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Dubin JA, Bains SS, Chen Z, Salib CG, Nace J, Mont MA, Delanois RE. Race Associated With Increased Complication Rates After Total Knee Arthroplasty. J Arthroplasty 2023; 38:2220-2225. [PMID: 37172792 DOI: 10.1016/j.arth.2023.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities have been suggested to be associated with poor outcomes after total knee arthroplasty (TKA). While socioeconomic disadvantage has been studied, analyses of race as the primary variable are lacking. Therefore, we examined the potential differences between Black and White TKA recipients. Specifically, we assessed 30-day and 90-day, as well as 1 year: (1) emergency department visits and readmissions; (2) total complications; (3) as well as risk factors for total complications. METHODS A consecutive series of 1,641 primary TKAs from January 2015 to December 2021 at a tertiary health care system were reviewed. Patients were stratified according to race, Black (n = 1,003) and White (n = 638). Outcomes of interest were analyzed using bivariate Chi-square and multivariate regressions. Demographic variables such as sex, American Society of Anesthesiologists classification, diabetes, congestive heart failure, chronic pulmonary disease, and socioeconomic status based on Area Deprivation Index were controlled for across all patients. RESULTS The unadjusted analyses found that Black patients had an increased likelihood of 30-day emergency department visits and readmissions (P < .001). However, in the adjusted analyses, Black race was demonstrated to be a risk factor for increased total complications at all-time points (P ≤ .0279). Area Deprivation Index was not a risk for cumulative complications at these time points (P ≥ .2455). CONCLUSION Black patients undergoing TKA may be at increased risk for complications with more risk factors including higher body mass index, tobacco use, substance abuse, chronic obstructive pulmonary disease, congestive heart failure, hypertension, chronic kidney disease, and diabetes and were thus, "sicker" initially than the White cohort. Surgeons are often treating these patients at the later stages of their diseases when risk factors are less modifiable, which necessitates a shift to early, preventable public health measures. While higher socioeconomic disadvantage has been associated with higher rates of complications, the results of this study suggest that race may play a greater role than previously thought.
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Affiliation(s)
- Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Christopher G Salib
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Matsuki K, Sugaya H, Hoshika S, Ueda Y, Takahashi N, Tokai M, Banks SA. Three-dimensional measurement of glenoid dimensions and orientations. J Orthop Sci 2019; 24:624-630. [PMID: 30579647 DOI: 10.1016/j.jos.2018.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asians generally have smaller stature than Europeans and Americans, and currently available implants used in reverse shoulder arthroplasty might not fit smaller bony anatomies. However, few articles have reported glenoid geometry in the Asian population. The purpose of this study was to measure the dimensions and orientations of the glenoid from three-dimensional computed tomography reconstructions of elderly Japanese subjects. METHODS This study included 100 shoulders (50 males and 50 females with >50 years of age). The mean age was 67 ± 7 years for both sexes, and the mean height was 167 ± 7 cm for males and 154 ± 6 cm for females. Three-dimensional scapular models were created from computed tomographic images, and the glenoid height, glenoid width, glenoid version, glenoid inclination, vault depth, and vault width were measured. RESULTS The mean glenoid height and width were 38.6 and 29.4 mm for males and 33.1 and 24.4 mm for females, respectively. Both retroversion and superior inclination were approximately 3° in both sexes. The glenoid vault was deeper in the posterior region with the maximum depth of 26.1 and 23.6 mm in males and females. The vault width was narrower in the anterior region with the anterior width of 2.5 mm at 15 mm medial from the glenoid face in females. CONCLUSION Glenoids of Japanese females are small compared to currently available baseplates for reverse shoulder arthroplasty. These results may be helpful to aid design in smaller baseplates that better fit the anatomic geometry of the Asian glenoid.
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Affiliation(s)
- Keisuke Matsuki
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan; Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.
| | - Hiroyuki Sugaya
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Shota Hoshika
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Yusuke Ueda
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Norimasa Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Morihito Tokai
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA
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Goodman SM, Mandl LA, Parks ML, Zhang M, McHugh KR, Lee YY, Nguyen JT, Russell LA, Bogardus MH, Figgie MP, Bass AR. Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty. Clin Orthop Relat Res 2016; 474:1986-95. [PMID: 27278675 PMCID: PMC4965380 DOI: 10.1007/s11999-016-4919-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. QUESTIONS/PURPOSES We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA? METHODS We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better). RESULTS Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decreasing in a linear fashion as poverty increases. In census tracts with greater than 40% poverty, blacks score 6 ± 3 points lower (worse) than whites for WOMAC pain (p = 0.03) and 7 ± 3 points lower than whites for WOMAC function (p = 0.01). CONCLUSIONS Blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities. Efforts to improve TKA outcomes among blacks will need to address individual- and community-level socioeconomic factors. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Susan M Goodman
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Lisa A Mandl
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael L Parks
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Meng Zhang
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Kelly R McHugh
- Department of Research, Hospital for Special Surgery, New York, NY, USA
| | - Yuo-Yu Lee
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Joseph T Nguyen
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Linda A Russell
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Mark P Figgie
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Anne R Bass
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Abstract
Using the protocol outlined in The Backbone of History: Health and Nutrition in the Western Hemisphere (BBH) (Steckel and Rose. 2002a. The backbone of history: health and nutrition in the Western Hemisphere. Cambridge: Cambridge University Press), this project compares the Mark I Health Index (MIHI) scores of the Ipiutak (n = 76; 100BCE-500CE) and Tigara (n = 298; 1200-1700CE), two samples of North American Arctic Eskimos excavated from Point Hope, Alaska. Macroscopic examination of skeletal remains for evidence of anemia, linear enamel hypoplasias (LEH), infection, trauma, dental health, and degenerative joint disease (DJD) was conducted to assess differences in health status resulting from a major economic shift at Point Hope. These data demonstrate that despite differences in settlement pattern, economic system, and dietary composition, the MIHI scores for the Ipiutak (82.1) and Tigara (84.6) are essentially equal. However, their component scores differ considerably. The Ipiutak component scores are suggestive of increased prevalence of chronic metabolic and biomechanical stresses, represented by high prevalence of nonspecific infection and high frequencies of DJD in the hip/knee, thoracic vertebrae, and wrists. The Tigara experienced more acute stress, evidenced by higher prevalence of LEH and trauma. Comparison of overall health index scores with those published in BBH shows the MIHI score for the Ipiutak and Tigara falling just above the average for sites in the Western Hemisphere, adding support to the argument that the human capacity for cultural amelioration of environmental hardships is quite significant.
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Affiliation(s)
- Gretchen R Dabbs
- Department of Anthropology, Southern Illinois University, Carbondale, IL 62901, USA.
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Ikem IC, Ikem RT, Olaogun MOB, Owoyemi A, Ola BA. Assessment of limited joint mobility of the hand in Black Africans with diabetes mellitus and in non-diabetics. W INDIAN MED J 2009; 58:506-511. [PMID: 20583675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and non-diabetes. METHODS Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. RESULTS Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). CONCLUSION We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM.
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Affiliation(s)
- I C Ikem
- Department of Orthopaedic Surgery and Traumatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Thambyah A. How critical are the tibiofemoral joint reaction forces during frequent squatting in Asian populations? Knee 2008; 15:286-94. [PMID: 18524597 DOI: 10.1016/j.knee.2008.04.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/16/2008] [Accepted: 04/18/2008] [Indexed: 02/02/2023]
Abstract
This study examines tibiofemoral joint moments and forces when performing a squat. The relevance of studying such an activity is to understand better the mechanical factors involved in the higher incidence of tibiofemoral osteoarthritis in Asian populations where squatting is a common daily activity. In this study, motion analysis data of walking versus squatting were compared, specifically looking at net external knee flexion moments, ground reaction forces and tibiofemoral contact forces. It was found that while squatting resulted in more than 2.5 times larger peak external moments compared with walking, tibiofemoral contact forces were not significantly different. This was due to reduced ground reaction forces recorded for the squatting phase compared to the larger dynamic effects of deceleration at heel strike during walking. The most significant finding of this study was that in squatting, there was a reversal in the tibiofemoral shear reaction force from posterior-directed to anterior-directed, occurring under full compressive load and within a fraction of a second. It is believed that repeated squatting results in many such reversals in shear reactions that may ultimately have significant implications to the long term mechanical function and structural integrity of the joint cartilage.
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Affiliation(s)
- Ashvin Thambyah
- Department of Chemical and Materials Engineering, 20 Symonds Street, The University of Auckland, Private bag 92019, Auckland, New Zealand.
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Affiliation(s)
- W. M. Tang
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - K. Y. Chiu
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong Kong
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Abstract
The association between HLA-B27 and the spondyloarthropathies (SpAs) is so strong that it is supposed that the HLA-B27 molecule plays a pathogenetic role. In whites and Indonesians, the frequency of HLA-B27 is about 10%; in Chinese it is about 8%; and in Japanese it is only about 1%. The prevalence of SpA in the Chinese is at least 0.2%, but in native Indonesians, Philippinos, and Malaysians, SpA is rarely seen. Twenty-three subtypes (B*2701-B*2723) have been distinguished. These subtypes are not equally distributed over the world. In most countries the distribution of the subtypes among HLA-B27 SpA patients is the same as that among the normal HLA-B27-positive population. In China, the subtype B*2704 is frequent and the prevalence of SpA is high. Native Indonesians, however, mostly have subtype B*2706, and SpA is rarely seen in this population. It was shown that B*2706, probably like B*2709 in Sardinia, is not associated with SpA. The difference between the SpA-associated and non-SpA-associated subtypes is limited to only two amino acid residues (114 and 116) at the bottom of the peptide-binding groove of HLA-B27. This small difference between health and disease rewards studies for different peptide-binding capacities and may help us characterize the peptides that are involved in the pathogenesis of SpA. The differences in disease associations in these countries also have clinical implications. In Southeast Asia, HLA-B27 typing without subtyping has less clinical usefulness than in parts of the world where B*2706 is rarely seen. When native Indonesians, Malaysians, or Philippinos are suspected of having ankylosing spondylitis or a related SpA, it is worth asking if they had white or Chinese ancestors. If native HLA-B27-positive Indonesians (with subtypes other than B*2706) develop SpA, the clinical features are not different from those in other parts of the world. In the Chinese population on the mainland and in Taiwan, juvenile SpA is frequently seen. The onset is often a peripheral arthritis or enthesitis.
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Abstract
Joint disorders in Asian children are varied due to the diversity of the Asian population and show some ethnic trends. The ethnic diversity, socio-economic and geographic factors in Asia have limited the availability of data from some of the ethnic groups, many of whom live in remote and relatively underdeveloped areas, are not subjected to epidemiological surveillance and have little awareness of these diseases and their consequences. Geographic and socio-economic factors also play a significant role in some of the joint diseases peculiar to Asian children. In general, the current available data suggests that there are no large differences in the epidemiology and clinical features between the Western and Asian children. This article reviews the available literature on joint diseases in Asian children.
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Affiliation(s)
- T H Tan
- Department of Radiology, North District Hospital, Fanling, NT, Hong Kong
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Cuéllar ML, Espinoza LR. Human immunodeficiency virus associated spondyloarthropathy: lessons from the Third World. J Rheumatol 1999; 26:2071-3. [PMID: 10529116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Njobvu PD, McGill PE. Is HIV the culprit? Spondyloarthropathy in the Third World. J Rheumatol 1999; 26:2074-5. [PMID: 10529117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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del Rincón I, Escalante A. HLA-DRB1 alleles associated with susceptibility or resistance to rheumatoid arthritis, articular deformities, and disability in Mexican Americans. Arthritis Rheum 1999; 42:1329-38. [PMID: 10403259 DOI: 10.1002/1529-0131(199907)42:7<1329::aid-anr5>3.0.co;2-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the genetics (HLA-DRB1 allele associations) of rheumatoid arthritis (RA) susceptibility and severity among Mexican Americans, an important, but understudied, US population. METHODS HLA-DRB1 alleles were compared between 141 Mexican American patients with RA and 54 unrelated Mexican Americans without RA, and the association of these alleles with articular deformities and disability was examined. HLA-DRB1 alleles were typed using polymerase chain reaction-sequence-specific primer amplification and were classified according to the 1996 World Health Organization nomenclature. RESULTS Of the 141 patients, 105 (74%) had at least 1 copy of the shared epitope (SE) sequence, compared with 29 (54%) of the 54 controls (P = 0.007). A significant gene-dose effect was observed, with 31 patients (22%) being homozygous for the SE compared with 1 (2%) of the controls (P = 0.004). In terms of disease severity, only 3% of RA patients who were "null" for the SE were outliers in the rate of development of articular deformities, compared with 10% of heterozygotes and 27% of homozygotes (P = 0.002). Patients who were DRB1*08 positive had significantly fewer deformities per year of disease and a slower rate of development of disability than did patients with other DRB1 alleles. CONCLUSION HLA-DRB1 alleles containing the SE are associated with susceptibility to RA in Mexican Americans, and may also be associated with a more rapid development of articular deformities and disability. HLA-DRB1*08 appears to have a protective influence on RA susceptibility and disease severity in Mexican Americans.
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Affiliation(s)
- I del Rincón
- The University of Texas Health Science Center at San Antonio, 78284, USA
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al Attia HM, Sherif AM, Hossain MM, Ahmed YH. The demographic and clinical spectrum of Arab versus Asian patients with ankylosing spondylitis in the UAE. Rheumatol Int 1998; 17:193-6. [PMID: 9542780 DOI: 10.1007/s002960050033] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ankylosing spondylitis is a rather uncommon condition in the UAE. Over a period of 10 years. 28 hospital-based patients diagnosed as having AS were retrospectively studied. They included 17 Arabs and 11 Asians. The onset of AS in most patients in this study was in adulthood (mean age at onset was 27.7 years in Arabs and 28.75 years in Asians). HLA B27 was positive in 56 and 81% in these two populations, respectively (P > 0.05). Analysis of these figures, however, along with previous relevant published data, could indicate that Arabs with AS are less likely to be B27-positive than Asians. Among the Arab patients there was not a single case from the local community, which could be attributed to the extremely low rate of B27 phenotype in their normal population. The interracial variations in the frequency of clinical features were statistically insignificant, therefore indicating some degree of similarity in the form and disease expression in both groups. AS is characterized as being predominantly axial in the majority of our patients. Extraspinal (oligo-poly) arthropathy involved mainly hips and knees, and there have been fewer extra-articular manifestations compared with other series published.
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Affiliation(s)
- H M al Attia
- Mafraq Hospital, Abu Dhabi, United Arab Emirates
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Jacobsson LT, Nagi DK, Pillemer SR, Knowler WC, Hanson RL, Pettitt DJ, Bennett PH. Low prevalences of chronic widespread pain and shoulder disorders among the Pima Indians. J Rheumatol 1996; 23:907-9. [PMID: 8724307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To establish the prevalence of shoulder disease and chronic widespread pain in Pima Indians. METHODS Cross sectional analyses of data from 4230 subjects for shoulder disease and 105 subjects for chronic widespread pain participating in population surveys RESULTS The prevalence of shoulder disease was 4.4% (95% CI, 3.8-5.1), age-sex adjusted to the 1980 US census population. This is lower than in a study of Caucasians [prevalence ratio (PR) = 0.29, 95% CI, 0.20-0.42 for men and PR = 0.55, 95% CI, 0.41-0.73 for women]. Shoulder disease was associated with non-insulin-dependent diabetes mellitus (PR = 1.67, 95% CI, 1.19-2.36). No chronic widespread pain was identified (95% CI, 0-3.5%). CONCLUSION Prevalence of these pain syndromes in Pima Indians is lower than in predominantly Caucasian populations. These findings suggest that these populations have different pain perception or different patterns of risk factors for these disorders.
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Affiliation(s)
- L T Jacobsson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Phoenix Arizona, USA
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Olivieri I, Foto M, Ruju GP, Gemignani G, Giustarini S, Pasero G. Low frequency of axial involvement in Caucasian pediatric patients with seronegative enthesopathy and arthropathy syndrome after 5 years of disease. J Rheumatol 1992; 19:469-75. [PMID: 1578464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In order to establish how many children with seronegative spondyloarthropathy (SpA) starting with peripheral arthritis and/or enthesitis will develop ankylosing spondylitis (AS), 13 consecutive Caucasian pediatric patients, (11 with the seronegative enthesopathy and arthropathy (SEA) syndrome and 2 with isolated B27 associated peripheral arthritis or enthesitis at entry), were followed prospectively with no loss for more than 5 years. Sacroiliac joint plain films obtained at the last visit were mixed with those of 14 control subjects and read blindly. The course of SpA was self-limiting in 6 patients and recurrent in the other 7. Six patients had episodes of inflammatory cervical and/or lumbar pain during followup. However, none showed any limitation of spinal movement in the asymptomatic periods. Only one patient (9.1%) of 11 with the SEA syndrome showed bilateral sacroiliitis and met New York criteria for AS after 5 years of disease. Our results suggest that the proportion of Caucasian children with the SEA syndrome developing AS is much lower than the 75% found in a similar study on Mexican children. Lack of evaluation of all patients after 5 years, the reading of pelvic plain films without reducing observer error, and the male predominance in the Mexican study, probably in addition to ethnic or environmental factors, may account for differences.
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Affiliation(s)
- I Olivieri
- Rheumatic Disease Unit, Institute of Medical Pathology 1, University of Pisa, Italy
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Boyer GS, Lanier AP, Templin DW, Bulkow L. Spondyloarthropathy and rheumatoid arthritis in Alaskan Yupik Eskimos. J Rheumatol Suppl 1990; 17:489-96. [PMID: 2348429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a Yupik Eskimo population, the prevalence, incidence and clinical features of rheumatoid arthritis (RA) were similar to those described for the United States population in general. More frequent than RA were seronegative spondyloarthropathic disorders, many of which could not be classified by existing disease criteria. Of the adult patients with spondyloarthropathy only half could be classified as having Reiter's syndrome (RS), ankylosing spondylitis (AS) or psoriatic spondylitis. The remaining patients had many signs and symptoms consistent with spondyloarthropathy, but they either did not meet the diagnostic criteria for any specific disease or had features pathognomonic of more than one. The clinical manifestations of the patients who did not meet standard disease definitions are summarized and compared to those of the patients with RS, AS and psoriatic spondylitis. Because of the many shared features, we believe that these as yet unclassified disease states belong with AS and RS in a single spondyloarthropathic disease spectrum and should be defined and recognized as such.
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Affiliation(s)
- G S Boyer
- Internal Medicine Service, Alaska Native Medical Center, Anchorage
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Boyer GS, Lanier AP, Templin DW. Prevalence rates of spondyloarthropathies, rheumatoid arthritis, and other rheumatic disorders in an Alaskan Inupiat Eskimo population. J Rheumatol 1988; 15:678-83. [PMID: 3260953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We reviewed rheumatic diseases in an Inupiat Eskimo population and found a high frequency of seronegative spondyloarthritides. Most cases of juvenile arthritis, which occurred with particularly high incidence in male children (47.4/100,000), appeared to belong in the spondyloarthropathic category. Both Reiter's disease and undifferentiated spondyloarthropathy were common disorders in adults. The prevalence of ankylosing spondylitis (0.2%) was less than expected in a population with a high percentage of HLA-B27 positive individuals. The prevalence rates of rheumatoid arthritis (1.0%), gout (0.3%), and other rheumatic diseases were similar to those of the United States population in general.
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Affiliation(s)
- G S Boyer
- Internal Medicine Service, Alaska Native Medical Center, Anchorage
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