No increased risk of alopecia in ankylosing spondylitis patients: A population-based cohort study in Taiwan

Validation of diagnosis algorithms for ankylosing spondylitis in claim-based database

BACKGROUND

Claims-based algorithms using International Classification of Diseases (ICD) codes have become a common approach for researchers to define ankylosing spondylitis (AS) in studies. To address potential misclassification bias caused by the claim-based algorithms, we conducted the current study to validate whether these algorithms of medical claims could accurately represent AS diagnoses.

METHODS

Patients diagnosed with AS based on ICD codes were retrieved from the electronic medical records database at a Taiwanese medical center (Chung Shan University Hospital, Taiwan). After random sampling and stratification based on age and sex, the medical information of participants was appraised based on the 2009 ASAS guideline to evaluate the actual status of ICD codes claim-based AS patients. Positive predict values (PPV) of different algorithms of ICD codes were also calculated.

RESULTS

Within the 4160 patients with claim-based AS diagnosis, 387 eligible patients were finally included in the study design after random sampling. The PPV of the diagnostic algorithm of having at least 4 outpatient or 1 inpatient ICD record was 72.77 (95% CI, 66.79-78.75), whereas the PPV increased to 85.64 when the diagnoses were restricted to be made by rheumatologists (95% CI, 80.53-90.74).

CONCLUSIONS

While performing database studies, researchers should be aware of the low PPV of specific algorithms when defining AS. Algorithms with higher PPV were recommended to be adopted to avoid misclassification biases.

Mitochondrial displacement loop region single nucleotide polymorphisms and mitochondrial DNA copy number associated with risk of ankylosing spondylitis

AIM

The pathogenesis of ankylosing spondylitis (AS) seems to be associated with genetics, the environment, heredity, and oxidative stress. Single nucleotide polymorphisms (SNPs) in the displacement loop (D-loop) region of mitochondrial DNA (mtDNA) and mtDNA copy number were investigated for their correlation with AS patients.

METHODS

This study included 83 AS patients and 100 healthy controls from the Second Hospital of Hebei Medical University. DNAs were extracted from blood samples for polymerase chain reaction analysis and quantitative real-time polymerase chain reaction analysis. Plasma reactive oxygen species (ROS) levels were measured by fluorescent probe technology.

RESULTS

The distribution frequencies of the minor alleles of nucleotides 16304C (p = .037), 16311C (p = .027), and 152C (p = .034) were remarkably higher in AS patients than in healthy controls, which indicated that the16304C, 16311C, and 152C alleles were correlated with an increased risk of AS. Simultaneously, mtDNA copy number was statistically higher in patients with AS compared with controls (1.450 ± 0.876 versus 0.835 ± 0.626, p < .001). We also observed an increased ROS generation in AS patients compared with controls (27 066.169 ± 18 364.819 versus 14 758.330 ± 5854.946, p < .001) subsequently. In addition, the AS susceptible SNP 16311C is associated with high ROS levels (35 065.177 ± 26 999.934 vs. 25 005.818 ± 14 999.495, p = .043).

CONCLUSION

Our study demonstrated that SNPs in the mtDNA D-loop could be AS risk biomarkers with the potential to promote oxidative stress levels; mtDNA copy number-induced mitochondrial dysfunction may also be involved in AS pathogenesis.