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Khalaji A, Kolahi S, Ghadakchi L, Jafarpour M. Axonal sensory-motor polyneuropathy in ankylosing spondylitis: A case report. Clin Case Rep 2023; 11:e8038. [PMID: 37822484 PMCID: PMC10562650 DOI: 10.1002/ccr3.8038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
Key Clinical Message In ankylosing spondylitis cases, axonal-type sensory-motor polyneuropathy is a rare manifestation and should be considered an underlying etiology in patients with unexplained neuropathy. Abstract This case report discusses a 45-year-old male diagnosed with ankylosing spondylitis (AS), a chronic inflammatory disorder affecting the axial skeleton and peripheral joints. The patient presented with polyneuropathy, characterized by tingling and numbness in the upper and lower limbs, which is an uncommon manifestation of AS. After undergoing various tests, including CT scans and EMG-NCV, no secondary cause for the neuropathy was identified; AS was considered the etiology of the patient's axonal-type sensory-motor polyneuropathy.
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Affiliation(s)
- Amirreza Khalaji
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Susan Kolahi
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Leyla Ghadakchi
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mehdi Jafarpour
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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Galal S, Hassan RM, Labib HSA. Association of vascular endothelial growth factor serum levels with ankylosing spondylitis in Egyptian patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background
Ankylosing spondylitis (AS) is one of inflammatory rheumatic diseases which result in wide range of manifestations on the musculoskeletal system and axial joint specifically. Endothelial cell migration and proliferation, as well as subsequent neoangiogenesis and remodelling in autoimmune disorders, are pathogenic mechanisms that are fundamental to inflammation activation and angiogenesis. The development of advanced lesions is thought to involve vascular proliferation as well as vascular endothelial growth factor (VEGF), which serves a regulatory role. It was found that AS patients had increased serum levels of VEGF, which were linked to the disease activity.
Aim of the work
The purpose of this study is to measure serum VEGF levels in Egyptian AS patients and assess their relation to disease-related variables, including radiographic findings.
Results
VEGF serum levels showed a highly significant positive correlation with Bath Ankylosing Spondylitis Functional Index (BASFI) and modified Stroke Ankylosing Spondylitis Spinal Score (MSASS) (p < 0.001); also, there was a significant correlation between the VEGF values and the Ankylosing Spondylitis Disease Activity Index (ASDAS) and the New York x-ray sacroiliac score.
Conclusions
These findings and data illustrate the strong relationship between ASDAS and VEGF and the radiographic score in AS patients. ASDAS combined with VEGF not only is considered a tool for determining the level of disease activity only but also is considered as an indicator for the assessment of the syndesmophytes formation, which performs a crucial role in the prognosis and outcome in AS patients.
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Zhou L, Li T, Wu X, Lu H, Lin L, Ye L, Yin J, Zhao J, Wang X, Bian J, Xu H. Assessment of Neuropathic Pain in Ankylosing Spondylitis: Prevalence and Characteristics. Pain Ther 2021; 10:1467-1479. [PMID: 34482533 PMCID: PMC8586434 DOI: 10.1007/s40122-021-00310-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pain in ankylosing spondylitis is currently considered an inflammatory pain (IP). However, it was found that some patients still had the sensation of pain even without inflammation. Our study was to investigate the prevalence and characteristics of neuropathic pain (NeP) in Chinese Han ankylosing spondylitis (AS) patients. METHODS The study consisted of three parts. Firstly, we assessed the prevalence and clinical data of NeP in 182 AS patients. Secondly, we evaluated pain improvement after etanercept therapy in 63 patients. Finally, serum neurotransmitters were measured for 20 AS patients and ten healthy controls (HC). RESULTS Out of 182 AS patients, our study showed that 14 patients (7.70%) had likely NeP and 55 (30.21%) had uncertain NeP. There were significant differences among the three groups with respect to nocturnal pain (NP), peripheral pain (PP), total back pain (TBP), BASDAI, ASDAS-CRP, HAD-A, HAD-D, and BASDAI-fatigue except fort CRP concentrations. Principal component analysis (PCA) of AS pain revealed that the weight of NeP was greater than PP in the first principal component (0.703 vs. 0.639). Structural equation modeling (SEM) revealed that NeP altered disease activity (β = 0.62, P < 0.001), which influenced psychological status (β = 0.42, P < 0.001). Of 63 patients who used etanercept for 3 months, significant improvement was found in NP, TBP, and PP (all P < 0.0001) but not in PDQ (10.60 ± 6.85 vs. 9.98 ± 6.40, P = 0.0671). Serum norepinephrine concentrations in patients with PDQ > 19 were higher than those in patients with PDQ ≤ 19 and HC. CONCLUSIONS We conclude that NeP contributes to pain in AS patients.
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Affiliation(s)
- Ling Zhou
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Hongjuan Lu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Lingying Ye
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jian Yin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Juan Zhao
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xiuwen Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jianye Bian
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
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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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Czuczman GJ, Mandell JC, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Cassidy RC, Demertzis JL, Garner HW, Klitzke A, Maynard JR, Pierce JL, Reitman C, Thiele R, Yost WJ, Beaman FD. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021; 18:S340-S360. [PMID: 34794593 DOI: 10.1016/j.jacr.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacob C Mandell
- Research Author, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Musculoskeletal Fellowship Director; and Chair, REiNS Whole Body MRI Committee, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Board of Directors, American College of Nuclear Medicine; Board of Directors, SNMMI Correlative Imaging Council; and Delegate, American Medical Association House of Delegates
| | - Jennifer R Maynard
- Program Director Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Medical Advisor Women's Tennis Association; Vice-Chair, Jacksonville Sports Medicine Program Executive Board; Chair, Florida High School Athletic Association Sports; and Medicine Advisory Committee
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York, American College of Rheumatology
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa, American College of Physicians
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Liu L, Yuan Y, Zhang S, Xu J, Zou J. Osteoimmunological insights into the pathogenesis of ankylosing spondylitis. J Cell Physiol 2021; 236:6090-6100. [PMID: 33559242 DOI: 10.1002/jcp.30313] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022]
Abstract
Ankylosing spondylitis (AS) is inflammatory arthritis predominantly affecting the spine, which is involved in the disorders of both immune and skeletal systems. The exact pathogenesis of AS is not fully understood. Osteoimmunology is a new subject of study in inflammatory arthritis, in particular the pathogenic events involved in the cross-regulation of both skeletal and immune systems. In this review, we discuss osteoimmunological and pathological changes of AS in the spine that are characterized by altered osteogenesis and osteolytic bone destruction, accompanied by the changes of the immune system. It was revealed that bone cells like mesenchymal stem cells, osteoblast, and osteoclast in crossing talking with immune cells such as T cells, B cells coregulate to the pathogenesis of AS. Further, an array of cytokines and molecules expressed by both skeletal and immune systems contribute to these complex interplays. Understanding the cellular and molecular mechanisms underlying the pathogenesis of AS will lay a foundation for the exploration of the potential new treatment to AS.
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Affiliation(s)
- Lifei Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation, The People's Hospital of Liaoning Province, Shenyang, China
| | - Yu Yuan
- School of Sport and Health, Guangzhou Sport University, Guangzhou, China
| | - Shihua Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jiake Xu
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jun Zou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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7
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Huang Y, Chen Y, Liu T, Lin S, Yin G, Xie Q. Impact of tumor necrosis factor α inhibitors on MRI inflammation in axial spondyloarthritis assessed by Spondyloarthritis Research Consortium Canada score: A meta-analysis. PLoS One 2020; 15:e0244788. [PMID: 33382842 PMCID: PMC7775088 DOI: 10.1371/journal.pone.0244788] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023] Open
Abstract
Spondyloarthritis Research Consortium Canada (SPARCC) score is an effective magnetic resonance imaging (MRI) evaluation method for inflammation in axial spondyloarthritis. Previously published meta-analyses have shown tumor necrosis factor α inhibitors (TNFi) had great effectiveness on improving disease activity and function in axial spondyloarthritis. However, there still has no one that concentrates on the impact of TNFi on MRI inflammation. We conduct a meta-analysis to summarize the impact of TNFi on MRI inflammation in axial spondyloarthritis using SPARCC score. Comprehensive search was conducted in the databases of OVID Medline, OVID EMBASE, and Cochrane library on November 14, 2020. We investigated the differences in SPARCC score of sacroiliac joint and spine, before and after TNFi treatment in patients with axial spondyloarthritis. SPARCC score was further compared in the subgroup by diagnostic category and TNFi types. In addition, clinical assessment indicators including ankylosing spondylitis disease activity score, bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, c-reactive protein were also analyzed. Data were pooled by mean differences (MD) with 95% confidence intervals (CI) and publication bias was assessed by Egger’s test. Jadad scale was applied to assess the quality of included trials. Compared with control group, TNFi significantly improved SPARCC score of sacroiliac joints (n = 11, MD = 2.86, 95% CI 2.50, 3.23) and spine (n = 5, MD = 1.87,95%CI 1.27, 2.46). This effect was consistent among subgroups by different diagnostic category (ankylosing spondylitis, non-radiographic axial spondyloarthritis) and TNFi types (adalimumab, certolizumab pegol). Analysis of clinical assessment indicators also confirmed the therapeutic effect on axial spondyloarthritis. Egger’s test suggested no possibility of publication bias. This meta-analysis shows that TNFi are effective to improve MRI inflammation in patients with axial spondyloarthritis and the treatment effectiveness is not affected by diagnostic category and TNFi types.
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Affiliation(s)
- Yupeng Huang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sang Lin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Geng Yin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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8
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Anti-IL-17A treatment reduces serum inflammatory, angiogenic and tissue remodeling biomarkers accompanied by less synovial high endothelial venules in peripheral spondyloarthritis. Sci Rep 2020; 10:21094. [PMID: 33273664 PMCID: PMC7713433 DOI: 10.1038/s41598-020-78204-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (SpA) is characterized by inflammation and new bone formation. The exact pathophysiology underlying these processes remains elusive. We propose that the extensive neoangiogenesis in SpA could play a role both in sustaining/enhancing inflammation and in new bone formation. While ample data is available on effects of anti-TNF on angiogenesis, effects of IL-17A blockade on serum markers are largely unknown. We aimed to assess the impact of secukinumab (anti-IL-17A) on synovial neoangiogenesis in peripheral SpA, and how this related to changes in inflammatory and tissue remodeling biomarkers. Serum samples from 20 active peripheral SpA patients included in a 12 week open-label trial with secukinumab were analyzed for several markers of angiogenesis and tissue remodeling. Synovial biopsies taken before and after treatment were stained for vascular markers. Serum levels of MMP-3, osteopontin, IL-6 (all P < 0.001), IL-31, S100A8, S100A9, Vascular Endothelial Growth Factor A (VEGF-A), IL-33, TNF-α (all P < 0.05) decreased significantly upon anti-IL17A treatment. Secukinumab treatment resulted in a decrease in the number of synovial high endothelial venules and lymphoid aggregate score. These results indicate that anti-IL-17A not only diminishes inflammation, but also impacts angiogenesis and tissue remodeling/new bone formation. This may have important implications for disease progression and/or structural damage.
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9
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Zou YC, Yan LM, Gao YP, Wang ZY, Liu G. miR-21 may Act as a Potential Mediator Between Inflammation and Abnormal Bone Formation in Ankylosing Spondylitis Based on TNF-α Concentration-Dependent Manner Through the JAK2/STAT3 Pathway. Dose Response 2020; 18:1559325819901239. [PMID: 32009856 PMCID: PMC6974759 DOI: 10.1177/1559325819901239] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To explore the role of microRNA (miR-21) in new bone formation in ankylosing
spondylitis (AS) as mediated by different concentration of tumor necrosis
factor-α (TNF-α). Methods: Fibroblasts isolated from the hips of patients with AS were induced to
osteogenesis. These cells were then stimulated with varying concentrations
of TNF-α. MicroRNA-21 expressions were evaluated using reverse
transcription–polymerase chain reaction (RT-PCR) and osteogenesis was
detected via Alizarin Red S (ARS) staining and measurement of alkaline
phosphatase (ALP) activity. Relative expressions of p-STAT3, Nuclear STAT3,
cytoplasm STAT3, Runx2, BMP2, osteopontin, osteocalcin, and LC3B in AS
fibroblasts were measured after exposure to different concentrations of
TNF-α. The STAT3-inhibiting small interfering RNA allowed further
exploration on its impact on miR-21 and primary miR-21 expressions. A
proteoglycan-induced arthritis (PGIA) Balb/c mouse model was established in
order to monitor sacroiliac joint (SIJ) inflammation and subsequent damage
through magnetic resonance image. Serum miR-21 and TNF-α expressions were
evaluated using RT-PCR and enzyme-linked immunosorbent assay. At week 16,
mice models were transfected intravenously with miR-21 overexpressing agomir
and miR-21 inhibiting antagomir for 7 successive days. The rate of abnormal
bone formation at SIJ was evaluated using microcomputed tomography and
hematoxylin and eosin staining at week 24. Western blot analysis enabled
quantification of STAT-3, JAK-2, and interleukin (IL)-17A expressions
present in the SIJ. Results: The in vitro miR-21 expression and osteogenesis activity were noted to be
augmented in the setting of low TNF-α concentrations (0.01-0.1 ng/mL) while
they were depressed in settings with higher TNF-α concentrations (1-10
ng/mL). Samples with the most distinct ARS manifestation and ALP activity as
well as the highest miR-21 expressions were those who received 0.1 ng/mL of
TNF-α. Primary miR-21 was found to be notable raised by Si-STAT3, while the
converse effect was seen in mature miR-21 expressions. Intravenous injection
of exogenous miR-21 contributed to new bone formation and significantly
elevated expressions of STAT3, JAK2, and IL-17 in PGIA mice. Conclusions: The results revealed that miR-21 may act as a potential mediator between new
bone formation and inflammation in AS.
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Affiliation(s)
- Yu-Cong Zou
- Department Of Rehabilitation Medicine, The Third Affiliated
Hospital, Southern Medical University, Guang Zhou, Guangdong Province, China
| | - Li-Man Yan
- Guangzhou University of Chinese Medicine, Guang Zhou, Guangdong
Province, China
| | - Yan-Ping Gao
- Department of TCM Orthopedics & Traumatology, The Third
Affiliated Hospital, Southern Medical University, Guang Zhou, Guangdong Province,
China
| | - Zhi- Yun Wang
- ShunDe Hospital, Southern Medical University, FoShan, Guangdong
Province, China
| | - Gang Liu
- Department Of Rehabilitation Medicine, The Third Affiliated
Hospital, Southern Medical University, Guang Zhou, Guangdong Province, China
- Gang Liu, Department of Rehabilitation, The
Third Affiliated Hospital, Southern Medical University, Zhongshan Road West, No.
183, Tianhe District, Guang Zhou, 510630, China.
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10
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Andersen T, Østgård RD, Aspari MP, Kragstrup TW, Glerup H, Jurik AG, Johansen C, Hvid M, Deleuran BW. Anti-tumor necrosis factor treatment increases both the Th17 and Th22 T helper subsets in spondyloarthritis. APMIS 2019; 127:789-796. [PMID: 31512766 DOI: 10.1111/apm.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/23/2019] [Indexed: 12/26/2022]
Abstract
The aim was to examine anti-tumor necrosis factor α (anti-TNFα) therapy influence changes on Th17 and Th22 cells in patients with spondyloarthritis (SpA), and its correlation with changes in clinical and magnetic resonance imaging (MRI) activity and chronicity scores. The Th17 and Th22 cells were assessed at baseline, after 12 and 52 weeks of anti-TNFα therapy by flow cytometry (ClinicalTrials.gov NCT4682724). The percentages of both Th17 and Th22 cells were increased by 70% at baseline compared with healthy controls (both p < 0.01). During treatment, these two subsets increased further to be 170% (Th17) and 123% (Th22) above levels in healthy controls (both p < 0.01). The same subsets decrease their expression of IL-23R significantly during the observation period (p < 0.05). High levels of Th17 and Th22 cells at baseline were associated with the degree of chronic changes in the sacroiliac joints on MRI and a good clinical response to anti-TNFα treatment after one year. Plasma levels were not associated with clinical changes. Th17 cells, and Th22 subsets, increased during one year of anti-TNF-α therapy in SpA, regardless of their clinical improvement. This supports that both the Th17 and Th22 subsets could be involved in the progression in SpA.
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Affiliation(s)
- Thomas Andersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - René Drage Østgård
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | | | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Glerup
- Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Johansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Dermatology and Venerology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hvid
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bent Winding Deleuran
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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11
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Lim DH, Lee EJ, Kwon OC, Hong S, Lee CK, Yoo B, Youn J, Kim TH, Kim YG. Effect of tumor necrosis factor inhibition on spinal inflammation and spinal ankylosis in SKG mice. Sci Rep 2019; 9:18000. [PMID: 31784598 PMCID: PMC6884438 DOI: 10.1038/s41598-019-54549-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
To prevent spinal progression in ankylosing spondylitis, initiating TNF-inhibitor treatment as early as possible is suggested. However, the outcomes are inconsistent in previous clinical studies. Here, we investigated the effect of TNF inhibition alone on spinal progression when used during arthritis development in a murine model. We injected 8-week-old SKG mice with curdlan (curdlan group). We injected adalimumab at 3 and 9 weeks after the first curdlan injection (ADA group). The clinical scores of peripheral arthritis decreased in the ADA group at 3 weeks after first adalimumab injection. Using positron emission tomography–magnetic resonance imaging and histologic examination, spinal inflammation was observed in the curdlan group, and was significantly deceased in the ADA group. However, spinal osteoblast activities by imaging using OsteoSense 680 EX and bone metabolism-related cytokines such as receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, Dickkopf-1, and sclerostin levels except IL-17A level were not different between the two groups. We conclude that treating TNF inhibitor alone reduced peripheral arthritis score and spinal inflammation in curdlan-injected SKG mice but did not decrease the spinal osteoblast activity, suggesting little effect on spinal ankylosis.
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Affiliation(s)
- Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun-Ju Lee
- Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
| | - Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeehee Youn
- Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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12
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Tužil J, Mlčoch T, Jirčíková J, Závada J, Nekvindová L, Svoboda M, Uher M, Křístková Z, Vencovský J, Pavelka K, Doležal T. Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry. Expert Opin Biol Ther 2019; 20:183-192. [PMID: 31736377 DOI: 10.1080/14712598.2020.1694900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Lucie Nekvindová
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Faculty of Medicine of the Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Zlatuše Křístková
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Jiří Vencovský
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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13
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Poddubnyy D, Amital H, Rubbert-Roth A. Should we combine biologics with methotrexate in axial spondyloarthritis? Autoimmun Rev 2019; 18:102402. [PMID: 31669544 DOI: 10.1016/j.autrev.2019.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
| | - Howard Amital
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.
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14
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Yang J, Xu S, Chen M, Yuan Y, Zhang X, Ma Y, Wu M, Han R, Hu X, Liu R, Deng J, Guan S, Gao X, Pan M, Xu S, Shuai Z, Jiang S, Guan S, Chen L, Pan F. Serum Sclerostin and Bone Morphogenetic Protein-2 Levels in Patients with Ankylosing Spondylitis: A Meta-Analysis. Calcif Tissue Int 2019; 105:37-50. [PMID: 30911810 DOI: 10.1007/s00223-019-00542-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 12/17/2022]
Abstract
Various studies have investigated the serum sclerostin and bone morphogenetic protein-2 (BMP-2) levels in patients with ankylosing spondylitis (AS), but the results were inconsistent. The aim of this meta-analysis was to synthetically assess the associations of serum levels of sclerostin and BMP-2 with AS. Multiple electronic databases were searched to locate relevant articles published before November 2018. Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by the random-effect model. Totally, 21 studies were included. Meta-analysis results showed no significant difference between AS group and control group in serum sclerostin levels (SMD = 0.098, 95% CI - 0.395 to 0.591, p = 0.697). Nevertheless, serum BMP-2 levels in AS patients were higher than that in controls (SMD = 1.184, 95% CI 0.209 to 2.159, p = 0.017). Subgroup analysis demonstrated that European and South American AS patients had lower serum levels of sclerostin than controls. AS patients with age ≥ 40 years, erythrocyte sedimentation rate (ESR) ≤ 20 mm/h and Bath Ankylosing Spondylitis Functional Index (BASFI) < 4 had statistically significant lower serum sclerostin concentrations compared to controls. Chinese and Korean AS patients as well as patients with lower CRP had higher serum BMP-2 levels than controls, and country may be a source of heterogeneity across the studies. No publication bias existed and sensitivity analysis confirmed the stability of results. Serum BMP-2, but not sclerostin levels may be closely related to the development of AS.
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Affiliation(s)
- Jiajia Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Mengya Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Yaping Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Meng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Renfang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xingxing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Rui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Jixiang Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Shiyang Guan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Meijuan Pan
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China
| | - Shengqian Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China
| | - Shanqun Jiang
- School of Life Sciences, Anhui University, 111 Jiulong Road, Hefei, 230601, People's Republic of China
| | - Shihe Guan
- Department of Clinical Laboratory, The Second Hospital of Anhui Medical University, NO. 678#, Furong Road, Hefei, 230601, Anhui, People's Republic of China
| | - Liwen Chen
- Department of Clinical Laboratory, The Second Hospital of Anhui Medical University, NO. 678#, Furong Road, Hefei, 230601, Anhui, People's Republic of China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
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