSION AS patients already receiving biological therapy may benefit from additional targeted physiotherapy. Physical therapy may be of important additive value in AS patients being treated with biological. The exercise program presented here showed an improvement in functional parameters as well as spine and chest mobility, thereby enhancing the favorable effects of biological therapy.
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Affiliation(s)
- Z Gyurcsik
- Department of Physiotherapy, University of Debrecen Medical and Health Sciences Center, Debrecen, Hungary
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Jamshidi AR, Shahlaee A, Farhadi E, Fallahi S, Nicknam MH, Bidad K, Barghamadi M, Mahmoudi M. Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis. Mod Rheumatol 2013; 24:499-504. [DOI: 10.3109/14397595.2013.844302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chilton-Mitchell L, Martindale J, Hart A, Goodacre L. Normative values for the Bath Ankylosing Spondylitis Metrology Index in a UK population. Rheumatology (Oxford) 2013; 52:2086-90. [PMID: 23962624 DOI: 10.1093/rheumatology/ket272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Spinal mobility is assessed frequently in patients with AS/axial SpA using the BASMI to provide baseline measurement and monitor change over time. The interpretation of BASMI scores has been hindered by the absence of normative values. We aimed to obtain normative values for the BASMI in healthy men and women in a UK population. METHODS A cross-sectional study of 168 volunteers stratified by gender and age was completed. Exclusion criteria comprised factors potentially influencing spinal mobility. Each component of the BASMI was assessed, with the total score computed using the 10-point scoring system. Measurements were taken by physiotherapists following an agreed protocol. Data were summarized and analysed with age-specific centiles and CIs calculated. RESULTS Total BASMI scores ranged from 0 to 4.4, with only 1.2% of the sample having a score of 0. The estimated median score for an individual age 25 years was 0.9, increasing with age to 2.1 for an individual age 65 years. There was a corresponding increase in component BASMI scores, which was more pronounced for some components than others. CONCLUSION Our data indicate that it is unusual for healthy individuals to score zero on the BASMI, which has implications for the interpretation of scores, especially at baseline. The generation of normative values has the potential to inform clinical assessment of spinal mobility and assist patients in understanding how their spinal mobility compares with that of a healthy age-matched population.
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Affiliation(s)
- Lucy Chilton-Mitchell
- Physiotherapy Department, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK. E-mail
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Navallas M, Ares J, Beltrán B, Lisbona MP, Maymó J, Solano A. Sacroiliitis Associated with Axial Spondyloarthropathy: New Concepts and Latest Trends. Radiographics 2013; 33:933-56. [DOI: 10.1148/rg.334125025] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Keller JJ, Kang JH, Lin HC. Association between ankylosing spondylitis and chronic periodontitis: A population-based study. ACTA ACUST UNITED AC 2012; 65:167-73. [DOI: 10.1002/art.37746] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/04/2012] [Indexed: 11/07/2022]
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Loss of Correction in the Treatment of Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis. ACTA ACUST UNITED AC 2012; 25:383-90. [DOI: 10.1097/bsd.0b013e318224b199] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Migliore A, Broccoli S, Bizzi E, Laganà B. Indirect comparison of the effects of anti-TNF biological agents in patients with ankylosing spondylitis by means of a mixed treatment comparison performed on efficacy data from published randomised, controlled trials. J Med Econ 2012; 15:473-80. [PMID: 22335398 DOI: 10.3111/13696998.2012.660255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare ASAS (Assessment in Ankylosing Spondylitis Response Criteria), 20 response patterns between anti-TNF biological agents in patients with ankylosing spondylitis by means of a mixed treatment comparison of different randomized, controlled trials (RCTs) on the efficacy of biological therapies. METHODS A systematic review of literature was performed to identify a number of similarly designed double-blind, randomized, placebo-controlled trials investigating the efficacy of the TNF-α inhibitors etanercept, infliximab, and adalimumab in the treatment of ankylosing spondylitis patients, conducted over an 18-year period. The end-point of interest was ASAS20 response criteria at 24 weeks. Results were analyzed simultaneously using Bayesian mixed treatment comparison techniques. Results were expressed as odds ratio (OR) of ASAS20 response and associated 95% credible intervals (CrIs). The probability of being the best treatment was also reported. RESULTS Three RCTs were selected for data extraction and further analysis. By mean of MTC, all anti-TNF agents demonstrated to be more efficacious in inducing an ASAS20 response than placebo. Infliximab shows a 72% probability of being the best treatment of all. Adalimumab and etanercept show probabilities of 13% and 15%, respectively. No differences were observed when comparing directly an anti-TNF-α agent against another. When compared with placebo, Infliximab increases the probability of response by ∼7-times (OR = 6.8), Adalimumab by ∼4-times (OR = 4.4), and Etanercept by 5-times (OR = 4.9). Differences in trials procedures, the use of a fixed-effect model, and the small number of trials included represent limitations of this study CONCLUSIONS Even if the mixed treatment comparisons between infliximab, adalimumab, and etanercept did not show a statistically significant difference, this analysis suggests that infliximab, compared to placebo, is expected to provide the highest rate of ASAS20 response in SA patients naive to biologic treatments.
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Affiliation(s)
- A Migliore
- Rheumatology Unit, and Research Center, S. Pietro Fatebenefratelli Hospital, Rome, Italy
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Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis. Rheumatol Int 2011; 32:1711-20. [DOI: 10.1007/s00296-011-1852-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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Abstract
STUDY DESIGN In all, 4 cases of the coexistence of congenital spinal deformity (CSD) and ankylosing spondylitis (AS) were reviewed. OBJECTIVE To provide an insight into the unusual association between CSD and AS. SUMMARY OF BACKGROUND DATA CSD combined with musculoskeletal anomalies, including clubfeet, Sprengel deformity, Klippel-Feil syndrome, and developmental dysplasia of the hip, has been described in the literature. Additionally, the rare coexistence between AS and other inflammatory joint diseases, such as systemic lupus erythematosus, mixed connective tissue disease, or Behçet disease, has also been reported. However, to the authors' knowledge, the coexistence of CSD and AS has not been described in the literature. METHODS In all, 4 patients presented with symptoms of lower back pain for at least 1 year. Among them, 3 patients (cases 1, 2, and 3) were initially diagnosed as CSD, and classified as butterfly vertebra in 2 patients (case 1, case 3), incarcerated hemivertebra in 1 patient (case 2). Furthermore, a diagnosis of coexistence of CSD and AS was proposed in these 3 cases with a delay in the diagnosis of AS for 1 to 10 years. The fourth patient sought initial medical attention in our hospital without delay in diagnosis. In case 1, polysegmental Smith-Petersen osteotomy and transpedicular fixation were performed, and drugs were administrated. Case 2, case 3, and case 4 were treated with amethopterin, folic acid, salicylazosulfapyridine, and celecoxib. RESULTS At the latest follow-up, 4 patients had no back pain and were satisfied with the outcome. CONCLUSION The coexistence of CSD and AS is very rare. However, it is necessary to consider the diagnosis of AS in CSD patients who present with symptoms such as inflammatory low back pain, morning stiffness, loss of global sagittal balance, and other clinical features can not be exclusively explained by CSD solely.
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O'Shea FD, Riarh R, Anton A, Inman RD. Assessing back pain: does the Oswestry Disability Questionnaire accurately measure function in ankylosing spondylitis? J Rheumatol 2010; 37:1211-3. [PMID: 20395642 DOI: 10.3899/jrheum.091240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether the Oswestry Disability Questionnaire (ODQ) can be used to assess the degree of pain or disability in patients with ankylosing spondylitis (AS). METHODS The ODQ was administered to a cohort of patients with AS. The resulting pain scores were correlated to the conventional measures in AS, the Bath AS Disease Activity Index and Functional Index (BASDAI and BASFI), as well as the Total and Nocturnal Back Pain scores, and the patient global assessment score. RESULTS A total of 49 patients with AS were assessed (38 men, 11 women), mean age 40 years (range 17-68). The mean ODQ score was 40/100 (range 0-92), the mean BASDAI 3.7/10 (range 0-9.5), the mean BASFI 3.3/10 (range 0-9.7), the mean total back pain score 3.7/10 (range 0-10), and the mean patient global assessment score 3.6/10 (range 0-10). Correlation between the ODQ and the traditional AS outcome measures was very good, with a correlation coefficient of r = 0.73 (BASFI) and r = 0.70 (BASDAI). Correlations between the ODQ and the total back pain score (r = 0.70) and the patient self-reported global assessment (r = 0.61) were good. CONCLUSION The strong correlations between the ODQ and BASFI and BASDAI indicate that it identifies both activity and function domains in AS. This is the first demonstration of a role for this outcome measure in the assessment of patients with AS.
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Affiliation(s)
- Finbar D O'Shea
- Division of Rheumatology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
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Chandran V, Barrett J, Schentag CT, Farewell VT, Gladman DD. Axial psoriatic arthritis: update on a longterm prospective study. J Rheumatol 2009; 36:2744-50. [PMID: 19884276 DOI: 10.3899/jrheum.090412] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate changes in symptoms, spinal mobility, and radiographic features in patients with axial psoriatic arthritis (AxPsA). METHODS Patients with AxPsA were identified from the University of Toronto Psoriatic Arthritis clinic database. Axial symptoms, metrology, and radiographic features at study entry were compared to 5-year and 10-year followup assessments. Data were analyzed using continuity adjusted McNemar's test, an exact binomial test, or logistic regression. RESULTS Of 297 patients (mean age 42.5 yrs, PsA duration 8 yrs) in the study, 56% had axial symptoms, 43% had radiographic evidence of sacroiliitis, and 13% had syndesmophytes at entry. The number of patients with neck/back pain, neck/back stiffness, and clinical sacroiliitis declined significantly at both 5- and 10-year followup periods. There was a significant increase in the number of patients with restricted cervical spinal mobility at both 5- and 10-year visits and significant reduction in lateral flexion at both timepoints. At 5 (10) years, of those without sacroiliitis at baseline, 36.6% (51.7%) developed at least grade 2 sacroiliitis; 46.5% (52.0%) of those who presented with grade 2 progressed to a higher grade; and 15.6% (25.0%) with grade 3 progressed to grade 4 sacroiliitis. Of the patients without cervical/thoracic/lumbar syndesmophytes at study entry, 11%/16%/14% (14%/21%/20%) developed syndesmophytes in these regions at 5 (10) year followup. Similar results were obtained when analyses were restricted to patients satisfying radiographic criteria alone. CONCLUSION Over a 10-year period, patients with AxPsA had improvement in neck and back pain, but lateral spinal flexion and cervical mobility deteriorated.
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Affiliation(s)
- Vinod Chandran
- Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol 2009; 28:1199-205. [PMID: 19618098 DOI: 10.1007/s10067-009-1227-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 05/11/2009] [Accepted: 06/27/2009] [Indexed: 02/08/2023]
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CT and MRI of Spine and Sacroiliac Involvement in Spondyloarthropathy. AJR Am J Roentgenol 2008; 191:1016-23. [DOI: 10.2214/ajr.07.3446] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gao P, Lu C, Zhang F, Sang P, Yang D, Li X, Kong H, Yin P, Tian J, Lu X, Lu A, Xu G. Integrated GC–MS and LC–MS plasma metabonomics analysis of ankylosing spondylitis. Analyst 2008; 133:1214-20. [DOI: 10.1039/b807369d] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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