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Schaefer RO, Rutsch N, Schnake KJ, Aly MM, Camino-Willhuber G, Holas M, Spiegl U, Muijs S, Albers CE, Bigdon SF. Rigid spine injuries - A comprehensive review on diagnostic and therapeutic challenges. BRAIN & SPINE 2024; 4:102811. [PMID: 38681176 PMCID: PMC11052905 DOI: 10.1016/j.bas.2024.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Injuries to the rigid spine have a distinguished position in the broad spectrum of spinal injuries due to altered biomechanical properties. The rigid spine is more prone to fractures. Two ossification bone disorders that are of particular interest are Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH). DISH is a non-inflammatory condition that leads to an anterolateral ossification of the spine. AS on the other hand is a chronic inflammatory disease that leads to cortical bone erosions and spinal ossifications. Both diseases gradually induce stiffening of the spine. The prevalence of DISH is age-related and is therefore higher in the older population. Although the prevalence of AS is not age-related the occurrence of spinal ossification is higher with increasing age. This association with age and the aging demographics in industrialized nations illustrate the need for medical professionals to be adequately informed and prepared. The aim of this narrating review is to give an overview on the diagnostic and therapeutic measures of the ankylosed spine. Because of highly unstable fracture configurations, injuries to the rigid spine are highly susceptible to neurological deficits. Diagnosing a fracture of the ankylosed spine on plain radiographs can be challenging. Moreover, since 8% of patients with ankylosing spine disorders (ASD) have multiple non-contagious fractures, a CT scan of the entire spine is highly recommended as the primary diagnostic tool. There are no consensus-based guidelines for the treatment of spinal fractures in ASD. The presence of neurological deficit or unstable fractures are absolute indications for surgical intervention. If conservative therapy is chosen, patients should be monitored closely to ensure that secondary neurologic deterioration does not occur. For the fractures that have to be treated surgically, stabilization of at least three segments above and below the fracture zone is recommended. These fractures mostly are treated via the posterior approach. Patients with AS or DISH share a significant risk for complications after a traumatic spine injury. The most frequent complications for patients with thoracolumbar burst fractures are respiratory failure, pseudoarthrosis, pneumonia, and implant failure.
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Affiliation(s)
| | - Niklas Rutsch
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Mohamed M. Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Martin Holas
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Ulrich Spiegl
- Klinik für Unfallchirurgie und Orthopädie, Klinik München Harlaching, Sanatoriumspl. 2, 81545, München, Germany
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | - Christoph E. Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
| | - Sebastian F. Bigdon
- Department of Orthopaedic Surgery, Sonnenhof Spital, University Bern, 3006, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital University Hospital Bern, 3010, Bern, Switzerland
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Tada K, Dobashi H, Taniguchi Y, Shuto T, Hagimori K, Hayashi E, Inoue H, Kobayashi S, Ymaji K, Tamura N. A multicentre study of clinical features and HLA typing in Japanese patients with ankylosing spondylitis. Mod Rheumatol 2023; 33:392-397. [PMID: 35137159 DOI: 10.1093/mr/roac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Due to the low prevalence of HLA-B27 and ankylosing spondylitis (AS) in Japan, rheumatologists have little experience with AS. We conducted a multicentre study to identify the characteristics and frequency of HLA-B types. METHODS We analysed epidemiological and clinical data, blood tests, spine radiographs, and HLA-B types in Japanese AS patients. RESULTS We evaluated 111 AS patients, predominantly men (82.9%). The mean age, disease onset, diagnosis, and time from onset to diagnosis were 43.7, 24.2, 36.0, and 11.6 years, respectively. Inflammatory low back pain was found in 96 cases (86.5%); peripheral arthritis in 59 (53.2%), enthesitis in 35 (31.5%), and dactylitis in 6 (5.4%). Extra-articular symptoms included uveitis, psoriasis, and inflammatory bowel disease in 41 (36.9%), 1 (0.9%), and 5 (4.5%) cases, respectively. HLA-B27 was positive in 83 cases (74.8%; odds ratio, 1146.0); and HLA-B48 in 9 (8.1%; odds ratio, 3.0). HLA-B27-positive patients were younger at onset and had a shorter diagnostic delay. CONCLUSIONS AS clinical symptoms were almost the same as other countries except for the low coexistence of psoriasis. HLA-B27 positivity in Japanese patients was 78%. HLA-B27-positive patients were younger and diagnosed earlier. In addition to HLA-B27, a relationship with HLA-B48 was suggested.
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Affiliation(s)
- Kurisu Tada
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Toshihide Shuto
- Department of Rheumatology and Orthopaedics Surgery, Chiyoda Hospital, Miyazaki, Japan
| | - Kohei Hagimori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Eri Hayashi
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hisashi Inoue
- Department of Orthopedic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Internal Medicine, Juntendo Koshigaya Hospital, Saitama, Japan
| | - Ken Ymaji
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars N, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol 2023; 52:42-50. [PMID: 35014920 DOI: 10.1080/03009742.2021.1997436] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.
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Affiliation(s)
- A M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - N Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - M Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Clinicum, University of Helsinki, Helsinki, Finland
| | - T K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Genome-wide association study reveals ethnicity-specific SNPs associated with ankylosing spondylitis in the Taiwanese population. J Transl Med 2022; 20:589. [PMID: 36510243 PMCID: PMC9746141 DOI: 10.1186/s12967-022-03701-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is an autoimmune disease affecting mainly spine and sacroiliac joints and adjacent soft tissues. Genome-wide association studies (GWASs) are used to evaluate genetic associations and to predict genetic risk factors that determine the biological basis of disease susceptibility. We aimed to explore the race-specific SNP susceptibility of AS in Taiwanese individuals and to investigate the association between HLA-B27 and AS susceptibility SNPs in Taiwan. METHODS Genotyping data were collected from a medical center participating in the Taiwan Precision Medicine Initiative (TPMI) in the northern district of Taiwan. We designed a case-control study to identify AS susceptibility SNPs through GWAS. We searched the genome browser to find the corresponding susceptibility genes and used the GTEx database to confirm the regulation of gene expression. A polygenic risk score approach was also applied to evaluate the genetic variants in the prediction of developing AS. RESULTS The results showed that the SNPs located on the sixth chromosome were related to higher susceptibility in the AS group. There was no overlap between our results and the susceptibility SNPs found in other races. The 12 tag SNPs located in the MHC region that were found through the linkage disequilibrium method had higher gene expression. Furthermore, Taiwanese people with HLA-B27 positivity had a higher proportion of minor alleles. This might be the reason that the AS prevalence is higher in Taiwan than in other countries. We developed AS polygenic risk score models with six different methods in which those with the top 10% polygenic risk had a fivefold increased risk of developing AS compared to the remaining group with low risk. CONCLUSION A total of 147 SNPs in the Taiwanese population were found to be statistically significantly associated with AS on the sixth pair of chromosomes and did not overlap with previously published sites in the GWAS Catalog. Whether those genes mapped by AS-associated SNPs are involved in AS and what the pathogenic mechanism of the mapped genes is remain to be further studied.
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Gaľová J, Tökölyová S, Petrejčíková E, Tajkov P, Balogh A, Chmelík M, Slováková P, Boroňová I. Ankylosing spondylitis on unidentified individual from early modern times found in reformed church (Silická Brezová, Slovakia): a case-based review. Rheumatol Int 2022; 42:1873-1881. [DOI: 10.1007/s00296-022-05155-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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Du J, Sun J, Wen Z, Wu Z, Li Q, Xia Y, Yang Q, Yang C. Serum IL-6 and TNF-α Levels Are Correlated with Disease Severity in Patients with Ankylosing Spondylitis. Lab Med 2021; 53:149-155. [PMID: 34415341 DOI: 10.1093/labmed/lmab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Previous studies have shown that a number of cytokines participate in the regulation of ankylosing spondylitis (AS). To investigate the potential role of interleukin (IL)-6 and tumor necrosis factor- α (TNF-α) in AS pathogenesis, this study examined the serum levels of IL-6 and TNF-α in patients with AS and its clinical association with disease activity. MATERIALS AND METHODS The serum concentrations of IL-6 and TNF-α from 80 patients with AS and 46 healthy control patients (HCs) were examined by electrochemiluminescence immunoassay. The correlations between the serum IL-6 and TNF-α levels and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), computed tomography (CT) imaging-based classification, and laboratory indicators were analyzed using the Spearman correlation test. RESULTS Compared to HCs, patients with AS showed higher levels of IL-6 and TNF-α. There was also a positive correlation between the serum IL-6 and TNF-α levels and the BASDAI, the progression of AS, and the CT imaging-based classification. The serum levels of IL-6 correlated closely with C-reactive protein and the erythrocyte sedimentation rate. More important, patients with AS with hip joint involvement exhibited a significant elevation of serum levels of TNF-α, and higher IL-6 was detected in patients with the involvement of joints other than the hip and sacroiliac joints. CONCLUSION The serum levels of IL-6 and TNF-α can function as important indicators for auxiliary diagnosis and disease activity evaluation of AS.
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Affiliation(s)
- Jing Du
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Jinxia Sun
- Shenzhen GenTarGet Biotherapeutics Co., Ltd., Shenzhen, P.R. China
| | - Zhanpeng Wen
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Zhicheng Wu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Qian Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Yuhao Xia
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, P.R. China
| | - Qiannan Yang
- Department of Biology, Case Western Reserve University, Cleveland, Ohio, US
| | - Chao Yang
- Department of Surgery, Shenzhen People's Hospital, Shenzhen, P.R. China
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Duruöz MT, Gezer HH, Nas K, Kılıç E, Sargın B, Kasman SA, Alkan H, Şahin N, Cengiz G, Cüzdan N, Gezer İA, Keskin D, Mülkoğlu C, Reşorlu H, Ataman Ş, Bal A, Küçükakkaş O, Yurdakul OV, Melikoğlu MA, Baykul M, Ayhan FF, Bodur H, Çalış M, Çapkın E, Devrimsel G, Gök K, Hizmetli S, Kamanlı A, Keskin Y, Ecesoy H, Kutluk Ö, Şen N, Şendur ÖF, Tekeoğlu İ, Tolu S, Toprak M, Tuncer T. Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Joint Bone Spine 2021; 88:105177. [PMID: 33771757 DOI: 10.1016/j.jbspin.2021.105177] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population. METHODS This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed. RESULTS The patients' mean age was 47.6years (SD: 12) for females and 46.3years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ (P<0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders. CONCLUSION In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Halise Hande Gezer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey.
| | - Kemal Nas
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Erkan Kılıç
- Kanuni Training and Research Hospital; Rheumatology Clinic, Trabzon, Turkey
| | - Betül Sargın
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sevtap Acer Kasman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University School of Medicine, Balıkesir, Turkey
| | - Gizem Cengiz
- Van Training and Research Hospital; Rheumatology Clinic, Van, Turkey
| | - Nihan Cüzdan
- Balıkesir Atatürk City Hospital, Rheumatology Clinic, Balıkesir, Turkey
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey
| | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Reşorlu
- Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey
| | - Meltem Alkan Melikoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Merve Baykul
- Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atilim University Medical School, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mustafa Çalış
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Kevser Gök
- Ankara City Hospital; Rheumatology Clinic, Ankara, Turkey
| | - Sami Hizmetli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Yaşar Keskin
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Hilal Ecesoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Öznur Kutluk
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nesrin Şen
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - İbrahim Tekeoğlu
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, İstanbul, Turkey
| | - Murat Toprak
- Department of Physical Medicine and Rehabilitation, Yuzuncu Yıl University School of Medicine, Van, Turkey
| | - Tiraje Tuncer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
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Huang S, Li H, Xiong J, Hua F, Xiang J, Jiang Y. The effectiveness of Du moxibustion for ankylosing spondylitis: A protocol for systematic review and meta-analysis of randomized clinical trials. Medicine (Baltimore) 2020; 99:e21450. [PMID: 32756165 PMCID: PMC7402767 DOI: 10.1097/md.0000000000021450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a common progressive autoimmune inflammatory disease. Du moxibustion can effectively treat AS with few adverse reactions. The aim of this protocol is to systematically investigate the effectiveness and safety for management of AS with Du moxibustion. METHODS Seven relevant databases, namely, PubMed, Cochrane Library, Embase, Chinese Biomedical Literatures Database (CBM), China National Knowledge Infrastructure (CNKI), WangFang Database (WF), Chinese Scientific Journal Database (VIP) will be searched from their inception until May 1st, 2020. All clinical randomized controlled trials containing eligible interventions(s) and outcome(s) will be included, regardless of blinding or publication types. Two reviewers will independently retrieval databases, extract data, and then assess the quality of studies. Data synthesis will be conducted by RevMan 5.3 software. We regard the effective rate, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analogue Scale (VAS) as the primary outcomes, and the secondary outcomes contain C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), finger-to-floor distance (FFD), occiput to wall distance (OWD), and side effects. The result about the curative effect and safety of Du moxibustion for AS will be presented as risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data. RESULTS The finding will be presented in a journal or related conferences. CONCLUSIONS This study expects to provide high-quality, evidence-based recommendations on further treatment for clinical guidance. PROSPERO REGISTRATION NUMBER CRD42020158727.
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Affiliation(s)
| | - Honglian Li
- Haiyang People's Hospital of Shandong Province, Haiyang
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, P.R. China
| | - Fanghui Hua
- Jiangxi University of Traditional Chinese Medicine
| | - Jie Xiang
- Jiangxi University of Traditional Chinese Medicine
| | - Yunfeng Jiang
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, P.R. China
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Abstract
Human leukocyte antigen (HLA) B27 is the key laboratory parameter for axial spondyloarthritis (axSpA). Its prevalence is variable across different geographic zones and ethnicities, and often mirrors the prevalence of axSpA. HLA-B27 plays a role in axSpA physiopathology. It is correlated with spondyloarthritis phenotype with a consistent positive association with family history, early disease onset, shorter diagnostic delay, hip involvement, and acute anterior uveitis. HLA-B27 has a pivotal role in many referral strategies. However, these strategies were developed in European populations and need to be evaluated in populations with lower HLA-B27 background prevalence, and where additional parameters might be needed.
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Haibel H, Redeker I, Zink A, Callhoff J, Marschall U, Hoffmann F, Sieper J, Poddubnyy D. [Health care and disease burden in persons with axial spondyloarthritis in Germany]. Z Rheumatol 2019; 78:865-874. [PMID: 31172266 DOI: 10.1007/s00393-019-0650-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease. OBJECTIVE Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists. METHODS A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis. RESULTS A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups. CONCLUSION The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.
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Affiliation(s)
- H Haibel
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - I Redeker
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - A Zink
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - U Marschall
- Forschungsbereichsleitung BARMER Institut für Gesundheitssystemforschung, Wuppertal, Deutschland
| | - F Hoffmann
- Abteilung für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J Sieper
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - D Poddubnyy
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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11
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Xi Y, Jiang T, Chaurasiya B, Zhou Y, Yu J, Wen J, Shen Y, Ye X, Webster TJ. Advances in nanomedicine for the treatment of ankylosing spondylitis. Int J Nanomedicine 2019; 14:8521-8542. [PMID: 31806960 PMCID: PMC6831987 DOI: 10.2147/ijn.s216199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is a complex disease characterized by inflammation and ankylosis primarily at the cartilage–bone interface. The disease is more common in young males and risk factors include both genetic and environmental. While the pathogenesis of AS is not completely understood, it is thought to be an immune-mediated disease involving inflammatory cellular infiltrates, and human leukocyte antigen-B27. Currently, there is no specific diagnostic technique available for this disease; therefore conventional diagnostic approaches such as clinical symptoms, laboratory tests and imaging techniques are used. There are various review papers that have been published on conventional treatment approaches, and in this review work, we focus on the more promising nanomedicine-based treatment modalities to move this field forward.
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Affiliation(s)
- Yanhai Xi
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Tingwang Jiang
- Department of Immunology and Microbiology, Institution of Laboratory Medicine of Changshu, Changshu, Jiangsu 215500, People's Republic of China
| | - Birendra Chaurasiya
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Yanyan Zhou
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiangmin Yu
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiankun Wen
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yan Shen
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Xiaojian Ye
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Thomas J Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA, USA
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12
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Wang HY, Xu X, Li L, Ding CY, Lu J, Zhang YY, Zhang YF, Zhang YL, Sun ZQ. Moxibustion therapy in Chinese patients with ankylosing spondylitis: A randomized controlled pilot trial. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Mease P, Walsh JA, Baraliakos X, Inman R, de Vlam K, Wei JCC, Hunter T, Gallo G, Sandoval D, Zhao F, Dong Y, Bolce R, Marzo-Ortega H. Translating Improvements with Ixekizumab in Clinical Trial Outcomes into Clinical Practice: ASAS40, Pain, Fatigue, and Sleep in Ankylosing Spondylitis. Rheumatol Ther 2019; 6:435-450. [PMID: 31254223 PMCID: PMC6702662 DOI: 10.1007/s40744-019-0165-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Ixekizumab, a humanized interleukin-17A antibody, has shown efficacy in ankylosing spondylitis (AS), with a greater proportion of ixekizumab-treated patients achieving an ASAS40 (Assessment of Spondyloarthritis International Society 40) endpoint compared to placebo. An ASAS40 response is a high standard that is not routinely used in clinical practice. The goals of this study were (a) to measure improvement in ixekizumab-treated patients in the four ASAS treatment response domains and in other patient-reported outcomes, and (b) to determine how the ASAS response was associated with changes in spinal pain at night, fatigue, sleep, and the Short Form 36-Item Physical Component Summary (SF-36 PCS). METHODS The COAST-V and COAST-W trials were randomized, double-blind, controlled trials examining ixekizumab efficacy in patients with AS who were biologic disease-modifying antirheumatic drug (bDMARD)-naïve and tumor necrosis factor inhibitor (TNFi)-experienced, respectively. Data for the ASAS treatment response domains and other outcomes were collected through 16 weeks. Comparisons between treatment groups were made using a mixed-effects model for repeated measures. To determine how the ASAS response was associated with the changes in spinal pain at night, fatigue, sleep, and SF-36 PCS, comparisons were made between patient groups according to their level of treatment response (ASAS40 vs. ASAS20 vs. ASAS20 nonresponse) using analysis of covariance. RESULTS Compared with placebo, patients treated with ixekizumab reported significantly greater improvement in the four ASAS treatment response domains and other outcomes (p < 0.05). Results were consistent for bDMARD-naïve and TNFi-experienced patients. Compared to ASAS20 nonresponders, patients who achieved ASAS40 reported significantly greater mean changes in spinal pain at night (1.0 vs. 5.1 for bDMARD-naïve; 0.5 vs. 5.4 for TNFi-experienced), fatigue (0.6 vs. 3.8 for bDMARD-naïve; 0.2 vs. 3.9 for TNFi-experienced), sleep quality (1.1 vs. 4.0 for bDMARD-naïve; 0.8 vs. 4.9 for TNFi-experienced), and SF-36 PCS (2.6 vs. 11.6 for bDMARD-naïve; 1.2 vs. 12.6 for TNFi-experienced) (p < 0.0001). CONCLUSION Patients with AS who were treated with ixekizumab reported greater improvements in multiple patient-reported outcomes than patients who received placebo. Importantly, achieving ASAS40 was associated with a 2.6-fold to 5.3-fold greater improvement in pain, fatigue, sleep, and quality of life for bDMARD-naïve patients, and a 5.1-fold to 18.5-fold greater improvement for TNFi-experienced patients, compared to ASAS20 nonresponders. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02696785 and NCT02696798. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Philip Mease
- Division of Rheumatology Clinical Research, University of Washington and Swedish Medical Center, Seattle, WA, USA.
| | - Jessica A Walsh
- University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | - Robert Inman
- Departments of Immunology and Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - James Cheng-Chung Wei
- Institute of Medicine , Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Fangyi Zhao
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yan Dong
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Abstract
Chest wall disorders represent deformities and/or injuries that alter the rib cage geometry and result in pulmonary restriction, increased work of breathing, exercise limitations, and cosmotic concerns. These disorders are congenital or acquired and affect all ages. Disorders affecting the spine (kyphoscoliosis, ankylosing spondylitis), ribs (flail chest), and sternum (pectus excavatum) are discussed in this article, with emphasis on clinical presentations, pulmonary function abnormalities, diagnosis, and treatment.
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Affiliation(s)
- Mazen O Al-Qadi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale-New Haven Hospital, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA.
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15
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Micu MC, Ostensen M, Bojincă V, Șerban O, Mihai M, Suța C, Ramazan A, Enache L, Bobircă A, Pătcaș SF, Micu R, Ionescu R. Pregnancy Outcomes in Couples with Males Exposed to Longterm Anti-tumor Necrosis Factor- α Inhibitor Therapies: A Prospective Study. J Rheumatol 2019; 46:1084-1088. [PMID: 30824658 DOI: 10.3899/jrheum.180588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the pregnancy achievement and outcomes in couples in which men with spondyloarthritis (SpA) were exposed to tumor necrosis factor inhibitors (TNFi). METHODS Information about pregnancies involving fathers with SpA was prospectively collected by 6 Romanian rheumatology centers. RESULTS Twenty-seven patients achieved 33 pregnancies and fathered 30 healthy children. Three elective abortions (personal reasons) and no spontaneous abortions, preeclampsia/eclampsia, stillbirths, congenital malformations, or pathologies in the children were recorded. Five patients showed normospermia before and after longterm TNFi treatment. CONCLUSION Pregnancy and child outcomes in male patients with SpA exposed to longterm TNFi therapy were reassuring.
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Affiliation(s)
- Mihaela C Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Monika Ostensen
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Violeta Bojincă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Oana Șerban
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Minodora Mihai
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Cristina Suța
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anamaria Ramazan
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Luminița Enache
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Anca Bobircă
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Sergiu F Pătcaș
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
| | - Romeo Micu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway. .,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report.
| | - Ruxandra Ionescu
- From the Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca; Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest; 2nd Internal Medicine Department, Mother and Child Department, and Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; ASTRA Outpatient Clinic, Sibiu; Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital, Constanța; Clinical Center of Rheumatic Diseases, Bucharest; Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim; Department of Rheumatology, Sørlandet Sykehus, Kristiansand, Norway.,M.C. Micu, MD, Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital; M. Ostensen, Professor, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olav's Hospital, Trondheim University Hospital and Department of Rheumatology, Sørlandet Sykehus; V. Bojincă, Lecturer, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; O. Șerban, Assistant Professor, 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy; M. Mihai, MD, ASTRA Outpatient Clinic; C. Suța, Assistant Professor, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; A. Ramazan, MD, Rheumatology Department, 2nd Internal Medicine Department, "Sf. Apostol Andrei" Emergency County Hospital; L. Enache, Assistant Professor, Clinical Center of Rheumatic Diseases; A. Bobircă, Assistant Professor, Department of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy; S.F. Pătcaș, MD, Mother and Child Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Micu, Associate Professor, Assisted Reproduction Department, 1st Gynecology Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy; R. Ionescu, Professor, Department of Internal Medicine and Rheumatology, "Sfânta Maria" Hospital, Bucharest "Carol Davila" University of Medicine and Pharmacy. Dr. M.C. Micu and Prof. M. Ostensen made equal contributions to this report
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Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
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17
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Sloan VS, Sheahan A, Stark JL, Suruki RY. Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study. J Rheumatol 2019; 46:1450-1457. [PMID: 30647189 DOI: 10.3899/jrheum.180972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use. METHODS This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use. RESULTS Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti-tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II. CONCLUSION Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.
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Affiliation(s)
- Victor S Sloan
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA. .,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh.
| | - Anna Sheahan
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
| | - Jeffrey L Stark
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
| | - Robert Y Suruki
- From UCB Pharma, Raleigh, North Carolina; Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; UCB Pharma, Smyrna, Georgia, USA.,V.S. Sloan, MD, FACP, FACR, Vice President and Development Strategy Lead (Immunology), UCB Pharma, Raleigh, and Clinical Associate Professor of Medicine, Rutgers-Robert Wood Johnson Medical School; A. Sheahan, PhD, Real World Evidence Lead Scientist (Immunology), UCB Pharma, Raleigh; J.L. Stark, MD, Head of Medical Affairs (Rheumatology), UCB Pharma, Smyrna; R.Y. Suruki, ScD, Real World Evidence Strategy Lead (Immunology), UCB Pharma, Raleigh
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18
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Assessment of immunological profile in ankylosing spondylitis patients following a clinical trial with guluronic acid (G2013), as a new NSAID with immunomodulatory properties. Immunol Res 2018; 67:108-115. [DOI: 10.1007/s12026-018-9042-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Ivanova M, Manolova I, Miteva L, Gancheva R, Stoilov R, Stanilova S. Genetic variations in the IL-12B gene in association with IL-23 and IL-12p40 serum levels in ankylosing spondylitis. Rheumatol Int 2018; 39:111-119. [PMID: 30443744 DOI: 10.1007/s00296-018-4204-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 12/22/2022]
Abstract
In the present study, we evaluated the implication of IL12Bpro (rs17860508) and IL12B 3' UTR A/C single nucleotide polymorphisms (SNPs) (rs3212227) for the ankylosing spondylitis (AS) development and the impact of IL12B genetic variations on IL-23 and IL-12p40 production and musculoskeletal disease characteristics. 80 patients with AS and 242 healthy controls were studied. Genotyping for the rs3212227 was performed by restriction fragment length polymorphisms-polymerase chain reaction (PCR) and for the rs17860508 by allele-specific PCR. Cytokines were measured by an enzyme-linked immunosorbent assay (ELISA). Clinical status was evaluated by calculation of the Ankylosing Spondylitis Disease Activity Score (ASDAS) using the C-reactive protein (CRP) level, the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI). An association was found for the rs17860508 polymorphism with AS under the allelic, the dominant, and the co-dominant models. Rs3212227 was not attributable to AS susceptibility by itself, but the carriage of C allele in the genotype amplifies the genetic risk for AS in the carriers of the high-risk IL12Bpro 2-allele, especially in homozygosity. Circulating IL-23 and IL-12p40 were raised among AS patients, as some of the genotypes of both IL12B polymorphisms positively regulate their expression. Carriage of the IL12Bpro genotype 2.2 has been linked to a worsened functional disability, while 3' UTR CC genotype-with severe disease activity. IL12B polymorphisms can impact AS susceptibility and modulate IL-23 and IL-12p40 production levels, and have a contribution to the disease phenotype.
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Affiliation(s)
- Mariana Ivanova
- Clinic of Rheumatology, Medical Faculty, University Hospital "St. Ivan Rilski", Medical University, 13, Urvich St, 1612, Sofia, Bulgaria.
| | - Irena Manolova
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, 11, Armeiska St, 6003, Stara Zagora, Bulgaria.
| | - Lyuba Miteva
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, 11, Armeiska St, 6003, Stara Zagora, Bulgaria
| | - Rada Gancheva
- Clinic of Rheumatology, Medical Faculty, University Hospital "St. Ivan Rilski", Medical University, 13, Urvich St, 1612, Sofia, Bulgaria
| | - Rumen Stoilov
- Clinic of Rheumatology, Medical Faculty, University Hospital "St. Ivan Rilski", Medical University, 13, Urvich St, 1612, Sofia, Bulgaria
| | - Spaska Stanilova
- Department of Molecular Biology, Immunology and Medical Genetics, Medical Faculty, Trakia University, 11, Armeiska St, 6003, Stara Zagora, Bulgaria
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20
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Jo S, Han J, Lee YL, Yoon S, Lee J, Wang SE, Kim TH. Regulation of osteoblasts by alkaline phosphatase in ankylosing spondylitis. Int J Rheum Dis 2018; 22:252-261. [PMID: 30415492 DOI: 10.1111/1756-185x.13419] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/22/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
AIM Ankylosing spondylitis (AS) is characterized by excessive spinal ankylosis and bone formation. Alkaline phosphatase (ALP) activity is reported to be high in AS, but little is known about the molecular relationship between ALP and AS. The aims of this study were to investigate the relevance of ALP to AS and the role of ALP in the regulation of osteoblast differentiation in AS. METHODS High-throughput data with accession numbers GSE73754 and GSE41038 were downloaded from the Gene Expression Omnibus. We retrospectively collected and compared the ALP levels of male patients with AS to those of sex- and age-matched healthy controls (HC) and rheumatoid arthritis (RA) patients. Total serum ALP and ALP activity were measured in the AS and RA groups. ALP gene expression and intracellular ALP activity were analyzed in microarray data from primary diseases control (Ct) and AS-bone-derived cells (BdCs) and in vitro experiments. Furthermore, the effect of ALP inhibitor was examined in both primary Ct- and AS-BdCs under osteoblast differentiation. Regulation of runt-related transcription factor 2 (RUNX2) by ALP was also analyzed. RESULTS Alkaline phosphatase level was higher in AS compared with RA and HC and was associated with radiograph progression. ALP expression was also enriched in the bone tissue of AS patients. Furthermore, AS-BdCs exhibited increasing ALP activity, leading to accelerated osteoblastic activity and differentiation. Intriguingly, inhibition of ALP reduced RUNX2 expression, a master transcriptional factor in osteoblasts, and differentiation status of both primary Ct- and AS-BdCs. Treatment of ALP activator or inhibitor modulated RUNX2 protein level and RUNX2 regulated ALP promoter activity, indicating a reciprocal ALP-RUNX2 positive feedback to regulate osteoblast differentiation. CONCLUSION Alkaline phosphatase was highly expressed in AS patients, may be involved in the ankylosis of AS, and represents a possible therapeutic target for ankylosis.
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Affiliation(s)
- Sungsin Jo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Young L Lee
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Subin Yoon
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Translational Medicine, Graduate School of Biomedical Science and Engineering, Hanyang University, Seoul, Korea
| | - Jaehyun Lee
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Translational Medicine, Graduate School of Biomedical Science and Engineering, Hanyang University, Seoul, Korea
| | - Sung E Wang
- Hanyang Biomedical Research Institute, Hanyang University, Seoul, Korea
| | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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21
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Rezaei R, Mostafaei S, Aslani S, Jamshidi A, Mahmoudi M. Association study between killer immunoglobulin-like receptor polymorphisms and ankylosing spondylitis disease: An updated meta-analysis. Int J Rheum Dis 2018; 21:1746-1755. [PMID: 30398028 DOI: 10.1111/1756-185x.13408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 08/03/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several genetic studies have assessed the association between polymorphisms in killer immunoglobulin-like receptors (KIR) genes and susceptibility of individuals to ankylosing spondylitis (AS), but the findings have been inconclusive and incongruous. Therefore, we conducted this meta-analysis of all case-control studies meeting the inclusion criteria for obtaining an exact conclusion of the effect of KIR polymorphisms on the risk of AS. METHODS A systematic literature search was conducted in electronic databases, including Scopus web of science, ScienceDirect, and PubMed to find all eligible studies exploring the association between KIR polymorphisms and the risk of AS, prior to June 2017. Pooled odds ratios (OR) and their corresponding 95% CIs were used to evaluate the strength of the association between KIR polymorphisms and the risk of AS. RESULTS A total of 16 case-control studies, encompassed in 12 papers, with 1770 cases and 2907 healthy subjects were included in the meta-analysis. This meta-analysis revealed three significant positive associations of 2DS1, 2DS5, and 3DS1 with susceptibility to AS, while two significant negative associations of 2DL2 and 2DS2 with susceptibility to AS were identified. In the subgroup analysis based on human leukocyte antigen (HLA)-B*27 positive patients and healthy subjects, results indicated that there were four significant positive associations between 2DL5, 2DS4, 2DS5, 3DS1 polymorphisms and susceptibility to AS in HLA-B*27-positive patients; a significant negative association of 3DL1 in HLA-B*27-positive patients was found. CONCLUSIONS While 2DS1, 2DS5, and 3DS1 polymorphisms increased AS risk, 2DL2 and 2DS2 polymorphisms were associated with reduced AS susceptibility.
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Affiliation(s)
- Ramazan Rezaei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Mostafaei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeed Aslani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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22
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Ankylosing spondylitis causes high burden to patients and the healthcare system: results from a German claims database analysis. Rheumatol Int 2018; 38:2121-2131. [PMID: 30094685 DOI: 10.1007/s00296-018-4124-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/03/2018] [Indexed: 12/17/2022]
Abstract
To compare healthcare resource utilization and costs between ankylosing spondylitis (AS) patients and a matched sample from the general population without AS covered by the German Statutory Health Insurance (SHI) system, a non-interventional retrospectively matched cohort analysis was conducted using anonymized SHI claims data. Data from January 1st, 2011 through December 31st, 2014 were analyzed. Individuals with a coded diagnosis of AS during the enrollment period comprising the full year of 2013 were directly matched (1:5) to individuals without AS diagnosis in the whole study period by age, gender, hospitalizations, and comorbidities. All-cause healthcare resource utilization and direct costs were analyzed for the year 2013. Statistical tests were applied to compare the differences between the two sampled populations. In 2013, 10,208 AS patients were identified and matched to a sample of 51,040 patients without AS from the general population. Healthcare resource utilization was significantly higher in all healthcare sectors (inpatient, outpatient, pharmaceuticals, remedies, devices and aids, and sick leave) in the AS cohort. Mean all-cause healthcare costs per patient were about €2475 higher in the AS cohort compared to the general population. Most important cost drivers were hospitalizations and pharmaceuticals in terms of bDMARDs prescribed in 10% of the patients. Real-world data from this German claims database analysis showed that AS is associated with a substantial incremental economic burden to the healthcare system.
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23
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Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford) 2018; 57:vi29-vi34. [PMID: 30445484 PMCID: PMC6238224 DOI: 10.1093/rheumatology/key200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.
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Affiliation(s)
- Jonathan Packham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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24
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van der Heijde D, Braun J, Rudwaleit M, Purcaru O, Kavanaugh AF. Improvements in workplace and household productivity with certolizumab pegol treatment in axial spondyloarthritis: results to week 96 of a phase III study. RMD Open 2018; 4:e000659. [PMID: 29670761 PMCID: PMC5903272 DOI: 10.1136/rmdopen-2018-000659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives To evaluate the effect of certolizumab pegol (CZP) on work and household productivity, and on participation in family, social and leisure activities in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic (nr-) axSpA. Methods RAPID-axSpA (NCT01087762) was a phase III, double-blind, placebo-controlled trial to week (Wk) 24, dose-blind to Wk48 and open-label to Wk204. A total of 325 patients were randomised 1:1:1 to placebo, CZP 200 mg Q2W or CZP 400 mg Q4W. The validated arthritis-specific Work Productivity Survey assessed the impact of axSpA on work and household productivity and participation in social activities during the preceding month. Data are shown to Wk96, with responses compared between treatment arms (placebo vs CZP 200 mg and 400 mg dose groups combined) and subpopulations using a non-parametric bootstrap-t method. Results At baseline, 63.2% of placebo and 72.0% of CZP patients were employed. By Wk24, CZP patients reported on average 1.0 fewer days of absenteeism and 2.6 fewer days of presenteeism per month, compared with 0.4 and 0.9 fewer days for placebo. At home, by Wk24, CZP patients reported on average 3.0 household work days gained per month versus 1.3 for placebo. CZP patients reported fewer days with reduced household productivity or days lost for social participation. Similar improvements were observed in AS and nr-axSpA subpopulations and improvements with CZP were maintained to Wk96. Conclusions Compared with placebo, treatment with CZP significantly improved work and household productivity and resulted in greater social participation for patients with axSpA, which could lead to considerable indirect cost gains. Trial registration number NCT01087762.
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Affiliation(s)
| | | | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | | | - Arthur F Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, San Diego, California, USA
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25
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Roozbehkia M, Mahmoudi M, Aletaha S, Rezaei N, Fattahi MJ, Jafarnezhad-Ansariha F, Barati A, Mirshafiey A. The potent suppressive effect of β-d-mannuronic acid (M2000) on molecular expression of the TLR/NF-kB Signaling Pathway in ankylosing spondylitis patients. Int Immunopharmacol 2017; 52:191-196. [PMID: 28938189 DOI: 10.1016/j.intimp.2017.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/13/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by the inflammation of sacroiliac joints and axial skeleton. A combination of genetic, environmental and immunological factors are involved in AS's pathogenesis. TLRs are type I transmembrane glycoproteins that play a crucial role in the innate immune responses against invading pathogens. Observational studies have demonstrated a possible association between TLR dysregulation and AS. The β-d-mannuronic acid (M2000), as a novel NSAID with immunosuppressive property, has shown an inhibitory effect on Toll-like receptor (TLR) 2, 4 signaling in HEK293 cells. In the present study, we investigated the gene expression of Myd88, IKB-alpha, NF-kB and MAPK14 (genes of the TLR/NF-kB Signaling Pathway) in AS patients in comparison to healthy subjects and also the effect of β-d-mannuronic acid on disease activity and mRNA expression of these molecules in affected patients. We showed for the first time that the gene expression level of Myd88, IKB-alpha, NF-kB and MAPK14 was higher in AS patients in comparison to healthy subjects. Moreover we confirmed that the β-d-mannuronic acid not just reduced significantly the disease activity of AS individuals compared to placebo, but also it could significantly decrease the expression level of genes associated with TLR/NF-kB Signaling Pathway in treated patients with M2000. These results may provide a new therapeutic approach to attenuate inflammatory responses in AS patients, (Identified; IRCT 2013062213739N1).
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Affiliation(s)
- Maryam Roozbehkia
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Somaye Aletaha
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Sheffield, UK
| | - Mohammad Javad Fattahi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Anis Barati
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mirshafiey
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Deodhar AA, Dougados M, Baeten DL, Cheng‐Chung Wei J, Geusens P, Readie A, Richards HB, Martin R, Porter B. Effect of Secukinumab on Patient-Reported Outcomes in Patients With Active Ankylosing Spondylitis: A Phase III Randomized Trial (MEASURE 1). Arthritis Rheumatol 2017; 68:2901-2910. [PMID: 27390130 PMCID: PMC5132041 DOI: 10.1002/art.39805] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the effect of secukinumab (interleukin-17A inhibitor) on patient-reported outcomes in patients with active ankylosing spondylitis (AS). METHODS In this phase III study, 371 patients were randomized (1:1:1) to receive intravenous (IV) secukinumab 10 mg/kg at baseline and weeks 2 and 4 followed by subcutaneous (SC) secukinumab 150 mg every 4 weeks (IV→150 mg group), or SC secukinumab 75 mg every 4 weeks (IV→75 mg group), or placebo. Patient-reported outcomes included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASDAI criteria for 50% improvement (BASDAI 50), Short Form 36 (SF-36) physical component summary (PCS) score and mental component summary (MCS) score, Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, Bath Ankylosing Spondylitis Functional Index (BASFI), EuroQol 5-domain (EQ-5D) questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Work Productivity and Activity Impairment-General Health questionnaire (WPAI-GH). RESULTS At week 16, secukinumab IV→150 mg or IV→75 mg was associated with statistically and clinically significant improvements from baseline versus placebo in the BASDAI (-2.3 for both regimens versus -0.6; P < 0.0001 and P < 0.001, respectively), SF-36 PCS (5.6 for both regimens versus 1.0; P < 0.0001 and P < 0.001, respectively), and ASQoL (-3.6 for both regimens versus -1.0; P < 0.0001 and P < 0.001, respectively). Clinically significant improvements in the SF-36 MCS, BASFI, EQ-5D, and BASDAI 50 were observed with both secukinumab groups versus placebo at week 16; improvements were also observed in the FACIT-F and WPAI-GH. All improvements were sustained through week 52. CONCLUSION Our findings indicate that secukinumab provides significant and sustained improvements in patient-reported disease activity and health-related quality of life, and reduces functional impairment, fatigue, and impact of disease on work productivity in patients with active AS.
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Affiliation(s)
| | | | | | | | - Piet Geusens
- Maastricht University HospitalMaastrichtThe Netherlands
| | - Aimee Readie
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | | | - Ruvie Martin
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Brian Porter
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
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Videm V, Thomas R, Brown MA, Hoff M. Self-reported Diagnosis of Rheumatoid Arthritis or Ankylosing Spondylitis Has Low Accuracy: Data from the Nord-Trøndelag Health Study. J Rheumatol 2017; 44:1134-1141. [PMID: 28412703 DOI: 10.3899/jrheum.161396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Self-reported diagnoses of inflammatory arthritis are not accurate. The primary study aim was to ascertain self-reported diagnoses of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the Norwegian population-based Nord-Trøndelag Health Study (HUNT) using hospital case files. The secondary aim was to provide updated estimates of the prevalence and incidence of RA and AS. METHODS All inhabitants ≥ 20 years old from the county of Nord-Trøndelag were invited. Data from 70,805 unique participants from HUNT2 (1995-1997) and HUNT3 (2006-2008) were included. For participants who self-reported RA or AS, case files from all 3 hospitals in the catchment area were evaluated using standardized diagnostic criteria. RESULTS Of 2703 self-reported cases of RA, 19.1% were verified in hospital files. Of 1064 self-reported cases of AS, 15.8% were verified. Of 259 cases self-reporting both RA and AS, 8.1% had RA and 5.4% had AS. Overall, a self-report of 1 or both diagnoses could not be verified in 82.1%, including 22.8% with insufficient information or no case file. The prevalence of RA was 768 (95% CI 705-835) per 100,000. The incidence of RA from HUNT2 to HUNT3 was 0.48 (0.41-0.56) per 1000 per year. The prevalence of AS was 264 (228-305) per 100,000. The incidence of AS from HUNT2 to HUNT3 was 0.19 (0.15-0.24) per 1000 per year. CONCLUSION Self-reported diagnoses of RA and AS are often false-positive. The prevalence and incidence of RA were comparable to reports from similar populations. The incidence of AS was higher than previously reported in a mixed population from Norway.
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Affiliation(s)
- Vibeke Videm
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia. .,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital.
| | - Ranjeny Thomas
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
| | - Matthew A Brown
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
| | - Mari Hoff
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
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Yan RJ, Lou TT, Wu YF, Chen WS. Single nucleotide polymorphisms of ABCB1 gene and response to etanercept treatment in patients with ankylosing spondylitis in a Chinese Han population. Medicine (Baltimore) 2017; 96:e5929. [PMID: 28151874 PMCID: PMC5293437 DOI: 10.1097/md.0000000000005929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Etanercept was highly recommended for patients with ankylosing spondylitis (AS), as its efficacy has been confirmed in AS, while genetic polymorphisms, by affecting drug metabolism or drug receptor, lead to interindividual variability in drug disposition and efficacy. Therefore, this study aims to investigate whether ABCB1 gene polymorphisms can predict therapeutic response to etanercept in patients with AS. METHODS A total of 185 patients with AS in our hospital were recruited into our study from December 2012 to May 2015. The frequency distributions of genotype and allele of rs2032582, rs1128503, and rs1045642 were detected by polymerase chain reaction (PCR) and electrophoresis verification enzyme products method. AS patients received etanercept treatment for 12 weeks, followed by this would be evaluated by the bath AS disease activity index (BASDAI) score improvement and the assessment of spondyloArthritis international society 20/50/70 (ASAS20/50/70) score improvements to explore the relationship between genotype of ABCB1 gene polymorphisms and therapeutic response to etanercept in patients with AS. RESULTS After 12 weeks, the BASDAI score mean improvement value of rs2032582 A/A genotype was 2.87 ± 0.52. The ratios of patients with rs2032582 A/A genotype reaching the BASDAI50 and ASAS20 evaluation criteria were 64.29% and 92.86%, respectively. The results indicated that efficacy of etanercept was promoted in rs2032582 A/A genotype. The BASDAI score mean improvement value of rs1128503 C/C genotype was 2.79 ± 0.54 after 12 weeks. The ratios of patients with rs1128503 C/C genotype reaching the BASDAI50 and ASAS20 evaluation criteria were 66.67% and 93.94%, respectively. The results indicated that efficacy of etanercept was promoted in rs1128503 C/C genotype. However, no significant associations were observed between rs1045642 and therapeutic response to etanercept in AS patients. CONCLUSION ABCB1 gene rs2032582 and rs1128503 polymorphisms may be associated with the efficacy of etanercept in AS patients. ABCB1 gene polymorphisms can act as biological indicators of etanercept efficacy.
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Affiliation(s)
- Rui-Jian Yan
- Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University
| | - Ting-Ting Lou
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Health Bureau of Zhejiang Province
| | - Yi-Fang Wu
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, P.R. China
| | - Wei-Shan Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University
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29
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Arnbak B, Jurik AG, Jensen RK, Schiøttz-Christensen B, van der Wurff P, Jensen TS. The diagnostic value of three sacroiliac joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging. Scand J Rheumatol 2016; 46:130-137. [PMID: 27498748 DOI: 10.1080/03009742.2016.1184308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the current study was to investigate the diagnostic value of three sacroiliac (SI) joint pain provocation tests for sacroiliitis identified by magnetic resonance imaging (MRI) and stratified by gender. METHOD Patients without clinical signs of nerve root compression were selected from a cohort of patients with persistent low back pain referred to an outpatient spine clinic. Data from Gaenslen's test, the thigh thrust test, and the long dorsal sacroilia ligament test and sacroiliitis identified by MRI were analysed. RESULTS The median age of the 454 included patients was 33 (range 18-40) years and 241 (53%) were women. The prevalence of SI joints with sacroiliitis was 5%. In the whole study group, only the thigh trust test was associated with sacroiliitis, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.58 [95% confidence interval (CI) 0.51-0.65], sensitivity 31% (95% CI 18-47), and specificity 85% (95% CI 82-87). In men, sacroiliitis was associated with all the SI joint tests assessed and multi-test regimens, with the greatest AUC found for at least one positive out of three tests [AUC 0.68 (95% CI 0.56-0.80), sensitivity 56% (95% CI 31-79), and specificity 81% (95% CI 77-85)]. In women, no significant associations were observed between the SI joint tests and sacroiliitis. CONCLUSIONS Only in men were the SI joint tests found to be associated with sacroiliitis identified by MRI. Although, the diagnostic value was relatively low, the results indicate that the use of SI joint tests for sacroiliitis may be optimized by gender-separate analyses.
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Affiliation(s)
- B Arnbak
- a Research Department , Spine Centre of Southern Denmark, Hospital Lillebaelt , Middelfart , Denmark.,b Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - A G Jurik
- a Research Department , Spine Centre of Southern Denmark, Hospital Lillebaelt , Middelfart , Denmark.,b Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark.,c Department of Radiology , Aarhus University Hospital , Aarhus , Denmark
| | - R K Jensen
- a Research Department , Spine Centre of Southern Denmark, Hospital Lillebaelt , Middelfart , Denmark.,b Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - B Schiøttz-Christensen
- a Research Department , Spine Centre of Southern Denmark, Hospital Lillebaelt , Middelfart , Denmark.,b Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | - P van der Wurff
- d Research and Development, Military Rehabilitation Centre Aardenburg , Doorn , The Netherlands.,e Department of Physiotherapy , HU University of Applied Sciences , Utrecht , The Netherlands
| | - T S Jensen
- a Research Department , Spine Centre of Southern Denmark, Hospital Lillebaelt , Middelfart , Denmark.,b Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
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Stolwijk C, van Onna M, Boonen A, van Tubergen A. Global Prevalence of Spondyloarthritis: A Systematic Review and Meta-Regression Analysis. Arthritis Care Res (Hoboken) 2016; 68:1320-31. [DOI: 10.1002/acr.22831] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Carmen Stolwijk
- Maastricht University Medical Center and School for Public Health and Primary Care, University of Maastricht; Maastricht The Netherlands
| | - Marloes van Onna
- Maastricht University Medical Center and School for Public Health and Primary Care, University of Maastricht; Maastricht The Netherlands
| | - Annelies Boonen
- Maastricht University Medical Center and School for Public Health and Primary Care, University of Maastricht; Maastricht The Netherlands
| | - Astrid van Tubergen
- Maastricht University Medical Center and School for Public Health and Primary Care, University of Maastricht; Maastricht The Netherlands
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Owlia MB, Danesh-Ardakani M. Frequency of sacroiliitis among patients with low back pain. Electron Physician 2016; 8:2094-100. [PMID: 27123217 PMCID: PMC4844474 DOI: 10.19082/2094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/24/2016] [Indexed: 01/27/2023] Open
Abstract
Introduction Sacroiliitis is one of the important symptoms in patients attending infectious diseases and rheumatology clinics. Some patients with sacroiliitis are asymptomatic, and some have unspecific symptoms. The aim of this study was to determine the frequency of sacroiliitis causes among patients attending Shahid Sadoughi’s infectious disease and rheumatology clinics. Methods In this study, we evaluated patients attending Shahid Sadoughi rheumatology and infectious diseases clinic in 2014. Patients who had positive findings in favor of sacroiliitis were evaluated by history, physical exam, laboratory tests, and imaging. The patients were divided into infectious, inflammatory non-infectious, and degenerative causes. The data were analyzed by IBM SPSS version 20 using the independent samples t-test, ANOVA, the chi-squared test, and the Fisher’s exact test. Results We studied 136 patients. Among them 64 (47.1%) were male, and 72 (52.9%) were female. The mean age of the participants was 34.28 ± 10.36 years. Among the patients, 12 (8.8%) had infectious causes, 120 (88.2%) had inflammatory non-infectious causes, and four (2.9%) had degenerative causes. Conclusion Based on our results, inflammatory non-infectious causes are at the top of the list of sacroiliitis causes, but we should always consider infectious causes, including brucellosis.
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Affiliation(s)
- Mohammad Bagher Owlia
- M.D., Full Professor of rheumatology, Department of Rheumatology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mitra Danesh-Ardakani
- M.D., Infectious Diseases Specialist, Department of Infectious Diseases, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Lv ZT, Zhou X, Chen AM. [Acupuncture Therapy versus Disease-modifying Antirheumatic Drugs for the Treatment of Ankylosing Spondylitis--a Meta-analysis]. Complement Med Res 2015; 22:395-402. [PMID: 26840422 DOI: 10.1159/000442733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We conducted a meta-analysis evaluating the efficacy and safety of acupuncture compared to disease-modifying antirheumatic drugs in patients with ankylosing spondylitis. METHODS Four databases including Pubmed, EMBASE, Cochrane library, and ISI Web of Science were searched in December 2014, taking also the reference section into account. Randomized controlled trials that aimed to assess the efficacy of acupuncture therapy were identified. The inclusion criteria for the outcome measurements were the clinical effect, ESR, occipital wall test, chest expansion, CRP and finger ground distance. Finally, six studies met these inclusion criteria. Two reviewers screened each article independently and were blinded to the findings of each other. RESULTS We analyzed data from 6 RCTs involving 541 participants. Acupuncture therapy could further improve the clinical effect (OR = 3.01; 95% CI, 1.48-6.13; P = 0.002) and reduce ESR level (SMD = -0.77; 95% CI, -1.46 to -0.08; P = 0.03) compared to DMARDs; a combination of acupuncture and DMARDs could further improve clinical effect (OR = 3.20, 95% CI, 1.36-7.54; P = 0.008), occipital-wall distance (SMD = -0.84; 95% CI, -1.37 to -0.31; P = 0.002), chest expansion (SMD = 0.38; 95% CI, 0.16-0.60; P = 0.0009), and finger-ground distance (SMD = -0.48; 95% CI, -0.87 to -0.09; P = 0.02) as compared to DMARDs treatment alone. CONCLUSIONS Our findings support that acupuncture therapy could be an option to relieve symptoms associated with AS. These results should be interpreted cautiously due to the generally poor methodological qualities of the included trials.
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Affiliation(s)
- Zheng-tao Lv
- Abteilung fx00FC;r Orthopx00E4;die, Universitx00E4;tsklinikum Tongji, Medizinische Fakultx00E4;t Tongji, Huazhong Universitx00E4;t fx00FC;r Wissenschaft und Technik, Wuhan, China
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Abstract
ABSTRACT:Many diseases with an auto-immune etiology have a skewed sex distribution. In the majority of instances, women are affected more frequently than men. A review of population studies demonstrates that the preponderance of women in multiple sclerosis (MS) is almost constant. We show that this preponderance is further increased in early as well as in late-onset cases, in familial cases as well as in MS twin pairs and that the HLA-DR2 allele, which has been associated with MS in Caucasian populations, is significantly more frequent in women than in men with MS. “Rules” have been established for multifactorial diseases; MS contravenes most of those rules. The skewed sex distribution in MS could be attributed to the known hormonal and gender influences on the immune response, as well as to genetic influences.
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Abstract
The term axial spondyloarthritis covers both non-radiographic disease and radiographic disease (also known as ankylosing spondylitis). Some studies have been performed to investigate the prevalence of axial spondyloarthritis, although most are limited to patients with radiographic disease. A strong genetic association has been shown between axial spondyloarthritis and human leukocyte antigen-B27 (HLA-B27), but the pathogenetic role of HLA-B27 has not yet been clarified. Tumour necrosis factor (TNF), IL-17, IL-23 and downstream pathways also seem to be important - based on the good results of therapies directed against these molecules - but their exact role in the inflammatory process is also not yet clear. Elucidating the interaction between osteoproliferation and inflammation will be crucial for the prevention of long-term structural damage of the bone. The development of new criteria for classification, diagnosis and screening of patients with axial spondyloarthritis will enable earlier intervention for this chronic inflammatory disease. MRI has become an important tool for the early detection of axial spondyloarthritis. NSAIDs and TNF blockers are effective therapies, including in the early non-radiographic stage. Therapeutic blockade of IL-17 or IL-23 seems to be a promising new treatment option. Tools for measuring quality of life in axial spondyloarthritis have become relevant to assess the impact that the disease has on patients. These diagnostic and therapeutic advances will continue to change the management of axial spondyloarthritis, and new insights into the disease pathogenesis will hopefully accelerate this process. For an illustrated summary of this Primer, visit: http://go.nature.com/51b1af.
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Affiliation(s)
- Joachim Sieper
- Rheumatology, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Maxime Dougados
- Faculty of Medicine, Paris Descartes University, Department of Rheumatology, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Dominique Baeten
- Clinical Immunology and Rheumatology and Amsterdam Rheumatology and Immunology Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van Tubergen A, Black PM, Coteur G. Are patient-reported outcome instruments for ankylosing spondylitis fit for purpose for the axial spondyloarthritis patient? A qualitative and psychometric analysis. Rheumatology (Oxford) 2015; 54:1842-51. [PMID: 26001635 DOI: 10.1093/rheumatology/kev125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Several patient-reported outcome (PRO) instruments have been validated in AS. This study aims to evaluate several measurement properties of such PROs in a broad axial SpA (axSpA) population, including both AS and non-radiographic axSpA (nr-axSpA) subpopulations. METHODS PROs assessed were total and nocturnal back pain, patient global assessment of disease activity, BASDAI, BASFI and the 36-item Short Form Health Survey. A literature review and both clinician and patient qualitative interviews provided information on instrument content validity. Reliability (test-retest and internal consistency), construct validity (PROs, clinical-outcome correlations and known-groups validity) and PRO responsiveness were assessed. Data from the RAPID-axSpA trial (NCT01087762) investigating certolizumab pegol efficacy in axSpA, including relevant subpopulations, were utilized. RESULTS Concepts identified for the broad axSpA population by both clinician and patient interviews were consistent with those identified through literature review of AS. All PROs demonstrated reliability in the RAPID-axSpA population (n = 325), with test-retest intraclass correlation coefficients and internal consistency Cronbach's α >0.8. Validity was supported by agreement between PROs and clinician-rated measures; except for the 36-item Short Form Health Survey Mental Components Summary, correlations between PROs and physician global assessment of disease activity ranged from 0.28 to 0.42 for week 0 and from 0.53 to 0.65 for week 24. PRO measures showed good sensitivity to change (effect size >0.8) at weeks 12 and 24 for responders. No variations in measurement properties were noted between the subpopulations. CONCLUSION This study indicates that both content validity and measurement properties of PRO instruments utilized in AS are preserved in the broad axSpA population.
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Affiliation(s)
- Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,
| | - Peter M Black
- Clinical Outcome Assessments Consulting, ERT, Philadelphia, PA, USA and
| | - Geoffroy Coteur
- Global Health Outcomes Research, UCB Pharma, Brussels, Belgium
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Chen HH, Chen YM, Lai KL, Lin CH, Tang CH, Chen DY. Factors affecting discontinuation of adalimumab and etanercept therapy in anti-TNF-naïve patients with ankylosing spondylitis: Nationwide population-based cohort study. Mod Rheumatol 2015; 25:903-907. [PMID: 25967132 DOI: 10.3109/14397595.2015.1038426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We investigated factors associated with discontinuation of anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS), who were anti-TNF-naïve and were given etanercept (ETN) or adalimumab (ADA). METHODS This is a retrospective nationwide population-based cohort study. We identified 1401 anti-TNF-naïve patients with AS who initiated ETN (n = 441) or ADA (n = 960) and measured the duration of anti-TNF drug use. We recorded demographic and clinical data of all patients, and calculated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard regression analyses. RESULTS Overall, the ADA and ETN groups had similar risk for drug discontinuation (HR: 0.83; 95% CI: 0.63-1.08). In each group, concomitant use of methotrexate (MTX) or a non-steroidal anti-inflammatory drug was associated with a lower risk of discontinuation. Subgroup analysis indicated that concomitant MTX use reduced risk of discontinuation of ADA (HR: 0.54; 95% CI: 0.40-0.74), but not ETN (HR: 1.03; 95% CI: 0.65-1.63). CONCLUSIONS This study of anti-TNF-naïve patients with AS indicated that users of ADA and ETN had similar overall risk of drug discontinuation. However, patients taking ADA with MTX had a lower risk of discontinuation than those taking ADA alone.
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Affiliation(s)
- Hsin-Hua Chen
- a Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine, National Yang-Ming University , Taipei , Taiwan.,c Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.,d Institute of Public Health and Community Medicine Research Center, National Yang-Ming University , Taipei , Taiwan.,e Institute of Hospital and Health Care Administration, National Yang-Ming University , Taipei , Taiwan.,f School of Medicine, Chung-Shan Medical University , Taichung , Taiwan.,g Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University , Taichung , Taiwan
| | - Yi-Ming Chen
- a Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine, National Yang-Ming University , Taipei , Taiwan.,c Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.,g Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University , Taichung , Taiwan
| | - Kuo-Lung Lai
- a Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Ching-Heng Lin
- c Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Chao-Hsiung Tang
- h School of Health Care Administration, Taipei Medical University , Taipei , Taiwan
| | - Der-Yuan Chen
- b School of Medicine, National Yang-Ming University , Taipei , Taiwan.,c Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.,f School of Medicine, Chung-Shan Medical University , Taichung , Taiwan.,g Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University , Taichung , Taiwan.,i Department of Medical Education , Taichung Veterans General Hospital , Taichung , Taiwan
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Exarchou S, Lindström U, Askling J, Eriksson JK, Forsblad-d'Elia H, Neovius M, Turesson C, Kristensen LE, Jacobsson LTH. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study. Arthritis Res Ther 2015; 17:118. [PMID: 25956915 PMCID: PMC4424886 DOI: 10.1186/s13075-015-0627-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/16/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. METHODS All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. RESULTS A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P < 0.001), a higher frequency of anterior uveitis (25.5% versus 20.0%, P < 0.001) and were more likely to receive tumor necrosis factor inhibitors than women (15.6% versus 11.8% in 2009, P < 0.001). Women were more likely than men to have peripheral arthritis (21.7% versus 15.3%, P < 0.001), psoriasis (8.0% versus 6.9%, P = 0.03), and treatment with oral corticosteroids (14.0% versus 10.4% in 2009, P < 0.001). CONCLUSION This nationwide, register-based study demonstrated a prevalence of clinically diagnosed ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.
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Affiliation(s)
- Sofia Exarchou
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Johan Askling
- Clinical Epidemiology Unit & Rheumatology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Jonas K Eriksson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Lars Erik Kristensen
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga Marie Nilssons gata 32, 205 02, Malmö, Sweden. .,The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark.
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Haroon NN, Paterson JM, Li P, Haroon N. Increasing proportion of female patients with ankylosing spondylitis: a population-based study of trends in the incidence and prevalence of AS. BMJ Open 2014; 4:e006634. [PMID: 25510888 PMCID: PMC4267076 DOI: 10.1136/bmjopen-2014-006634] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE With the introduction of MRI in diagnosis and tumour necrosis factor inhibitors for treatment, the field of ankylosing spondylitis (AS) has undergone significant changes. We carried out a population-based study of the trends in incidence and prevalence of AS over the past 15 years. METHODS This is a retrospective analysis of provincial health administrative databases. Residents of Ontario, Canada aged 15 years or older diagnosed with AS between 1995 and 2010 were included in the study. Crude as well as age-standardised and sex-standardised incidence and prevalence of AS between 1995 and 2010 were calculated. Trends in prevalence and incidence of male and female patients with AS were separately analysed. RESULTS We identified 24,976 Ontarians with AS. Age/sex-standardised AS prevalence increased from 79/100,000 in 1995 to 213/100,000 in 2010. Men had higher prevalence than women, but the male/female prevalence ratio decreased from 1.70 in 1995 to 1.21 by 2010. A higher proportion of male compared with female patients with AS were diagnosed in the 15-45 age group. Annual incidence rates revealed increasing diagnosis of AS among women after 2003. CONCLUSIONS The prevalence of AS in Ontario has nearly tripled over the past two decades. The proportion of women with new diagnosis of AS is increasing, a trend that began around the year 2003. A higher proportion of male compared with female patients with AS are diagnosed at an earlier age.
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Affiliation(s)
- Nisha N Haroon
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Ping Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Nigil Haroon
- University Health Network, Toronto, Ontario, Canada
- Toronto Western Research Institute, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rashid T, Wilson C, Ebringer A. Raised incidence of ankylosing spondylitis among Inuit populations could be due to high HLA-B27 association and starch consumption. Rheumatol Int 2014; 35:945-51. [PMID: 25385438 DOI: 10.1007/s00296-014-3164-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/23/2014] [Indexed: 12/29/2022]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis mainly affecting the spinal joints. It would appear that the most likely causative agent in the development of AS is an environmental factor in the genetically susceptible, HLA-B27 positive, individuals. Extensive data from several countries support the notion that Klebsiella pneumonia bacteria are the most likely culprit in the causation of AS. These microbes possess antigens which resemble HLA-B27 and spinal collagens. Increased intake of high-starch diet is directly proportional to the gut-associated bacterial load, especially in the large intestine, and among these microbial agents, Klebsiella is considered as one of the main constituting components. Therefore, a low-starch diet intake alongside the currently used medical therapeutic modalities could be beneficial in the management of patients with early AS. It is suggested that a change in the dietary habits from high protein, low-starch marine components to the Westernized high-starch diet among the Inuit peoples of Alaska and Canada could be considered as one of the main contributing factors in the increased prevalence of AS during the last few decades within this genetically unmixed native population.
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Affiliation(s)
- Taha Rashid
- Analytical Sciences Group, Kings College London, 150 Stamford Street, London, SE1 9NH, UK
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Garg N, van den Bosch F, Deodhar A. The concept of spondyloarthritis: Where are we now? Best Pract Res Clin Rheumatol 2014; 28:663-72. [DOI: 10.1016/j.berh.2014.10.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Osterhaus JT, Purcaru O. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis. Arthritis Res Ther 2014; 16:R164. [PMID: 25099160 PMCID: PMC4448884 DOI: 10.1186/ar4680] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/22/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The arthritis-specific Work Productivity Survey (WPS) was developed to evaluate productivity limitations associated with arthritis within and outside the home. There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis (axSpA), including nonradiographic axSpA and ankylosing spondylitis. Following its validation in rheumatoid and psoriatic arthritis, we aimed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis. METHODS Psychometric properties were assessed using data from the RAPID-axSpA trial (NCT01087762) in which researchers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24. Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), back pain, Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form 36 health survey (SF-36) and Ankylosing Spondylitis Quality of Life Scale (ASQoL). Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20% improvement criteria (ASAS20), BASDAI50, ASDAS clinically important improvement/major improvement (CII/MI) and BASFI minimum clinically important difference (MCID) responders versus nonresponders at week 12. All comparisons were conducted on observed cases in the randomized set using a nonparametric bootstrap-t method. RESULTS The results confirmed the psychometric properties of WPS. AxSpA patients with a worse health state had significantly more days of household work lost, household work with reduced productivity, social activities missed and outside help hired, as well as a higher interference rate of arthritis, than patients with a better health state. Similarly, employed patients with a worse health state had significantly more work days lost or with productivity reduced, and a higher interference of arthritis on work productivity. Similar findings were also observed in the nonradiographic (nr) axSpA and AS subpopulations. The WPS was responsive to clinical changes, with responders reporting larger improvements at week 12 in WPS scores versus nonresponders. Effect sizes in responders were generally moderate to large (standardized response mean >0.5). CONCLUSIONS These analyses demonstrate that WPS is a valid, responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA, as well as the in subpopulations of AS and nr-axSpA.
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Affiliation(s)
- Jane T Osterhaus
- Wasatch Health Outcomes, 2613 Silver Cloud Drive, Park City, UT, 84060, USA.
| | - Oana Purcaru
- UCB Pharma, Allee de la Recherche, 60, 1070, Brussels, Belgium.
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Hajialilo M, Ghorbanihaghjo A, Khabbazi A, Kolahi S, Rashtchizadeh N. Ankylosing spondylitis in iran; late diagnosis and its causes. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11798. [PMID: 24910782 PMCID: PMC4028755 DOI: 10.5812/ircmj.11798] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/30/2013] [Indexed: 11/16/2022]
Abstract
Background: Ankylosing spondylitis (AS) is a chronic destructive and inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine. Objectives: The aim of the present cross-sectional study was to evaluate and identify factors leading to delayed diagnosis of AS in Iranian patients. Patients and Methods: Sixty patients, (53 males, 7 females) with a diagnosis of AS according to the modified New York criteria were recruited. Diagnosis delay was defined as the interval between a patient’s first spondyloarthritic symptoms [inflammatory back pain (IBP), inflammatory arthritis, enthesopathy and uveitis] and a correct diagnosis of AS. Results: The average age of patients at diagnosis of AS was 36.4 ± 4.5 years and the average of delay in diagnosis was 6.2 ± 3.5 years. The most common diagnosis at the first visit was disc herniation (68.3%). Delay in diagnosis of Human Leukocyte Antigen (HLA-B27) positive and negative patients were 4.6 ± 2.2 years and 10.1 ± 3.2 years, respectively (P = 0.0001). Diagnosis delay in patients with morning stiffness and IBP were significantly shorter than that of patients without these symptoms (P = 0.0001 and P = 0.001, respectively). Patients with uveitis had the shortest diagnosis delay (P = 0.02). The Bath Ankylosing spondylitis disease activity index (BASDAI) was not significantly different in early (< 3years) and late (> 3years) diagnosis (3.3 ± 0.9 and 3.6 ± 0.7, respectively) (P = 0.18), but the Both ankylosing spondylitis functional index (BASFI) was significantly different between them (3.3 ± 1.0 and 4.1 ± 0.7 respectively) (P = 0.001). Conclusions: In this study, delay in diagnosis was similar to other studies. Educating physicians to careful history taking especially in the case of IBP, non-musculoskeletal symptoms such as uveitis and precise physical examination are important in early diagnosis.
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Affiliation(s)
- Mehrzad Hajialilo
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Amir Ghorbanihaghjo
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Amir Ghorbanihaghjo, Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4113364666, Fax: +98-4114426078, E-mail:
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Suosan Kolahi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Nadereh Rashtchizadeh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Yang J, Zhao Q, Han C, Zhao C, Zheng L, Zhang X, Liu L, Wei H, Zeng F, Yang Y, Su W, Hua Q, Zhan X, Chen Q, Li T, Liao J, Wu H, Zhao J. Association of variants in 21q22 with ankylosing spondylitis in the Chinese Guangxi Zhuang population. Rheumatol Int 2014; 34:1251-5. [DOI: 10.1007/s00296-014-2973-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/18/2014] [Indexed: 01/17/2023]
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Abstract
The classification of Spondyloarthritis (SpA) has been revised with the introduction of the ASAS classification criteria. Although this has best been described in ankylosing spondylitis and psoriatic arthritis, there are population studies evaluating the epidemiology of the different subgroups of SpA. In this paper, we present data on the incidence and prevalence of the subgroups of SpA in different populations, and point to data indicating how the introduction of new classification criteria, with the altered perception of the SpA entity, might impact on the epidemiology.
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Micu MC, Micu R, Surd S, Gîrlovanu M, Bolboacă SD, Ostensen M. TNF-α inhibitors do not impair sperm quality in males with ankylosing spondylitis after short-term or long-term treatment. Rheumatology (Oxford) 2014; 53:1250-5. [DOI: 10.1093/rheumatology/keu007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Koko V, Ndrepepa A, Skënderaj S, Ploumis A, Backa T, Tafaj A. An epidemiological study on ankylosing spondylitis in southern Albania. Mater Sociomed 2014; 26:26-9. [PMID: 24757397 PMCID: PMC3990378 DOI: 10.5455/msm.2014.26.26-29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/18/2014] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To evaluate the incidence and prevalence of ankylosing spondylitis (AS) in southern Albania and to assess the association of various demographic risk factors with the severity of disease. MATERIAL AND METHODS This is an observational study with cross-sectional analyses, conducted in the region of Gjirokaster, between 1995 until 2011. The diagnosis of AS was based on the modified New York criteria. Data on population are obtained from the reports of the National Institute of Statistics. RESULTS Between 1995 and 2011, there were 54 patients diagnosed with AS. Of them, 48 subjects were males (88.9%) and 6 subjects females (11.1%). The AS prevalence in adult population (≥14 years of age), in December 2010, was 0.061%. The 5-year incidence (2006-2010) in adult population was 0.006 %. The mean age at the onset of disease was 29.7±8.4 years. The mean age in 2011 (n=50 subjects) was 51.6±12.7 years. The duration of the disease was 22.7±11.2 years. More than two thirds of the patients (70.3%) were in the advanced radiological stages of the disease. A younger age at the onset of the disease, longer delay in diagnosis, lower educational level and smoking were significant independent factors associated with the advanced forms of the disease. CONCLUSION In southern Albania, the AS prevalence in 2010 was 0.061% and the 5-year incidence (2006-2010) was 6 new cases per 105 adults. The incidence and prevalence of AS in Southern Albania are close to the respective regional epidemiological data.
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Affiliation(s)
| | - Ana Ndrepepa
- IBE Institut, Ludwig-Maximilian University, Munich, Germany
| | - Skënder Skënderaj
- Service of Professional Diseases, University Hospital Center of Tirana Albania
| | - Avraam Ploumis
- Department of Orthopaedics and Rehabilitation, University of Ioannina Medical School, Greece
| | - Teuta Backa
- Department of Rheumatology, University Hospital Center of Tirana, Albania
| | - Argjend Tafaj
- Department of Rheumatology, University Hospital Center of Tirana, Albania
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Inanir A, Ceyhan K, Okan S, Kadi H. Frequency of fragmented QRS in ankylosing spondylitis : a prospective controlled study. Z Rheumatol 2014; 72:468-73. [PMID: 23262561 DOI: 10.1007/s00393-012-1102-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Since inflammatory diseases may also cause fibrosis, we hypothesized that patients with ankylosing spondylitis (AS) may have frequent fragmented QRS complexes (fQRS) when compared to a control group. PATIENTS AND METHODS In this prospective study, 71 patients with AS (group 1) were compared with 42 age- and gender-matched individuals without rheumatic disease (group 2, control). fQRS was described as the presence of an additional R wave (R') or R or S wave bridging, or the presence of fragmentation on two consecutive derivations that correspond to the major coronary artery regions. RESULTS The mean ages of groups 1 and 2 were 37.67 ± 9.17 and 40.43 ± 11.09 years, respectively (p = 0.270). fQRS was detected in 23 AS patients (32.4%), whereas 3 patients in the control group had fQRS (7.14%). Age, gender, medication, and echocardiography results were comparable. The disease duration score was 101.37 ± 59.96 months in fQRS(+) patients; in contrast, it was 57.93 ± 30.95 months in fQRS(-) patients. This difference was of statistical significance (p = 0.046). A statistically significant difference was not determined between the fQRS(+) and fQRS(-) groups when evaluated in terms of HLAB27 (p = 0.739). In the fQRS(+) group, the mean lumbar Schober score was 2.91 ± 1.52; in patients without fQRS, it was 4.10 ± 1.40. The mean thoracic expansion test scores in the fQRS(+) and fQRS(-) groups were 1.44 ± 0.66 and 2.69 ± 1.22, respectively. CONCLUSION Given the higher frequency of fQRS detected in electrocardiography studies in AS patients than in the control group, cardiac fibrosis is thought to be more likely to occur in AS patients without cardiovascular disease. The presence of fQRS may be a simple and cost-effective method for predicting cardiac fibrosis in AS patients. fQRS can be a predictive marker for fibrosis in patients with AS.
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Affiliation(s)
- A Inanir
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Gaziosmanpasa University, 60100, Tokat, Turkey.
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Baraliakos X, Braun J. Anti-TNF-α therapy with infliximab in spondyloarthritides. Expert Rev Clin Immunol 2014; 6:9-19. [DOI: 10.1586/eci.09.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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