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  1. Ankylosing spondylitis

    MedlinePlus

    ... spondylitis may occur with other conditions, such as: Psoriasis Ulcerative colitis or Crohn disease Recurring or chronic ... people with ankylosing spondylitis may have problems with: Psoriasis, a chronic skin disorder Inflammation in the eye ( ...

  2. What Is Ankylosing Spondylitis?

    MedlinePlus

    ... Spondylitis PDF Version Size: 135 KB November 2014 What Is Ankylosing Spondylitis? Fast Facts: An Easy-to- ... affects about twice as many men as women. What Causes Ankylosing Spondylitis? The cause of AS is ...

  3. Ankylosing spondylitis

    MedlinePlus

    ... spondylitis may occur with other conditions, such as: Psoriasis Ulcerative colitis or Crohn disease Chronic eye inflammation ( ... large intestine ( colitis ) Inflammation in the eye (iritis) Psoriasis, a chronic skin disorder

  4. Alternative Treatments for Ankylosing Spondylitis

    MedlinePlus

    ... fractures and neurological complications, especially in individuals with fusion (extra bone growth) due to spondylitis. — "Ankylosing Spondylitis: ... the body remains unclear, but stimulation of acupuncture points by puncturing the skin with hair-thin needles ...

  5. Genetics of ankylosing spondylitis.

    PubMed

    Robinson, Philip C; Brown, Matthew A

    2014-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the spine and sacroiliac joints. It causes significant disability and is associated with a number of other features including peripheral arthritis, anterior uveitis, psoriasis and inflammatory bowel disease (IBD). Significant progress has been made in the genetics of AS have in the last five years, leading to new treatments in trial, and major leaps in understanding of the aetiopathogenesis of the disease. PMID:23916070

  6. Computer Aided Evaluation of Ankylosing Spondylitis Using High-Resolution CT

    PubMed Central

    Yao, Jianhua; Ward, Michael M.; Yao, Lawrence; Summers, Ronald M.

    2009-01-01

    Ankylosing Spondylitis is a disease characterized by abnormal bone structures (syndesmophytes) growing at intervertebral disk spaces. Because this growth is so slow as to be undetectable on plain radiographs taken over years, it is desirable to resort to computerized techniques to complement qualitative human judgment with precise quantitative measures. We developed an algorithm with minimal user intervention that provides such measures using high-resolution computed tomography (CT) images. To the best of our knowledge it is the first time that determination of the disease’s status is attempted by direct measurement of the syndesmophytes. The first part of our algorithm segments the whole vertebral body using a 3-D multiscale cascade of successive level sets. The second part extracts the continuous ridgeline of the vertebral body where syndesmophytes are located. For that we designed a novel level set implementation capable of evolving on the isosurface of an object represented by a triangular mesh using curvature features. The third part of the algorithm segments the syndesmophytes from the vertebral body using local cutting planes and quantitates them. We present experimental work done with 10 patients from each of which we processed five vertebrae. The results of our algorithm were validated by comparison with a semi-quantitative evaluation made by a medical expert who visually inspected the CT scans. Correlation between the two evaluations was found to be 0.936 (p < 10−18). PMID:18779065

  7. Medical Treatment of Ankylosing Spondylitis

    PubMed Central

    Kim, Young-Tae

    2014-01-01

    The diagnosis of ankylosing spondylitis is often delayed due to ambiguous clinical manifestations and strict diagnostic criteria. However, imaging techniques such as magnetic resonance imaging have been found effective for the early diagnosis of non-radiographic sacroiliitis. New tumor necrosis factor alpha (TNF-α) inhibitors have good efficacy for patients with persistently high disease activity despite conventional nonsteroidal anti-inflammatory drug treatment. Thus, early diagnosis and aggressive treatments are essential for ankylosing spondylitis patients. Because many patients complain of musculoskeletal pains, especially around the sacroiliac joint area, hip specialists should be informed of up-to-date knowledge. In this review, we discuss new diagnostic criteria for ankylosing spondylitis, administration methods of TNF-α inhibitors, and the long-term follow-up results for patients treated with TNF-α inhibitors.

  8. Ankylosing spondylitis: an overview

    PubMed Central

    Sieper, J; Braun, J; Rudwaleit, M; Boonen, A; Zink, A

    2002-01-01

    Ankylosing spondylitis (AS) is a complex, potentially debilitating disease that is insidious in onset, progressing to radiological sacroiliitis over several years. Patients with symptomatic AS lose productivity owing to work disability and unemployment, have a substantial use of healthcare resources, and reduced quality of life. The pathogenesis of AS is poorly understood. However, immune mediated mechanisms involving human leucocyte antigen (HLA)-B27, inflammatory cellular infiltrates, cytokines (for example, tumour necrosis factor α and interleukin 10), and genetic and environmental factors are thought to have key roles. The detection of sacroiliitis by radiography, magnetic resonance imaging, or computed tomography in the presence of clinical manifestations is diagnostic for AS, although the presence of inflammatory back pain plus at least two other typical features of spondyloarthropathy (for example, enthesitis and uveitis) is highly predictive of early AS. Non-steroidal anti-inflammatory drugs (NSAIDs) effectively relieve inflammatory symptoms and are presently first line drug treatment. However, NSAID treatment has only a symptomatic effect and probably does not alter the disease course. For symptoms refractory to NSAIDs, second line treatments, including corticosteroids and various disease modifying antirheumatic drugs, are employed but are of limited benefit. Emerging biological therapies target the inflammatory processes underlying AS, and thus, may favourably alter the disease process, in addition to providing symptom relief. PMID:12381506

  9. Diagnosis of Ankylosing Spondylitis

    MedlinePlus

    ... Of Spondylitis The Heart In Spondyloarthritis Inflammatory vs. Mechanical Back Pain Alternative Treatments Diet & Spondylitis Medication & Diet ... Enteropathic Arthritis Blood Work and the HLA-B27 Test First, HLA-B27 is a perfectly normal gene ...

  10. Cardiac Involvement in Ankylosing Spondylitis.

    PubMed

    Ozkan, Yasemin

    2016-06-01

    Ankylosing spondylitis is one of the subgroup of diseases called "seronegative spondyloarthropathy". Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  11. Diagnosis of Ankylosing Spondylitis

    MedlinePlus

    ... Reactive Arthritis Enteropathic Arthritis Blood Work and the HLA-B27 Test First, HLA-B27 is a perfectly normal gene found in 8% ... Secondly, it is important to note that the HLA-B27 test is not a diagnostic test for ankylosing ...

  12. Cardiac Involvement in Ankylosing Spondylitis

    PubMed Central

    Ozkan, Yasemin

    2016-01-01

    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  13. Temporomandibular joint involvement in ankylosing spondylitis

    PubMed Central

    Arora, Pallak; Amarnath, Janardhan; Ravindra, Setru Veerabhadrappa; Rallan, Mandeep

    2013-01-01

    Frequency of temporomandibular joint (TMJ) involvement in patients with ankylosing spondylitis (AS) has varied from 4% to 35%. It is more common in men and produces generalised stiffness in involved joints. Clinician should be suspicious of AS when a patient reports with painful restricted movements of joint, neck or back and with no trauma history. Conventional radiographic methods have allowed the demonstration of TMJ abnormalities in patients with AS, but CT is necessary to establish joint space relations and bony morphology. We describe a case of severe AS with TMJ involvement in a 40-year-old female patient and demonstrated TMJ changes on CT. A CT was able to demonstrate articular cartilage changes, disc- and joint abnormalities. Thus, if conventional radiographs in a symptomatic patient with rheumatic diseases are unable to demonstrate changes, CT can provide valuable additional information of the changes in the TMJ. PMID:23645650

  14. Andersson lesion in ankylosing spondylitis.

    PubMed

    Dhakad, Urmila; Das, Siddharth K

    2013-01-01

    A middle-aged male patient developed acute back pain and a lumbar vertebral lesion following trivial physical trauma. The lesion was considered as tuberculous on vertebral x-rays and MRI. After biopsy of the lesion and spinal fixation, the patient was kept on empirical antituberculous treatment (ATT) to which he did not respond. On re-evaluation he was diagnosed to have an Andersson lesion in ankylosing spondylitis (AS). ATT was stopped and he was successfully managed by rest, steroids, methotrexate and sulfasalazine. A careful look at the patient's plain x-ray spine and awareness about the lesion can avoid misdiagnosis of this characteristic vertebral lesion found in AS. PMID:23559648

  15. Conventional treatments for ankylosing spondylitis

    PubMed Central

    Dougados, M; Dijkmans, B; Khan, M; Maksymowych, W; van der Linden, S.; Brandt, J

    2002-01-01

    Management of ankylosing spondylitis (AS) is challenged by the progressive nature of the disease. To date, no intervention is available that alters the underlying mechanism of inflammation in AS. Currently available conventional treatments are palliative at best, and often fail to control symptoms in the long term. Current drug treatment may perhaps induce a spurious state of "disease remission," which is merely a low level of disease activity. Non-steroidal anti-inflammatory drugs are first line treatment, but over time, the disease often becomes refractory to these agents. Disease modifying antirheumatic drugs are second line treatment and may offer some clinical benefit. However, conclusive evidence of the efficacy of these drugs from large placebo controlled trials is lacking. Additionally, these drugs can cause treatment-limiting adverse effects. Intra-articular corticosteroid injection guided by arthrography, computed tomography, or magnetic resonance imaging is an effective means of reducing inflammatory back pain, but controlled studies are lacking. A controlled study has confirmed moderate but significant efficacy of intravenous bisphosphonate (pamidronate) treatment in patients with AS; further evaluation of bisphosphonate treatment is warranted. Physical therapy and exercise are necessary adjuncts to pharmacotherapy; however, the paucity of controlled data makes it difficult to identify the best way to administer these interventions. Surgical intervention may be required to support severe structural damage. Thus, for patients with AS, the future of successful treatment lies in the development of pharmacological agents capable of both altering the disease course through intervention at sites of disease pathogenesis, and controlling symptoms. PMID:12381510

  16. Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome

    PubMed Central

    Kobak, Şenol; Yalçin, Murat; Karadeniz, Muamer; Oncel, Guray

    2013-01-01

    Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints. PMID:23762731

  17. CT- and fluoroscopy-guided percutaneous screw fixation of a "carrot-stick" spinal fracture in an elderly man with ankylosing spondylitis.

    PubMed

    Huwart, Laurent; Amoretti, Nicolas

    2013-12-01

    We present a case of percutaneous fixation of a "carrot-stick" spinal fracture in an elderly patient with ankylosing spondylitis (AS). A surgical stabilization was not possible in this 83-year-old man with comorbidities. Under local anesthesia, percutaneous screw fixation of a transdiscal shear fracture at the level T10-T11 was performed using computed tomography (CT) and fluoroscopy guidance. Two 4.0-mm Asnis III cannulated screws were placed to fix facet joints using transfacet pedicle pathway. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 10, preoperatively, to 1 after the procedure. Radiographic fusion was observed at a 3-month post-procedural CT scan. CT- and fluoroscopy-guided percutaneous screw fixation of spinal fractures could potentially be an alternative to surgery in elderly AS patients with poor performance status. PMID:23842576

  18. [Diagnosis and approach in suspected ankylosing spondylitis].

    PubMed

    Rentsch, H U; van der Linden, S; Gerber, N

    1991-05-21

    The time interval from first clinical symptoms to definite diagnosis of ankylosing spondylitis (Morbus Bechterew) is still too long. Thus, many years for essential therapeutic interventions are unequivocally lost. Therefore, it is most important to improve early diagnosis. To this aim the diagnostic criteria recently suggested by van der Linden are useful in relatively early stages of disease (table 1). Diagnosis is based on patient history, clinical examination and radiological signs of sacroiliitis. Blood examinations for ESR, rheumatoid factors and antinuclear antibodies are important with regard to differential diagnosis. The determination of the HLA-B27 haplotype as a diagnostic tool is irrelevant on terms of single cases, because at least 8% of ankylosing spondylitis patients are HLA-B27-negative and in middle europe at least 7% of normal controls exhibit this genetic marker. PMID:2052824

  19. Concomitant systemic lupus erythematosus and ankylosing spondylitis.

    PubMed Central

    Olivieri, I; Gemignani, G; Balagi, M; Pasquariello, A; Gremignai, G; Pasero, G

    1990-01-01

    The case is reported of a 42 year old white woman meeting currently used diagnostic criteria for both ankylosing spondylitis and systemic lupus erythematosus (SLE). As found in a previously described similar case of a black man, HLA typing showed antigens associated with both SLE and seronegative spondyloarthropathy. This case thus supports the hypothesis that the two diseases occur together only when this rare combination of HLA antigens is present. Images PMID:2344214

  20. Ankylosing Spondylitis: A rheumatology clinic experience

    PubMed Central

    Ahsan, Tasnim; Erum, Uzma; Jabeen, Rukhshanda; Khowaja, Danish

    2016-01-01

    Objective: To determine the frequency, demographics, laboratory and radiological features in patients with Ankylosing Spondylitis. Methods: This is a retrospective analysis of prospectively collected data of patients with a diagnosis of Ankylosing Spondylitis (AS), based on Modified New York criteria. The study was conducted at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), from February 2004 to February 2014. Detailed history, examination and laboratory investigations were recorded in a pre-designed structured proforma. The frequency, demographic characteristics, extra-articular features and associated co-morbidities were studied. Results: A total of 603 patients were registered in our Rheumatology Clinic during this period, with a definitive diagnosis of inflammatory rheumatological disorders. Out of these, Ankylosing Spondylitis (AS) was diagnosed in 32 (5.3%) patients. 24 were male and 8 patients were female. The commonest affected age group was between 21-40 years. Majority of the patients belonged to Pathan ethnicity. Conclusion: The demographic features of AS are same as reported in earlier studies from other parts of the world. The predominance of AS in specific ethnic groups is a fact that needs to be studied. Larger studies are required for clarifying the triggers of this disease. It often leads to severe disability, hence an early diagnosis and prompt treatment is required for better disease control and quality of life. PMID:27182241

  1. Ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis in royal Egyptian mummies of 18th -20th Dynasties? CT and archaeology studies.

    PubMed

    Saleem, Sahar N; Hawass, Zahi

    2014-12-01

    Objective. To study the computed tomography(CT) images of royal Ancient Egyptian mummies dated to the 18th to early 20th Dynasties for the claimed diagnoses of ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) and to correlate the findings with the archaeology literature.Methods. We studied the CT images of 13 royal Ancient Egyptian mummies (1492–1153 BC) for evidence of AS and DISH and correlated our findings with the archaeology literature.Results. The findings of the CT scans excluded the diagnosis of AS, based on the absence of sacroiliac joint erosions or fusion of the facet joints. Four mummies fulfilled the diagnostic criteria for DISH:Amenhotep III (18th Dynasty), Ramesses II, his son Merenptah, and Ramesses III (19th to early 20th Dynasties).The diagnosis of DISH, a commonly a symptomatic disease of old age, in the 4 pharaohs is in concordance with their longevity and active lifestyles.Conclusion. CT findings excluded the diagnosis of AS in the studied royal Ancient Egyptian mummies and brought into question the antiquity of the disease. The CT features of DISH during this ancient period were similar to those commonly seen in modern populations,and it is likely that they will also be similar in the future.The affection of Ramesses II and his son Merenptah supports familial clustering of DISH. The process of mummification may induce changes in the spine that should be considered during investigations of disease in ancient mummies. PMID:25329920

  2. Neurological complications of ankylosing spondylitis: neurophysiological assessment.

    PubMed

    Khedr, Eman M; Rashad, Sonia M; Hamed, Sherifa A; El-Zharaa, Fatma; Abdalla, Abdel Karim H

    2009-07-01

    Studies examined the neurological involvement of ankylosing spondylitis (AS) are limited. This study aimed to assess the frequency of myelopathy, radiculopathy and myopathy in AS correlating them to the clinical, radiological and laboratory parameters. Included were 24 patients with AS. Axial status was assessed using bath ankylosing spondylitis metrology index (BASMI). Patients underwent (a) standard cervical and lumbar spine and sacroiliac joint radiography, (b) somatosensory (SSEP) and magnetic motor (MEP) evoked potentials of upper and lower limbs, (c) electromyography (EMG) of trapezius and supraspinatus muscles. Patients' mean age and duration of illness were 36 and 5.99 years. Bath ankylosing spondylitis metrology index mean score was 4.6. Twenty-five percent (n = 6) of patients had neurological manifestations, 8.3% of them had myelopathy and 16.7% had radiculopathy. Ossification of the posterior (OPLL) and anterior (OALL) longitudinal ligaments were found in 8.3% (n = 2) and 4.2% (n = 1). About 70.8% (n = 17) had >or=1 neurophysiological test abnormalities. Twelve patients (50%) had SSEP abnormalities, seven had prolonged central conduction time (CCT) of median and/or ulnar nerves suggesting cervical myelopathy. Six had delayed peripheral or root latencies at Erb's or interpeak latency (Erb's-C5) suggesting radiculopathy. Motor evoked potentials was abnormal in 54% (n = 13). Twelve (50%) and five (20.8%) patients had abnormal MEP of upper limbs and lower limbs, respectively. About 50% (n = 12) had myopathic features of trapezius and supraspinatus muscles. Only 8.3% (n = 2) had neuropathic features. We concluded that subclinical neurological complications are frequent in AS compared to clinically manifest complications. Somatosensory evoked potential and MEP are useful to identify AS patients prone to develop neurological complications. PMID:19153738

  3. Spironolactone improves endothelial dysfunction in ankylosing spondylitis.

    PubMed

    Syngle, Ashit; Vohra, Kanchan; Khichi, Dinesh; Garg, Nidhi; Verma, Inderjeet; Kaur, Ladbans

    2013-07-01

    Chronic inflammation in ankylosing spondylitis (AS) is associated with vascular endothelial dysfunction which leads to accelerated atherosclerosis. Accelerated atherosclerosis contributes to premature cardiovascular disease and increased cardiovascular mortality in AS. Spironolactone inhibits the production of proinflammatory cytokines and improves endothelial dysfunction in rheumatoid arthritis. This study aimed to determine the effect of spironolactone in antitumor necrosis factor (TNF)-naive AS patients. Twenty anti-TNF-naive AS patients (M/F = 15/5) with high disease activity (Bath ankylosing spondylitis disease activity index, BASDAI >4) despite treatment with stable doses of conventional disease-modifying antirheumatic drugs were investigated. Inflammatory disease activity (BASDAI and Bath ankylosing spondylitis functional index (BASFI) scores, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels), serum nitrite concentration, and endothelium-dependent and -independent vasodilatation of the brachial artery were measured at baseline and after 12 weeks of therapy with oral spironolactone 2 mg/kg/day. Ten healthy subjects matched for age and sex acted as the control. Flow-mediated dilation (FMD) in AS patients at baseline was significantly impaired compared with healthy control group (p < 0.001). After treatment, FMD improved from 11.3 ± 1.70 to 24.69 ± 2.34% (p < 0.001); nitrite concentration reduced from 7.9 ± 0.28 to 4.79 ± 0.19 μmol/L (p < 0.001); ESR from 33.8 ± 4.38 to 15.13 ± 1.30 mm in the first hour, (p < 0.001); and CRP level from 22.39 ± 3.80 to 6.3 ± 1.29 mg/dL, (p < 0.001). BASDAI and BASFI also reduced significantly (p < 0.001). The study suggests that in AS endothelial dysfunction is a part of the disease process. This is the first study to show that treatment with spironolactone improves both endothelial dysfunction and inflammatory disease activity in AS. PMID:23504211

  4. Feasibility of US-CT image fusion to identify the sources of abnormal vascularization in posterior sacroiliac joints of ankylosing spondylitis patients

    PubMed Central

    Hu, Zhenlong; Zhu, Jiaan; Liu, Fang; Wang, Niansong; Xue, Qin

    2015-01-01

    Ultrasound (US) can be used to evaluate the inflammatory activity of the sacroiliac joints (SIJs) in ankylosing spondylitis (AS) patients, but to precisely locate the abnormal vascularization observed on color Doppler US (CDUS) was difficult. To address this issue, we performed US and computed tomography (CT) fusion imaging of SIJs with 84 inpatients and 30 controls, and then assessed the sources of abnormal vascularization in the posterior SIJs of AS patients based on the fused images. Several possible factors impacting the fusion process were considered including the lesion classes of SIJ, the skinfold thickness of the sacral region and the cross-sectional levels of the first, second and third posterior sacral foramina. Our data showed high image fusion success rates at the 3 levels in the AS group (97.0%, 87.5% and 79.8%, respectively) and the control group (96.7%, 86.7%, and 86.7%, respectively).The skinfold thickness was identified as the main factor affecting the success rates. The successfully fused images revealed significant differences in the distribution of abnormal vascularization between 3 levels, as detected via CDUS (P = 0.011), which suggested that inflammation occurred in distinct tissues at different levels of the SIJ (intraligamentous inflammation in Regions 1 and 2; intracapsular inflammation in Region 3). PMID:26669847

  5. Autophagy in the pathogenesis of ankylosing spondylitis.

    PubMed

    Ciccia, Francesco; Haroon, Nigil

    2016-06-01

    The pathogenesis of ankylosing spondylitis (AS) is not well understood, and treatment options have met with limited success. Autophagy is a highly conserved mechanism of controlled digestion of damaged organelles within a cell. It helps in the maintenance of cellular homeostasis. The process of autophagy requires the formation of an isolation membrane. They form double-membraned vesicles called "autophagosomes" that engulf a portion of the cytoplasm. Beyond the role in maintenance of cellular homeostasis, autophagy has been demonstrated as one of the most remarkable tools employed by the host cellular defense against bacteria invasion. Autophagy also affects the immune system and thus is implicated in several rheumatic disease processes. In this article, we explore the potential role of autophagy in the pathogenesis of AS. PMID:27075464

  6. Ankylosing spondylitis: the challenge of early diagnosis.

    PubMed

    Felts, W R

    1982-09-01

    Ankylosing spondylitis can present a difficult diagnostic challenge. Not only is its etiology unknown, but its clinical manifestations are myriad and sometimes precede classic low back pain by years. The foremost aid in diagnosis is an awareness of these manifestations, coupled with a willingness to make a tentative (possible or probable) diagnosis of the disease. HLA-B27 positivity and radiologic evidence of sacroiliitis cannot be considered more than nonspecific findings. The earlier the diagnosis, the earlier therapy can be instituted to prevent or minimize disabling deformities. Patient education is integral to therapy and should stress proper posture and exercise in addition to realistic expectations. Medication, particularly the nonsteroidal antiinflammatory drugs, to relieve pain and timely surgical intervention, such as total hip replacement, to relieve pain and/or improve function may also be necessary. PMID:6981803

  7. Polyclonal B cell activation in ankylosing spondylitis.

    PubMed Central

    Barbieri, P; Olivieri, I; Benedettini, G; Marelli, P; Ciompi, M L; Pasero, G; Campa, M

    1990-01-01

    The peripheral blood lymphocyte response of patients with ankylosing spondylitis (AS) to several polyclonal B cell activators was investigated. No differences were found in the reactivity to pokeweed mitogen and protein A between patients and controls; in contrast, the peripheral blood lymphocyte response to Staphylococcus aureus strain Cowan I (SAC) was significantly higher in patients with AS than in controls. This responsiveness was not influenced either by the presence of the HLA-B27 antigen or by environmental factors or associated diseases, and it was higher in patients with active AS than in those with inactive disease. The percentage of circulating B cells was normal. The responses to T cell mitogens and the percentages of T cell subpopulations were similar in patients and in controls. The peripheral blood lymphocyte hyperactivity of patients with AS to SAC was associated with an increased in vitro production of immunoglobulins. PMID:2383063

  8. Coexistence of rheumatoid arthritis and ankylosing spondylitis

    PubMed Central

    Węgierska, Małgorzata; Żuchowski, Paweł; Dura, Marta; Zalewska, Joanna; Waszczak, Marzena; Jeka, Sławomir

    2015-01-01

    Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic progressive inflammatory diseases, leading to joint damage and reducing the physical fitness of patients. They are among the most common rheumatic diseases. However, their etiology and symptomatology are different. Formerly, AS was often wrongly diagnosed as RA. Today there are no major diagnostic difficulties in differentiation between these diseases, thanks to modern laboratory tests and imaging. However, a problem may arise when the patient has symptoms typical for both diseases simultaneously. Cases of coexistence of RA with AS – according to our best knowledge – are rare. This study aims to compare our experience in diagnosis and treatment of concomitant RA and AS with the experience of other researchers. Implementation of the proper diagnostic algorithm, allowing for correct diagnosis of both diseases in one patient, may be useful for differential diagnosis of similar cases in the future.

  9. Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

    PubMed Central

    Imrich, R; Rovensky, J; Zlnay, M; Radikova, Z; Macho, L; Vigas, M; Koska, J

    2004-01-01

    Objective: To assess basal function and responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis in patients with ankylosing spondylitis during dynamic testing. Methods: Insulin induced hypoglycaemia (IIH) (Actrapid HM 0.1 IU/kg, as intravenous bolus) was induced in 17 patients and 11 healthy controls matched for age, sex, and body mass index. Concentrations of glucose, adrenocorticotrophic hormone (ACTH), cortisol, insulin, dehydroepiandrosterone sulphate (DHEAS), 17α-hydroxyprogesterone, interleukin 6 (IL-6), and tumour necrosis factor α (TNFα) were determined in plasma. Results: Comparable basal cortisol levels were found in the two groups, with a trend to be lower in ankylosing spondylitis. In the ankylosing spondylitis group, there were higher concentrations of IL-6 (mean (SEM): 16.6 (2.8) pg/ml v 1.41 (0.66) pg/ml in controls; p<0.001) and TNFα (8.5 (1.74) pg/ml v 4.08 (0.42) pg/ml in controls; p<0.01). Glucose, insulin, ACTH, DHEAS, and 17α-hydroxyprogesterone did not differ significantly from control. The IIH test was carried out successfully in 11 of the 17 patients with ankylosing spondylitis, and the ACTH and cortisol responses were comparable with control. General linear modelling showed a different course of glycaemia (p = 0.041) in the ankylosing spondylitis patients who met the criteria for a successful IIH test compared with the controls. Conclusions: The results suggest there is no difference in basal HPA axis activity and completely preserved responsiveness of the HPA axis in patients with ankylosing spondylitis. The interpretation of the different course of glycaemia during IIH in ankylosing spondylitis requires further investigation. PMID:15140773

  10. Arthropathy, ankylosing spondylitis, and clubbing of fingers in ulcerative colitis

    PubMed Central

    Jalan, K. N.; Prescott, R. J.; Walker, R. J.; Sircus, W.; McManus, J. P. A.; Card, W. I.

    1970-01-01

    In a retrospective study of 399 patients with ulcerative colitis, 27 patients had colitic arthritis, 17 had ankylosing spondylitis, and 20 had clubbing of the fingers. Colitic arthritis and ankylosing spondylitis were not related to severity, extent of involvement, or duration of colitis. A significant association between colitic arthropathy and other complications of ulcerative colitis, such as pseudopolyposis, perianal disease, eye lesions, skin eruptions, aphthous ulceration, and liver disease has been demonstrated. The outcome of the first referred attack of colitis in the presence of colitic arthritis and ankylosing spondylitis remained uninfluenced. Clubbing of fingers was related to severity, extent of involvement, and length of the history of colitis. A significant association between clubbing of the fingers and carcinoma of the colon, pseudopolyposis, toxic dilatation, and arthropathy has been shown. The frequency of surgical intervention in patients with clubbing was higher but the overall mortality was not significantly different from the patients without clubbing. PMID:5473606

  11. Ankylosing Spondylitis: From Cells to Genes

    PubMed Central

    Zambrano-Zaragoza, José Francisco; Agraz-Cibrian, Juan Manuel; González-Reyes, Christian; Durán-Avelar, Ma. de Jesús; Vibanco-Pérez, Norberto

    2013-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown etiology, though it is considered an autoimmune disease. HLA-B27 is the risk factor most often associated with AS, and although the mechanism of involvement is unclear, the subtypes and other features of the relationship between HLA-B27 and AS have been studied for years. Additionally, the key role of IL-17 and Th17 cells in autoimmunity and inflammation suggests that the latter and the cytokines involved in their generation could play a role in the pathogenesis of this disease. Recent studies have described the sources of IL-17 and IL-23, as well as the characterization of Th17 cells in autoimmune diseases. Other cells, such as NK and regulatory T cells, have been implicated in autoimmunity and have been evaluated to ascertain their possible role in AS. Moreover, several polymorphisms, mutations and deletions in the regulatory proteins, protein-coding regions, and promoter regions of different genes involved in immune responses have been discovered and evaluated for possible genetic linkages to AS. In this review, we analyze the features of HLA-B27 and the suggested mechanisms of its involvement in AS while also focusing on the characterization of the immune response and the identification of genes associated with AS. PMID:23970995

  12. Secukinumab: A Review in Ankylosing Spondylitis.

    PubMed

    Blair, Hannah A; Dhillon, Sohita

    2016-07-01

    Secukinumab (Cosentyx(®)) is a fully human monoclonal antibody against the proinflammatory cytokine interleukin-17A. It is the first drug in its class to be approved for use in patients with active ankylosing spondylitis (AS). This article reviews the efficacy and tolerability of secukinumab in this indication and briefly summarizes its pharmacology. In ongoing phase III trials, 16 weeks' treatment with subcutaneous secukinumab 150 mg was effective in terms of improving the clinical signs and symptoms of disease and health-related quality of life in patients with AS, with these improvements maintained during longer-term (up to 2 years) treatment. In subgroup analyses, secukinumab was effective both in tumour necrosis factor (TNF) inhibitor-naïve patients and in patients intolerant of or refractory to TNF inhibitors. Secukinumab was generally well tolerated, with a tolerability profile consistent with that seen previously in patients with plaque psoriasis. In the absence of head-to-head trials, the position of secukinumab with respect to TNF inhibitors remains to be fully determined. Nevertheless, secukinumab is an effective and generally well tolerated treatment option for patients with AS. PMID:27255593

  13. High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI

    PubMed Central

    2012-01-01

    Background This study compares the frequency and distribution of increased activity on 18 F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS). Methods Ten patients (6 men and 4 women), between 30 and 58 years old (median 44) with active AS, were prospectively examined with both whole-body MRI and 18 F-fluoride PET/CT. Patients fulfilled modified NY criteria and had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4. Increased radiotracer uptake in PET/CT and bone marrow edema in whole-body MRI of spine and SIJ was evaluated independently by two blinded observers for each modality. Kappa statistics were used to compare interobserver agreement as well as scores of consensus reading of the two imaging modalities. Results Analysis of interobserver agreement for PET/CT yielded a kappa value of 0.68 for spinal lesions and of 0.88 for SIJ lesions. The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively. More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17). Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions. Conclusion Increased 18 F-fluoride uptake in PET/CT is only modestly associated with bone marrow edema on MRI in the spine and SIJ of patients with AS, suggesting different aspects of bone involvement in AS. PMID:22788874

  14. Update on the treatment of ankylosing spondylitis

    PubMed Central

    Maksymowych, Walter P

    2007-01-01

    Non-steroidal anti-inflammatory agents (NSAIDs) remain the mainstay of treatment for ankylosing spondylitis (AS) though one recent trial suggests that continuous as opposed to on-demand use may be superior in preventing progression of structural damage. One particular NSAID, which is a highly selective cyclo-oxygenase 2 inhibitor, etoricoxib, may be superior to standard NSAIDs for AS. Second-line agents typically used for rheumatoid arthritis appear to lack efficacy. Salazopyrin is only moderately effective in the subgroup of AS patients with concomitant peripheral arthritis and not in those with purely axial disease. A recent trial showed that there is no greater efficacy in patients presenting early in their disease course. Three anti-tumor necrosis factor alpha agents, infliximab, etanercept, and adalimumab, are now available for the treatment of AS, the latest being adalimumab. All possess similar clinical efficacy in phase III trials with response rates of about 60%. Imaging studies using magnetic resonance show substantial amelioration of inflammatory lesions in the spine and sacroiliac joints. There is as yet no evidence that any of these agents prevent progression of structural damage. One study that evaluated etanercept demonstrated no impact on damage progression. Increasing evidence points to the superiority of the two monoclonal antibodies, infliximab and adalimumab, over etanercept for the treatment of extra-articular manifestations typically seen in AS such as acute anterior uveitis and inflammatory bowel disease. All three agents can be used as monotherapy and concomitant methotrexate appears to offer no advantages although insufficient doses have been used to date. Future studies should target patients earlier in their disease course as well as those with adverse prognostic factors such as elevated serum metalloproteinase 3 levels and radiographic evidence of spinal ankylosis. PMID:18516314

  15. Testicular Sertoli cell function in ankylosing spondylitis.

    PubMed

    Almeida, Breno Pires; Saad, Carla Gonçalves Schahin; Souza, Fernando Henrique Carlos; Moraes, Julio Cesar Bertacini; Nukumizu, Lucia Akemi; Viana, Vilma Santos Trindade; Bonfá, Eloísa; Silva, Clovis Artur

    2013-07-01

    To assess the testicular Sertoli cell function according to inhibin B levels in ankylosing spondylitis (AS) patients and the possible effect of anti-TNF therapy on this hormone production, 20 consecutive AS patients and 24 healthy controls were evaluated. At study entry, AS patients were not receiving sulfasalazine/methotrexate and never have used biological/cytotoxic agents. They were assessed by serum inhibin B levels, hormone profile, urological examination, testicular ultrasound, seminal parameters, and clinical features. Ten of these patients received anti-TNF treatment and they were reevaluated for Sertoli function and disease parameters at 6 months. Four of them agreed to repeat sperm analysis. At study entry, the median of inhibin B (68 vs. 112.9 pg/mL, p = 0.111), follicle-stimulating hormone levels (3.45 vs. 3.65 IU/L, p = 0.795), and the other hormones was comparable in AS patients and controls (p > 0.05). Sperm analysis was similar in AS patients and controls (p > 0.05) with one AS patient presenting borderline low inhibin B levels. Further analysis at 6 months of the 10 patients referred for anti-TNF therapy, including one with borderline inhibin B, revealed that median inhibin B levels remained stable (116.5 vs. 126.5 pg/mL, p = 0.431) with a significant improvement in C-reactive protein (27.8 vs. 2.27 mg/L, p = 0.039). Sperm motility and concentration were preserved in the four patients who repeated this analysis after TNF blockage. In conclusion, this was the first study to report, using a specific marker, a normal testicular Sertoli cell function in AS patients with mild to moderate disease activity. PMID:23417428

  16. Audiovestibular manifestations in patients with ankylosing spondylitis.

    PubMed

    Amor-Dorado, Juan C; Barreira-Fernandez, Maria P; Vazquez-Rodriguez, Tomas R; Gomez-Acebo, Ines; Miranda-Filloy, Jose A; Diaz de Teran, Teresa; Llorca, Javier; Gonzalez-Gay, Miguel A

    2011-03-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin affecting up to 1% of the population. Little is known about audiovestibular impairment in patients with AS, especially the presence of cochleovestibular dysfunction in these patients. To investigate audiovestibular manifestations in AS, we studied a series of 50 consecutive patients who fulfilled the modified New York diagnostic criteria for AS and 44 matched controls. Individuals with history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. Most patients with AS were men (80%). The mean age at the time of study was 52.5 years, and mean age at the onset of symptoms was 34.4 years. Twenty-nine (58%) patients showed abnormal hearing loss in the audiogram compared to only 8 (18%) controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). It is noteworthy that the audiogram shape disclosed a predominant pattern of high-frequency sensorineural hearing loss in AS patients (50%) compared to controls (18%) (p = 0.002). Also, AS patients exhibited abnormal vestibular tests more commonly than controls. AS patients had an increased frequency of head-shaking nystagmus (20%) compared to controls (0%) (p < 0.001). Moreover, patients (26%) showed a significantly increased frequency of abnormal caloric test compared to controls (0%) (p < 0.001). Finally, a significantly increased frequency of abnormal clinical test of sensory integration and balance with a predominant vestibular loss pattern was observed in patients (36%) compared to controls (5%) (p < 0.001). In conclusion, the current study demonstrates strong evidence for inner ear compromise in patients with AS. PMID:21358443

  17. Variable histopathology of discovertebral lesion (spondylodiscitis) of ankylosing spondylitis.

    PubMed

    Agarwal, A K; Reidbord, H E; Kraus, D R; Eisenbeis, C H

    1990-01-01

    Extensive discovertebral lesion is an infrequent complication of long-standing ankylosing spondylitis. Reported histopathological descriptions vary from predominantly inflammatory to fibrous granulation with reactive bone formation. We report variable histological findings in four symptomatic patients with extensive discovertebral lesions who required spinal fusion. PMID:2347137

  18. Effect of Pilates training on people with ankylosing spondylitis.

    PubMed

    Altan, L; Korkmaz, N; Dizdar, M; Yurtkuran, M

    2012-07-01

    The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (week 12 and week 24) evaluation was performed by one of the authors who was blind to the group allocation. Primary outcome measure was functional capacity. Evaluation was done using the Bath Ankylosing Spondylitis Functional Index (BASFI). Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Chest expansion, and ankylosing spondylitis quality of life (ASQOL) questionnaire. In group I, BASFI showed significant improvement at week 12 (P = 0.031) and week 24 (P = 0.007). In group II, this parameter was not found to have significantly changed at week 12 and week 24. Comparison of the groups showed significantly superior results for group I at week 24 (P = 0.023). We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients. Our study is the first clinical study designed to investigate the role of Pilates method in AS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS. PMID:21499876

  19. Gender and disease features in Moroccan patients with ankylosing spondylitis.

    PubMed

    Ibn Yacoub, Yousra; Amine, Bouchra; Laatiris, Assia; Hajjaj-Hassouni, Najia

    2012-02-01

    This study was conducted to determine differences in ankylosing spondylitis (AS) between men and women in terms of clinical characteristics, biological features, structural severity and quality of life (QoL). A total of 130 consecutive AS patients fulfilling the modified New York criteria were included. Sociodemographic data were collected. The activity of disease was assessed by the Bath ankylosing spondylitis disease activity index (BASDAI) and the functional disability by the Bath Ankylosing spondylitis functional index (BASFI). Spinal mobility was measured using the occiput-to-wall distance, chest expansion, Schober index and the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Bath Ankylosing Spondylitis Radiologic Index (BASRI) was used to evaluate structural damage. Fatigue was evaluated using a visual analogue scale and the QoL was measured by using the generic instrument SF-36. Laboratory tests included the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). In our sample, there were 87 (66.9%) men and 43 (33.1%) women. Women had significantly lower educational levels but there were no differences in socioeconomic status, age at onset, diagnosis delay, disease duration or treatments. Also, women had higher clinical disease activity (morning stiffness and BASDAI score), higher number of tender joints, more severe enthesitis and higher scores of fatigue (for all p ≤ 0.05). Moreover, hip involvement was more prevalent in men and the impairment of spinal mobility was significantly worse compared to women (for all p ≤ 0.001). Men had worse radiographic damage and lower scores in physical and social domains of QoL, but there were no differences in functional impairment scores. In this study, we noticed that AS presents differently according to gender in our patients. More longitudinal studies seem to be necessary to identify gender-related parameters of disease, thing that may help in diagnosis and therapeutic management of

  20. Common MIR146A Polymorphisms in Chinese Ankylosing Spondylitis Subjects and Controls.

    PubMed

    Niu, Zhenmin; Wang, Jiucun; Zou, Hejian; Yang, Chengde; Huang, Wei; Jin, Li

    2015-01-01

    Common polymorphisms of microRNA gene MIR146A were reported as associated with different autoimmune diseases, include systemic lupus erythematosus, psoriatic arthritis, asthma and ankylosing spondylitis. In this study we investigated MIR146A SNPs in Chinese people with ankylosing spondylitis. Three common SNPs: rs2910164, rs2431697 and rs57095329 were selected and genotyped in 611 patients and 617 controls. We found no association between these SNPs and ankylosing spondylitis in our samples. PMID:26366721

  1. Common MIR146A Polymorphisms in Chinese Ankylosing Spondylitis Subjects and Controls

    PubMed Central

    Niu, Zhenmin; Wang, Jiucun; Zou, Hejian; Yang, Chengde; Huang, Wei; Jin, Li

    2015-01-01

    Common polymorphisms of microRNA gene MIR146A were reported as associated with different autoimmune diseases, include systemic lupus erythematosus, psoriatic arthritis, asthma and ankylosing spondylitis. In this study we investigated MIR146A SNPs in Chinese people with ankylosing spondylitis. Three common SNPs: rs2910164, rs2431697 and rs57095329 were selected and genotyped in 611 patients and 617 controls. We found no association between these SNPs and ankylosing spondylitis in our samples. PMID:26366721

  2. Risk factors of uveitis in ankylosing spondylitis

    PubMed Central

    Sun, Li; Wu, Rui; Xue, Qin; Wang, Feng; Lu, Peirong

    2016-01-01

    Abstract Background: Uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis (AS). The prevalence and characteristics of uveitis in AS have been studied in previous literatures, whereas its associated risk factors have not been clarified. Therefore, this study analyzed the risk factors of uveitis in patients with AS. Methods: A total of 390 patients with AS who fulfilled the modified New York criteria were enrolled from January to December in 2015. The history of uveitis was accepted only if diagnosed by ophthalmologists. The medical records of the patients were retrospectively reviewed and associated information was collected, such as disease duration, HLA-B27, and the number of peripheral arthritis. Hip-joint lesion was identified by imaging examination. Meanwhile, biochemical examinations were performed to determine the patient's physical function. Results: Of 390 patients with AS (80.5% male, mean age 33.3 years), 38 (9.7%) had experienced 1 or more episodes of uveitis. The incidence rate for hip-joint lesion was obviously higher for patients with uveitis than the nonuveitis group (44.7% vs 22.2%; P < 0.01). The number of peripheral arthritis was also larger for the uveitis group than nonuveitis group (2.18 ± 0.23 vs 0.55 ± 0.04; P < 0.001). Meanwhile, patients with uveitis had a significantly higher level of antistreptolysin O (ASO) and circulating immune complex (CIC) than those without (P < 0.05 and P < 0.0001, respectively). However, there were no significant differences in disease duration, HLA-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the 2 groups. Binary logistic regression results showed that ASO (OR = 12.2, 95% CI:3.6–41.3, P < 0.01) and the number of peripheral arthritis (OR = 4.1, 95%CI:2.6–6.3, P < 0.01) are significantly associated with uveitis in AS. Conclustion: This study provides some evidence that hip-joint lesion, the number of

  3. Rosuvastatin improves endothelial dysfunction in ankylosing spondylitis.

    PubMed

    Garg, Nidhi; Krishan, Pawan; Syngle, Ashit

    2015-06-01

    Enhanced cardiovascular risk in ankylosing spondylitis (AS) provides a strong rationale for early therapeutical intervention. In view of the proven benefit of statins in atherosclerotic vascular disease, we aimed to investigate the effect of rosuvastatin on endothelial dysfunction (ED) and inflammatory disease activity in AS. In a single-blind, placebo-controlled, parallel study, 32 AS patients were randomized to receive 24 weeks of treatment with rosuvastatin (10 mg/day, n = 17) and placebo (n = 15) as an adjunct to existing stable antirheumatic drugs. Flow-mediated dilatation (FMD) was assessed by AngioDefender™ (Everest Genomic Ann Arbor, USA). Inflammatory measures (BASDAI, BASFI, CRP and ESR) and pro-inflammatory cytokines (tumour necrosis factor-alpha [TNF-α], interleukin-6 [IL-6] and interleukin-1 [IL-1]) were measured at baseline and after treatment. Lipids and adhesion molecules (intracellular adhesion molecule [ICAM-1] and vascular cell adhesion molecule [VCAM-1]) were estimated at baseline and after treatment. At baseline, inflammatory measures, pro inflammatory cytokines and adhesion molecules were elevated among both groups. After treatment with rosuvastatin, FMD improved significantly (p < 0.01). Levels of inflammatory measures, TNF-α, IL-6 and ICAM-1 decreased significantly (p < 0.01) after treatment with rosuvastatin. Rosuvastatin exerted positive effect on lipid spectrum. No significant change in the placebo group. Significant negative correlation was observed between FMD and IL-6, ICAM-1, CRP after treatment with rosuvastatin. First study to show that rosuvastatin improves inflammatory disease activity and ED in AS. Rosuvastatin lowers the proinflammatory cytokines, especially IL-6 and TNF-α, which downregulates adhesion molecules and CRP production which in turns improves ED. Improvement in ED in AS occurs through both cholesterol-independent and cholesterol-dependent pathways. Rosuvastatin can mediate modest but clinically

  4. Treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis

    PubMed Central

    Machado, Marina Amaral de Ávila; de Moura, Cristiano Soares; Ferré, Felipe; Bernatsky, Sasha; Rahme, Elham; Acurcio, Francisco de Assis

    2016-01-01

    ABSTRACT OBJECTIVE To evaluate treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis who started therapies with disease-modifying antirheumatic drugs (DMARD) and tumor necrosis factor blockers (anti-TNF drugs). METHODS This retrospective cohort study from July 2008 to September 2013 evaluated therapy persistence, which is defined as the period between the start of treatment until it is discontinued, allowing for an interval of up to 30 days between the prescription end and the start of the next prescription. Odds ratio (OR) with 95% confidence intervals (95%CI) were calculated by logistic regression models to estimate the patients’ chances of persisting in their therapies after the first and after the two first years of follow-up. RESULTS The study included 11,642 patients with rheumatoid arthritis – 2,241 of these started on anti-TNF drugs (+/-DMARD) and 9,401 patients started on DMARD – and 1,251 patients with ankylosing spondylitis – 976 of them were started on anti-TNF drugs (+/-DMARD) and 275 were started on DMARD. In the first year of follow-up, 63.5% of the patients persisted in their therapies with anti-TNF drugs (+/-DMARD) and 54.1% remained using DMARD in the group with rheumatoid arthritis. In regards to ankylosing spondylitis, 79.0% of the subjects in anti-TNF (+/-DMARD) group and 41.1% of the subjects in the DMARD group persisted with their treatments. The OR (95%CI) for therapy persistence was 1.50 (1.34-1.67) for the anti-TNF (+/-DMARD) group as compared with the DMARD group in the first year for the patients with rheumatoid arthritis, and 2.33 (1.74-3.11) for the patients with ankylosing spondylitis. A similar trend was observed at the end of the second year. CONCLUSIONS A general trend of higher rates of therapy persistence with anti-TNF drugs (+/-DMARD) was observed as compared to DMARD in the study period. We observed higher persistence rates for anti-TNF drugs (+/-DMARD) in patients with ankylosing

  5. A randomised, double-blind, multicentre, parallel-group, prospective study comparing the pharmacokinetics, safety, and efficacy of CT-P13 and innovator infliximab in patients with ankylosing spondylitis: the PLANETAS study

    PubMed Central

    Park, Won; Hrycaj, Pawel; Jeka, Slawomir; Kovalenko, Volodymyr; Lysenko, Grygorii; Miranda, Pedro; Mikazane, Helena; Gutierrez-Ureña, Sergio; Lim, MieJin; Lee, Yeon-Ah; Lee, Sang Joon; Kim, HoUng; Yoo, Dae Hyun; Braun, Jürgen

    2013-01-01

    Objectives To compare the pharmacokinetics (PK), safety and efficacy of innovator infliximab (INX) and CT-P13, a biosimilar to INX, in patients with active ankylosing spondylitis (AS). Methods Phase 1 randomised, double-blind, multicentre, multinational, parallel-group study. Patients were randomised to receive 5 mg/kg of CT-P13 (n=125) or INX (n=125). Primary endpoints were area under the concentration-time curve (AUC) at steady state and observed maximum steady state serum concentration (Cmax,ss) between weeks 22 and 30. Additional PK, efficacy endpoints, including 20% and 40% improvement response according to Assessment in Ankylosing Spondylitis International Working Group criteria (ASAS20 and ASAS40), and safety outcomes were also assessed. Results Geometric mean AUC was 32 765.8 μgh/ml for CT-P13 and 31 359.3 μgh/ml for INX. Geometric mean Cmax,ss was 147.0  μg/ml for CT-P13 and 144.8 μg/ml for INX. The ratio of geometric means was 104.5% (90% CI 94% to 116%) for AUC and 101.5% (90% CI 95% to 109%) for Cmax,ss. ASAS20 and ASAS40 responses at week 30 were 70.5% and 51.8% for CT-P13 and 72.4% and 47.4% for INX, respectively. In the CT-P13 and INX groups more than one adverse event occurred in 64.8% and 63.9% of patients, infusion reactions occurred in 3.9% and 4.9%, active tuberculosis occurred in 1.6% and 0.8%, and 27.4% and 22.5% of patients tested positive for anti-drug antibodies, respectively. Conclusions The PK profiles of CT-P13 and INX were equivalent in patients with active AS. CT-P13 was well tolerated, with an efficacy and safety profile comparable to that of INX up to week 30. PMID:23687259

  6. Coexistence of Ankylosing Spondylitis and Neurofibromatosis Type 1.

    PubMed

    Gundogdu, Baris; Yolbas, Servet; Yildirim, Ahmet; Gonen, Murat; Koca, Suleyman Serdar

    2016-01-01

    Ankylosing spondylitis (AS) is a systemic disease primarily characterized by the inflammation of sacroiliac joints and axial skeleton. Neurofibromatosis type 1 (NF1) is a multisystem genetic disease which is characterized by cutaneous findings, most importantly café-au-lait spots and axillary freckling, by skeletal dysplasia, and by the growth of both benign and malignant nervous system neoplasms, most notably benign neurofibromas. In this case report, we present a 43-year-old male with AS and NF1. PMID:27597922

  7. Coexistence of Ankylosing Spondylitis and Neurofibromatosis Type 1

    PubMed Central

    Gundogdu, Baris; Yolbas, Servet; Yildirim, Ahmet; Gonen, Murat

    2016-01-01

    Ankylosing spondylitis (AS) is a systemic disease primarily characterized by the inflammation of sacroiliac joints and axial skeleton. Neurofibromatosis type 1 (NF1) is a multisystem genetic disease which is characterized by cutaneous findings, most importantly café-au-lait spots and axillary freckling, by skeletal dysplasia, and by the growth of both benign and malignant nervous system neoplasms, most notably benign neurofibromas. In this case report, we present a 43-year-old male with AS and NF1. PMID:27597922

  8. Cardiac Autonomic Function in Patients With Ankylosing Spondylitis

    PubMed Central

    Wei, Cheng-Yu; Kung, Woon-Man; Chou, Yi-Sheng; Wang, Yao-Chin; Tai, Hsu-Chih; Wei, James Cheng-Chung

    2016-01-01

    Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease involing spine and enthesis. The primary aim of this study is to investigate the autonomic nervous system (ANS) function and the association between ANS and the functional status or disease activity in AS. The study included 42 AS patients, all fulfilling the modified New York criteria. All the patients are totally symptom free for ANS involvement and had normal neurological findings. These AS patients and 230 healthy volunteers receive analysis of 5 minutes heart rate variability (HRV) in lying posture. In addition, disease activity and functional status of these AS patients are assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G). Both groups were age and sex-matched. Although the HRV analysis indicates that the peaks of total power (TP, 0–0.5 Hz) and high-frequency power (HF, 0.15–0.40 Hz) are similar in both groups, the activities of low-frequency power (LF, 0.04–0.15 Hz), LF in normalized units (LF%), and the ratio of LF to HF (LF/HF) in AS patients are obviously lower than healthy controls. The erythrocyte sedimentation rate and C-reactive protein revealed negative relationship with HF. The AS patients without peripheral joint disease have higher LF, TP, variance, LF%, and HF than the patients with peripheral joint disease. The AS patients without uvetis have higher HF than the patients with uvetis. The total scores of BASDI, BASFI, and BAS-G do not show any association to HRV parameters. AS patients have significantly abnormal cardiac autonomic regulation. This is closely related with some inflammatory activities. Reduced autonomic function may be one of the factors of high cardiovascular risk in AS patients. PMID:27227940

  9. Ankylosing spondylitis in an athlete with chronic sacroiliac joint pain.

    PubMed

    Miller, Timothy L; Cass, Nathan; Siegel, Courtney

    2014-02-01

    Ankylosing spondylitis is a disease in which inflammation of joints, most often in the axial skeleton, can lead to reactive fibrosis and eventual joint fusion with associated immobility and kyphosis. The disease often involves extra-articular features, such as uveitis and aortic regurgitation, as well as associated inflammatory conditions of the intestines. Its etiology is unknown. Ankylosing spondylitis most commonly presents in young males (15-30 years old) as persistent low back pain and stiffness that is worse in the morning and at night and improves with activity. The authors report the case of a young male athlete whose symptoms were initially incorrectly diagnosed as sacroiliac joint instability and dysfunction and later as a sacroiliac stress fracture before further workup revealed a seronegative spondyloarthropathy and the diagnosis of ankylosing spondylitis. The patient was prescribed oral indomethacin daily by the attending rheumatologist and started on a slow progression of return to running, jumping, and weight lifting. Within 4 weeks of beginning this treatment, the patient had complete cessation of pain with the medication. At follow-up 1 year after graduation from his university, the patient was nearly symptom free and working in a non-heavy labor job. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition. PMID:24679210

  10. Total respiratory resistance and reactance in ankylosing spondylitis and kyphoscoliosis.

    PubMed

    van Noord, J A; Cauberghs, M; Van de Woestijne, K P; Demedts, M

    1991-09-01

    Ankylosing spondylitis and kyphoscoliosis both alter the function of the lung by modifying the mechanical properties of the thoracic cage. The purpose of the present study was to assess the changes in total respiratory resistance (Rrs) and reactance (Xrs) in these patients and to compare these data with conventional pulmonary function tests. In 16 patients with ankylosing spondylitis and seven with kyphoscoliosis we measured lung volumes, maximal flows, diffusing capacity, airway resistance, lung compliance and Rrs and Xrs between 2-26 Hz by means of the forced oscillation technique (FOT). In the patients with ankylosing spondylitis mean total lung capacity was 83% predicted (range 60-105%). Mean values of Rrs were normal; there was a small decrease in Xrs at the lowest frequency. In the patients with kyphoscoliosis mean total lung capacity (TLC) was 41% predicted for arm span (range 26-75%). Mean Rrs was elevated with a negative frequency dependence, and mean Xrs was decreased. The observed differences in Rrs and Xrs between the two groups of patients are related to differences in severity of the restriction. There is evidence that the changes in Rrs and Xrs in both groups are mainly attributable to an increase in chest wall resistance and a decrease in chest wall compliance, while in the patients with kyphoscoliosis an increase in airway resistance and a decrease in lung compliance also intervenes. PMID:1783085

  11. Nursing and safety of silver needle diathermy treating ankylosing spondylitis.

    PubMed

    Ning, Huaxiu; Wang, Yun; Yuan, Yiwen; Ning, Huaying

    2015-03-01

    This paper aims to discuss the nursing and safety of silver needle diathermy in the treatment for ankylosing spondylitis. We nursed 46 patients with ankylosing spondylitis treated with silver needle diathermy. Specific nursing was focused on physical condition evaluation and mental nursing before treatment, observation during and after treatment, diet nursing, needle eye nursing, functional training and propaganda and education when discharged. The result suggested that all the patients received mental nursing, diet guide, skin care, health education, functional training and follow-up visit from the nurse and all of them could endure silver needle diathermy as discomfort or drug allergy was barely found, so were slight scald and skin infection nearby the needle eye caused by fainting during acupuncture, accidental puncture or overheat. Follow-up visit showed that no patient suffered obvious untoward effect and the pain, joint range of motion and living condition were distinctly improved a week after discharging. In conclusion, during the treatment for ankylosing spondylitis applying silver needle diathermy, the nursing before, during and after the treatment can obviously reduce the complication, accelerate the recovery, which is highly safe. PMID:25796147

  12. Inflammatory bowel disease in ankylosing spondylitis

    PubMed Central

    Jayson, M. I. V.; Salmon, P. R.; Harrison, W. J.

    1970-01-01

    Routine detailed gastroenterological investigations were performed in a series of 47 ankylosing spondylitics. Evidence of chronic inflammatory bowel disease was found in eight patients, a prevalence of 17%. Unsuspected bowel disease was found in the absence of symptoms in three of these patients. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:5430378

  13. Continuous posterior lumbar plexus and continuous parasacral and intubation with lighted stylet for ankylosing spondylitis.

    PubMed

    Imbelloni, Luiz Eduardo; Lucena, Neli

    2015-01-01

    Ankylosing spondylitis is characterized by progressive ossification of the spinal column with resultant stiffness. Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway and performing neuraxial blockade. We describe a case of intubation with lighted stylet, and use of the continuous lumbosacral plexus for THA and postoperative analgesia with an elastomeric pump. Key words: Airways difficult anticipated, anesthesia, ankoylosing spondylitis, arthroplasty, conduction, continuous lumbosacral plexus, hip, infusion pumps, intubation awake, replacement. PMID:25886430

  14. Ankylosing spondylitis clinical registries: principles, practices and possibilities.

    PubMed

    Caplan, Liron; Clegg, Daniel O; Inman, Robert D

    2013-06-01

    The need for a rigorously developed longitudinal registry of patients with spondyloarthritis (SpA) is clear and urgent. Like randomized controlled trials, registries rely on a prospective, systematic protocol-driven approach to data acquisition to assess outcomes for a prescribed cohort of patients. Registries seek to capture large numbers of patients across large geographic zones and can serve as a valuable resource for patient advocacy, patient education and support, incidence and prevalence, and broad demographic profiles. Building on 3 existing registries--the Prospective Study of Outcomes in Ankylosing Spondylitis, the Program to Understand the Longterm Outcomes of Spondyloarthritis (PULSAR) and the University Health Network Spondyloarthritis Program--these registries and the Spondylitis Association of America propose to form a combined registry of North American SpA patients. The combined registry would, ideally, complement ongoing clinical goals and improve patient care. PMID:23841118

  15. [Toxoplasma uveitis in a patient with ankylosing spondylitis].

    PubMed

    Deveci, Hülya; Kobak, Şenol

    2013-01-01

    In this paper, a posterior uveitis case was reported in a patient who was being followed and under treatment for Ankylosing Spondylitis. Toxoplasma antibodies were investigated and anti-toxoplasma IgG was positive. Systematic treatment (Sulfamethoxazole/Trimethoprim and Clindamycin) was started. Despite medical treatment, reduction in visual acuity and development of dense membranous condensation in vitreous occurred. Surgical vitrectomy was performed. When posterior uveitis develops in patients who undergo immunosuppressive treatment, toxoplasma is among the first infectious agents that we should consider. A delay in diagnosis and treatment may result in failure in obtaining the desired outcome from medical treatment and a shift to surgical treatment. PMID:24192627

  16. Thiol/disulfide homeostasis in patients with ankylosing spondylitis

    PubMed Central

    Dogru, Atalay; Balkarli, Ayse; Cetin, Gozde Yildirim; Neselioglu, Salim; Erel, Ozcan; Tunc, Sevket Ercan; Sahin, Mehmet

    2016-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease. In many inflammatory diseases, increased production of pro-inflammatory cytokines is associated with an increase in oxidative stress mediators. Thiol/disulfide homeostasis is a marker for oxidative stress. The aim of this study was to examine the dynamic thiol/disulfide homeostasis in AS. Sixty-nine patients with AS and 60 age- and sex-matched controls were included in the study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and visual analogue scale (VAS) were used to determine the disease activity. Native thiol, total thiol, and disulfide levels were measured with a novel automated method recently described by Erel and Neselioglu. The aforementioned method is also optionally manual spectrophotometric assay. The total thiol levels were significantly lower in the AS group compared with the control group (p = 0.03). When the patients were divided into active (n = 35) and inactive (n = 34) subgroups using BASDAI scores, the native plasma thiol and total thiol levels were significantly lower in the active AS patients compared to the inactive AS patients (p = 0.02, p = 0.03 respectively). There was a negative correlation between the plasma native thiol levels and VAS, BASDAI scores. Thiol/disulfide homeostasis may be used for elucidating the effects of oxidative stress in AS. Understanding the role of thiol/disulfide homeostasis in AS might provide new therapeutic intervention strategies for patients.

  17. Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis.

    PubMed

    van der Linden, S; van der Heijde, D

    2000-07-01

    The cause of ankylosing spondylitis remains unclear. Proof that this disorder is an autoimmune disease attributable to crossreactivity between bacteria and HLA-B27 is still lacking. Differences in endogenous peptide presentation by HLA-B27 subtypes might be relevant in the etiopathogenesis. Fractures of the osteoporotic spine contribute to morbidity. Spinal cord injury may occur. MR imaging enables identifying sacroiliitis earlier than plain radiography. Sweet syndrome has now been described in patients with ankylosing spondylitis and Crohn disease. Progress has been made in the assessment of ankylosing spondylitis. There are now core sets for different settings and validated instruments for functioning and disease activity that will enable demonstrating efficacy of new therapeutic interventions. The debate continues on classification of postinfectious and reactive arthritis. Bacterial antigens may be found in the inflamed joints; occasionally 16S ribosomal RNA is also demonstrated. Antibiotics seem not to be effective in postenteric reactive arthritis. More than 25 years have now elapsed since the association between ankylosing spondylitis and HLA-B27 was first described in 1973. The cause of this disease is still unknown, but a lot of progress has been made regarding the molecular structure of HLA-B27, the spectrum of disease, the clinical and radiographic assessment of ankylosing spondylitis, and its treatment. Recent advances in research on ankylosing spondylitis are reviewed here. PMID:10910177

  18. Ankylosing Spondylitis in Iran; Late Diagnosis and Its Causes

    PubMed Central

    Hajialilo, Mehrzad; Ghorbanihaghjo, Amir; Khabbazi, Alireza; Kolahi, Suosan; Rashtchizadeh, Nadereh

    2014-01-01

    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. PMID:24910782

  19. Do sex hormones play a role in ankylosing spondylitis?

    PubMed

    Masi, A T

    1992-02-01

    Ankylosing spondylitis (AS) has a striking disease marker, i.e., HLA-B27, indicating the major genetic predisposition; however, expression of disease is also strongly influenced by age- and sex-related factors. Sex steroids studies suggest greater androgenicity in AS than normal control persons. Therapeutic interventions that normalize such sex steroid status have shown clinical improvements in males and females. Muscle histopathology in AS shows frequent changes early in disease consistent with neuropathic and myopathic mechanisms of a noninflammatory nature. Accepting the available, aggregate data, one may infer that sex steroid imbalance in persons susceptible to AS may target axial and proximal muscle tissues, resulting in relative functional hypertonicity. Such phenomenon, developing in preteen and younger adult ages, may contribute to peripheral and axial manifestations of enthesopathy in this disease by complex and currently unknown mechanisms. PMID:1561401

  20. Ankylosing spondylitis: A state of the art factual backbone

    PubMed Central

    Ghasemi-rad, Mohammad; Attaya, Hosam; Lesha, Emal; Vegh, Andrea; Maleki-Miandoab, Tooraj; Nosair, Emad; Sepehrvand, Nariman; Davarian, Ali; Rajebi, Hamid; Pakniat, Abdolghader; Fazeli, Seyed Amirhossein; Mohammadi, Afshin

    2015-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS. PMID:26435775

  1. A systematic MEDLINE analysis of therapeutic approaches in ankylosing spondylitis.

    PubMed

    Goh, L; Samanta, A

    2009-08-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available that provide persistent control of inflammatory symptoms with improvement in daily function. NSAIDs remain the first step in patient treatment. Sulphasalazine may be effective in peripheral arthritis and there are emerging data to support its use in early inflammatory back pain. Studies have shown that pamidronate and steroid injection into SIJ have a symptom-modifying effect in AS. Current data suggest that anti-TNF treatment promises early benefit which is likely to continue in the longer term. Treatment with biologics should be considered sooner rather than later in the management of AS. PMID:19562344

  2. Relapsing Polychondritis in a Patient with Ankylosing Spondylitis Using Etanercept

    PubMed Central

    Azevedo, Valderilio Feijó; Galli, Natalia Bassalobre; Kleinfelder, Alais Daiane Fadini; D'Ippolito, Julia Farabolini; Gulin Tolentino, Andressa; Paiva, Eduardo

    2014-01-01

    Relapsing polychondritis (RP) is an autoimmune disease characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues, especially of the ears, nose, joints, and tracheobronchial tree. Its etiology is not well understood, but some studies have linked its pathophysiology with autoimmune disease and autoantibody production. We described a case of a 46-year-old male patient with ankylosing spondylitis who developed RP after the use of etanercept. Few similar cases have been described in the literature. However, they show a possible association between the use of biological inhibitors of tumor necrosis factor (anti-TNFα), which potentially produces autoantibodies, and the development of RP. The treatment was based on data in the literature and included the cessation of biological therapy and the addition of corticosteroids with substantial improvement. PMID:25276463

  3. Normal anti-Klebsiella lymphocytotoxicity in ankylosing spondylitis

    SciTech Connect

    Kinsella, T.D.; Fritzler, M.J.; Lewkonia, R.M.

    1986-03-01

    We compared in vitro lymphocytotoxicity (LCT) of peripheral blood lymphocytes (PBL), obtained from patients with ankylosing spondylitis (AS) and normal controls (NC). Assays were performed with antibacterial antisera prepared from AS- and NC-derived Klebsiella and coliforms Escherichia coli. LCT assessed by eosin staining was not significantly different in PBL of 12 AS patients and 28 controls when reacted with 3 Klebsiella and 1 E coli antisera. LCT assessed by /sup 51/Cr release was not significantly different for PBL of 20 age- and sex-matched pairs of AS patients and NC when reacted with 3 Klebsiella and 1 E coli antisera. Similarly, LCT-/sup 51/Cr of PBL of 15 matched AS and NC pairs was not significantly different for anti-K21, a serotype putatively implicated in Klebsiella-HLA-B27 antigenic cross-reactivity. Our results do not support the notion of molecular mimicry between Klebsiella and B27 in the pathogenesis of primary AS.

  4. Leading a Patient of Ankylosing Spondylitis to Death by Iatrogenic Spinal Fracture

    PubMed Central

    Oh, Jae-Sang; Shim, Jai-Joon; Lee, Kyeong-Seok

    2016-01-01

    Fractures in ankylosing spondylitis (AS) are often difficult to identify and treat. If combined with osteoporosis, the spine becomes weaker and vulnerable to minor trauma. An 83-year-old woman with a history of chronic AS and severe osteoporosis developed paraparesis and voiding difficulty for 4 days prior. She had been placed in the lateral decubitus position in a bedridden state in a convalescent hospital due to the progressive paraparesis. The laboratory findings showed CO2 retention in the arterial blood gas analysis. After the patient was transferred to the computed tomography (CT) room, a CT was taken in the supine position. Approximately half an hour later, the resident in our neurosurgical department checked on her, and the neurological examination showed a complete paraplegic state. She was treated conservatively and finally expired 20 days later. PMID:27437020

  5. Normative values for the bath ankylosing spondylitis functional index in the general population compared with ankylosing spondylitis patients in Morocco

    PubMed Central

    2012-01-01

    Background The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with Ankylosing Spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients. Methods A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index. Results The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%. Conclusions This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research. PMID:22436379

  6. Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci.

    PubMed

    Cortes, Adrian; Hadler, Johanna; Pointon, Jenny P; Robinson, Philip C; Karaderi, Tugce; Leo, Paul; Cremin, Katie; Pryce, Karena; Harris, Jessica; Lee, Seunghun; Joo, Kyung Bin; Shim, Seung-Cheol; Weisman, Michael; Ward, Michael; Zhou, Xiaodong; Garchon, Henri-Jean; Chiocchia, Gilles; Nossent, Johannes; Lie, Benedicte A; Førre, Øystein; Tuomilehto, Jaakko; Laiho, Kari; Jiang, Lei; Liu, Yu; Wu, Xin; Bradbury, Linda A; Elewaut, Dirk; Burgos-Vargas, Ruben; Stebbings, Simon; Appleton, Louise; Farrah, Claire; Lau, Jonathan; Kenna, Tony J; Haroon, Nigil; Ferreira, Manuel A; Yang, Jian; Mulero, Juan; Fernandez-Sueiro, Jose Luis; Gonzalez-Gay, Miguel A; Lopez-Larrea, Carlos; Deloukas, Panos; Donnelly, Peter; Bowness, Paul; Gafney, Karl; Gaston, Hill; Gladman, Dafna D; Rahman, Proton; Maksymowych, Walter P; Xu, Huji; Crusius, J Bart A; van der Horst-Bruinsma, Irene E; Chou, Chung-Tei; Valle-Oñate, Raphael; Romero-Sánchez, Consuelo; Hansen, Inger Myrnes; Pimentel-Santos, Fernando M; Inman, Robert D; Videm, Vibeke; Martin, Javier; Breban, Maxime; Reveille, John D; Evans, David M; Kim, Tae-Hwan; Wordsworth, Bryan Paul; Brown, Matthew A

    2013-07-01

    Ankylosing spondylitis is a common, highly heritable inflammatory arthritis affecting primarily the spine and pelvis. In addition to HLA-B*27 alleles, 12 loci have previously been identified that are associated with ankylosing spondylitis in populations of European ancestry, and 2 associated loci have been identified in Asians. In this study, we used the Illumina Immunochip microarray to perform a case-control association study involving 10,619 individuals with ankylosing spondylitis (cases) and 15,145 controls. We identified 13 new risk loci and 12 additional ankylosing spondylitis-associated haplotypes at 11 loci. Two ankylosing spondylitis-associated regions have now been identified encoding four aminopeptidases that are involved in peptide processing before major histocompatibility complex (MHC) class I presentation. Protective variants at two of these loci are associated both with reduced aminopeptidase function and with MHC class I cell surface expression. PMID:23749187

  7. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis

    PubMed Central

    Chen, Chao; Zhang, XiaoLin; Xiao, Lu; Zhang, XueSong; Ma, XinLong

    2016-01-01

    Abstract To establish the comparative effectiveness of all available biologic therapy regimens for ankylosing spondylitis, we performed a systematic review and a Bayesian network meta-analysis of randomized controlled trials. PubMed, Medline, Embase, Cochrane library, and ClinicalTrials.gov were searched from the inception of each database to June 2015. Systematic review and network meta-analysis was reported according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses. The primary outcome was 20% improvement of Assessments in SpondyloArthritis International Society Response Criteria (ASAS20) at Week 12 or 14; secondary outcomes were ASAS40, ASAS5/6, ASAS partial remission and 50% improvement in baseline Bath ankylosing spondylitis (AS) disease activity index. We reported relative risks and 95% confidence intervals from direct meta-analysis and 95% credible intervals from Bayesian network meta-analysis, and ranked the treatment for outcomes. We also used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. Fourteen RCTs comprising 2672 active AS patients were included in the network meta-analysis. Most biologic therapy regimens were more effective than placebo regarding all the outcomes assessed, except for secukinumab and tocilizumab. No differences between biologic therapies in the treatment of AS could be found, except for the finding that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg had the highest probability of being ranked the best for achieving ASAS20, whereas notably, secukinumab had the highest probability of being ranked the second best. Our study suggests that no differences between biologic therapies in the treatment of AS could be found except that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg seems to be the better biologic therapy regimen

  8. Investigating the genetic association between ERAP1 and ankylosing spondylitis

    PubMed Central

    Harvey, David; Pointon, Jennifer J.; Evans, David M.; Karaderi, Tugce; Farrar, Claire; Appleton, Louise H.; Sturrock, Roger D.; Stone, Millicent A.; Oppermann, Udo; Brown, Matthew A.; Wordsworth, B. Paul

    2009-01-01

    A strong association between ERAP1 and ankylosing spondylitis (AS) was recently identified by the Wellcome Trust Case Control Consortium and the Australo-Anglo-American Spondylitis Consortium (WTCCC-TASC) study. ERAP1 is highly polymorphic with strong linkage disequilibrium evident across the gene. We therefore conducted a series of experiments to try to identify the primary genetic association(s) with ERAP1. We replicated the original associations in an independent set of 730 patients and 1021 controls, resequenced ERAP1 to define the full extent of coding polymorphisms and tested all variants in additional association studies. The genetic association with ERAP1 was independently confirmed; the strongest association was with rs30187 in the replication set (P = 3.4 × 10−3). When the data were combined with the original WTCCC-TASC study the strongest association was with rs27044 (P = 1.1 × 10−9). We identified 33 sequence polymorphisms in ERAP1, including three novel and eight known non-synonymous polymorphisms. We report several new associations between AS and polymorphisms distributed across ERAP1 from the extended case–control study, the most significant of which was with rs27434 (P = 4.7 × 10−7). Regression analysis failed to identify a primary association clearly; we therefore used data from HapMap to impute genotypes for an additional 205 non-coding SNPs located within and adjacent to ERAP1. A number of highly significant associations (P < 5 × 10−9) were identified in regulatory sequences which are good candidates for causing susceptibility to AS, possibly by regulating ERAP1 expression. PMID:19692350

  9. Is there a common pathogenesis in aggressive periodontitis & ankylosing spondylitis in HLA-B27 patient?

    PubMed

    Agrawal, Neeraj; Agarwal, Kavita; Varshney, Atul; Agrawal, Navneet; Dubey, Ashutosh

    2016-05-01

    HLA-B27 is having strong association to ankylosing spondylitis (AS) and other inflammatory diseases collectively known as seronegative spondyloarthropathy. In literature, although the evidence for association between AS and periodontitis as well as AS and HLA-B27 are there but the association of aggressive periodontitis in HLA-B27 positive patient with AS are not there. We hypothesize that there may be a common pathogenesis in aggressive periodontitis and ankylosing spondylitis in HLA-B27 patient. A 27-years-old female presented with the features of generalized aggressive periodontitis and difficulty in walking. On complete medical examination, ankylosing spondylitis was diagnosed with further positive HLA-B27 phenotype and negative rheumatic factor. This report may open up a new link to explore in the pathogenesis of aggressive periodontitis. PMID:27063088

  10. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

    PubMed Central

    Senabre-Gallego, José Miguel; Santos-Ramírez, Carlos; Santos-Soler, Gregorio; Salas-Heredia, Esteban; Sánchez-Barrioluengo, Mabel; Barber, Xavier; Rosas, José

    2013-01-01

    To date, anti-tumor necrosis factor alfa (anti-TNF-α) therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, hematologic disorders like aplastic anemia and pancytopenia, vasculitis, immunogenicity, and exacerbation or induction of psoriasis are class effects of all the anti-TNF drugs, and have been seen in patients with ankylosing spondylitis. However, etanercept is less likely to induce reactivation of tuberculosis than the other anti-TNF drugs and it has been suggested that etanercept might be less immunogenic, especially in ankylosing spondylitis. Acute uveitis, Crohn’s disease, and sarcoidosis are other adverse events that have been rarely associated with etanercept

  11. Human leukocyte antigen-B27 alleles in Xinjiang Uygur patients with ankylosing spondylitis.

    PubMed

    Zou, H-Y; Yu, W-Z; Wang, Z; He, J; Jiao, M

    2015-01-01

    We investigated the distribution of human leukocyte antigen (HLA)-B27 subtypes in Uygur ankylosing spondylitis patients in Xinjiang. B27-positive patients with ankylosing spondylitis were subtyped by using polymerase chain reaction-sequence-based typing. The HLA-B27 subtype frequencies of Uygur patients were compared with those in Han patients in Xinjiang and the other areas of China. B*2705 was the predominant subtype in Uygur patients with a frequency of 58.95%, which was much higher than that in Han patients in Xinjiang (31.58%, P < 0.05) and the other areas of China (excluding the Shandong region, which was 63.89%). The frequency of B*2704 (27.37%) in Uygur patients was the lowest and significantly lower than that in Han patients (61.18%, P < 0.05) and in 8 other areas of China. B*2710 has not been previously reported in Uygur ankylosing spondylitis patients; B*2704 was the main (61.18%) subtype in Han patients in Xinjiang, followed by B*2705 (31.58%) and was similar to the characteristics of Han patients in the other areas of China. B*2724 in Han ankylosing spondylitis patients has not been previously reported. Additionally, the B*2702/B*2705 homozygote was identified in Uygur patients. B*2702/B*2704, B*2704/B*2705, and B*2705/B*2705 homozygotes were identified in 3 Han patients. The distribution of HLAB27 subtypes in Uygur ankylosing spondylitis patients in Xinjiang significantly differed from that in Han patients. Understanding the distribution of HLAB27 subtypes in ethnic minority populations of Xinjiang is important for anthropological genetic studies and for analyzing the impact of genetic background on ankylosing spondylitis susceptibility. PMID:26125763

  12. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis.

    PubMed

    Senabre-Gallego, José Miguel; Santos-Ramírez, Carlos; Santos-Soler, Gregorio; Salas-Heredia, Esteban; Sánchez-Barrioluengo, Mabel; Barber, Xavier; Rosas, José

    2013-01-01

    To date, anti-tumor necrosis factor alfa (anti-TNF-α) therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, hematologic disorders like aplastic anemia and pancytopenia, vasculitis, immunogenicity, and exacerbation or induction of psoriasis are class effects of all the anti-TNF drugs, and have been seen in patients with ankylosing spondylitis. However, etanercept is less likely to induce reactivation of tuberculosis than the other anti-TNF drugs and it has been suggested that etanercept might be less immunogenic, especially in ankylosing spondylitis. Acute uveitis, Crohn's disease, and sarcoidosis are other adverse events that have been rarely associated with etanercept

  13. Detection of novel diagnostic antibodies in ankylosing spondylitis: An overview.

    PubMed

    Quaden, Dana H F; De Winter, Liesbeth M; Somers, Veerle

    2016-08-01

    Ankylosing spondylitis (AS) is a debilitating, chronic, rheumatic disease characterized by inflammation and new bone formation resulting in fusion of the spine and sacroiliac joints. Since early treatment is impeded by a delayed diagnosis, it is highly important to find new biomarkers that improve early diagnosis and may also contribute to a better assessment of disease activity, prognosis and therapy response in AS. Because of the absence of rheumatoid factor, AS was long assumed to have a seronegative character and antibodies are thus not considered a hallmark of the disease. However, emerging evidence suggests plasma cells and autoantibodies to be involved in the disease course. In this review, the role of B cells and antibodies in AS is discussed. Furthermore, an overview is provided of antibodies identified in AS up till now, and their diagnostic potential. Many of these antibody responses were based on small study populations and further validation is lacking. Moreover, most were identified by a hypothesis-driven approach and thus limited to antibodies against targets that are already known to be involved in AS pathogenesis. Hence, we propose an unbiased approach to identify novel diagnostic antibodies. The already successfully applied techniques cDNA phage display and serological antigen selection will be used to identify antibodies against both known and new antigen targets in AS plasma. These newly identified antibodies will enhance early diagnosis of AS and provide more insight into the underlying disease pathology, resulting in a more effective treatment strategy and eventually an improved disease outcome. PMID:27288842

  14. Meta-analysis of differentially expressed genes in ankylosing spondylitis.

    PubMed

    Lee, Y H; Song, G G

    2015-01-01

    The purpose of this study was to identify differentially expressed (DE) genes and biological processes associated with changes in gene expression in ankylosing spondylitis (AS). We performed a meta-analysis using the integrative meta-analysis of expression data program on publicly available microarray AS Gene Expression Omnibus (GEO) datasets. We performed Gene Ontology (GO) enrichment analyses and pathway analysis using the Kyoto Encyclopedia of Genes and Genomes. Four GEO datasets, including 31 patients with AS and 39 controls, were available for the meta-analysis. We identified 65 genes across the studies that were consistently DE in patients with AS vs controls (23 upregulated and 42 downregulated). The upregulated gene with the largest effect size (ES; -1.2628, P = 0.020951) was integral membrane protein 2A (ITM2A), which is expressed by CD4+ T cells and plays a role in activation of T cells. The downregulated gene with the largest ES (1.2299, P = 0.040075) was mitochondrial ribosomal protein S11 (MRPS11). The most significant GO enrichment was in the respiratory electron transport chain category (P = 1.67 x 10-9). Therefore, our meta-analysis identified genes that were consistently DE as well as biological pathways associated with gene expression changes in AS. PMID:26125709

  15. Ayurvedic approach for management of ankylosing spondylitis: A case report.

    PubMed

    Singh, Sarvesh Kumar; Rajoria, Kshipra

    2016-03-01

    Ankylosing spondylitis (AS) is a rheumatic disease with various skeletal and extra skeletal manifestations. No satisfactory treatment is available in modern medicine for this disorder. Various Panchakarma procedures and Ayurvedic drugs have been proved useful for these manifestations. We present a case of AS, which was treated for two months with a combination of Panchakarma procedures and Ayurvedic drugs. Ayurvedic treatments, in this case, were directed toward alleviating symptoms and to reduce severe disability. The patient was considered suffering from Asthimajja gata vata (∼Vata disorder involving bone and bone marrow) and was treated with Shalishastika Pinda Svedana (sudation with medicated cooked bolus of rice) for one month and Mustadi Yapana Basti (enema with medicated milk) with Anuvasana (enema with Asvagandha oil) in 30 days schedule along with oral Ayurvedic drugs for two months. Pratimarsha nasya (nasal drops) with Anu Taila (oil) for one month was given after completion of Basti procedure. Patient's condition was assessed for symptoms of Asthimajja gata vata and core sets of Assessment of Spondylo Arthritis International Society showed substantial improvement. This study shows the cases of AS may be successfully managed with Ayurvedic treatment. PMID:27297511

  16. Ankylosing spondylitis functional and activity indices in clinical practice

    PubMed Central

    Popescu, C; Trandafir, M; Bădică, AM; Morar, F; Predeţeanu, D

    2014-01-01

    Background: Clinicians have at hand several indices to evaluate disease activity and functionality in ankylosing spondylitis (AS), in order to evaluate the prognostic and the treatment of AS patients. Objectives: to examine the relationship between functional and activity scores in AS; to note whether disease activity is associated with any clinical or laboratory variables. Methods: the study included AS patients, classified according to the revised New York criteria; data recorded: demographics, disease duration, type of articular involvement, HLA B27 presence, history of uveitis, calculation of BASFI, BASDAI and ASDASCRP, quantification of inflammation markers. Results: 50 AS patients; ASDASCRP correlated significantly (p < 0.001) with BASFI (r = 811), BASDAI (r = 0.810) and with erythrocyte sedimentation rate (ESR; r = 0.505); HLA B27 positive patients had a median BASDAI 5 times higher than HLA B27 negative patients (p = 0.033); compared with patients with strictly axial disease form, patients with axial and peripheral disease had a median ESR 3 times higher (p = 0.042) and a median BASDAI 2 times higher (p = 0.050). Conclusions: functional and activity AS indices are strongly correlated in assessing disease severity; inflammation and HLA B27 can predict the high value of these indices; axial and peripheral disease pattern is associated with higher disease activity. PMID:24653763

  17. Genetics of ankylosing spondylitis--insights into pathogenesis.

    PubMed

    Brown, Matthew A; Kenna, Tony; Wordsworth, B Paul

    2016-02-01

    Ankylosing spondylitis (AS), an immune-mediated arthritis, is the prototypic member of a group of conditions known as spondyloarthropathies that also includes reactive arthritis, psoriatic arthritis and enteropathic arthritis. Patients with these conditions share a clinical predisposition for spinal and pelvic joint dysfunction, as well as genetic associations, notably with HLA-B(*)27. Spondyloarthropathies are characterized by histopathological inflammation in entheses (regions of high mechanical stress where tendons and ligaments insert into bone) and in the subchondral bone marrow, and by abnormal osteoproliferation at involved sites. The association of AS with HLA-B(*)27, first described >40 years ago, led to hope that the cause of the disease would be rapidly established. However, even though many theories have been advanced to explain how HLA-B(*)27 is involved in AS, no consensus about the answers to this question has been reached, and no successful treatments have yet been developed that target HLA-B27 or its functional pathways. Over the past decade, rapid progress has been made in discovering further genetic associations with AS that have shed new light on the aetiopathogenesis of the disease. Some of these discoveries have driven translational ideas, such as the repurposing of therapeutics targeting the cytokines IL-12 and IL-23 and other factors downstream of this pathway. AS provides an excellent example of how hypothesis-free research can lead to major advances in understanding pathogenesis and to the development of innovative therapeutic strategies. PMID:26439405

  18. Sexual activity in Moroccan men with ankylosing spondylitis.

    PubMed

    Rostom, Samira; Mengat, Meryam; Mawani, Nada; Jinane, Hakkou; Bahiri, Rachid; Hajjaj-Hassouni, Najia

    2013-06-01

    The aim of this study was to assess the perceived impact of ankylosing spondylitis (AS) on sexual activity within Moroccan men and to identify the associations with demographic, psychological status, quality of sleep, and disease-related variables. A total of 110 patients with a confirmed diagnosis of AS according to the modified New York classification criteria were invited to participate in the study. Patients completed a questionnaire, which also included questions relating to the impact of AS on their sexual function, socio-demographic and clinical characteristics. The patient sample comprised 110 men. The mean age of patients was 38.5 ± 12.6 years. Among the 110 patients, only 73 (67 %) have already had sexual activity. In this group of patients, 32 (44 %) were unsatisfied, 30 (41 %) reported erectile dysfunction, and 28 (38.4 %) had orgasmic trouble. Multivariate analysis showed that fatigue and sleep disturbance were independently associated with erectile dysfunction. This study suggests that AS in men seems to impact on sexual lives. Fatigue and sleep disturbance were independently associated with perceived problems with sexual activity. PMID:23184008

  19. Pelvic MRI findings of juvenile-onset ankylosing spondylitis.

    PubMed

    Yilmaz, Mehmet Halit; Ozbayrak, Mustafa; Kasapcopur, Ozgur; Kurugoglu, Sebuh; Kanberoglu, Kaya

    2010-09-01

    Ankylosing spondylitis (AS) is the most common clinical subgroup of sero-negative spondyloarthropathies. Radiographic and clinical signs of bilateral inflammatory involvement of sacroiliac joints are the gold standard for the diagnosis of juvenile AS. Although radiographic evidence of sacroiliitis is included in the definition, it is not mandatory for the diagnosis of juvenile AS. The aim of this study is to describe pelvic enthesitis-osteitis MRI findings accompanying sacroiliitis in a group of juvenile AS. Eleven patients suffering from low back pain underwent MRI of the pelvis and were enrolled in this retrospective study. The mean duration of symptoms was 12 months. The mean age of the 11 cases in our study was 12.18 years (range, 6-19). There were eight boys and three girls. Anteroposterior radiographs of the pelvis were obtained in all patients. Sacroiliac joint involvement was detected in all of the cases by pelvic MRI. Pathologic signal changes were detected in the pubic symphisis (osteitis pubis) in ten cases, trochanteric bursitis in six cases, coxofemoral joint in five cases, crista iliaca in three cases, and ischion pubis in three cases. There was increased T2 signal intensity in eight of the 11 cases (72.7%) relevant with soft tissue edema/inflammation. This high correlation between sacroiliitis and enthesitis suggests that enthesitis could be an important finding in juvenile AS. PMID:20549278

  20. ERAP1 in the pathogenesis of ankylosing spondylitis.

    PubMed

    Reeves, Emma; Elliott, Tim; James, Edward; Edwards, Christopher J

    2014-12-01

    The endoplasmic reticulum aminopeptidase 1 (ERAP1) performs a major role in antigen processing, trimming N-terminally extended peptides to the final epitope for presentation by major histocompatibility complex class I molecules. Recent genome-wide association studies have identified single nucleotide polymorphisms (SNPs) within ERAP1 as being associated with disease, in particular ankylosing spondylitis (AS). AS is a polygenic chronic inflammatory disease with a strong genetic link to HLA-B27 known for over 40 years. The association of ERAP1 SNPs with AS susceptibility is only observed in HLA-B27-positive individuals, which intersect on the antigen processing pathway. Recent evidence examining the trimming activity of polymorphic ERAP1 highlights its role in generating peptides for loading onto and stabilizing HLA-B27, and the consequent alterations in the interaction of specific NK cell receptors, and the activation of the unfolded protein response as important in the mechanism of disease pathogenesis. Here, we discuss the recent genetic association findings linking ERAP1 SNPs with AS disease susceptibility and the effect of these variants on ERAP1 function, highlighting mechanisms by which AS may arise. The identification of these functional variants of ERAP1 may lead to better stratification of AS patients by providing a diagnostic tool and a potential therapeutic target. PMID:25434650

  1. Critical appraisal of the guidelines for the management of ankylosing spondylitis: disease-modifying antirheumatic drugs.

    PubMed

    Soriano, Enrique R; Clegg, Daniel O; Lisse, Jeffrey R

    2012-05-01

    Surprisingly, little data are available for the use of disease-modifying antirheumatic drugs in ankylosing spondylitis. Sulfasalazine has been the best studied. Efficacy data for individual agents (including pamidronate) and combinations of agents are detailed in this review. Intriguingly, these agents continue to be used with some frequency, even in the absence of efficacy data. To answer these questions, additional systematic studies of these agents in ankylosing spondylitis are needed and will likely need to be done by interested collaborative groups such as SPARTAN. PMID:22543537

  2. Two unusual organisms, Aspergillus terreus and Metschnikowia pulcherrima, associated with the lung disease of ankylosing spondylitis

    PubMed Central

    Kennedy, W. P. U.; Milne, L. J. R.; Blyth, W.; Crompton, G. K.

    1972-01-01

    Two male patients with ankylosing spondylitis and upper lobe fibrosis and cavitation are described. A pneumonic disease in one was associated with mycological and serological evidence of infection with Aspergillus terreus but no other aspergillus species. A large pulmonary mycetoma developed in the second patient and among a number of other fungal isolates was found the yeast Metschnikowia pulcherrima. The association of ankylosing spondylitis with bronchopulmonary aspergillosis is considered; A. terreus is described for the first time as a human pulmonary pathogen, and the possible pathogenicity of M. pulcherrima in the debilitated human subject is discussed. Images PMID:4628429

  3. Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis?

    PubMed

    Masi, Alfonse T

    2014-01-01

    Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hypertonicity was hypothesized as a potential excessive polymorphic trait which could contribute to chronic biomechanical overloading and exaggerated stresses at entheseal sites. Such a mechanism may help to integrate many of the characteristic host, pathological, and structural features of ankylosing spondylitis and axial spondyloarthritis. Biomechanical stress and strain were recently documented to correlate with peripheral entheseal inflammation and new bone formation in a murine model of spondyloarthritis. Ankylosing spondylitis has traditionally been classified by the modified New York criteria, which require the presence of definite radiographic sacroiliac joint lesions. New classification criteria for axial spondyloarthritis now include patients who do not fulfill the modified New York criteria. The male-to-female sex ratios clearly differed between the two patient categories - 2:1 or 3:1 in ankylosing spondylitis and 1:1 in non-radiographic axial spondyloarthritis - and this suggests a spectral concept of disease and, among females, milder structural alterations. Magnetic resonance imaging of active and chronic lesions in ankylosing spondylitis and axial spondyloarthritis reveals complex patterns, usually interpreted as inflammatory reactions, but shows similarities to acute degenerative disc disease, which attributed to edema formation following mechanical stresses and micro-damage. A basic question is whether mechanically induced microinjury and immunologically mediated

  4. [Fatal complex fracture of the cervical spine in a patient with ankylosing spondylitis after a fall from a racing bicycle].

    PubMed

    Heyde, C E; Robinson, Y; Kayser, R; John, T

    2007-09-01

    Patients with ankylosing spondylitis are endangered suffering from cervical spine fractures following falls caused by kyphosis, stiffness and osteoporotic bone quality of the spine. Risk sustaining neurological deficits is higher than average. We present a patient with ankylosing spondylitis, who was admitted to our hospital with a complex fracture pattern of the cervical spine after a fall from a racing cycle. In spite of early operative treatment the patient died in the follow up because of severe hypoxic brain damage. We discuss the area of conflict between the recommendation for sport activities in patients with ankylosing spondylitis and the resulting risks for the diseased spine. PMID:17896331

  5. Serum homocysteine level in patients with ankylosing spondylitis.

    PubMed

    Başkan, Bedriye Mermerci; Sivas, Filiz; Aktekin, Lale Akbulut; Doğan, Yasemin Pekin; Ozoran, Kürşat; Bodur, Hatice

    2009-10-01

    In this study serum homocystein (Hcy) level was measured and its relationship with disease activity criteria and treatment protocols was investigated in ankylosing spondylitis (AS) patients. Ninety-two AS patients and 58 healthy individuals were recruited. Erythrocyte sedimentation rate and serum C-reactive protein were determined. Bath AS disease activity index and Bath AS functional index were calculated. Serum Hcy levels >15 micromol/l were considered as hyperhomocysteinemia. The mean serum homocysteine levels were 14.40 and 12.60 micromol/l in patients with AS and the control group, respectively, and the difference between two groups was significant. While there was no significant difference between the sulfasalazine (SSZ) group with 14.25 micromol/l mean Hcy level and the methotrexate (MTX)/SSZ group with 16.05 micromol/l, there was a statistically significant difference between the Hcy levels of these two groups and Hcy level of 12.15 micromol/l of the non-steroidal anti-inflammatory drugs group, and 12.60 micromol/l Hcy level of the control group. Mean serum Hcy level was 13.65 micromol/l in patients with active AS and 14.60 micromol/l in patients with inactive AS, and there was no significant difference between the groups. In our study serum Hcy level was found to be significantly higher in patients with AS than in healthy control subjects. Especially for the AS patients receiving MTX and SSZ treatment without folic acid supplementation, addition of folic acid to their therapy may decrease the risk of cardiovascular disease which in turn decreases the mortality in these patients, but further prospective studies are needed for supporting these results. PMID:19288264

  6. Ankylosing Spondylitis: Patterns of Spinal Injury and Treatment Outcomes

    PubMed Central

    Yuksel, Kasım Zafer

    2016-01-01

    Study Design Retrospective review. Purpose We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. Overview of Literature Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. Methods Between January 1, 1998 and March 2011, 30 patients (23 males, 7 females; mean age, 70.43 years; range, 45 to 95 years) with the radiographic diagnosis of AS of the spinal column had 42 fractures. Eight patients presented with significant trauma, 17 after falls, and 5 after minor falls or no recorded trauma. Eleven patients presented with a neurological injury, ranging from mild sensory loss to quadriplegia. Results There were 16 compression and 10 transverse fractures, two Jefferson's fractures, one type II and two type III odontoid process fractures, and five fractures of the posterior spinal elements (including lamina and/or facet, three spinous process fractures, three transverse process fractures). Twenty-four fractures affected the craniocervical junction and/or cervical vertebrae, 17 were thoracic, and one involved the lumbar spine. The most affected vertebrae were C6 and T10. The mean follow-up was 29.9 months. One patient was lost to follow-up. Eighteen patients were treated conservatively with bed rest and bracing. Twelve patients underwent surgery for spinal stabilization either with an anterior, posterior or combined approach. Conclusions Nonsurgical treatment can be considered especially in the elderly patients with AS and spinal trauma but without instability or major neurological deficits. The nonfusion rate in conservatively treated patients is low. When treatment is selected for patients with spinal fractures and AS, the pattern of injury must be considered and the need

  7. Predictive factors of radiographic progression in ankylosing spondylitis

    PubMed Central

    Kim, Hyungjin; Lee, Jaejoon; Ahn, Joong Kyong; Hwang, Jiwon; Park, Eun-Jung; Jeong, Hyemin; Cha, Hoon-Suk

    2015-01-01

    Background/Aims The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. Methods In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. Results Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. Conclusions These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine. PMID:25995670

  8. Association between HRH4 polymorphisms and ankylosing spondylitis susceptibility

    PubMed Central

    Ran, Bo; Wang, Yongcheng; Zhang, Yonggang; Mao, Keya; Wang, Yan

    2015-01-01

    Target: The purpose of the study was to investigate the association between the histamine H4 receptor (HRH4) polymorphisms and the susceptibility to ankylosing spondylitis (AS). Methods: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to analyze the HRH4 rs8088140 and rs657132 polymorphisms. Linkage disequilibrium and haplotype analyses were conducted with Haploview software. The genotypes distributions of HRH4 polymorphisms in the control group were tested by Hardy-Weinberg equilibrium (HWE), allele, genotype and haplotype frequencies between the cases and control groups were compared by χ2 test. The controls were matched with cases by age and gender. The relative risk of AS with HRH4 polymorphisms was represented by odds ratio (OR) with 95% confidence interval (CI) calculated by χ2 test. Results: The genotypes distributions of HRH4 rs8088140, rs657132 polymorphisms in controls conformed to HWE. The frequency of rs657132 AA genotype in the case group was obviously higher than that in the control group (P=0.040), and so was the A allele (OR=2.572, 95% CI=1.475-4.486, P=0.022). The frequency differences of A-A haplotype between two groups had statistical significance (P=0.011, OR=2.071, 95% CI=1.172-3.660) through haplotype analysis, indicating A-A might be the susceptible haplotype to AS. Conclusion: The AA genotypes of HRH4 rs657132 polymorphism may be the susceptible factors for AS, and rs657132 plays a role in generation of AS. In addition, A-A haplotype in rs8088140-rs657132 is also increased the risk of AS. PMID:26823878

  9. Genome-wide association study of ankylosing spondylitis identifies non-MHC susceptibility loci

    PubMed Central

    Reveille, John D; Sims, Anne-Marie; Danoy, Patrick; Evans, David M; Leo, Paul; Pointon, Jennifer J; Jin, Rui; Zhou, Xiaodong; Bradbury, Linda A; Appleton, Louise H; Davis, John C; Diekman, Laura; Doan, Tracey; Dowling, Alison; Duan, Ran; Duncan, Emma L; Farrar, Claire; Hadler, Johanna; Harvey, David; Karaderi, Tugce; Mogg, Rebecca; Pomeroy, Emma; Pryce, Karena; Taylor, Jacqueline; Savage, Laurie; Deloukas, Panos; Kumanduri, Vasudev; Peltonen, Leena; Ring, Sue M; Whittaker, Pamela; Glazov, Evgeny; Thomas, Gethin P; Maksymowych, Walter P; Inman, Robert D; Ward, Michael M; Stone, Millicent A; Weisman, Michael H; Wordsworth, B Paul; Brown, Matthew A

    2011-01-01

    To identify susceptibility loci for ankylosing spondylitis, we undertook a genome-wide association study in 2,053 unrelated ankylosing spondylitis cases among people of European descent and 5,140 ethnically matched controls, with replication in an independent cohort of 898 ankylosing spondylitis cases and 1,518 controls. Cases were genotyped with Illumina HumHap370 genotyping chips. In addition to strong association with the major histocompatibility complex (MHC; P < 10−800), we found association with SNPs in two gene deserts at 2p15 (rs10865331; combined P = 1.9 × 10−19) and 21q22 (rs2242944; P = 8.3 × 10−20), as well as in the genes ANTXR2 (rs4333130; P = 9.3 × 10−8) and IL1R2 (rs2310173; P = 4.8 × 10−7). We also replicated previously reported associations at IL23R (rs11209026; P = 9.1 × 10−14) and ERAP1 (rs27434; P = 5.3 × 10−12). This study reports four genetic loci associated with ankylosing spondylitis risk and identifies a major role for the interleukin (IL)-23 and IL-1 cytokine pathways in disease susceptibility. PMID:20062062

  10. Optimizing physical therapy for ankylosing spondylitis: a case study in a young football player

    PubMed Central

    Tricás-Moreno, José Miguel; Lucha-López, María Orosia; Lucha-López, Ana Carmen; Salavera-Bordás, Carlos; Vidal-Peracho, Concepción

    2016-01-01

    [Purpose] Ankylosing spondylitis is prevalent in men. Modern and expert consensus documents include physical therapy among the strategies for the treatment of ankylosing spondylitis. This study aimed to describe the physical therapy approach in an athlete with ankylosing spondylitis. [Subject and Methods] The patient, refractory to treatment with anti-inflammatory medication, showed pelvic and lumbar pain and joint, muscle, and functional disorders, which were treated with orthopedic joint mobilization, dry needling, exercise, and whole-body hyperthermia. [Results] After the treatment, pain relief, normal joint mobility, improved muscle function, and return to activities of daily living and competitive sporting activities were recorded. [Conclusion] The literature provides evidence for the use of joint mobilization techniques; however, no previous studies have used the same techniques and methods. There is no previous evidence for the use of dry needling in this pathology. Exercise therapy has a higher level of evidence, and guidelines with scientific support were followed. This research confirms the effectiveness of hyperthermia for arthritis. The early stage of ankylosing spondylitis, and the young age, good overall condition, and cooperative attitude of the patient led to positive outcomes. In conclusion, a favorable response that promoted the remission of the disease was observed. PMID:27190490

  11. Optimizing physical therapy for ankylosing spondylitis: a case study in a young football player.

    PubMed

    Tricás-Moreno, José Miguel; Lucha-López, María Orosia; Lucha-López, Ana Carmen; Salavera-Bordás, Carlos; Vidal-Peracho, Concepción

    2016-04-01

    [Purpose] Ankylosing spondylitis is prevalent in men. Modern and expert consensus documents include physical therapy among the strategies for the treatment of ankylosing spondylitis. This study aimed to describe the physical therapy approach in an athlete with ankylosing spondylitis. [Subject and Methods] The patient, refractory to treatment with anti-inflammatory medication, showed pelvic and lumbar pain and joint, muscle, and functional disorders, which were treated with orthopedic joint mobilization, dry needling, exercise, and whole-body hyperthermia. [Results] After the treatment, pain relief, normal joint mobility, improved muscle function, and return to activities of daily living and competitive sporting activities were recorded. [Conclusion] The literature provides evidence for the use of joint mobilization techniques; however, no previous studies have used the same techniques and methods. There is no previous evidence for the use of dry needling in this pathology. Exercise therapy has a higher level of evidence, and guidelines with scientific support were followed. This research confirms the effectiveness of hyperthermia for arthritis. The early stage of ankylosing spondylitis, and the young age, good overall condition, and cooperative attitude of the patient led to positive outcomes. In conclusion, a favorable response that promoted the remission of the disease was observed. PMID:27190490

  12. Enthesitis and its relationships with disease parameters in Moroccan patients with ankylosing spondylitis.

    PubMed

    Laatiris, Assia; Amine, Bouchra; Ibn Yacoub, Yousra; Hajjaj-Hassouni, Najia

    2012-03-01

    In this study, we evaluated the relationship between enthesitis and clinical, laboratory and quality-of-life parameters in ankylosing spondylitis (AS) in Moroccan patients. Seventy-six patients were included in this cross-sectional study according to the modified New York criteria for AS. All patients had enthesitis involvement. Clinical and biological parameters were evaluated. Enthesitis were assessed by two indices: Mander Enthesis Index (MEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impact was assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). The quality of life was measured by the Short form-36 (SF-36). Severity of enthesitis was significantly correlated with disease activity, functional disability and degradation of quality of life. There was no relation between enthesitis indices and disease duration or laboratory parameters. The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indices could be used to evaluate disease activity in patients with AS. PMID:21161533

  13. Chest Wall Motion during Speech Production in Patients with Advanced Ankylosing Spondylitis

    ERIC Educational Resources Information Center

    Kalliakosta, Georgia; Mandros, Charalampos; Tzelepis, George E.

    2007-01-01

    Purpose: To test the hypothesis that ankylosing spondylitis (AS) alters the pattern of chest wall motion during speech production. Method: The pattern of chest wall motion during speech was measured with respiratory inductive plethysmography in 6 participants with advanced AS (5 men, 1 woman, age 45 plus or minus 8 years, Schober test 1.45 plus or…

  14. Delayed diagnosis of porphyria based on manifestations of systemic lupus erythematosus and ankylosing spondylitis.

    PubMed

    Korkmaz, Cengiz

    2006-01-01

    In this case report, a patient with systemic lupus erythematosus and ankylosing spondylitis is presented, who was diagnosed with hereditary coproporphyria after 5 years of follow-up. Diagnostic difficulties and possible role of genetic background in the autoimmune response in patients with porphyria are briefly discussed. PMID:17048215

  15. Association of IL1R polymorphism with HLA-B27 positive in Iranian patients with ankylosing spondylitis.

    PubMed

    Mahmoudi, M; Amirzargar, A A; Jamshidi, A R; Farhadi, E; Noori, S; Avraee, M; Nazari, B; Nicknam, M H

    2011-12-01

    Ankylosing spondylitis (AS) is one of the most common causes of inflammatory arthritis, with an estimated prevalence of 0.1-0.9%. Genetic factors have been strongly implicated in its aetiology, and heritability as assessed by twin studies has been estimated to be >90%. HLA- B27 is almost essential for inheritance of AS; it is not merely sufficient for explaining the pattern of familial recurrence of the disease. This study's purpose is to investigate the association of ankylosing spondylitis with single-nucleotide polymorphisms (SNPs) in the IL-1 family: IL-1a (-889C/T) rs1800587, IL-1b (-511C/T) rs16944, IL-1b (+3962C/T) rs1143634, IL-1R (Pst-1 1970C/T) rs2234650 and IL-1RA (Mspa-1 11100C/T) rs315952. 99 unrelated Iranian AS patients and 217 healthy control subjects were selected. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. The allele and genotype frequencies of the polymorphisms were determined: The IL1α rs1800587, IL1β rs16944 and IL1β rs1143634 were not significantly associated with AS. Genotype frequencies at IL1R rs2234650 differed between cases and controls (χ(2)=8.85; p=0.01); the IL1R rs2234650 C/T and T/T genotypes were less common in AS patients than controls. The IL1R rs2234650 C/T genotype was inversely associated with AS comparing with the IL1R rs2234650 C/C genotype (OR=0.48; p=0.005). IL1R rs2234650 C/T genotype was less common in patients than controls (OR=0.37; p=0.02).Furthermore IL1R rs2234650 T allele was strongly associated with HLA-B2702 patients rather than HLA-B2705 but was not associated with HLA-B27 negative patients (OR=0.33; p=0.01). Polymorphisms of IL1α rs1800587, IL1β rs16944 and IL1β rs1143634 were not significantly associated with ankylosing spondylitis but inversely in this study IL1R rs2234650 was significantly associated and carriage of T allele in IL1R rs2234650 seems to be protective, while carriage of C allele result in two fold higher risk of developing AS. PMID

  16. Elevated serum interleukin-23 levels in ankylosing spondylitis patients and the relationship with disease activity

    PubMed Central

    Ugur, Mahir; Baygutalp, Nurcan Kilic; Melikoglu, Meltem Alkan; Baygutalp, Fatih; Altas, Elif Umay; Seferoglu, Buminhan

    2015-01-01

    ABSTRACT This study was aimed to evaluate the relationship between serum interleukin-23 (IL-23) levels and ankylosing spondylitis (AS).Twenty male patients diagnosed with ankylosing spondylitis according to the 1984 modified New York criteria for AS and twenty male healthy controls were included in this study.The demographic characteristics, clinical and laboratory findings of the patients were recorded. Serum IL-23 levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured in both the AS and control groups. The Bath ankylosing spondylitis disease activity ındex (BASDAI), the Bath ankylosing spondylitis functional index (BASFI), and the Bath ankylosing spondylitis metrology index (BASMI) were evaluated as disease activity parameters. The AS patients were divided into two subgroups as active and inactive in respect of CRP, ESR levels and BASDAI scores. The mean serum IL-23 levels of the AS and control groups were 334.45±176.54 pg/ml and 166.49±177.50 pg/ml respectively, and there was a significant difference between the groups. Correlation analysis of serum IL-23 levels with clinical and laboratory parameters showed that there were positive correlations between serum IL-23 levels and the BASDAI, BASFI scores in total, active and inactive patients and the BASMI scores in total and inactive patients and negative correlations between serum IL-23 levels and ESR in inactive patients. It was shown that altered serum IL-23 levels were related to AS disease activity. Further studies in large patient series are necessary to investigate the role of IL-23 protein in etiopathogenesis of AS. PMID:26663940

  17. Aortic valve replacement and ascending aorta replacement in ankylosing spondylitis: report of three surgical cases and review of the literature.

    PubMed

    Kawasuji, M; Hetzer, R; Oelert, H; Stauch, G; Borst, H G

    1982-10-01

    Out of 887 consecutive patients who underwent aortic valve replacement between January 1976 and December 1981 at Hannover Medical School Hospital, 3 patients had severe aortic valve insufficiency associated with ankylosing spondylitis (Morbus Bechterew). One of them had huge aneurysmatic dilatation of the ascending aorta and successfully underwent replacement of the ascending aorta by a vascular prosthesis. Microscopical examination of the resected aortic wall showed characteristic findings of aortitis in ankylosing spondylitis. The 3 patients are in good clinical condition at 5 and 6 months, and 2 1/2 years, respectively, after uneventful surgery. It is concluded that aortic valve replacement in patients with ankylosing spondylitis can be performed feasibly and clinical results have been satisfactory. The risk of aneurysmatic dilatation of the ascending aorta resulting from aortitis associated with ankylosing spondylitis is emphasized. PMID:6183782

  18. Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci

    PubMed Central

    Cortes, Adrian; Hadler, Johanna; Pointon, Jenny P; Robinson, Philip C; Karaderi, Tugce; Leo, Paul; Cremin, Katie; Pryce, Karena; Harris, Jessica; lee, Seunghun; Joo, Kyung Bin; Shim, Seung-Cheol; Weisman, Michael; Ward, Michael; Zhou, Xiaodong; Garchon, Henri-Jean; Chiocchia, Gilles; Nossent, Johannes; Lie, Benedicte A; Førre, Øystein; Tuomilehto, Jaakko; Laiho, Kari; Jiang, Lei; Liu, Yu; Wu, Xin; Bradbury, Linda A; Elewaut, Dirk; Burgos-Vargas, Ruben; Stebbings, Simon; Appleton, Louise; Farrah, Claire; Lau, Jonathan; Kenna, Tony J; Haroon, Nigil; Ferreira, Manuel A; Yang, Jian; Mulero, Juan; Fernandez-Sueiro, Jose Luis; Gonzalez-Gay, Miguel A; lopez-Larrea, Carlos; Deloukas, Panos; Donnelly, Peter; Bowness, Paul; Gafney, Karl; Gaston, Hill; Gladman, Dafna D; Rahman, Proton; Maksymowych, Walter P; Xu, Huji; Crusius, J Bart A; van der Horst-Bruinsma, Irene E; Chou, Chung-Tei; Valle-Oñate, Raphael; Romero-Sánchez, Consuelo; Hansen, Inger Myrnes; Pimentel-Santos, Fernando M; Inman, Robert D; Videm, Vibeke; Martin, Javier; Breban, Maxime; Reveille, John D; Evans, David M; Kim, Tae-Hwan; Wordsworth, Bryan Paul; Brown, Matthew A

    2013-01-01

    Ankylosing spondylitis is a common, highly heritable inflammatory arthritis affecting primarily the spine and pelvis. In addition to HLA-B*27 alleles, 12 loci have previously been identified that are associated with ankylosing spondylitis in populations of European ancestry, and 2 associated loci have been identified in Asians. In this study, we used the Illumina Immunochip microarray to perform a case-control association study involving 10,619 individuals with ankylosing spondylitis (cases) and 15,145 controls. We identified 13 new risk loci and 12 additional ankylosing spondylitis–associated haplotypes at 11 loci. Two ankylosing spondylitis–associated regions have now been identified encoding four aminopeptidases that are involved in peptide processing before major histocompatibility complex (MHC) class I presentation. Protective variants at two of these loci are associated both with reduced aminopeptidase function and with MHC class I cell surface expression. PMID:23749187

  19. Focal spinal abnormalities on bone scans in ankylosing spondylitis: a clue to the presence of fracture or pseudarthrosis.

    PubMed

    Resnick, D; Williamson, S; Alazraki, N

    1981-05-01

    Four cases of ankylosing spondylitis are presented in which radionuclide bone studies indicated focal abnormalities of the spine. In three patients, the area of abnormal nuclide uptake corresponded to a site of pseudarthrosis, and in the fourth an acute fracture was present. As such focal lesions on bone scans are unusual in cases of chronic ankylosing spondylitis in which a complication is not apparent, their presence can be a useful finding. PMID:6262000

  20. Successful lumbar puncture with Taylor's approach for the diagnostic workup of meningitis in a patient with Ankylosing spondylitis

    PubMed Central

    Shrestha, Gentle Sunder; Acharya, Subhash Prasad; Keyal, Niraj; Paneru, Hem Raj; Shrestha, Pramesh Sunder

    2015-01-01

    Meningitis and encephalitis are the neurological emergencies. As the clinical findings lack specificity, once suspected, cerebrospinal fluid (CSF) analysis should be performed and parenteral antimicrobials should be administered without delay. Lumbar puncture can be technically challenging in patients with ankylosing spondylitis due to ossification of ligaments and obliteration of interspinous spaces. Here, we present a case of ankylosing spondylitis where attempts for lumbar puncture by conventional approach failed. CSF sample was successfully obtained by Taylor's approach. PMID:26628829

  1. Association between CTLA-4 gene polymorphism and ankylosing spondylitis: a case-control study

    PubMed Central

    Wang, Nai-Guo; Wang, Da-Chuan; Tan, Bing-Yi; Wang, Feng; Yuan, Ze-Nong

    2015-01-01

    Aims: The aim of our study was to evaluate the association between CTLA-4 polymorphisms (+49A/G, -318C/T and CT60A/G) and ankylosing spondylitis (AS) susceptibility. Methods: A total of 120 AS cases and healthy controls, matched on the age and gender, were enrolled in the study. Polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) were used to determine the gentypes of +49A/G, -318C/T and CT60A/G polymorphisms. Genotype distribution in control group was assessed by Hardy Weinberg Equilibrium (HWE) test. Odds ratio (OR) with 95% confidence interval (95% CI) were adopted to evaluate the relationship of CTLA-4 polymorphisms and AS susceptibility. Results: In our study, genotype distribution of the three polymorphisms in control group was consistent with the HWE (P > 0.05). The genotype analysis showed that AA genotype of + 49A/G polymorphism could increase the risk for AS (OR=2.357, 95% CI=1.127-4.930). Moreover, the frequency of A allele was also presented as a risk factor for AS. Additionally, AA genotype and A allele of CT60A/G appeared to be related with AS susceptibility (OR=2.610, 95% CI=1.047-6.510; OR=1.751, 95% CI=1.160-2.641). However, the T allele of -318C/T appeared to be a protective factor for AS (OR=0.383, 95% CI=0.228-0.643). Conclusion: In summary, there existed significant association between CTLA-4 gene polymorphisms and increased or decreased risk for AS. PMID:26261646

  2. Clinical features of Crohn disease concomitant with ankylosing spondylitis

    PubMed Central

    Liu, Song; Ding, Jie; Wang, Meng; Zhou, Wanqing; Feng, Min; Guan, Wenxian

    2016-01-01

    Abstract Extraintestinal manifestations (EIMs) cause increased morbidity and decreased quality of life in Crohn disease (CD). Ankylosing spondylitis (AS) belongs to EIMs. Very little is known on the clinical features of CD concomitant with AS. This study is to investigate the clinical features of CD patients with AS. We retrospectively collected all CD patients with AS in our hospital, and established a comparison group (CD without AS) with age, sex, and duration of Crohn disease matched. Clinical information was retrieved for comparison. Eight CD + AS patients were identified from 195 CD patients. Sixteen CD patients were randomly selected into comparison group. All CD + AS patients were male, HLA-B27 (+), and rheumatoid factor (−) with an average age of 40.8 ± 4.52 years. Significant correlation between disease activity of CD and AS was revealed (r = 0.857, P = 0.011). Significant correlation between disease activity of CD and functional limitation associated with AS was identified (r = 0.881, P < 0.01). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and globulin were positively correlated to Crohn disease activity index (CDAI), Bath AS disease activity index, and Bath AS functional index(BASFI) scores (r = 0.73–0.93, P < 0.05). Albumin was negatively associated with CDAI and BASFI (r = −0.73 to −0.91, P < 0.05). The ratio of albumin to globulin (Alb/Glo) was significantly related to all 3 scores (r = −0.81 to −0.91, P < 0.05). Male predominance with a 4.12% concomitant incidence of AS is observed in CD patients. Disease activity of CD correlates with disease activity of AS and functional limitation caused by AS. CRP, ESR, and Alb/Glo may serve as biomarkers for disease activity and functional limitation in CD patients concomitant with AS, although future studies are expected. PMID:27428240

  3. Surgery in the Treatment of Rheumatoid Arthritis and Ankylosing Spondylitis

    PubMed Central

    Law, W. Alexander

    1948-01-01

    The pain, deformities and disabilities resulting from rheumatoid arthritis and ankylosing spondylitis must be treated by a team composed of physician, physical medicine expert, orthopædic surgeon, and, in certain cases, deep X-ray therapist working simultaneously. The principle of “rest” in order to relieve pain has to be combined with methods designed to preserve and restore function. The multiple joint deformities in these cases may necessitate a long programme of reconstructive or functional treatment, which entails whole-hearted co-operation on the part of the patient in intensive post-operative exercise regime. Procedures advocated for the upper limb include excision of the acromion process together with the subacromial bursa to allow free movement between the central tendon of the deltoid and the tendinous shoulder cuff: arthrodesis of the shoulder in cases where there is more severe joint destruction: in certain cases of elbow-joint arthritis, excision of the radial head and sub-total synovectomy may preserve joint function and avoid or delay the necessity for arthroplasty which can be carried out in two ways: (a) similar to the formal joint excision, or (b) re-shaping the lower end of the humerus and upper end of the ulna lining these surfaces with fascia. The former method is preferable in cases of rheumatoid arthritis. To overcome wrist-joint deformity and restore pronation and supination excision of the lower end of the ulna together with radiocarpal fusion in position for optimum function is advocated. Finger and toe joints may be corrected by resection of the bone ends and capsulectomy. In the lower limbs bilateral involvement of the hip-joint is best treated by vitallium mould arthroplasty which may be carried out in four ways: (1) Routine arthroplasty; (2) Modified Whitman procedure; (3) Modified Colonna operation; and (4) The proximal shaft or intertrochanteric arthroplasty. It is essential in these operations to have knowledge of the operative

  4. Mortality in patients with ankylosing spondylitis in Argentina.

    PubMed

    Buschiazzo, Emilio Andres; Schneeberger, Emilce Edith; Sommerfleck, Fernando Andres; Ledesma, Cesar; Citera, Gustavo

    2016-09-01

    Some reports describe an increased mortality in patients with ankylosing spondylitis (AS) compared to the general population. The aims of this study were to evaluate the cumulative survival in patients with AS and to establish possible factors associated with mortality. In cross-sectional retrospective study, AS patients were included according to 1984 modified NY criteria, in the 2000-2010 period, the prevalence of mortality was determined by review of medical records, telephone contact, family reports, and death certificates, and it was compared with mortality in Argentina's general population. One hundred twenty-seven patients were studied, 96 (75.6 %) were male, median age 49 years (interquartile range (IQR) 34-60) and median disease duration 8 years (IQR 4-17). During the follow-up period, 9 patients died (7.1 %). The median estimated survival from diagnosis of AS was 39 years (IQR 34-50) and median cumulative survival was 76 years (IQR 74-85). Cardiovascular disease was the most frequent cause of death (5/9 patients). Deceased patients had a mean age and a mean AS disease duration significantly higher than living patients (68.1 ± 12.4 years vs 46.4 ± 15.09 years, p = 0.0001 and 33 ± 13.7 years vs 12 ± 10.7 years, p = 0.001, respectively), higher frequency of total surgeries [3/5 (60 %) vs 5/105 (4.76 %), p = 0.002] and cauda equina syndrome [3/6 (50 %) vs 2/116 (1.72 %), p = 0.001], respectively. Frequency of mortality in AS patients was higher than the crude mortality rate of Argentina's general population in the same period, with cardiovascular cause being the most frequent one. PMID:27377455

  5. Traumatic Death due to Simultaneous Double Spine Fractures in Patient with Ankylosing Spondylitis

    PubMed Central

    Yagi, Mitsuru; Sato, Shunsuke; Miyake, Atsushi; Asazuma, Takashi

    2015-01-01

    The aim of this study is to report the rare occurrence of simultaneous double spine fractures in a patient with progressive ankylosing spondylitis (AS). An 82-year-old male with established AS had low-energy falls. He had sustained simultaneous double spine fractures and died. Plain radiographs of the cervical spine were unremarkable in detecting a cervical spine fracture in a patient with AS and a spinal cord injury following a fall. CT scan showed a displaced fracture at the C6/C7 with American Spinal Injury Association-A spinal cord injury and displaced fracture at L1. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fracture and dislocation that were facilitated by spinal rigidity from AS. This case report illustrates the importance of obtaining a detailed medical history and thorough imaging study when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of entire spine CT scan in the evaluation of the mechanism, further spine fractures, and manner of death. Despite the occurrence of spine fracture in AS patients, simultaneous double or multiple spine fractures are extremely rare and can be missed. Care should be taken for the further spine fracture in the entire spine in patient with AS. PMID:26435867

  6. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis

    PubMed Central

    Xu, Xujuan; Shen, Biyu; Zhang, Aixian; Liu, Jingwei; Da, Zhanyun; Liu, Hong; Gu, Zhifeng

    2016-01-01

    Aim To evaluate the relationship between mental and physical health in Chinese patients with ankylosing spondylitis (AS) and to identify the predictors of psychological status. Methods Patients with AS (n=103) and healthy controls (n=121) were surveyed between 2010 and 2011 (cross-sectional study). The Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, pain visual analog scale, Health Assessment Questionnaire, revised Self-Rating Anxiety Scale, revised Self-Rating Depression Scale, and Short-Form 36 questionnaire were administered. Results The frequency of anxiety and depression in patients with AS was higher than that in healthy controls (P<0.001). Severe disease status and reduced quality of life (QoL) were associated with anxiety and depression. Disease activity and somatic pain were more severe in the anxious and depressed subgroups. Impaired physical functioning (assessed by Bath Ankylosing Spondylitis Functional Index) was higher in the anxious and depressed subgroups, while measures of spinal mobility (assessed by Bath Ankylosing Spondylitis Metrology Index) were not associated with depression. Lower QoL was observed in the depressed subgroup. Conclusion Low socioeconomic status, lack of health insurance, and fatigue contributed to depression in Chinese patients with AS. These patients may require a psychological care approach that is different from those of other countries. PMID:27284241

  7. Late-onset ankylosing spondylitis and related spondylarthropathies: clinical and radiological characteristics and pharmacological treatment options.

    PubMed

    Toussirot, Eric; Wendling, Daniel

    2005-01-01

    Ankylosing spondylitis is the prototype of related diseases commonly called spondylarthropathies which include reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel diseases (enteropathic arthritis) and undifferentiated spondylarthropathies. Ankylosing spondylitis and spondylarthropathies are generally observed in young patients but can be observed later in life or in persons >50 years of age. All the spondylarthropathy subgroups are represented in the elderly with some features particular to this age group. Indeed, radiological aspects of ankylosing spondylitis may be difficult to interpret because of the radiological changes induced by aging. Late-onset peripheral spondylarthropathies are characterised by severe disease, marked elevation of laboratory parameters of inflammation, oligoarthritis involving the lower limbs and oedema of the extremities. Psoriatic arthritis is more severe in the elderly and is associated with worse outcomes than in young patients. The clinical presentation of undifferentiated spondylarthropathy is as varied in the elderly as in young and middle-aged adults. Reactive arthritis and enteropathic arthritis are observed in the elderly more rarely. The effects of aging on drug metabolism and pharmacokinetics, together with the existence of co-morbidities and polypharmacy, are responsible for difficulties in the therapeutic management of late-onset ankylosing spondylitis or spondylarthropathies. Indeed, NSAIDs should be used with caution in older patients because of the high risk of serious gastrointestinal complications. Sulfasalazine and methotrexate have been used as disease-controlling drugs but did not prove very effective. Pamidronate and tumour necrosis factor (TNF)-alpha antagonists offer a therapeutic alternative but have not been specifically tested in the elderly. Pamidronate has been tested in young-onset ankylosing spondylitis and spondylarthropathies with conflicting results but can be used in

  8. Structural Identity of Human Histocompatibility Leukocyte Antigen-B27 Molecules from Patients with Ankylosing Spondylitis and Normal Individuals

    PubMed Central

    Karr, Robert W.; Hahn, Yaffa; Schwartz, Benjamin D.

    1982-01-01

    Although the association between human histocompatibility leukocyte antigen (HLA) B27 and ankylosing spondylitis is the prototype of HLA-disease association, the mechanism underlying these associations has not been determined. We have investigated the possibility that the B27 molecules from patients with ankylosing spondylitis are different from those of normals, and only the “different” molecules predispose the individual to disease. Biosynthetically radiolabeled HLA-B27 molecules from patients with ankylosing spondylitis and normal individuals were compared by two-dimensional gel electrophoresis and tryptic peptide mapping with high pressure liquid chromatography. Extensive charge heterogeneity in the 45,000-dalton heavy chain was detected when B27 molecules were analyzed by two-dimensional gel electrophoresis; the charge heterogeneity was reduced, but not eliminated, when the B27 molecules were treated with neuraminidase to remove sialic acid residues before analysis. No structural difference in the B27 molecules from an ankylosing spondylitis patient and a normal individual were detected by two-dimensional gel electrophoresis. Analysis of [3H]leucine-labeled and [3H]arginine-labeled tryptic peptides and chymotryptic peptides of the trypsin insoluble material by reverse-phase high pressure liquid chromatography revealed identity of the B27 molecules from ankylosing spondylitis patients and normal individuals. These studies indicate that development of akylosing spondylitis in only some B27 positive individuals is not attributable to those individuals possessing variant B27 molecules. Images PMID:7056855

  9. Level set based vertebra segmentation for the evaluation of Ankylosing Spondylitis

    NASA Astrophysics Data System (ADS)

    Tan, Sovira; Yao, Jianhua; Ward, Michael M.; Yao, Lawrence; Summers, Ronald M.

    2006-03-01

    Ankylosing Spondylitis is a disease of the vertebra where abnormal bone structures (syndesmophytes) grow at intervertebral disk spaces. Because this growth is so slow as to be undetectable on plain radiographs taken over years, it is necessary to resort to computerized techniques to complement qualitative human judgment with precise quantitative measures on 3-D CT images. Very fine segmentation of the vertebral body is required to capture the small structures caused by the pathology. We propose a segmentation algorithm based on a cascade of three level set stages and requiring no training or prior knowledge. First, the noise inside the vertebral body that often blocks the proper evolution of level set surfaces is attenuated by a sigmoid function whose parameters are determined automatically. The 1st level set (geodesic active contour) is designed to roughly segment the interior of the vertebra despite often highly inhomogeneous and even discontinuous boundaries. The result is used as an initial contour for the 2nd level set (Laplacian level set) that closely captures the inner boundary of the cortical bone. The last level set (reversed Laplacian level set) segments the outer boundary of the cortical bone and also corrects small flaws of the previous stage. We carried out extensive tests on 30 vertebrae (5 from each of 6 patients). Two medical experts scored the results at intervertebral disk spaces focusing on end plates and syndesmophytes. Only two minor segmentation errors at vertebral end plates were reported and two syndesmophytes were considered slightly under-segmented.

  10. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome

    PubMed Central

    Putnis, S.E; Wartemberg, G.K; Khan, W.S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  11. The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis.

    PubMed

    Malinowski, Krzysztof Piotr; Kawalec, Paweł

    2015-04-01

    The aim of this systematic review was to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with ankylosing spondylitis. The search was conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2013 prices USD using the consumer price index and purchasing power parity. Identified studies were then analyzed to assess their possible inclusion in the meta-analysis. We identified 32 records. The average annual indirect cost per patient varies among all the identified results from US$660.95 to 45,953.87. The mean annual indirect per patient equals US$6454.76. This systematic review summarizes current data related to indirect costs generated by ankylosing spondylitis; it revealed the great economic burden of the disease for society. We observed a great variety of the considered components of indirect costs and their definitions. PMID:25579502

  12. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome.

    PubMed

    Putnis, S E; Wartemberg, G K; Khan, W S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  13. Cardiac Autonomic Function in Patients With Ankylosing Spondylitis: A Case-Control Study.

    PubMed

    Wei, Cheng-Yu; Kung, Woon-Man; Chou, Yi-Sheng; Wang, Yao-Chin; Tai, Hsu-Chih; Wei, James Cheng-Chung

    2016-05-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease involing spine and enthesis. The primary aim of this study is to investigate the autonomic nervous system (ANS) function and the association between ANS and the functional status or disease activity in AS.The study included 42 AS patients, all fulfilling the modified New York criteria. All the patients are totally symptom free for ANS involvement and had normal neurological findings. These AS patients and 230 healthy volunteers receive analysis of 5 minutes heart rate variability (HRV) in lying posture. In addition, disease activity and functional status of these AS patients are assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G).Both groups were age and sex-matched. Although the HRV analysis indicates that the peaks of total power (TP, 0-0.5 Hz) and high-frequency power (HF, 0.15-0.40 Hz) are similar in both groups, the activities of low-frequency power (LF, 0.04-0.15 Hz), LF in normalized units (LF%), and the ratio of LF to HF (LF/HF) in AS patients are obviously lower than healthy controls. The erythrocyte sedimentation rate and C-reactive protein revealed negative relationship with HF. The AS patients without peripheral joint disease have higher LF, TP, variance, LF%, and HF than the patients with peripheral joint disease. The AS patients without uvetis have higher HF than the patients with uvetis. The total scores of BASDI, BASFI, and BAS-G do not show any association to HRV parameters.AS patients have significantly abnormal cardiac autonomic regulation. This is closely related with some inflammatory activities. Reduced autonomic function may be one of the factors of high cardiovascular risk in AS patients. PMID:27227940

  14. Fetuin-A is related to syndesmophytes in patients with ankylosing spondylitis: a case control study

    PubMed Central

    Tuylu, Tugba; Sari, Ismail; Solmaz, Dilek; Kozaci, Didem Leyla; Akar, Servet; Gunay, Necati; Onen, Fatos; Akkoc, Nurullah

    2014-01-01

    OBJECTIVES: New bone formation is one of the hallmark characteristics of ankylosing spondylitis, which is thereby associated with syndesmophytes. Fetuin-A is a molecule that is abundantly found in calcified tissues and it shows high affinity for calcium phosphate minerals and related compounds. Considering the role of fetuin-A in the regulation of calcified matrix metabolism, we compared the fetuin-A levels in ankylosing spondylitis patients with syndesmophytes with those in patients without syndesmophytes and in healthy controls. We also studied other biomarkers that are thought to be related to syndesmophytes. METHODS: Ninety-four patients (49 patients without syndesmophytes, 67.3% male, 40.7±8.7 years; 45 patients with syndesmophytes, 71.1% M, 43.9±9.9 years) and 68 healthy controls (44.2±10.6 years and 70.6% male) were included in this study. Syndesmophytes were assessed on the lateral radiographs of the cervical and lumbar spine. The serum levels of fetuin-A, dickkopf-1, sclerostin, IL-6, high-sensitivity C-reactive protein and bone morphogenetic protein-7 were measured with an enzyme-linked immunosorbent assay. RESULTS: Patients with syndesmophytes had significantly higher levels of fetuin-A compared with patients without syndesmophytes and controls (1.16±0.13, 1.05±0.09 and 1.08±0.13 mg/ml, respectively). However, fetuin-A was not different between the patients without syndesmophytes and controls. Bone morphogenetic protein-7 was significantly lower; dickkopf-1 was significantly higher in patients with ankylosing spondylitis compared with controls. The sclerostin concentrations were not different between the groups. In regression analysis, fetuin-A was an independent, significant predictor of syndesmophytes. CONCLUSION: Our results suggest that fetuin-A may a role in the pathogenesis of bony proliferation in ankylosing spondylitis. PMID:25518021

  15. Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept.

    PubMed

    Deng, Xiaohu; Zhang, Jianglin; Zhang, Jie; Huang, Feng

    2013-06-01

    A previous study showed that most ankylosing spondylitis (AS) patients presented recurrence within 6 months post-discontinuation of etanercept. How to reduce recurrence following discontinuation of etanercept should be further researched. In this study, 111 ankylosing spondylitis patients meeting the Assessment in AS 20 % response (ASAS20) criteria after 12-week administration of etanercept were randomized into three groups: Group I, 150 mg thalidomide once/day; Group II, 1 g sulfasalazine, twice/day; Group III, NSAIDs for the maintenance treatment. The patients were regularly followed up once a month, and AS recurrence was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the patient global assessment (PGA), and rachialgia. The follow-up lasted for 1 year, and AS recurrence was considered as the end of a visit. Finally, 100 patients completed the follow-up study, of whom 30 were in Group I, 33 in Group II, and 37 in Group III. The average follow-up period was 5.1 ± 3.9 months and the longest lasted for 12 months. At the end of the follow-up study, the recurrence rates in Groups I, II, and III were, respectively, 60.0 % (18/30), 84.8 % (28/33), and 89.2 % (33/37). The recurrence rates of Group I were statistically significantly lower than that of Group II and III (P = 0.0265; P = 0.0053), while there was no significant difference between Group II and Group III. In addition, we found that PGA, C-reactive protein (CRP), and spinal inflammation could be regarded as predictive factors for AS recurrence by analysis with the Cox proportional hazard model. This study points to a new way for maintenance therapy of AS following discontinuation of etanercept and reveals several useful indicators for prediction of AS recurrence. PMID:23143621

  16. Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis.

    PubMed

    Wang, H H; Wang, Q F

    2016-07-01

    Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis. PMID:27383120

  17. Relationship between diagnosis delay and disease features in Moroccan patients with ankylosing spondylitis.

    PubMed

    Ibn Yacoub, Yousra; Amine, Bouchra; Laatiris, Assia; Bensabbah, Rachida; Hajjaj-Hassouni, Najia

    2012-02-01

    We aimed to evaluate diagnosis delay and its impact on disease in terms of activity, functional disability, and radiographic damage in Moroccan patients with ankylosing spondylitis (AS). We recruited 100 Moroccan patients who fulfilled New York Classification criteria for AS. Diagnosis delay was defined as the interval between the first symptom of AS and the moment of a correct diagnosis. Disease activity was evaluated by the bath ankylosing spondylitis disease activity index (BASDAI), functional status by the bath ankylosing spondylitis functional index (BASFI), and radiographic damage by the bath ankylosing spondylitis radiologic index (BASRI). Measurements of spinal mobility were assessed. The average age at disease onset was 28.56 ± 10.9 years. Of the patients, 16% had juvenile-onset AS. Disease duration was 9.5 ± 6.8 years, and the average of diagnosis delay was 4.12 ± 3.99 years. There were no differences in diagnosis delay according to the age at onset, educational level, or the presence of extra-articular involvement. Our patients had altered functional ability. Patients with late diagnosis (>5 years) had statistically significant higher structural damage (BASRI) and severe limited spinal mobility. There was no correlation between diagnosis delay and the activity of disease. Few studies focused on diagnostic delay and its impact in patients with AS. It is necessary in our context to establish an early diagnosis taking into account the high frequency of severe functional disability in Moroccan AS. PMID:21110026

  18. Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis

    PubMed Central

    Wang, H.H.; Wang, Q.F.

    2016-01-01

    Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis. PMID:27383120

  19. Carotid Intima Media Thickness as a Marker of Atherosclerosis in Ankylosing Spondylitis

    PubMed Central

    Gupta, Naveen; Goyal, Laxmikant; Agrawal, Abhishek; Bhargava, Rajat; Agrawal, Arun

    2014-01-01

    Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study. Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04; P < 0.001). CIMT in the cases group positively correlated with age (r = 0.357; P < 0.05), duration of disease (r = 0.549; P < 0.01), and BASMI (r = 0.337; P < 0.05) and negatively correlated with ESR (r = −0.295; P < 0.05). Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity. PMID:24803936

  20. Tramadol/acetaminophen combination as add-on therapy in the treatment of patients with ankylosing spondylitis.

    PubMed

    Chang, Jhi-Kai; Yu, Chen-Tung; Lee, Ming-Yung; Yeo, Kj; Chang, I-Chang; Tsou, Hsi-Kai; Wei, James Cheng-Chung

    2013-03-01

    This study aimed to determine the safety and efficacy of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (Ultracet®) in patients with ankylosing spondylitis (AS). This was a 12-week, randomized, double-blind, placebo-controlled study. Sixty patients with active AS according to the Modified New York Criteria were enrolled. Active disease was defined by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for more than 3 at randomization. Subjects were randomized equally into two groups: the treatment group received aceclofenac plus Ultracet® one tablet twice a day, and the control group received aceclofenac plus placebo for 12 weeks. The primary endpoint was a difference of Assessment in Ankylosing Spondylitis (ASAS20) response criteria between two groups at week 12. At week 12, ASAS20 was achieved by 53.3 % of the aceclofenac plus Ultracet group and 31 % of the aceclofenac alone group (p = 0.047). For the pain visual analogue scale at week 12, there was a reduction of 45.6 % in aceclofenac plus Ultracet group and 25.7 % in the aceclofenac alone group (p = 0.087). There was no statistically significant difference between two groups in BASDAI, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Global Index, Physician Global Assessment, spinal mobility, ESR, hs-CRP, and Ankylosing Spondylitis Quality of Life Questionnaire. A slight increase in total adverse events was noted with dizziness (7.5 vs 1.5 %), vertigo (4.5 vs 1.5 %), and nausea/vomiting (6 vs 0 %) in the Ultracet arm compared to placebo. The tramadol 37.5 mg/acetaminophen 325 mg combination tablet (Ultracet®) might has additional effect to nonsteroidal anti-inflammatory drugs in the treatment of patients with ankylosing spondylitis. It showed marginal benefit in pain and disease activity. However, a slight increase in minor adverse events was noted. PMID:23192419

  1. Clinical research for curing ankylosing spondylitis through combining etanercept, thalidomide and sulfasalazine.

    PubMed

    Xiao, Peng; Pang, Changhe; Zhu, Xu; Wu, Xuejian

    2015-01-01

    This article is to explore the curative effect of treating ankylosing spondylitis (AS) through combining etanercept, thalidomide and sulfasalazine. Sixty-two patients with AS were divided into 3 groups: experimental group Ais treated by etanercept+ thalidomide + sulfasalazine for 1 year (n=22); control group B was treated with etanercept; control group C was treated with thalidomide + sulfasalazine for 1 year (n=20). In 1st, 3rd, 6th, 12th month after the treatment, ASAS20 and ASAS50 were obtained through Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), erythrocyte sedimentation rate (ESR), C react protein (CRP) and then curative effect was analyzed. In 1 and 3 months after the treatment, each indicator had downtrend, and ASAS20 of experimental group and etanercept control group reached 100%; ASAS50 increased compared with the first months' treatment; although ASAS20 and ASAS50 in thalidomide control group was smaller, they increased; in 6 and 12 months after the treatment, ASAS20 improvement ratio in group A still remained on 100%, ASA50 improvement ratio increased; recurrence rate of group B increased; ASA20 and ASA50 had a continuous and significant increase, but its their was less than group A. This study proved that, the effect of curing AS combiningetanercept, thalidomide and sulfasalazine is better, therefore, it is a high-feasible treatment approach. PMID:25631513

  2. Atherosclerosis in male patients with ankylosing spondylitis: the relation with methylenetetrahydrofolate reductase (C677T) gene polymorphism and plasma homocysteine levels.

    PubMed

    Geçene, Muharrem; Tuncay, Figen; Borman, Pınar; Yücel, Dogan; Senes, Mehmet; Yılmaz, Behice Kaniye

    2013-06-01

    The aim of this study was to determine the intima-media thickness (IMT) in carotid arteries and to assess the relation of these values with plasma homocysteine (pHcy) levels and methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in patients with Ankylosing spondylitis (AS). Serum lipids, vitamin B12, folic acid, pHcy and acute phase protein levels were measured in all cases. MTHFR C677T gene polymorphisms were determined, and IMT of main carotid artery were evaluated ultrasonographically in all subjects. Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity score and Bath Ankylosing Spondylitis Metrology Index were used to assess disease activity and spinal mobility. Fifty AS patients (mean age of 36.6 ± 4.79 years) and 50 control subjects (36.34 ± 4.72 years) were included in the study. Plasma homocysteine levels of AS patients and control group were also similar (14.26 ± 9.96 vs. 11.81 ± 5.53 μmol/L). Hyperhomocysteinemia was present in 11 subjects in patient group (22.0 %), while it was seen in 5 subjects in the control group (10.0 %). The MTHFR C677T genotype distribution was as follows: CC 31 (62 %), CT 14 (28 %), TT 5 (10 %) in AS patients. The mean carotid IMT values were also found to be similar between the groups. The most important factor influencing pHcy level was found as MTHFR 677TT genotype. We indicated no difference of atherosclerosis indices revealed by IMT values and pHcy levels AS patients and control subjects. But an association between MTHFR 677 gene polymorphism and pHcy levels was concluded, which may suggest that MTHFR 677 TT polymorphism may be a potential prognostic factor for cardiovascular disease in patients with AS. PMID:23247802

  3. MMP-2, TNF-α and NLRP1 polymorphisms in Chinese patients with ankylosing spondylitis and rheumatoid arthritis.

    PubMed

    Sun, Rongbin; Huang, Yong; Zhang, Hui; Liu, Ruiping

    2013-11-01

    Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are autoimmune, inflammatory diseases with substantial genetic contributions. Matrix metalloproteinase (MMP)-2, tumor necrosis factor (TNF)-α and NLR family pyrin domain-containing 1 (NLRP1) play important roles in the immune response. We studied the MMP-2 rs243865 C/T, TNF-α rs1800629 A/G, NLRP1 rs878329 C/G and NLRP1 rs6502867 C/T polymorphisms in a Chinese cohort of 520 patients with RA, 100 with AS and 520 controls. Genotyping was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Using the MMP-2 rs243865 CC homozygote genotype as the reference group, the CT and TT/CT genotypes were associated with significantly reduced risks of AS. However, logistic regression analyses revealed that the MMP-2 rs243865 C/T polymorphism was not associated with risk of RA. TNF-α rs1800629 A/G, NLRP1 rs878329 C/G and NLRP1 rs6502867 C/T polymorphisms were not associated with risk of RA or AS. These findings suggest that the MMP-2 rs243865 C/T polymorphism is associated with AS development. PMID:24065540

  4. Fluoroscopy-guided Intra-articular Sacroiliac Joint Steroid Injection for Sacroiliitis in Ankylosing Spondylitis: A Case Report

    PubMed Central

    Dawson, PUA; Dewar, NA; Tulloch-Reid, D

    2014-01-01

    Sacroiliitis, a condition commonly seen in ankylosing spondylitis, is well known to be one of the main pain generators of low back pain, which may result in difficulty with walking. A 20-year old male with history of ankylosing spondylitis presented to the University Hospital of the West Indies, Physical Medicine and Rehabilitation Clinic, with a two-year history of right buttock, low back and groin pain. Radiographic evaluation revealed increased sclerosis and erosive changes in bilateral sacroiliac joints, right greater than left. Right intra-articular sacroiliac joint steroid injection was administered under fluoroscopy guidance. Post-injection visual analogue pain scale (VAS) score with activity improved from 8 to 1 and Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. The patient's overall assessment was 95% perceived improvement in pain. This case report illustrates the effectiveness of intra-articular sacroiliac joint steroid injection in treating sacroiliitis in ankylosing spondylitis. PMID:25303203

  5. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance.

    PubMed

    Aissaoui, N; Rostom, S; Hakkou, J; Berrada Ghziouel, K; Bahiri, R; Abouqal, R; Hajjaj-Hassouni, N

    2012-07-01

    This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥ 5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS. PMID:21516494

  6. Airway management in a patient of ankylosing spondylitis with traumatic cervical spine injury

    PubMed Central

    Kumar, Nilesh; Bindra, Ashish; Mahajan, Charu; Yadav, Naveen

    2015-01-01

    Traumatic cervical lesions compressing the spinal cord pose a significant risk of exacerbating the existing neurological condition during tracheal intubation and subsequent positioning. Preexisting ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient with traumatic cervical spinal cord. To improve ease and success, and reduce cervical spine movement, awake fibreoptic intubation (FOI) is considered the gold standard technique for airway management in such cases. Attaining appropriate position for intubation was challenge in this case due to rigid curvature of the ankylosed spinal column. To prevent neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and attaining appropriate position was of prime concern. Optimal sedation with self-positioning by the patient in a comfortable posture is quite imperative and assures both airway as well as neurological protection in such expected difficult situations. We report the use of dexmedetomidine for self-positioning and awake FOI in a patient with ankylosing spondylitis having traumatic cervical spine who was otherwise neither able to co-operative nor able to give appropriate position for FOI. PMID:26240557

  7. Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

    PubMed

    Ul Haq, Muhammad Irfan; Shamim, Faisal; Lal, Shankar; Shafiq, Faraz

    2015-12-01

    Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope. PMID:26691367

  8. Association of Genetic Variants in Pentraxin 3 Gene with Ankylosing Spondylitis

    PubMed Central

    Zhang, Xu; Ding, Wenyuan

    2016-01-01

    Background Pentraxin 3 is considered to play an important role in immune and inflammatory reaction. This study aimed to detect the effect of pentraxin3 gene (PTX3) polymorphisms on ankylosing spondylitis (AS) risk. Material/Methods The genotyping of PTX3 polymorphisms in 101 AS patients and 93 controls was conducted by allelic discrimination assay and the genotype distribution was assessed for Hardy-Weinberg equilibrium (HWE). The differences of genotype, allele, haplotype, and some basic indexes were compared by χ2 test. Odds ratio (OR) and 95% confidence interval (95%CI) were also calculated by χ2 test and were used to evaluate the association intensity between gene polymorphisms and disease. Haploview software was used to analyze the linkage disequilibrium (LD) and haplotypes of PTX3 polymorphisms. Results CC genotype of rs3816527 had an obviously higher frequency in cases than in controls and had a positive effect on AS occurrence (OR=3.14, 95%CI=1.04–9.52), and the same was true of the C allele in rs3816527. For rs3845978, CT genotype showed a significant frequency difference between the case and control groups (P=0.03) and people with genotypes carrying the T allele developed AS earlier (OR=1.94, 95%CI=1.09–3.47), and the same was found in the analysis of the T allele. G-C-T haplotype dramatically increased the risk of AS, as may A-C-C haplotype. Conclusions In PTX3 polymorphisms rs3816527 and rs3845978 were found to be associated with AS, but rs2305619 was not. PMID:27538101

  9. Performance characteristics of the simplified version of ankylosing spondylitis disease activity score (SASDAS).

    PubMed

    Solmaz, Dilek; Yildirim, Tulay; Avci, Okan; Tomas, Nazmiye; Akar, Servet

    2016-07-01

    Various types of disease activity measures are available for axial spondyloarthritis (axSpA), and there is no gold standard for all individual patients. The ankylosing spondylitis disease activity score (ASDAS) is highly discriminatory, sensitive to change, and associated with structural progression. A simplified version of the ASDAS (SASDAS) was proposed and found to be a simple and practical tool to assess disease activity. Our aim was to test the performance characteristics of the SASDAS and compare it with validated tools. In total, 97 consecutive ankylosing spondylitis (AS) patients were included in the study. Disease activity was assessed by the ASDAS-erythrocyte sedimentation rate (ESR), ASDAS-C-reactive protein (CRP), bath ankylosing spondylitis disease activity index (BASDAI), and SASDAS. The relationship among these activity indices and the level of agreement of various activity categories were tested. There was a strong correlation between the SASDAS and other activity indices, including the BASDAI (r = 0.916, p < 0.001), ASDAS-CRP (r = 0.847, p < 0.001), and ASDAS-ESR (r = 0.942, p < 0.001). Although the agreement between the ASDAS-ESR and SASDAS was good (weighted kappa of 0.744 and total agreement of 77 %), there was moderate agreement between the ASDAS-CRP and SASDAS (weighted kappa of 0.579 and total agreement of 66 %). The disagreement was particularly striking in "moderate" and "high disease activity" states. Approximately 40 % of patients classified as moderate activity according to the ASDAS-ESR and 45 % according to the ASDAS-CRP were differentially categorized by the SASDAS. The results of the present analysis suggest that the simplified version of the ASDAS-ESR should be further validated in various settings and populations due to a questionable level of agreement between the ASDAS-CRP and SASDAS. PMID:26670454

  10. Social Role Participation Questionnaire for patients with ankylosing spondylitis: translation into Dutch, reliability and construct validity

    PubMed Central

    van Genderen, Simon; Plasqui, Guy; Lacaille, Diane; Arends, Suzanne; van Gaalen, Floris; van der Heijde, Désirée; Heuft, Liesbeth; Keszei, András; Luime, Jolanda; Spoorenberg, Anneke; Landewé, Robert; Gignac, Monique; Boonen, Annelies

    2016-01-01

    Objective The Social Role Participation Questionnaire (SRPQ) assesses the influence of health on participation in 11 specific and one general participation role across 4 participation dimensions: ‘importance’, ‘satisfaction with time’, ‘satisfaction with performance’ and ‘physical difficulty’. This study aimed to translate the SRPQ into Dutch, and assess the clinimetric properties and aspects of its validity among patients with ankylosing spondylitis (AS). Methods Translation was performed using the dual panel approach. For each participation dimension, internal consistency, test-retest reliability (n=31), and construct validity were assessed in 246 patients with AS. Results The translation required only minor adaptations. Cronbach αs were α≥0.7. A strong correlation was present between satisfaction with ‘time’ and ‘performance’(r=0.85). Test-retest reliability was satisfactory (κ=0.79–0.95). Correlations with participation domains of the Short-Form Health Survey 36 (SF-36), the WHO Disease Assessment Score II, and generic as well as disease-specific health outcomes (Physical and Mental component scale of the SF-36, Satisfaction With Life Scale, Bath Ankylosing Spondylitis Disease Index (BASDAI), Bath Ankylosing Spondylitis Functioning Index (BASFI)) were at least moderate (r=−0.41 to 0.75) for all dimensions except for ‘role importance’ where correlations were weak (r≤40). Discriminative ability across 5 self-reported health states was good for all dimensions (p<0.01). The ‘general participation’ role showed similar reliability and validity for each dimension, as the average of the all 11 roles. Conclusions The Dutch version of the SRPQ is available to help understand social role participation of patients with AS. The dimension ‘role importance’ measures a distinct aspect of participation. The general participation item was a good global measure of participation. PMID:26870393

  11. Ankylosing spondylitis associated with Sweet’s syndrome: a case report

    PubMed Central

    2013-01-01

    Introduction Sweet’s syndrome is an acute neutrophilic dermatosis characterized by a diffuse dermal infiltrate of mature neutrophils. In most cases, it occurs as an isolated phenomenon (idiopathic Sweet’s syndrome) but it can be drug induced or associated with a variety of underlying diseases such as infections, neoplasms, and chronic inflammatory diseases. The association between Sweet’s syndrome and ankylosing spondylitis is rare. Only a few cases have been reported in the literature. We report a new case in which we describe an outbreak of acute neutrophilic dermatosis revealing ankylosing spondylitis. Case presentation A 33-year-old Moroccan man presented with large-joint polyarthralgia, inflammatory pain in his buttocks and lower lumbar spine, fever and skin lesions. On examination, the patient had a low-grade fever, six tender but not swollen joints, limitation of motion of the lumbar spine, and painful erythematous maculopapules over his face, neck, and hands. Laboratory tests showed hyperleukocytosis, and elevated erythrocyte sedimentation rate and C-reactive protein. The immunological tests and infectious disease markers were negative. Investigations for an underlying neoplastic disease remained negative. Magnetic resonance imaging showed a bilateral sacroiliitis. Skin biopsy findings were consistent with Sweet’s syndrome. The diagnosis of Sweet’s syndrome associated with ankylosing spondylitis was established. Nonsteroid anti-inflammatory drugs were started and the patient showed rapid clinical and biological improvement. Conclusion Three observations of the association between Sweet’s syndrome and spondylarthropathy have been reported in the literature. The cause of this association remains unclear. Some hypotheses have been developed, but further studies are needed to confirm or refute them. PMID:23305505

  12. Ultrasound features of shoulder involvement in patients with ankylosing spondylitis: a case–control study

    PubMed Central

    2013-01-01

    Background During Ankylosing spondylitis (AS) courses, shoulder involvement is common. However, etiologies of shoulder pain in patients with AS remain to be defined. The aim of this study was to investigate the prevalence of ultrasound (US) abnormalities in shoulders of patients with ankylosing spondylitis (AS), and to determine predictive factors of ultrasound shoulder enthesitis. Methods 38 patients with AS were included with 38 age and sex-matched healthy controls. All patients fulfilled the modified New York criteria for ankylosing spondylitis. Clinical and demographical data were recorded. US examination of bilateral shoulders was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the insertions of supraspinatus, subscapularis and infraspinatus tendons, rotator cuff tendons, subacromial-subdeltoid bursa, acromioclavicular joint, and glenohumeral joint. Results The mean age of patients and controls was 36 years, each group of patients and controls comprised 22 men (57.9%) and 16 women (42.1%). Disease duration was 9.6 ± 7.2 years. Among 38 patients with AS, 21 had coxitis (55%) and 19 had previous or current shoulder pain (50%). AS shoulders presented significantly more ultrasound enthesitis than controls shoulders (43 shoulders (56.6%) versus 8 shoulders (10.5%) respectively). Involvement of rotator cuff tendons was significantly higher in patients with AS compared with control subjects (16/38 (42.1%) versus 6 (15.2%) respectively). However, involvement of gleno-humeral and acromio-clavicular joints was infrequent in both groups. In patients with AS, we found that the presence of coxitis was the only significant predictive factors of shoulder enthesitis (Odds Ratio (OR) = 9.4; Confidence interval (CI) 95% (1.10; 81.9), p = 0.04). Conclusions Ultrasound abnormalities of shoulders are common in patients with AS, and the most frequent abnormalitie was enthesitis, which was associated with the

  13. Assessment of spinal mobility in ankylosing spondylitis using a video-based motion capture system.

    PubMed

    Garrido-Castro, Juan L; Medina-Carnicer, Rafael; Schiottis, Ruxandra; Galisteo, Alfonso M; Collantes-Estevez, Eduardo; Gonzalez-Navas, Cristina

    2012-10-01

    This paper describes the use of a video-based motion capture system to assess spinal mobility in patients with ankylosing spondylitis (AS). The aim of the study is to assess reliability of the system comparing it with conventional metrology in order to define and analyze new measurements that reflect better spinal mobility. A motion capture system (UCOTrack) was used to measure spinal mobility in forty AS patients and twenty healthy subjects with a marker set defining 33 3D measurements, some already being used in conventional metrology. Radiographic studies were scored using the modified Stoke Ankylosing Spondylitis Spine Score index (mSASSS). Test-retest reliability studies were performed on the same day and over a two-week period. Motion capture shows very high reliability with Intraclass Correlation Coefficient values ranging from 0.89 to 0.99, low Standard Error of the Measurement (0.37-1.33 cm and 1.58°-6.54°), correlating very well with the Bath Ankylosing Spondylitis Metrology Index (BASMI) (p < 0.001) and, in some individual measures (cervical flexion, cervical lateral flexion, back inclination, shoulder-hip angle and spinal rotation), with mSASSS (p < 0.01). mSASSS also added significantly to the variance in multivariate linear regression analysis to certain measures (back inclination, cervical flexion and cervical lateral flexion). Quantitative results obtained with motion capture system using the protocol defined show to be highly reliable in patients with AS. This technique could be a useful tool for assessing the outcome of the disease and for monitoring the evolution of spinal mobility in AS patients. PMID:22560166

  14. Association study of ankylosing spondylitis and polymorphisms in ERAP1 gene in Zhejiang Han Chinese population.

    PubMed

    Liu, Yangbo; Li, Liangda; Shi, Shanfen; Chen, Xin; Gao, Jianqing; Zhu, Minyu; Yuan, Jiandong

    2016-02-01

    The susceptibility loci of ERAP1 polymorphisms have been found to be strongly associated with ankylosing spondylitis (AS). The researches in multiple ethnic cohorts suggested that the population attributable risk in ERAP1 polymorphisms is at a high significance level. This study was undertaken to estimate the prevalence and incidence of subsets of AS and investigate the specific variants of ERAP1 polymorphisms in AS susceptibility, in the Han ethnic Chinese population in Zhejiang Province. AS patients were selected, diagnosed, and confirmed by a qualified rheumatologist. The basal clinical and demographic characteristics were compared with all subjects. Genotypes for eight selected single nucleotide polymorphisms (SNPs) in ERAP1 gene (rs27038, rs27037, rs27434, rs27980, rs7711564, rs30187, rs10050860, and rs17482078) were determined by using the Sequenom MassARRAY iPLEX platform in Zhejiang Han Chinese population. Association analyses were performed on the whole genotyped data set in 707 unrelated ankylosing spondylitis cases and 837 ethnically matched controls. We observed the strongest association between AS and HLA-B27, which confers over 90 % of ankylosing spondylitis cases. Moreover, we found three loci of ERAP1 polymorphisms were at a high significance level (rs27037 P = 0.00451; rs27434 P = 0.00012; rs27980 P = 0.00682) with AS in Zhejiang population. We also confirmed polymorphism locus of ERAP1 previously reported association with AS (rs27434; P = 5.3 × 10(-12)). Our results indicated a difference in the mechanism of susceptibility loci in subsets of Zhejiang Han Chinese population and provided further evidence that rs27434 is the key polymorphism associated with AS in ERAP1 gene. PMID:26350268

  15. Effectiveness of adalimumab in treating patients with ankylosing spondylitis associated with enthesitis and peripheral arthritis

    PubMed Central

    2010-01-01

    Introduction The purpose of this study was to investigate the effectiveness of adalimumab in enthesitis and peripheral arthritis in patients with ankylosing spondylitis (AS). Methods Adults with active AS (Bath ankylosing spondylitis disease activity index [BASDAI] ≥ 4) received adalimumab 40 mg every other week with standard antirheumatic therapies in a 12-week, open-label study. Effectiveness in enthesitis was assessed using the Maastricht ankylosing spondylitis enthesitis score (MASES, 0-13) and by examining the plantar fascia in patients with enthesitis (≥ 1 inflamed enthesis) at baseline; effectiveness in peripheral arthritis was evaluated using tender and swollen joint counts (TJC, 0-46; SJC, 0-44) in patients with peripheral arthritis (≥ 1 swollen joint) at baseline. Overall effectiveness measures included Assessment of SpondyloArthritis International Society 20% response (ASAS20). Results Of 1,250 patients enrolled, 686 had enthesitis and 281 had peripheral arthritis. In 667 patients with MASES ≥ 1 at baseline, the median MASES was reduced from 5 at baseline to 1 at week 12. At week 12, inflammation of the plantar fascia ceased in 122 of 173 patients with inflammation at baseline. The median TJC in 281 patients with SJC ≥ 1 at baseline was reduced from 5 at baseline to 1 at week 12; the median SJC improved from 2 to 0. ASAS20 responses were achieved by 70.5% of 457 patients with no enthesitis and no arthritis; 71.0% of 512 patients with only enthesitis; 68.0% of 107 patients with only arthritis; and 66.7% of 174 patients with both. Conclusions Treatment with adalimumab improved enthesitis and peripheral arthritis in patients with active AS. Trial registration ClinicalTrials.gov NCT00478660. PMID:20230622

  16. LLLT for the management of patients with ankylosing spondylitis.

    PubMed

    Stasinopoulos, D; Papadopoulos, K; Lamnisos, D; Stergioulas, A

    2016-04-01

    This study aimed to compare the effectiveness of the combined low-level laser therapy (LLLT) and passive stretching with combined placebo LLLT laser and the same passive stretching exercises in patients suffering from Αnkylosing spondylitis. Forty-eight patients suffering from Αnkylosing spondylitis participated in the study and were randomized into two groups. Group A (n = 24) was treated with a λ = 820 Ga-Al-As laser CW, with power intensity = 60 mW/cm(2), energy per point in each session = 4.5 J, total energy per session = 27.0 J, in contact with specific points technique, plus passive stretching exercises. Group B (n = 24), received placebo laser plus the same passive stretching exercises. Both groups received 12 sessions of laser or placebo within 8 weeks; two sessions per week (weeks 1-4) and one session per week (weeks 5-8). Pain and function scales were completed before the treatment, at the end of the fourth and eighth week of treatment, and 8 weeks after the end of treatment (follow-up). Group A revealed a significant improvement after 8 weeks of treatment in all pain and function scales. At 8-week follow-up, the improvement remained only for the pain, while for all other function outcomes the differences were not statistically significant. The results suggested that after an 8-week treatment and after a follow-up, the combination of LLLT and passive stretching exercises decreased pain more effectively than placebo LLLT along with the same passive stretching exercises in patients with Αnkylosing spondylitis. Future studies are needed to establish the relative and absolute effectiveness of the above protocol. PMID:26796709

  17. The Interleukin 1 Gene Cluster Contains a Major Susceptibility Locus for Ankylosing Spondylitis

    PubMed Central

    Timms, Andrew E.; Crane, Alison M.; Sims, Anne-Marie; Cordell, Heather J.; Bradbury, Linda A.; Abbott, Aaron; Coyne, Mark R. E.; Beynon, Owen; Herzberg, Ibi; Duff, Gordon W.; Calin, Andrei; Cardon, Lon R.; Wordsworth, B. Paul; Brown, Matthew A.

    2004-01-01

    Ankylosing spondylitis (AS) is a common and highly heritable inflammatory arthropathy. Although the gene HLA-B27 is almost essential for the inheritance of the condition, it alone is not sufficient to explain the pattern of familial recurrence of the disease. We have previously demonstrated suggestive linkage of AS to chromosome 2q13, a region containing the interleukin 1 (IL-1) family gene cluster, which includes several strong candidates for involvement in the disease. In the current study, we describe strong association and transmission of IL-1 family gene cluster single-nucleotide polymorphisms and haplotypes with AS. PMID:15309690

  18. [Disease-modifying anti-rheumatic drugs for treatment of ankylosing spondylitis].

    PubMed

    Madsen, Ole Rintek; Egsmose, Charlotte

    2009-08-10

    Ankylosing spondylitis (AS) is an inflammatory disorder affecting the axial skeleton, peripheral joints, entheses and extra-articular sites. Patients with early disease, a higher level of erythrocyte sedimentation rate and/or peripheral arthritis might benefit from sulfasalazine. Otherwise, there is no evidence that disease-modifying anti-rheumatic (DMARDs) have a therapeutic effect in AS. Clinical evidence that greater TNF-inhibitor effectiveness can be achieved by combining with a DMARD is lacking, but further studies should be performed. More research is needed to clarify the role of DMARDs in the treatment of AS. PMID:19732504

  19. Disease-modifying anti-rheumatic drugs in rheumatoid arthritis and ankylosing spondylitis.

    PubMed

    Haibel, H; Specker, C

    2009-01-01

    Disease modifying antirheumatic drugs (DMARDs) are widely used and well accepted for the treatment of patients with rheumatoid arthritis (RA). Many studies have been performed with monotherapy and combinations of DMARDs showing their efficacy and safety. In ankylosing spondylitis (AS) DMARDs, sulfasalazine especially, are recommended only for the peripheral involvement and not for the axial symptoms. For this disease there is a lack of clinical trials and most of the trials did not show efficacy on the axial symptoms of the disease. In this paper, the differences and similarities of DMARDs in the treatment of RA and AS patients will be discussed. PMID:19822065

  20. Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis.

    PubMed

    Fournié, B; Boutes, A; Dromer, C; Sixou, L; Le Guennec, P; Granel, J; Railhac, J J

    1997-01-01

    A prospective study of anterior chest wall involvement was conducted in 50 ankylosing spondylitis patients and 50 psoriatic arthritis patients in the absence of palmoplantar pustulosis. All patients underwent a physical examination, tomograms, and a radionuclide bone scan. Magnetic resonance imaging with gadolinium was done in some cases. Half the patients in both groups had anterior chest wall involvement. Enthesitis was the mechanism of the lesions. The manubriosternal symphysis and sternocostoclavicular joints were the most common sites of involvement, although other entheses in the region were affected in some patients. PMID:9051856

  1. Periodontal Pathogens are Likely to be Responsible for the Development of Ankylosing Spondylitis

    PubMed Central

    Ogrendik, Mesut

    2015-01-01

    The role of oral bacteria in the etiology of ankylosing spondylitis (AS) is examined in this review. Periodontitis is related to AS to a significant degree, and periodontitis is significantly more prevalent in patients with AS. Anti-Pophyromonas gingivalis and anti-Prevotella intermedia antibodies titers are higher in AS patients than in healthy subjects. Eight randomized controlled trials that used sulfasalazine were reviewed. Moxifloxacin and rifamycin are significantly effective in the treatment of AS. Periodontal pathogens are likely to be responsible for the development of AS in genetically susceptible individuals. These results will guide more comprehensive and efficacious treatment strategies for AS.

  2. Bilateral hip pain in a young man? It may be worth considering juvenile-onset ankylosing spondylitis (JAS).

    PubMed

    Agarwal, Neetu Nandkishore; Patil, Dnyanesh; Nagendra, Shashank; Jadhav, Shailesh Maruti

    2015-01-01

    A 15-year-old boy with severe bilateral hip joint pain and restriction of mobility presented to the casualty ward. He had earlier been treated for tuberculosis of the hip, with no relief. Our work up revealed a case of severe juvenile-onset ankylosing spondylitis with predominant hip involvement and accompanying sacroiliitis. PMID:26511993

  3. The use of low-dose etanercept as an alternative therapy for treatment of ankylosing spondylitis: a case series.

    PubMed

    Moghimi, Jamileh; Sheikhvatan, Mehrdad; Semnani, Vahid

    2012-08-01

    During recent decades, biological medications play a crucial role for treating rheumatologic disorders and thus are strongly recommended for initial treatment of ankylosing spondylitis. However, because of high cost of biological drugs, the use of these drugs has been limited. In current series, we tried to assess safety of low-dose etanercept as a common usable biological drug in patients with ankylosing spondylitis. In a case-series study, 4 men with ankylosing spondylitis were treated with low-dose etanercept (25 mg/2 weeks) plus methotrexate (10 mg/week). Safety was assessed by measuring rate of differences in severity of clinical manifestations and level of C-reactive protein (CRP). After the completion of treatment with low-dose etanercept, inflammatory low back pain and morning stiffness was reduced lower than 30 min in all patients. Only one patient had baseline high serum ESR and positive CRP that was changed to negative following treatment protocol. At one-year follow-up, all participants continued their regular treatment regimen with the etanercept survival rate 100%. Neither side effects related to drug nor clinical complications were observed within the follow-up period. Our findings suggest that low-dose etanercept (25 mg/2 weeks) has an acceptable safety and effectiveness profile in individuals with ankylosing spondylitis and can be good alternative instead of conventional therapy with etanercept (25 mg two times per week). PMID:21553278

  4. Validation of a new objective index to measure spinal mobility: the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI).

    PubMed

    Garrido-Castro, Juan L; Escudero, Alejandro; Medina-Carnicer, Rafael; Galisteo, Alfonso M; Gonzalez-Navas, Cristina; Carmona, Loreto; Collantes-Estevez, Eduardo

    2014-03-01

    Spinal mobility measures are subject to high variability and subjectivity. Automated motion capture allows an objective and quantitative measure of mobility with high levels of precision. To validate the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI), an index measure of spinal mobility, based on automated motion capture, validation studies included the following: (1) validity, tested by correlation--Pearson's r--between the UCOASMI and the mobility index Bath Ankylosing Spondylitis Metrology Index (BASMI), and a measure of structural damage, the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS); (2) reliability, with internal consistency tested by Cronbach's alpha, test-retest by intraclass correlation coefficient (ICC) after 2 weeks, and error measurement, by variation coefficient (VC) and smallest detectable difference (SDD); and (3) responsiveness, by effect size (ES) in a clinical trial of anti-TNF. Patients for the different studies all had ankylosing spondylitis. Validity studies show correlation between the BASMI (r = 0.881) and the mSASSS (r = 0.780). Reliability studies show an internal consistency of Cronbach's α = 0.894, intra-observer ICC = 0.996, test-retest ICC = 0.996, and a measurement error of VC = 2.80% and SDD = 0.25 points. Responsiveness showed an ES after 24 weeks of treatment of 0.48. In all studies, the UCOASMI's performance was better than that of the BASMI. The UCOASMI is a validated index to measure spinal mobility with better metric properties than previous indices. PMID:24356712

  5. Elevated Serum Levels of Soluble CD30 in Ankylosing Spondylitis Patients and Its Association with Disease Severity-Related Parameters

    PubMed Central

    Gao, Rongfen; Sun, Wei; Chen, Yu; Su, Yuying; Wang, Chenqiong; Dong, Lingli

    2015-01-01

    Soluble CD30 (sCD30), a transmembrane glycoprotein that belongs to the tumor necrosis factor receptor (TNFR) superfamily, has been shown to be associated with various pathological conditions. This study was designed to measure the levels of serum sCD30 in patients with ankylosing spondylitis (AS) and to evaluate the relationships between serum sCD30 levels and other disease severity-related indexes, including bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS), and bath ankylosing spondylitis functional index (BASFI). Our results demonstrated significantly elevated sCD30 levels in AS patients compared to healthy controls (HCs) with mean values of 32.0 ± 12.2 and 24.9 ± 8.0 ng/mL, respectively (P** = 0.007), suggesting a potential role of sCD30 in the pathogenesis of AS. However, no significant correlations of sCD30 with BASDAI, ASDAS, or BASFI were detected in our study (P > 0.05). Therefore, sCD30 cannot be used as a reliable marker for reflecting disease activity and functional ability of AS patients. PMID:26273636

  6. Finnish HLA studies confirm the increased risk conferred by HLA‐B27 homozygosity in ankylosing spondylitis

    PubMed Central

    Jaakkola, E; Herzberg, I; Laiho, K; Barnardo, M C N M; Pointon, J J; Kauppi, M; Kaarela, K; Tuomilehto‐Wolf, E; Tuomilehto, J; Wordsworth, B P; Brown, M A

    2006-01-01

    Objective To determine the influence of HLA‐B27 homozygosity and HLA‐DRB1 alleles in the susceptibility to, and severity of, ankylosing spondylitis in a Finnish population. Methods 673 individuals from 261 families with ankylosing spondylitis were genotyped for HLA‐DRB1 alleles and HLA‐B27 heterozygosity/homozygosity. The frequencies of HLA‐B27 homozygotes in probands from these families were compared with the expected number of HLA‐B27 homozygotes in controls under Hardy–Weinberg equilibrium (HWE). The effect of HLA‐DRB1 alleles was assessed using a logistic regression procedure conditioned on HLA‐B27 and case–control analysis. Results HLA‐B27 was detected in 93% of cases of ankylosing spondylitis. An overrepresentation of HLA‐B27 homozygotes was noted in ankylosing spondylitis (11%) compared with the expected number of HLA‐B27 homozygotes under HWE (4%) (odds ratio (OR) = 3.3 (95% confidence interval, 1.6 to 6.8), p = 0.002). HLA‐B27 homozygosity was marginally associated with reduced BASDAI (HLA‐B27 homozygotes, 4.5 (1.6); HLA‐B27 heterozygotes, 5.4 (1.8) (mean (SD)), p = 0.05). Acute anterior uveitis (AAU) was present in significantly more HLA‐B27 positive cases (50%) than HLA‐B27 negative cases (16%) (OR = 5.4 (1.7 to 17), p<0.004). HLA‐B27 positive cases had a lower average age of symptom onset (26.7 (8.0) years) compared with HLA‐B27 negative cases (35.7 (11.2) years) (p<0.0001). Conclusions HLA‐B27 homozygosity is associated with a moderately increased risk of ankylosing spondylitis compared with HLA‐B27 heterozygosity. HLA‐B27 positive cases had an earlier age of onset of ankylosing spondylitis than HLA‐B27 negative cases and were more likely to develop AAU. HLA‐DRB1 alleles may influence the age of symptom onset of ankylosing spondylitis. PMID:16249228

  7. Core set of recommendations for patients with ankylosing spondylitis concerning behaviour and environmental adaptations.

    PubMed

    Feldtkeller, Ernst; Lind-Albrecht, Gudrun; Rudwaleit, Martin

    2013-09-01

    Advice concerning behaviour and adaptations of living and working environment is considered an unmet need by patients with ankylosing spondylitis (AS). The aim of this study was to develop a core set of recommendations to be given to patients by their rheumatologists. A systematic literature research of scientific and patient-oriented literature revealed 70 raw recommendations. These recommendations were evaluated and ranked at a meeting of the Ankylosing Spondylitis International Federation (ASIF, 26 participants including 19 patients with AS, 5 rheumatologists and 2 physiotherapists from 13 countries) in November 2011. Thereafter, the 59 remaining recommendations were extensively discussed, supplemented, reworded, condensed and voted on during a meeting of local branch leaders of the AS patient organisation in Germany (Deutsche Vereinigung Morbus Bechterew, DVMB) with 80 participants (95 % of whom with AS), 2 rheumatologists and 1 occupational therapist in March 2012. The core set of final recommendations comprises (1) a general statement regarding living with AS which was considered highly important by patients and (2) the following domains: sitting position, walking, sleeping, at work, exercises, sports and recreational activities, diet and lifestyle, sexuality and pregnancy, fall prevention, car driving and advantages of membership in an AS-specific patient organisation. Most recommendations are relevant already in early disease, others concern advanced AS (e.g. fall prevention and car driving). The selected recommendations received high agreements (80-100 %). A first core set of recommendations for the behaviour and environmental adaptations of patients with AS was established under participation of many patients. PMID:23539272

  8. Protective effect of naringin against ankylosing spondylitis via ossification, inflammation and oxidative stress in mice

    PubMed Central

    Liu, Kang; Wu, Lianguo; Shi, Xiaolin; Wu, Fengqing

    2016-01-01

    Naringin is an abundant flavanone in pomelo, grapefruit as well as lime and its variants, has been shown to exhibit certain antioxidative, anti-inflammatory, anti-cancer and hypoglycemic effects. The aim of the current study was to evaluate the protective effects of naringin against ankylosing spondylitis (AS) and to elucidate the potential underlying mechanism. Firstly, a mouse model of ankylosing spondylitis (AS) was established. Next, osteocalcin (OC), alkaline phosphatase (ALP) and triglyceride (TG) activity values, inflammatory factor and oxidative stress were evaluated in the AS mice. Then, the Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) protein expression levels in the AS mice were investigated using western blot analysis. The results showed that naringin increased OC, ALP and TG activity values in the AS mouse model. Furthermore, inflammatory factor and oxidative stress levels in the AS mice were restrained by treatment with naringin. Furthermore, JAK2 and STAT3 protein expression levels were reduced by treatment with naringin. In conclusion, the present results indicated that the protective effects of naringin against AS are exerted via the induction of ossification, suppression of inflammation and oxidative stress and the downregulation of JAK2/STAT3 in mice. PMID:27446336

  9. Partitioning of the contributions of rib cage and abdomen to ventilation in ankylosing spondylitis

    PubMed Central

    Grimby, Gunnar; Fugl-Meyer, Axel R.; Blomstrand, Ann

    1974-01-01

    Grimby, G., Fugl-Meyer, A. R., and Blomstrand, A. (1974).Thorax,29, 179-184. Partitioning of the contributions of rib cage and abdomen to ventilation in ankylosing spondylitis. The relative contributions of the rib cage and abdomen to ventilation were studied in the sitting position in patients with ankylosing spondylitis, using measurements of changes in the anteroposterior diameters. The functional impairment of the spine and adjacent joints was also evaluated. In most patients vital capacity and total lung capacity were reduced, but functional residual capacity was normal. The relative contribution of the rib cage to ventilation was reduced at rest compared to normal subjects, and decreased further during hyperventilation induced by rebreathing. The end-expiratory level of the abdomen decreased more markedly during hyperventilation than in normal subjects and even the end-inspiratory level of the abdomen increased somewhat. The findings are consistent with a reduced mobility of the ribs and a greater than normal excursion of the diaphragm during breathing. PMID:4831523

  10. Detection of Multiple Autoantibodies in Patients with Ankylosing Spondylitis Using Nucleic Acid Programmable Protein Arrays*

    PubMed Central

    Wright, Cynthia; Sibani, Sahar; Trudgian, David; Fischer, Roman; Kessler, Benedikt; LaBaer, Joshua; Bowness, Paul

    2012-01-01

    Ankylosing spondylitis (AS) is a common, inflammatory rheumatic disease that primarily affects the axial skeleton and is associated with sacroiliitis, uveitis, and enthesitis. Unlike other autoimmune rheumatic diseases, such as rheumatoid arthritis or systemic lupus erythematosus, autoantibodies have not yet been reported to be a feature of AS. We therefore wished to determine whether plasma from patients with AS contained autoantibodies and, if so, characterize and quantify this response in comparison to patients with rheumatoid arthritis (RA) and healthy controls. Two high density nucleic acid programmable protein arrays expressing a total of 3498 proteins were screened with plasma from 25 patients with AS, 17 with RA, and 25 healthy controls. Autoantigens identified were subjected to Ingenuity Pathway Analysis to determine the patterns of signaling cascades or tissue origin. 44% of patients with ankylosing spondylitis demonstrated a broad autoantibody response, as compared with 33% of patients with RA and only 8% of healthy controls. Individuals with AS demonstrated autoantibody responses to shared autoantigens, and 60% of autoantigens identified in the AS cohort were restricted to that group. The autoantibody responses in the AS patients were targeted toward connective, skeletal, and muscular tissue, unlike those of RA patients or healthy controls. Thus, patients with AS show evidence of systemic humoral autoimmunity and multispecific autoantibody production. Nucleic acid programmable protein arrays constitute a powerful tool to study autoimmune diseases. PMID:22311593

  11. [Anterior uveitis in ankylosing spondylitis. A retrospective study].

    PubMed

    Piergiacomi, G; Agostinelli, M; Baccarini, V; Gasparini, M; Pepi, M; Cervini, C

    1988-12-01

    In ankylosing spondylarthritis (AS), there is sometimes an anterior uveitis (AUV) or a previous history of AUV. The authors have reviewed the medical files of 338 hospitalised AS and 30 AS seen in consultation. They found an AUV in 28 hospitalised AS, or 8.3 p. cent of all cases (7.7 p. cent in men and 14.8 p. cent in women). In 3 cases (0.9 p. cent), the AUV was the first manifestation of the disease, preceding joint involvement. AUV was never found in patients seen in consultation. The findings of this investigation agree, but only partially, with those from the literature which, usually, acknowledge a greater frequency of AUV. Comparison with other previous investigations conducted in Italy enables to confirm that among Italian AS, AUV is less frequent than in other European and out of Europe series. It is possible that in a certain number of cases the AUV is not diagnosed clinically. However, it seems that the reduced incidence of the AUV discovered by a few Italian authors is not fortuitous (genetic factors?). PMID:3238310

  12. Treatment efficacy of etanercept and MTX combination therapy for ankylosing spondylitis hip joint lesion in Chinese population.

    PubMed

    Lian, Fan; Yang, Xiuyan; Liang, Liuqin; Xu, Hanshi; Zhan, Zhongping; Qiu, Qian; Ye, Yujin

    2012-06-01

    To investigate the efficacy of etanercept and MTX (methotrexate) combination therapy in Chinese patients with ankylosing spondylitis hip joint lesion, the possible courses and maintenance protocol, altogether 97 ankylosing spondylitis patients fulfilling the modified New York criteria with hip joint lesion were enrolled in a 12-month trial treated with combined etanercept and MTX. All these patients were required to be poor responders to SSZ (Sulfasalazine) or MTX therapy for 6 consecutive months or the longer. Etanercept was administered subcutaneously twice a week at a fixed dosage of 25 mg for the first six months, followed by 25 mg once a week in patients with good control of both symptoms and radiological progression, or twice a week for another six months in patients with BASDAI > or = 4. Combined MTX was administered intravenously once a week at the dosage of 15 mg. Demographics, clinical and laboratory features, physical function and quality of life using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris hip score, and radiological assessment using the BASRI-hip index were recorded. Most patients achieved pain release at the end point of assessment. Significant improvement in Bath AS Disease Activity Index (BASDAI) (P < 0.05), Bath AS Functional Activity Index (BASFI) (P < 0.05), and Harris hip score (P < 0.05) was demonstrated. Radiographic progression was recorded as no exacerbation or alleviated. Larger interval between two etanercept administrations would provide similar advantages to standard method and possibly less adverse events if MTX was combined. Etanercept and MTX combination therapy was beneficial to ankylosing spondylitis patients with hip joint lesion, and staged dosage deduction in the long term proved to be effective as well as adverse event preventing. PMID:21387110

  13. Effects of tumor necrosis factor-alpha on sexual activity of male patients with ankylosing spondylitis.

    PubMed

    Dong, Xin; Zheng, Yi; Shi, Tian-Yan; Liu, Hong-Yan

    2015-05-01

    The objective of this study was to investigate the therapeutic effect of a tumor necrosis factor-alpha (TNF-α) antagonist on the sexual quality of life of male patients with ankylosing spondylitis (AS). In this open-label study, 42 AS patients were grouped into the TNF-α antagonist treatment group and the non-TNF-α antagonist treatment group for 3 months. Clinical and laboratory indices and changes in the sexual quality of life were compared to assess the efficacy of TNF-α antagonists on sexual activity. The relationship between sexual quality and disease activity was analyzed. There were no significant differences in baseline data between the two groups. After treatment, disease activity and quality of life were improved in these two groups. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (1.9 ± 1.6 vs. 3.0 ± 1.3, p = 0.020), erythrocyte sedimentation rate (ESR) (9 ± 7 mm/1 h vs. 18 ± 17 mm/1 h, p = 0.031), and C-reactive protein (CRP) levels (1.8 ± 2.1 mg/dl vs. 6.2 ± 8.5 mg/dl, p = 0.035) were significantly lower in the TNF-α antagonist treatment group than in the non-TNF-α antagonist treatment group. The extent of improvement in the quality of life was more evident in the TNF-α antagonist treatment group. The average degree of improvement in the quality of life was negatively related to the BASDAI score and the Bath Ankylosing Spondylitis Functional Index score in the TNF-α antagonist treatment group (r = -0.497, p = 0.018; r = -0.558, p = 0.007, respectively). Sexual quality of life and disease activity are improved after treatment with TNF-α antagonists in male patients with AS. The extent of improvement in sexual quality and disease activity are positively related. PMID:25064131

  14. Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis

    PubMed Central

    Zochling, J; van der Heijde, D; Dougados, M; Braun, J

    2006-01-01

    Objective To assess available management strategies in ankylosing spondylitis (AS) using a systematic approach, as a part of the development of evidence based recommendations for the management of AS. Methods A systematic search of Medline, Embase, CINAHL, PEDro, and the Cochrane Library was performed to identify relevant interventions for the management of AS. Evidence for each intervention was categorised by study type, and outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated for each intervention where possible. Results from randomised controlled trials were pooled where appropriate. Results Both pharmacological and non‐pharmacological interventions considered to be of interest to clinicians involved in the management of AS were identified. Good evidence (level Ib) exists supporting the use of non‐steroidal anti‐inflammatory drugs (NSAIDs) and coxibs for symptomatic treatment. Non‐pharmacological treatments are also supported for maintaining function in AS. The use of conventional antirheumatoid arthritis drugs is not well supported by high level research evidence. Tumour necrosis factor inhibitors (infliximab and etanercept) have level Ib evidence supporting large treatment effects for spinal pain and function in AS over at least 6 months. Level IV evidence supports surgical interventions in specific patients. Conclusion This extensive literature review forms the evidence base considered in the development of the new ASAS/EULAR recommendations for the management of AS. PMID:16126792

  15. Association between arterial stiffness, disease activity and functional impairment in ankylosing spondylitis patients: a cross-sectional study.

    PubMed

    Avram, Claudiu; Drăgoi, Răzvan Gabriel; Popoviciu, Horațiu; Drăgoi, Mihai; Avram, Adina; Amaricăi, Elena

    2016-08-01

    Cardiovascular risk is an important factor for increased morbidity and mortality in patients with ankylosing spondylitis. The aim of this study is to assess arterial stiffness in relation to the disease activity and functional limitation in patients with ankylosing spondylitis. Twenty-four patients (mean age 45.8 ± 11.7 years) suffering of ankylosing spondylitis (disease duration 11.1 ± 5.1 years) and 24 gender and age-matched healthy controls were included in the study. Clinical, biological, and functional status of ankylosing spondylitis patients was recorded. Arterial stiffness was assessed by measuring pulse wave velocity (PWV) and pulse wave analysis (PWA) was performed using applanation tonometry. We found significant differences between ankylosing spondylitis patients and healthy controls in regard to PWV (p = 0.047), aortic augmentation pressure-AP (p = 0.028), augmentation index-AIx (p = 0.038) and aortic augmentation index adjusted for heart rate-AIx75 (p = 0.011). PWV and AIx75 were significantly associated with the disease functioning score-BASFI (p = 0.012, r = 0.504; p = 0.041, r = 0.421). Aortic AP and augmentation indexes (AIx and AIx75) were all associated to ASDAS score (p = 0.028, r = 0.448; p = 0.005, r = 0.549; p = 0.025, r = 0.455). Our study showed that ankylosing spondylitis patients have a higher arterial stiffness than the age-matched controls, leading to an increased cardiovascular risk. We found that arterial stiffness is positively associated with disease activity and functional impairment. Chronic spondiloarthropaties should be screened for arterial stiffness, even in the absence of traditional cardiovascular risk factors, in order to benefit from primary prevention measures. PMID:27169859

  16. Whole-Genome Screening in Ankylosing Spondylitis: Evidence of Non-MHC Genetic-Susceptibility Loci

    PubMed Central

    Laval, S. H.; Timms, A.; Edwards, S.; Bradbury, L.; Brophy, S.; Milicic, A.; Rubin, L.; Siminovitch, K. A.; Weeks, D. E.; Calin, A.; Wordsworth, B. P.; Brown, M. A.

    2001-01-01

    Ankylosing spondylitis (AS) is a common inflammatory arthritis predominantly affecting the axial skeleton. Susceptibility to the disease is thought to be oligogenic. To identify the genes involved, we have performed a genomewide scan in 185 families containing 255 affected sibling pairs. Two-point and multipoint nonparametric linkage analysis was performed. Regions were identified showing “suggestive” or stronger linkage with the disease on chromosomes 1p, 2q, 6p, 9q, 10q, 16q, and 19q. The MHC locus was identified as encoding the greatest component of susceptibility, with an overall LOD score of 15.6. The strongest non-MHC linkage lies on chromosome 16q (overall LOD score 4.7). These results strongly support the presence of non-MHC genetic-susceptibility factors in AS and point to their likely locations. PMID:11231900

  17. JMY Polymorphism Is Related to Severity of Ankylosing Spondylitis in Chinese Han Patients

    PubMed Central

    Chai, Wei; Lian, Zijian; Chen, Chao; Liu, Jingyi; Shi, Lewis L.

    2013-01-01

    Ankylosing spondylitis (AS) is a largely genetically determined autoimmune disease. JMY has recently been found to be associated with susceptibility to AS in patients of western European descent. We aimed to examine the influence of JMY polymorphisms on the severity of AS in the Chinese ethnic majority Han population. Blood samples were drawn from 396 Chinese Han AS patients whose duration of disease was about 9–12 years. Four tag single-nucleotide polymorphisms (tagSNPs) in JMY were selected and genotyped. Frequencies of different genotypes and clinical indexes about the severity of AS were analyzed. The rs2607142, rs16876619, and rs4704556 SNPs are related to BASFI. The rs2607142, rs4704556, and rs16876657 SNPs are related to BADAI. The rs4704556 and rs16876657 SNPs are related to mSASSS. JMY is related to the severity of AS in Chinese Han patients. PMID:23758122

  18. rs10865331 Associated with Susceptibility and Disease Severity of Ankylosing Spondylitis in a Taiwanese Population

    PubMed Central

    Chiou, Hung-Yi; Wong, Henry Sung-Ching; Wong, Ruey-Hong; Ikegawa, Shiro; Chang, Wei-Chiao

    2014-01-01

    Ankylosing spondylitis (AS) is a highly familial rheumatic disorder and is considered as a chronic inflammatory disease. Genetic factors are involved in the pathogenesis of AS. To identify genes which render people susceptible to AS in a Taiwanese population, we selected six single-nucleotide polymorphisms (SNPs) from previous genome-wide association studies (GWASs) which were associated with AS in European descendants and Han Chinese. To assess whether the six SNPs contributed to AS susceptibility and severity in Taiwanese population, 475 AS patients fulfilling the modified New York Criteria and 527 healthy subjects were recruited. We found that rs10865331 was significantly associated with AS susceptibility and with Bath AS Function Index (BASFI). The AA and AG genotypes of rs10865331 were also significantly associated with a higher erythrocyte sedimentation rate. Our findings provided evidence that rs10865331 is associated AS susceptibility and with disease activity (BASFI) in a Taiwanese population. PMID:25184745

  19. JMY polymorphism is related to severity of ankylosing spondylitis in Chinese Han patients.

    PubMed

    Chai, Wei; Lian, Zijian; Chen, Chao; Liu, Jingyi; Shi, Lewis L; Wang, Yan

    2013-08-01

    Ankylosing spondylitis (AS) is a largely genetically determined autoimmune disease. JMY has recently been found to be associated with susceptibility to AS in patients of western European descent. We aimed to examine the influence of JMY polymorphisms on the severity of AS in the Chinese ethnic majority Han population. Blood samples were drawn from 396 Chinese Han AS patients whose duration of disease was about 9-12 years. Four tag single-nucleotide polymorphisms (tagSNPs) in JMY were selected and genotyped. Frequencies of different genotypes and clinical indexes about the severity of AS were analyzed. The rs2607142, rs16876619, and rs4704556 SNPs are related to BASFI. The rs2607142, rs4704556, and rs16876657 SNPs are related to BADAI. The rs4704556 and rs16876657 SNPs are related to mSASSS. JMY is related to the severity of AS in Chinese Han patients. PMID:23758122

  20. Circulating cytotoxic CD8+ CD28- T cells in ankylosing spondylitis

    PubMed Central

    Schirmer, Michael; Goldberger, Christian; Würzner, Reinhard; Duftner, Christina; Pfeiffer, Karl-P; Clausen, Johannes; Neumayr, Günther; Falkenbach, Albrecht

    2002-01-01

    Circulating CD8+ CD28- T cells were found to be expanded more in patients with ankylosing spondylitis than in an age-matched healthy population (41.2 ± 17.7% versus 18.6 ± 7.6%). The level of CD8+CD28- T cells was dependent on the disease status, but was independent of age. Most of the CD8+ CD28- T cells produced perforin after stimulation in vitro, in contrast to their CD8+CD28+ counterparts. From the clinical perspective, the percentage of the cytotoxic CD8+ CD28- T cells reflected a more severe course of disease, as it correlated with distinct movement restrictions, as well as the metrology score summarizing cervical rotation (in sitting position), chin-to-jugulum distance, thoracic Schober, chest expansion, and fingers-to-floor distance (P = 0.032). PMID:11879540

  1. Airway management in cervical spine ankylosing spondylitis: Between a rock and a hard place

    PubMed Central

    Eipe, Naveen; Fossey, Susan; Kingwell, Stephen P

    2013-01-01

    We report the perioperative course of a patient with long standing ankylosing spondylitis with severe dysphagia due to large anterior cervical syndesmophytes at the level of the epiglottis. He was scheduled to undergo anterior cervical decompression and the surgical approach possibly precluded an elective pre-operative tracheostomy. We performed a modified awake fibreoptic nasal intubation through a split nasopharyngeal airway while adequate oxygenation was ensured through a modified nasal trumpet inserted in the other nares. We discuss the role of nasal intubations and the use of both the modified nasopharyngeal airways we used to facilitate tracheal intubation. This modified nasal fibreoptic intubation technique could find the application in other patients with cervical spine abnormalities and in other anticipated difficult airways. PMID:24403620

  2. Inefficacy or Paradoxical Effect? Uveitis in Ankylosing Spondylitis Treated with Etanercept

    PubMed Central

    Ometto, Francesca; Botsios, Costantino; Punzi, Leonardo

    2014-01-01

    Ankylosing spondylitis (AS) is presented with axial and peripheral articular involvement. Uveitis is a severe and rather specific manifestation of AS. Biologics targeting tumor necrosis factor (TNF) α are effective on both articular and ocular manifestations of disease. The occurrence of uveitis in patients that never had eye involvement or the relapse of uveitis is described during anti-TNFα treatment. The frequency of these events is slightly higher during therapy with etanercept. The available TNFα blockers show different pharmacokinetics and pharmacodynamics yielding different biological effects. There is an ongoing debate whether uveitis during anti-TNFα has to be considered as paradoxical effect or an inadequate response to therapy. Here, we present a case report and review what the evidences for the two hypotheses are. PMID:24991219

  3. The interleukin (IL)-23/IL-17 axis in ankylosing spondylitis: new advances and potentials for treatment.

    PubMed

    Jethwa, H; Bowness, P

    2016-01-01

    Ankylosing spondylitis (AS), the most common form of spondyloarthropathy, is a chronic, progressive multi-system inflammatory disorder characteristically affecting the sacroiliac joints and axial skeleton. Although the exact mechanisms underlying the pathogenesis of AS remain to be elucidated, the presence of human leucocyte antigen (HLA)-B27 is known to markedly increase its risk of development. Current treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers. In recent years, the interleukin (IL)-23/IL-17 pathway has been shown to have significance in the pathogenesis of AS and treatment modalities targeting this pathway have been shown to be beneficial in various other inflammatory conditions. This review provides an overview of the IL-23/IL-17 pathway in the pathogenesis of AS and summarizes new potential treatments for AS and related inflammatory diseases. PMID:26080615

  4. rs10865331 associated with susceptibility and disease severity of ankylosing spondylitis in a Taiwanese population.

    PubMed

    Wen, Ya-Feng; Wei, James Cheng-Chung; Hsu, Yu-Wen; Chiou, Hung-Yi; Wong, Henry Sung-Ching; Wong, Ruey-Hong; Ikegawa, Shiro; Chang, Wei-Chiao

    2014-01-01

    Ankylosing spondylitis (AS) is a highly familial rheumatic disorder and is considered as a chronic inflammatory disease. Genetic factors are involved in the pathogenesis of AS. To identify genes which render people susceptible to AS in a Taiwanese population, we selected six single-nucleotide polymorphisms (SNPs) from previous genome-wide association studies (GWASs) which were associated with AS in European descendants and Han Chinese. To assess whether the six SNPs contributed to AS susceptibility and severity in Taiwanese population, 475 AS patients fulfilling the modified New York Criteria and 527 healthy subjects were recruited. We found that rs10865331 was significantly associated with AS susceptibility and with Bath AS Function Index (BASFI). The AA and AG genotypes of rs10865331 were also significantly associated with a higher erythrocyte sedimentation rate. Our findings provided evidence that rs10865331 is associated AS susceptibility and with disease activity (BASFI) in a Taiwanese population. PMID:25184745

  5. Sulphasalazine (Salazopyrin) in the treatment of enterogenic reactive synovitis and ankylosing spondylitis with peripheral arthritis.

    PubMed

    Mielants, H; Veys, E M; Joos, R

    1986-01-01

    Sulphasalazine was administered to 48 patients with reactive synovitis (RS) and ankylosing spondylitis (AS) with peripheral arthritis, resistant to nonsteroidal anti-inflammatory drugs. Thirty-seven patients underwent an ileocolonoscopy and in 33 patients signs of chronic or active inflammation of the ileum and/or ileocecal valve were found. Forty-two patients improved after 3 to 12 months of treatment; 50 per cent of them went into remission. In most of the patients improvement failed to occur in the first 2 months of treatment. There was no recurrent disease activity in patients responding to the treatment. Adverse reactions were rare and did not necessitate interruption of treatment. The beneficial effect of sulphasalazine in the treatment of RS and AS with peripheral arthritis needs to be confirmed in double-blind controlled studies. PMID:2869851

  6. Vitamin D-deficient rickets mimicking ankylosing spondylitis in an adolescent girl.

    PubMed

    Demirbilek, Hüseyin; Aydoğdu, Didem; Ozön, Alev

    2012-01-01

    Vitamin D-deficient rickets (VDDR) remains an important health problem especially in developing countries. Insufficient dietary intake of vitamin D and inadequate sun exposure increase the risk of vitamin D deficiency. Since their vitamin D requirement is increased, children and adolescents are potentially at higher risk for vitamin D deficiency. In adolescents, vitamin D deficiency causes osteomalacia, osteoporosis and muscle weakness. While osteoporosis is not associated with bone pain, osteomalacia has been associated with isolated or generalized bone pain. The present case suffered from generalized bone pain for three years. She was misdiagnosed as ankylosing spondylitis, which is a seronegative arthropathy, and was treated with corticosteroids and methotrexate, which have potential side effects. Hypocalcemia, hypophosphatemia, elevated alkaline phosphatase level, secondary hyperparathyroidism, and extremely low vitamin D level were consistent with the diagnosis of severe vitamin D deficiency. Complete clinical and biochemical resolution was achieved with vitamin D replacement. PMID:22734306

  7. Blind confirmation in Leiden of Geczy factor on the cells of Dutch patients with ankylosing spondylitis

    SciTech Connect

    Geczy, A.F.; van Leeuwen, A.; van Rood, J.J.; Ivanyi, P.; Breur, B.S.; Cats, A.

    1986-11-01

    A follow-up blind study, of the ability of cross-reactive antisera to distinguish between the cells of Dutch patients with ankylosing spondylitis (AS) and normal controls, was performed in Leiden. Of the 45 cell samples tested, 29 were fresh peripheral blood mononuclear (PBM) cells while 15 were cryopreserved PBM. No false positives but one false negative was identified among the 45 samples, and the negative was confirmed after the recoded cryopreserved cells from this patient were retested. It is concluded that the cross-reactive antisera raised in Sydney give good discrimination between patients and normals. Factors affecting the success of the /sup 51/Cr-release cytotoxicity assay, and possible reasons for the failure of others to confirm these observations, are briefly discussed.

  8. Association of PTPN22 polymorphsims and ankylosing spondylitis susceptibility

    PubMed Central

    Meng, Qingxi; Zhang, Xiaojun; Liu, Xin; Wang, Weiguo; Yu, Peng; Shan, Qunqun; Mao, Zhaohu; Zhao, Tingbao

    2015-01-01

    Background: As a susceptibility gene for AS, the polymorphsims of PTPN22 associated with disease susceptibility. Methods: We selected two SNPs of rs1217406 and rs1217414 within PTPN22 with Haploview software and investigated the relationship between the SNPs of PTPN22 gene and AS susceptibility. 120 AS patients and 100 healthy people were enrolled from Qilu Hospital of Shandong University. And we genotyped the SNPs of PTPN22 with PCR-RFLP method. Results: The results showed that C allele (rs1217406) and T allele (rs1217414) both were risk factors for AS (OR: 3.12, 2.13). The persons with A-T, C-C or C-T haplotypes were more likely to suffer AS (OR: 3.17, 3.66, 4.011). Conclusions: Due to the close relationship of PTPN22 and AS, the study may be helpful for the early diagnosis and differential diagnosis. PMID:25755798

  9. Range of Motion Improvement in Ankylosing Spondylitis Patient with Persian Traditional Medicine; Case Report

    PubMed Central

    Gorji, Narjes; Moeini, Reihaneh

    2016-01-01

    Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the skeletal system without definitive treatment. Nowadays, the aim of therapeutic interventions is preventing disease progression, but eventually many patients have different degrees of decreased range of motion, especially in the spine accompanied by pain and fatigue. Methods: A 44-year-old man with AS from 22 years ago was treated with NSAIDs and sulfasalazine. He visited for developed pain and stiffness in spine from 7 years ago. He did not confer with the rheumatologist from 2012 due to the lack of treatment satisfaction and maintained his treatment with 75 mg indomethacin daily. The patient was assessed in the Iranian traditional medicine clinic and other problems were chronic fatigue, interrupted sleep, and extreme dry skin. Diagnosis was general dryness and treatment started with oral and tropical moisture and nutritional advice. Results: In the third month of treatment, joint pain, morning stiffness and sleep disturbance improved. After 8 months, in addition to complete improvement of skin dryness, sleep disturbance and joint pain, range of motion in cervical and lumbar spine were increased. In cervical rotation, distance from the chin to acromion decreased from 24 to 15 cm in right rotation and 20 to 13 cm in left rotation. Additionally, in cervical flexion distance from the chin to sternal notch decreased from 16 to 8 cm after treatment. In the lumbar spine, an increased Schober’s index was seen. Conclusion: The use of Persian traditional medicine’s viewpoints and treatment strategies can be effective in improving Ankylosing spondylitis prognosis and proposed for future clinical research.

  10. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?

    PubMed Central

    Baraliakos, X; Braun, J

    2015-01-01

    The development of the axial spondyloarthritis and ankylosing spondylitis (ASAS) classification criteria has had several implications for our understanding of the entire spectrum of spondyloarthritides (SpA). Going beyond the modified New York criteria, which concentrate on conventional radiographs of the sacroiliac joints (SIJ) for the classification of ankylosing spondylitis, the ASAS criteria add active inflammation of the SIJ as obtained by MRI and human leucocyte antigen (HLA) B27 to classify patients with chronic back pain starting at a young age as axial SpA (axSpA). AxSpA should be considered as one disease that includes AS, the radiographic form, as well as the non-radiographic (nr-axSpA) form. Similarities and differences between these subgroups have been described in 3 studies: 1 local study, 1 national study (German SpA Inception Cohort) and 1 international study mainly conducted to test the efficacy of a tumour necrosis factor α blocker. Most clinical features and assessments of axSpA showed the same prevalence in patients with and without radiographic changes. However, some differences have been observed: the male:female ratio, the proportion of patients with objective signs of inflammation such as bone marrow oedema as detected by MRI, and the proportion of patients with increased levels of C reactive protein were higher in patients with AS. Importantly, these factors have also been identified as prognostic factors for more severe disease in terms of new bone formation. Thus, nr-axSpA may represent an early stage of AS but may also just be an abortive form of a disease which does cause much pain but which may also never lead to structural changes of the axial skeleton. Since the cut-off between nr-axSpA and AS is artificial and unreliable, we think that the term nr-axSpA should not be used for diagnosis but only for classification for historical reasons. PMID:26557375

  11. Bone Morphogenetic Protein 6 Polymorphisms Are Associated with Radiographic Progression in Ankylosing Spondylitis

    PubMed Central

    Kim, Tae-Hwan; Shim, Seung-Cheol; Lee, Seunghun; Joo, Kyung Bin; Kim, Jong Heon; Min, Hye Joon; Rahman, Proton; Inman, Robert D.

    2014-01-01

    Background and Object Nearly 25 genetic loci associated with susceptibility to ankylosing spondylitis (AS) have been identified by several large studies. However, there have been limited studies to identify the genes associated with radiographic severity of the disease. Thus we investigated which genes involved in bone formation pathways might be associated with radiographic severity in AS. Methods A total of 417 Korean AS patients were classified into two groups based on the radiographic severity as defined by the modified Stoke’ Ankylosing Spondylitis Spinal Score (mSASSS) system. Severe AS was defined by the presence of syndesmophytes and/or fusion in the lumbar or cervical spine (n = 195). Mild AS was defined by the absence of any syndesmophyte or fusion (n = 170). A total of 251 single nucleotide polymorphisms (SNPs) within 52 genes related to bone formation were selected and genotyped. Odds ratios (OR) and 95% confidence interval (95% CI) were analysed by multivariate logistic regression controlling for age at onset of symptoms, sex, disease duration, and smoking status as covariates. Results We identified new loci of bone morphogenetic protein 6 (BMP6) associated with radiographic severity in patients with AS that passed false discovery rate threshold. Two SNPs in BMP6 were significantly associated with radiologic severity [rs270378 (OR 1.97, p = 6.74×10−4) and rs1235192 [OR 1.92, p = 1.17×10−3]) adjusted by covariates. Conclusion This is the first study to demonstrate that BMP6 is associated with radiographic severity in AS, supporting the role wingless-type like/BMP pathway on radiographic progression in AS. PMID:25121767

  12. Greek adaptation and validation of the Ankylosing Spondylitis Quality of Life (ASQoL) measure

    PubMed Central

    Graham, J E; Rouse, M; Twiss, J; McKenna, S P; Vidalis, A A

    2015-01-01

    Background Ankylosing Spondylitis (AS) is a chronic rheumatic disease that has a significant impact on patient’s quality of life (QoL). The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific patient-reported outcome measure for assessing QoL in AS. While the ASQoL has been adapted for use in 46 countries worldwide, a Greek language version of the measure has not been available and was required for an international clinical trial. Aim The aim was to develop and assess the psychometric properties of a Greek language version of the ASQoL. Methods The adaptation of the ASQoL into Greek involved three procedures: translation, assessment of face and content validity, and formal validation. The measure was translated into Greek using two translation panels. Cognitive debriefing interviews were employed to determine face and content validity. Finally, the translation’s psychometric properties were examined by administering it on two occasions, with a 14-day interval. The Nottingham Health Profile (NHP) was used as a comparator measure. Results The ASQoL proved straightforward to translate into Greek and interviewees found it relevant, comprehensible and easy to complete.  The measure had good internal consistency (α =0.92) and test-retest reliability (r =0.98). Predicted correlations with the NHP provided evidence of the convergent validity of the two measures. Construct validity was confirmed by the measure’s ability to distinguish groups of AS patients varying by perceived disease severity and general health. Conclusions The Greek ASQoL has been shown to be well-accepted, reliable and valid and can be recommended for use in clinical studies and routine clinical practice in AS. Hippokratia 2015; 19 (2):119-124.

  13. The relationship between enthesitis indices and disease activity parameters in patients with ankylosing spondylitis.

    PubMed

    Sivas, Filiz; Mermerci Başkan, Bedriye; Erkol Inal, Esra; Akbulut Aktekin, Lale; Barça, Nurdan; Ozoran, Kürşat; Bodur, Hatice

    2009-03-01

    In this study, patients with ankylosing spondylitis (AS) were assessed both by patient and physician using two enthesitis indices and the relationship between these indices and disease activity parameters was investigated. The study involved 100 AS patients. The patients were evaluated with 10-cm visual analog scale (VAS) for spinal pain (VAS-S), peripheral joint pain (VAS-P), global assessment of patient, and global assessment of doctor. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index, and Bath AS radiology index were calculated. The severity of enthesitis was evaluated according to Mander enthesitis index (MEI) and Maastricht ankylosing spondylitis enthesitis score applied by both the patient (MASES-P) him/herself and the physician (MASES-D). There was a correlation between BASDAI and BASFI as well as MEI, MASES-D, and MASES-P indices (r = 0.447, r = 0.342, r = 0.663, r = 0.530, r = 0.464, and r = 0.435, respectively). No correlation between the laboratory parameters and enthesitis indices were detected. In multiple linear regression analysis, BASFI, VAS-S, and female gender (41.3%) were the best predictors of MEI-D, whereas BASFI, VAS-S, female gender, and ESR (32.5%) were the best predictors for MASES-D and BASFI (18.9%) was the best predictor of MASES-P. The assessment of simple and easily applicable MASES score by a patient may be expected to help the physician in clinical practice. When the disease activity of the patients with AS are evaluated, both BASDAI, the clinical importance of which has been confirmed in numerous studies and which is recommended by ASAS, and BASFI, which is valued by patients, should be considered. PMID:18953622

  14. [Vitamin D levels in ankylosing spondylitis: does deficiency correspond to disease activity?].

    PubMed

    Pokhai, Gabriel G; Bandagi, Sabiha; Abrudescu, Adriana

    2014-01-01

    Ankylosing spondylitis (AS) is an inflammatory disorder that presents with arthritis of the axial skeleton, including sacroiliac joints. Vitamin D is a secosteroid hormone with a long-established role in calcium and phosphate homeostasis, and in the regulation of bone formation and resorption. It is now known that vitamin D plays an immunosuppressive role in the body, and there is interest of late in the role of vitamin D in autoimmune diseases. Inflammation may be responsible for some of the loss of bone mineral density seen in AS. We reviewed the literature for studies assessing vitamin D level as a marker of AS disease activity and those examining vitamin D levels in AS in comparison to healthy controls. Four of 7 studies found a significant negative correlation between vitamin D levels and Bath Ankylosing Spondylitis Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In a review of 8 case-control studies, the mean level of 25-hydroxyvitamin D3 was 22.8 ± 14.1 ng/mL in 555 AS patients versus 26.6 ± 12.5 ng/mL in 557 healthy controls. When compared with a 2-sample t test, vitamin D levels were significantly higher in healthy controls (p < 0.01). We conclude that patients with AS appear to have lower vitamin D levels versus healthy controls; however, the cause is unclear. Existing studies do not demonstrate a consistent link between vitamin D levels and disease activity in AS. Further studies are in need to determine if a causative link exists between vitamin D deficiency and AS. PMID:25627231

  15. Investigation of Cardiac Complications and their Incidence in Patients with Ankylosing Spondylitis

    PubMed Central

    Soroush, Mohsen; Mominzadeh, Mahmood; Ghelich, Younes; Soroosh, Soosan; Pasha, Morteza Aghajanpoor

    2016-01-01

    Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory disease with unknown etiology which involves the sacroiliac and axial joints, but can also cause peripheral conflicts. It also comprises non-joint symptoms such as acute anterior uveitis, cardiac conduction defects, upper lobe pulmonary fibrosis, neurological involvement and renal amyloidosis. Material and Methods: This study was a cross-sectional descriptive and analytical survey. In this study, 50 patients with AS were examined according to the New York Criteria in Army 501 Hospital in Tehran. Physical examinations, laboratory testing and HLA-B27, as well as X-ray of the spine and sacroiliac joint were taken from all subjects and involvement grading was identified. The control group consisted of 40 healthy people with no evidence of disease. The people resembled the study group in terms of age, sex, smoking, presence of high blood pressure, history of ischemic heart disease and also diabetes. Results: The mean age of patients in control and study group was 33.97 and 33.65 years, respectively. 37 (92.5%) patients in the control group and 46 in study group (92%) were male. The mean duration of cardiac involvement in patients was 8.6 years with SD=6.26. In AS group, 48 (96%) patients suffered from back pain, 43 from enteritis, 100% from Ankylosing Spondylitis, one from unilateral involvement, 22(44%) from peripheral arthritis and 27 (54%) from HLA–B27. Conclusion: In total, Average heart involvement in the control group and AS group was 13.25 with SD=7.64 and 16.2 with SA=8.54, respectively, indicating no significant difference. In sum, based on the results obtained in this study, some types of heart involvements, such as mitral valve regurgitation and Mitral Valve Prolapse in AS patients are more prevalent than in the normal population. PMID:26980929

  16. Direct and indirect costs associated with ankylosing spondylitis and related disease activity scores in Turkey.

    PubMed

    Akkoç, Nurullah; Direskeneli, Haner; Erdem, Hakan; Gül, Ahmet; Kabasakal, Yasemin; Kiraz, Sedat; Balkan Tezer, Dilara; Hacıbedel, Başak; Hamuryudan, Vedat

    2015-09-01

    This study assessed quality of life, direct and indirect healthcare costs related to ankylosing spondylitis (AS). This study included 650 prevalent AS patients visiting seven centers at tertiary healthcare institutions in Turkey who were interviewed using a standard questionnaire to determine annual direct and indirect healthcare costs. Eligible patients were age ≥18 years with AS for at least 12 months. Direct costs were categorized as inpatient, outpatient and pharmacy, and AS-related consultation. Indirect costs were categorized as workday loss, additional AS-related costs, and caregiver costs. Clinical outcome measures were obtained, including Patients' Global Disease Activity (Pt-GDA); visual analog scale (Pain-VAS) for pain; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Functional Index (BASFI), and Metrology Index (BASMI) scores, and EuroQoL 5 dimension (EQ-5D) health status survey scores. Mean (€,335.20) and median (€5,671.00) annual costs per patient were calculated. Pharmacy costs (€4,032.73) were highest among overall expenditures, followed by additional AS-related consultation (€2,480.38), outpatient (€225.02), and inpatient costs (€29.98). Over half of AS patients (54.8 %) experienced work loss. Related average annual costs were €414.16, based on income level. 10.3 % of AS patients incurred an additional €2,008.07 in 1 year. 6.8 % of patients required caregivers and incurred €778.70 in average annual patient paid costs. Mean Pt-GDA, Pain-VAS, EQ-5D, BASDAI, BASFI, and BASMI scores were 4.4, 40.5, 62.7, 3.6, 3.1, and 2.9, respectively. Direct and indirect AS-related costs are high and represent a considerable economic burden on Turkish AS patients. PMID:25749712

  17. Association of FCRL4 polymorphisms on disease susceptibility and severity of ankylosing spondylitis in Chinese Han population.

    PubMed

    Zeng, Zhen; Duan, Zhenhua; Zhang, Tianchen; Wang, Sheng; Li, Guixing; Mei, Yang; Gao, Jing; Ge, Rui; Ye, Dongqing; Zou, Yanfeng; Xu, Shengqian; Xu, Jianhua; Zhang, Li; Pan, Faming

    2012-10-01

    Previous studies have found that the Fc receptor-like (FCRL) molecule, involved in controlling B cell signaling, may contribute to the autoimmune disease process. Many studies have reported the relation of FCRL gene family with SLE and RA. We hypothesized that FCRL4 may be a key gene for ankylosing spondylitis (AS) development. To test this hypothesis, we screened FCRL4 polymorphisms in the Chinese Han population. Five tag single nucleotide polymorphisms (SNPs), including rs14335, rs849826, rs10489674, rs2778003, and rs2777963, were selected. Using a case-control study, five tag SNPs, which captured the majority of known common variation within FCRL4 gene, were selected and genotyped by Multiplex Snapshot technique. We analyzed 299 patients and 300 controls from China. The genotype analysis demonstrated that one of the FCRL4 tag SNPs rs2777963 TT genotype may be a risk factor of AS (χ(2) = 7.374, p = 0.024). The haplotype analysis indicated that there were no significant differences between AS cases and controls. Patients with AS who had rs14335 AA genotype had a significantly declined visual analogue scale patient's global assessment scores compared to those with the GG genotype (31.21 ± 26.25 vs 40.54 ± 25.40, p = 0.035) and GA genotype (38.29 ± 24.94 vs 40.54 ± 25.40, p = 0.044), and in locus rs10489674, TT genotype had significantly increased Bath Ankylosing Spondylitis Disease Activity Index scores compared to those with the CC genotype (4.73 ± 2.43 vs 3.15 ± 1.61, p = 0.003) and CT genotype (4.73 ± 2.43 vs 2.97 ± 1.71, p = 0.001). The FCRL4 polymorphisms may play an important role in the susceptibility and severity of AS in the Chinese Han population. PMID:22777505

  18. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis

    PubMed Central

    Tsui, Florence WL; Tsui, Hing Wo; Akram, Ali; Haroon, Nigil; Inman, Robert D

    2014-01-01

    Ankylosing spondylitis (AS) is a complex disease involving multiple risk factors, both genetic and environmental. AS patients are predominantly young men, and the disease is characterized by inflammation and ankylosis, mainly at the cartilage–bone interface and enthesis. HLA-B27 has been known to be the major AS-susceptibility gene for more than 40 years. Despite advances made in the past few years, progress in the search for non-human leukocyte antigen susceptibility genes has been hampered by the heterogeneity of the disease. Compared to other complex diseases, such as inflammatory bowel disease (IBD), fewer susceptibility loci have been identified in AS. Furthermore, non-major histocompatibility-complex susceptibility loci discovered, such as ERAP1 and IL23R, are likely contributors to joint inflammation. Identification and confirmation of functional variants remains a significant challenge of investigations involving genome-wide association studies (GWAS). It remains unclear why none of the AS-susceptibility genes identified in GWAS appear to be directly involved in the ankylosing process. Numerous reviews have recently been published on the genetics of AS. Therefore, aside from a brief summary of what AS GWAS has successfully achieved thus far, this review will focus on directions that could address unanswered questions raised by GWAS. PMID:24971029

  19. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis.

    PubMed

    Tsui, Florence Wl; Tsui, Hing Wo; Akram, Ali; Haroon, Nigil; Inman, Robert D

    2014-01-01

    Ankylosing spondylitis (AS) is a complex disease involving multiple risk factors, both genetic and environmental. AS patients are predominantly young men, and the disease is characterized by inflammation and ankylosis, mainly at the cartilage-bone interface and enthesis. HLA-B27 has been known to be the major AS-susceptibility gene for more than 40 years. Despite advances made in the past few years, progress in the search for non-human leukocyte antigen susceptibility genes has been hampered by the heterogeneity of the disease. Compared to other complex diseases, such as inflammatory bowel disease (IBD), fewer susceptibility loci have been identified in AS. Furthermore, non-major histocompatibility-complex susceptibility loci discovered, such as ERAP1 and IL23R, are likely contributors to joint inflammation. Identification and confirmation of functional variants remains a significant challenge of investigations involving genome-wide association studies (GWAS). It remains unclear why none of the AS-susceptibility genes identified in GWAS appear to be directly involved in the ankylosing process. Numerous reviews have recently been published on the genetics of AS. Therefore, aside from a brief summary of what AS GWAS has successfully achieved thus far, this review will focus on directions that could address unanswered questions raised by GWAS. PMID:24971029

  20. How should clinicians manage osteoporosis in ankylosing spondylitis?

    PubMed

    Bessant, Rupa; Keat, Andrew

    2002-07-01

    Osteoporosis is a common complication of AS, with an incidence between 18.7% and 62%. The prevalence of osteoporosis is greater in males, and increases with increasing patient age and disease duration. Osteoporosis is also more common in patients with syndesmophytes, cervical fusion, and peripheral joint involvement. These variables are not all independent, as they may be indicators of disease duration. Osteoporosis in patients with AS is largely confined to the axial skeleton, in contrast to the pattern of osteoporosis seen in rheumatoid arthritis. BMD at the lumbar spine and femoral neck may be severely reduced, while most studies indicate that carpal and radial BMD remain within normal limits. The development of syndesmophytes in late AS can lead to difficulties in the use of DEXA scanning to determine lumbar BMD, as the extraspinal bone may obscure osteoporotic vertebrae. Under these circumstances more accurate assessment of lumbar BMD, and one that correlates better with femoral neck BMD, may be obtained by quantitative CT scanning or DEXA scanning of the lateral aspect of the L3 vertebra. Osteoporosis in AS significantly increases the risk of vertebral compression fractures within 5 years of the diagnosis of AS. The risk of a vertebral compression fracture occurring over a 30 year period following the diagnosis of AS is 14%, compared to 3.4% for population controls. In patients with vertebral osteoporosis relatively minor trauma, such as slipping, can lead to spinal fracture and dislocatior with subsequent damage to the spinal cord. There is a higher incidence of spinal cord injury following spinal fracture dislocations in patients with AS, and the resulting neurological deficit can range from mild sensory loss to complete paraplegia. Cytokines such as TNF-alpha and IL-6 may play an important part in the pathogenesis of osteoporosis in early AS, and IL-6 levels have been correlated with markers of disease activity and severity. In late AS, mechanical factors

  1. Construct validity of clinical spinal mobility tests in ankylosing spondylitis: a systematic review and meta-analysis.

    PubMed

    Castro, Marcelo P; Stebbings, Simon M; Milosavljevic, Stephan; Bussey, Melanie D

    2016-07-01

    The study aimed to determine, using systematic review and meta-analysis, the level of evidence supporting the construct validity of spinal mobility tests for assessing patients with ankylosing spondylitis. Following the guidelines proposed in the Preferred Reporting Items for Systematic reviews and Meta-Analyses, three sets of keywords were used for data searching: (i) ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; (ii) accuracy, association, construct, correlation, Outcome Measures in Rheumatoid Arthritis Clinical Trials, OMERACT, truth, validity; (iii) mobility, Bath Ankylosing Spondylitis Metrology Index-BASMI, radiography, spinal measures, cervical rotation, Schober (a further 19 keywords were used). Initially, 2558 records were identified, and from these, 21 studies were retained. Fourteen of these studies were considered high level of evidence. Compound indexes of spinal mobility showed mostly substantial to excellent levels of agreement with global structural damage. Individual mobility tests for the cervico-thoracic spine showed only moderate agreements with cervical structural damage, and considering structural damage at the lumbar spine, the original Schober was the only test that presented consistently substantial levels of agreement. Three studies assessed the construct validity of mobility measures for inflammation and low to fair levels of agreement were observed. Two meta-analyses were conducted, with assessment of agreement between BASMI and two radiological indexes of global structural damage. The spinal mobility indexes and the original Schober test show acceptable construct validity for inferring the extent of structural damage when assessing patients with ankylosing spondylitis. Spinal mobility measures do not reflect levels of inflammation at either the sacroiliac joints and/or the spine. PMID:26337175

  2. Relationship of serum osteoprotegerin with arterial stiffness, preclinical atherosclerosis, and disease activity in patients with ankylosing spondylitis.

    PubMed

    Serdaroğlu Beyazal, Münevver; Erdoğan, Turan; Türkyılmaz, Aysegül Kücükali; Devrimsel, Gül; Cüre, Medine Cumhur; Beyazal, Mehmet; Sahin, Ismail

    2016-09-01

    Patients with ankylosing spondylitis (AS) reportedly have a higher mortality and morbidity risk. Osteoprotegerin (OPG) was recently defined as an important cardiovascular (CV) marker in the general population. We aimed to assess the relationship of serum OPG levels with arterial stiffness, carotid intima media thickness (CIMT), and clinical and laboratory data in AS patients. We examined 60 AS patients without CV disease or risk factors and 50 healthy controls. Disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS), whereas functional capacity was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Serum OPG levels were measured with the enzyme-linked immunosorbent assay. Carotid-femoral pulse wave velocity (PWV) was used as an indicator of arterial stiffness, whereas CIMT (examined via carotid ultrasonography) was used to evaluate preclinical atherosclerosis. The mean serum OPG level, PWV, and CIMT were significantly higher in AS patients than in controls (106.7 ± 50.9 vs. 58.1 ± 12.7 pg/mL; 7.4 ± 1.8 vs. 6.2 ± 1.2 m/s; 0.72 ± 0.13 vs. 0.57 ± 0.07 mm, respectively; P < 0.001 for all). In AS patients, the serum OPG levels were not significantly correlated with PWV and CIMT but were significantly correlated with erthrocyte sedimentation rate, BASFI, and ASDAS. AS patients without CV disease or risk exhibited high OPG levels and increased PWV and CIMT values. Although OPG levels were not significantly correlated with PWV or CIMT, future long-term follow-up studies will help define the predictive value of OPG in these patients. PMID:26847856

  3. Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis

    PubMed Central

    İlçin, Nursen; Gürpınar, Barış; Bayraktar, Deniz; Savcı, Sema; Çetin, Pınar; Sarı, İsmail; Akkoç, Nurullah

    2016-01-01

    [Purpose] This study describes the cultural adaptation, validation, and reliability of the Turkish version of the Pain Catastrophizing Scale in patients with ankylosing spondylitis. [Methods] The validity of the Turkish version of the Pain Catastrophizing Scale was assessed by evaluating data quality (missing data and floor and ceiling effects), principal components analysis, internal consistency (Cronbach’s alpha), and construct validity (Spearman’s rho). Reproducibility analyses included standard measurement error, minimum detectable change, limits of agreement, and intraclass correlation coefficients. [Results] Sixty-four adult patients with ankylosing spondylitis with a mean age of 42.2 years completed the study. Factor analysis revealed that all questionnaire items could be grouped into two factors. Excellent internal consistency was found, with a Chronbach’s alpha value of 0.95. Reliability analyses showed an intraclass correlation coefficient (95% confidence interval) of 0.96 for the total score. There was a low correlation coefficient between the Turkish version of the Pain Catastrophizing Scale and body mass index, pain levels at rest and during activity, health-related quality of life, and fear and avoidance behaviors. [Conclusion] The results of this study indicate that the Turkish version of the Pain Catastrophizing Scale is a valid and reliable clinical and research tool for patients with ankylosing spondylitis. PMID:26957778

  4. Ankylosing Spondylitis

    MedlinePlus

    ... more vertical position. After the bones are realigned, hardware may be implanted to hold them in their ... diseases and conditions. NIH RePORTER is an electronic tool that allows users to search a repository of ...

  5. Spondylitis Association of America

    MedlinePlus

    ... Complications Ankylosing Spondylitis About the Spondylitis Association of America Join Today Renew Your Membership Contact Us News ... Twitter Pinterest YouTube Copyright 2016 Spondylitis Association of America | Privacy Statement | Terms Of Use

  6. Diet and Spondylitis

    MedlinePlus

    ... Complications Ankylosing Spondylitis About the Spondylitis Association of America Join Today Renew Your Membership Contact Us News ... Twitter Pinterest YouTube Copyright 2016 Spondylitis Association of America | Privacy Statement | Terms Of Use

  7. Cross-cultural adaptation and validation of the Portuguese version of "The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire".

    PubMed

    da Rocha Lopes, Sofia Manuela; Duarte, José Alberto; Mesquita, Cristina Teresa Torrão Carvalho

    2016-04-01

    Knowledge is an important factor in patients with ankylosing spondylitis regarding the adoption of appropriate behaviours and education. The aim of this study was to culturally adapt and validate "The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire" for the Portuguese population with ankylosing spondylitis. The Portuguese version of "The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire" was administered to a sample of 180 subjects, from which 63 individuals responded. The adaptation process involved translation, back-translation and submission to a committee of experts in the area, culminating with a Portuguese version of the instrument. Next, the scale reliability and validity were assessed. There was a statistically significant decrease from test to retest, although the intra-class correlation coefficient between test and retest was 0.76 (95 % CI 0.61-0.86), which was considered good. From 180 individuals, 63 (35.0 %) subjects were available for the present study. The proportion of individuals that correctly answered each item ranged from 19 to 92 %, corresponding to items 8 and 13, respectively. The mean number of correct answers was 8.5 [mean (SD) = 2.4] in 12 questions. The proposed Portuguese version of the ankylosing spondylitis knowledge scale showed good reliability, reproducibility and construct validity. PMID:26856726

  8. Optimisation of rheumatology assessments - the actual situation in axial spondyloarthritis including ankylosing spondylitis.

    PubMed

    Braun, J; Kiltz, U; Baraliakos, X; van der Heijde, D

    2014-01-01

    The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and magnetic resonance imaging (MRI), and laboratory results such as HLA B27 and CRP are important tools for classification and diagnosis of SpA. The Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of SpA since 1995, has published on assessments and outcome parameters in SpA. The publication of classification criteria for axSpA has now largely replaced the 1984 criteria for AS. However, the established cut-off between AS and nr-axSpA, 'definite' structural changes in the sacroiliac joints, has been recently debated because of limited reliability. Since imaging plays an important role in all criteria sets, the ASAS group has recently published definitions for inflammatory changes in the SIJ and the spine. The most important domains in AS are disease activity, function, spinal mobility, structural damage, and quality of life, some of which are discussed in this manuscript. For axSpA there are two major tools to assess disease activity, the BASDAI and the ASDAS, one for function, the BASFI, and several mobility measures including the BASMI. The AS Health Index (AS-HI) is introduced elsewhere in this supplement. PMID:25365096

  9. Serum from patients with ankylosing spondylitis can increase PPARD, fra-1, MMP7, OPG and RANKL expression in MG63 cells

    PubMed Central

    Hu, Zaiying; Lin, Dongfang; Qi, Jun; Qiu, Minli; Lv, Qing; Li, Qiuxia; Lin, Zhiming; Liao, Zetao; Pan, Yunfeng; Jin, Ou; Wu, Yuqiong; Gu, Jieruo

    2015-01-01

    OBJECTIVES: To explore the effects of serum from patients with ankylosing spondylitis on the canonical Wnt/β-catenin pathway and to assess whether the serum has an osteogenic effect in MG63 cells. METHODS: MG63 cells were cultured with serum from 45 ankylosing spondylitis patients, 30 healthy controls, or 45 rheumatoid arthritis patients. The relative PPARD, fra-1, MMP7, OPG and RANKL mRNA levels were measured using quantitative real-time polymerase chain reaction. Associations between gene expression and patient demographics and clinical assessments were then analyzed. RESULTS: MG63 cells treated with serum from ankylosing spondylitis patients had higher PPARD, fra-1, MMP7 and OPG gene expression than did cells treated with serum from controls or rheumatoid arthritis patients (all p<0.05). RANKL expression was higher in MG63 cells treated with serum from patients with ankylosing spondylitis or rheumatoid arthritis than in those treated with serum from controls (both p<0.05). The OPG/RANKL ratio was also higher in MG63 cells treated with serum from ankylosing spondylitis patients than in those treated with serum from controls (p<0.05). No associations were found between the expression of the five genes and the patient demographics and clinical assessments (all p>0.05). CONCLUSIONS : Serum from ankylosing spondylitis patients increases PPARD, fra-1, MMP7, OPG and RANKL expression and the OPG/RANKL ratio in MG63 cells; these effects may be due to the stimulatory effect of the serum on the Wnt pathway. PMID:26602520

  10. Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era.

    PubMed

    Giannotti, Erika; Trainito, Sabina; Arioli, Giovanni; Rucco, Vincenzo; Masiero, Stefano

    2014-09-01

    Exercise is considered a fundamental tool for the management of ankylosing spondylitis (AS), in combination with pharmacological therapy that with the advent of biological therapy has improved dramatically the control of signs and symptoms of this challenging disease. Current evidence shows that a specific exercise protocol has not been validated yet. The purpose of this review is to update the most recent evidence (July 2010-November 2013) about physiotherapy in AS, analyzing the possible role and synergistic interactions between exercise and biological drugs. From 117 studies initially considered, only 15 were included in the review. The results support a multimodal approach, including educational sessions, conducted in a group setting, supervised by a physiotherapist and followed by a maintaining home-based regimen. Spa exercise and McKenzie, Heckscher, and Pilates methods seem promising in AS rehabilitation, but their effectiveness should be further investigated in future randomized controlled trials (RCTs). When performed in accordance with the American College of Sports Medicine guidelines, cardiovascular training has been proven safe and effective and should be included in AS rehabilitation protocols. Exercise training plays an important role in the biological era, being now applicable to stabilized patients, leading ultimately to a better management of AS by physiatrists and rheumatologists throughout the world. On the basis of the current evidence, further research should aim to determine which exercise protocols should be recommended. PMID:24797772

  11. Attenuated insulin response and normal insulin sensitivity in lean patients with ankylosing spondylitis.

    PubMed

    Penesova, A; Rovensky, J; Zlnay, M; Dedik, L; Radikova, Z; Koska, J; Vigas, M; Imrich, R

    2005-01-01

    Chronic low-grade inflammation is associated with insulin resistance. The aim of this study was to determine insulin response to intravenous glucose load and insulin sensitivity in patients with ankylosing spondylitis (AS). Fourteen nonobese male patients with AS and 14 matched healthy controls underwent frequent-sampling intravenous glucose tolerance test (FSIVGTT). Insulin secretion and insulin sensitivity were calculated using the computer-minimal and homeostasis-model assessment 2 (HOMA2) models. Fasting glucose, insulin, cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglyceride levels, HOMA2, glucose effectiveness, insulin sensitivity and insulin response to FSIVGTT did not differ between patients and controls. Tumor necrosis factor-alpha and interleukin (IL)-6 concentrations tended to be higher in AS patients than in controls. Second-phase beta-cell responsiveness was 37% lower (p = 0.05) in AS patients than in controls. A negative correlation was found between the percentage of beta-cell secretion and IL-6 in all subjects (r = -0.54, p = 0.006). We found normal insulin sensitivity but attenuated glucose utilization in the second phase of FSIVGTT in AS patients. Our results indicate that elevated IL-6 levels may play a pathophysiological role in attenuating beta-cell responsiveness, which may explain the association between elevated IL-6 levels and increased risk for type 2 diabetes. PMID:16366418

  12. ETS1 variants confer susceptibility to ankylosing spondylitis in Han Chinese

    PubMed Central

    2014-01-01

    Introduction ETS1 is a negative regulator of the Th17 differentiation gene and plays a central role in the pathogenesis of autoimmune diseases. We aimed to investigate whether polymorphisms in ETS1 confer susceptibility to ankylosing spondylitis (AS) in Han Chinese. Methods We selected seven single nucleotide polymorphisms (SNPs) within ETS1 based on HapMap data and previous genome-wide association study. Genotyping involved the TaqMan method in 1,015 patients with AS and 1,132 healthy controls from Shandong Province, and 352 AS patients and 400 healthy controls from Ningxia, a northwest region in China. Gene expression was determined by real-time PCR. Results The SNP rs1128334 was strongly associated with AS (odds ratio 1.204, 95% confidence interval 1.06-1.37; P = 0.005). This association was confiexrmed in the Ningxia population (P = 0.015). Carriers of the haplotype TAT for rs12574073, rs1128334 and rs4937333 were associated with increased risk of AS and haplotype CGC with reduced risk as compared to controls. In addition, ETS1 expression was lower in AS patients than controls. The risk allele A of rs1128334 and haplotype A-T of rs1128334 and rs4937333 were associated with decreased expression of ETS1. Conclusions Common variants in ETS1 may contribute to AS susceptibility in Han Chinese people. PMID:24708692

  13. Functionally distinct ERAP1 allotype combinations distinguish individuals with Ankylosing Spondylitis

    PubMed Central

    Reeves, Emma; Colebatch-Bourn, Alexandra; Elliott, Tim; Edwards, Christopher J.; James, Edward

    2014-01-01

    For more than 40 y, expression of HLA-B27 has been strongly associated with the chronic inflammatory disease Ankylosing Spondylitis (AS); however, the mechanisms underlying this association are still unknown. Single nucleotide polymorphisms within the aminopeptidase endoplasmic reticulum aminopeptidase 1 (ERAP1), which is essential for trimming peptides before they are presented to T cells by major histocompatibility complex (MHC) class I molecules, have been linked with disease. We show that ERAP1 is a highly polymorphic molecule comprising allotypes of single nucleotide polymorphisms. The prevalence of specific ERAP1 allotypes is different between AS cases and controls. Both chromosomal copies of ERAP1 are codominantly expressed, and analysis of allotype pairs provided clear stratification of individuals with AS versus controls. Functional analyses demonstrated that ERAP1 allotype pairs seen in AS cases were poor at generating optimal peptide ligands for binding to murine H-2Kb and -Db and the AS-associated HLA-B*2705. We therefore provide strong evidence that polymorphic ERAP1 alters protein function predisposing an individual to AS via its influence on the antigen processing pathway. PMID:25422414

  14. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis

    PubMed Central

    Braun, J; van den Berg, R; Baraliakos, X; Boehm, H; Burgos-Vargas, R; Collantes-Estevez, E; Dagfinrud, H; Dijkmans, B; Dougados, M; Emery, P; Geher, P; Hammoudeh, M; Inman, RD; Jongkees, M; Khan, MA; Kiltz, U; Kvien, TK; Leirisalo-Repo, M; Maksymowych, WP; Olivieri, I; Pavelka, K; Sieper, J; Stanislawska-Biernat, E; Wendling, D; Özgocmen, S; van Drogen, C; van Royen, BJ; van der Heijde, D

    2011-01-01

    This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made — if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good. PMID:21540199

  15. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis.

    PubMed

    Braun, J; van den Berg, R; Baraliakos, X; Boehm, H; Burgos-Vargas, R; Collantes-Estevez, E; Dagfinrud, H; Dijkmans, B; Dougados, M; Emery, P; Geher, P; Hammoudeh, M; Inman, R D; Jongkees, M; Khan, M A; Kiltz, U; Kvien, Tk; Leirisalo-Repo, M; Maksymowych, W P; Olivieri, I; Pavelka, K; Sieper, J; Stanislawska-Biernat, E; Wendling, D; Ozgocmen, S; van Drogen, C; van Royen, Bj; van der Heijde, D

    2011-06-01

    This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made - if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good. PMID:21540199

  16. Risk of malignancy in ankylosing spondylitis: a systematic review and meta-analysis.

    PubMed

    Deng, Chuiwen; Li, Wenli; Fei, Yunyun; Li, Yongzhe; Zhang, Fengchun

    2016-01-01

    Current knowledge about the overall and site-specific risk of malignancy associated with ankylosing spondylitis (AS) is inconsistent. We conducted a systematic review and meta-analysis to address this knowledge gap. Five databases (PubMed, EMBASE, Web of Science, the Cochrane library and the virtual health library) were systematically searched. A manual search of publications within the last 2 years in key journals in the field (Annals of the Rheumatic Diseases, Rheumatology and Arthritis &rheumatology) was also performed. STATA 11.2 software was used to conduct the meta-analysis. After screening, twenty-three studies, of different designs, were eligible for meta-analysis. AS is associated with a 14% (pooled RR 1.14; 95% CI 1.03-1.25) increase in the overall risk for malignancy. Compared to controls, patients with AS are at a specific increased risk for malignancy of the digestive system (pooled RR 1.20; 95% CI 1.01 to 1.42), multiple myelomas (pooled RR 1.92; 95% CI 1.37 to 3.69) and lymphomas (pooled RR 1.32; 95% CI 1.11 to 1.57). On subgroup analysis, evidence from high quality cohort studies indicated that AS patients from Asia are at highest risk for malignancy overall. Confirmation of findings from large-scale longitudinal studies is needed to identify specific risk factors and to evaluate treatment effects. PMID:27534810

  17. Anti-TNF Therapy in Ankylosing Spondylitis: Insights for the Clinician

    PubMed Central

    Coates, Laura C.; Marzo-Ortega, Helena; Bennett, Alexander N.; Emery, Paul

    2010-01-01

    The introduction of tumour necrosis factor (TNF)-blocking therapy has revolutionized the management of ankylosing spondylitis (AS) over the last decade. This review highlights the current evidence relating to the use of TNF-blocking therapy in AS. International guidelines for the use of TNF blockers in AS are summarized. An outline of the evidence for efficacy and safety of these drugs is included, highlighting recent data from registries and real-life observational studies. Such cohort data is also reviewed highlighting the evidence for ‘switching’ TNF blockers in AS in the case of non-response or adverse events. The potential new application of TNF blockers in preradiographic axial spondyloarthropathy (SpA) or ‘early AS’ is discussed with reviews of two recent studies in this area. Finally research into the possible additional impacts of TNF therapies is reviewed. The question of whether TNF blockers are truly disease modifying in AS remains unanswered with conflicting reports. The additional burden of AS in terms of cardiovascular disease is now becoming understood. Recent data from basic science studies highlights the potential impact of TNF blockers on this excess cardiovascular morbidity and mortality. Future studies and registry data will be able to assess whether TNF blockers have an additional role in controlling systemic inflammation and its associated cardiovascular risk. PMID:22870436

  18. A registry of ankylosing spondylitis registries and prospects for global interfacing

    PubMed Central

    Reveille, John D.

    2013-01-01

    Purpose of review To review the optimal criteria and conditions for establishing a clinical registry, as well as detailing their application in a number of ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) Registries already in existence. Recent findings Recent genetic studies and studies of long-term treatment efficacy and side-effects have underscored the need for large numbers of patients, much larger than would be possible from a single center or consortium. An optimal Registry should have its aims established upfront, with appropriate governance and oversight, and inclusion and exclusion criteria for participating collaborators and subject defined. Collaborators contributing subjects to a Registry should use validated instruments for which they have been previously trained. The numerous cross-sectional and longitudinal Registries on AS and axSpA have been recently established that differ widely depending on the referral and selection issues. Summary The challenge of large-scale examinations of genetics, comorbidities, medication usage, and side-effects in spondyloarthritis underscores the need for combining data from well characterized registries of AS patients which require careful planning. There are currently many such registries available internationally, offering promise for collaborations and data pooling that can answer some of the pressing questions facing rheumatology clinicians and researchers. PMID:23656716

  19. Drug Survival Rates of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

    PubMed Central

    2014-01-01

    We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials. Graphical Abstract PMID:25246737

  20. Faecal carriage of klebsiella by patients with ankylosing spondylitis and rheumatoid arthritis.

    PubMed Central

    Warren, R E; Brewerton, D A

    1980-01-01

    In consecutive samples submitted to a clinical microbiology laboratory 22 out of 99 from outpatients and 23 out of 51 from inpatients yielded Klebsiella sp. A clinical reassessment of outpatients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) who had not been inpatients within the last year was made for disease activity and drug requirements. 124 patients with AS and 92 with RA were requested at assessment to submit a stool specimen for klebsiella examination, this being carried out without disclosure of the patient's clinical category. Two months later a questionnaire on symptom changes was collected and the results correlated with klebsiella carriage. Eighty-nine patients with AS and 82 patients with RA fulfilled all criteria for assessment. Of those assessed, 24 out of 89 AS patients and 26 out of 82 RA patients had klebsiella in the faeces. There was no correlation betweeh the initial clinical assessment category and klebsiella carriage. Seventy patients with AS and 57 paients with RA had no change in symptoms over the 2-month period. Nineteen AS patients and 31 RA patients noted symptom improvement or worsening. Of these, 3 AS and 10 RA patients had klebsiella in their faeces. There was no correlation between worsening of symptoms over a 2-month period and klebsiella carriage at initial assessment. PMID:7377857

  1. Biomarkers for diagnosis, monitoring of progression, and treatment responses in ankylosing spondylitis and axial spondyloarthritis

    PubMed Central

    2015-01-01

    With the growing awareness of the impact of chronic back pain and axial spondyloarthritis and recent breakthroughs in genetics and the development of novel treatments which may impact best on early disease, the need for markers that can facilitate early diagnosis and profiling those individuals at the highest risk for a bad outcome has never been greater. The genetic basis of ankylosing spondylitis has been considerably advanced, and HLA-B27 testing has a role in the diagnosis. Knowledge is still incomplete of the rest of the genetic contribution to disease susceptibility, and it is likely premature to use extensive genetic testing (other than HLA-B27) for diagnosis. Serum and plasma biomarkers have been examined extensively in assessing disease activity, treatment response, and as predictors or radiographic severity. For assessing disease activity, other than C-reactive protein and erythrocyte sedimentation rate, the most work has been in examining cytokines (particularly interleukin 17 and 23), matrix metalloproteinase (MMP) markers (particularly MMP3). For assessing those at the highest risk for radiographic progression, biomarkers of bony metabolism, cartilage and connective tissue degradation products, and adipokines have been most extensively assessed. The problem is that no individual biomarkers has been reproducibly shown to assess disease activity or predict outcome, and this area still remains an unmet need, of relevance to industry stakeholders, to regulatory bodies, to the healthcare system, to academic investigators, and finally to patients and providers. PMID:25939520

  2. Risk of malignancy in ankylosing spondylitis: a systematic review and meta-analysis

    PubMed Central

    Deng, Chuiwen; Li, Wenli; Fei, Yunyun; Li, Yongzhe; Zhang, Fengchun

    2016-01-01

    Current knowledge about the overall and site-specific risk of malignancy associated with ankylosing spondylitis (AS) is inconsistent. We conducted a systematic review and meta-analysis to address this knowledge gap. Five databases (PubMed, EMBASE, Web of Science, the Cochrane library and the virtual health library) were systematically searched. A manual search of publications within the last 2 years in key journals in the field (Annals of the Rheumatic Diseases, Rheumatology and Arthritis & rheumatology) was also performed. STATA 11.2 software was used to conduct the meta-analysis. After screening, twenty-three studies, of different designs, were eligible for meta-analysis. AS is associated with a 14% (pooled RR 1.14; 95% CI 1.03–1.25) increase in the overall risk for malignancy. Compared to controls, patients with AS are at a specific increased risk for malignancy of the digestive system (pooled RR 1.20; 95% CI 1.01 to 1.42), multiple myelomas (pooled RR 1.92; 95% CI 1.37 to 3.69) and lymphomas (pooled RR 1.32; 95% CI 1.11 to 1.57). On subgroup analysis, evidence from high quality cohort studies indicated that AS patients from Asia are at highest risk for malignancy overall. Confirmation of findings from large-scale longitudinal studies is needed to identify specific risk factors and to evaluate treatment effects. PMID:27534810

  3. Major histocompatibility complex associations of ankylosing spondylitis are complex and involve further epistasis with ERAP1

    PubMed Central

    Cortes, Adrian; Pulit, Sara L.; Leo, Paul J.; Pointon, Jenny J.; Robinson, Philip C.; Weisman, Michael H.; Ward, Michael; Gensler, Lianne S.; Zhou, Xiaodong; Garchon, Henri-Jean; Chiocchia, Gilles; Nossent, Johannes; Lie, Benedicte A.; Førre, Øystein; Tuomilehto, Jaakko; Laiho, Kari; Bradbury, Linda A.; Elewaut, Dirk; Burgos-Vargas, Ruben; Stebbings, Simon; Appleton, Louise; Farrah, Claire; Lau, Jonathan; Haroon, Nigil; Mulero, Juan; Blanco, Francisco J.; Gonzalez-Gay, Miguel A.; Lopez-Larrea, C; Bowness, Paul; Gaffney, Karl; Gaston, Hill; Gladman, Dafna D.; Rahman, Proton; Maksymowych, Walter P.; Crusius, J. Bart A.; van der Horst-Bruinsma, Irene E.; Valle-Oñate, Raphael; Romero-Sánchez, Consuelo; Hansen, Inger Myrnes; Pimentel-Santos, Fernando M.; Inman, Robert D.; Martin, Javier; Breban, Maxime; Wordsworth, Bryan Paul; Reveille, John D.; Evans, David M.; de Bakker, Paul I.W.; Brown, Matthew A.

    2015-01-01

    Ankylosing spondylitis (AS) is a common, highly heritable, inflammatory arthritis for which HLA-B*27 is the major genetic risk factor, although its role in the aetiology of AS remains elusive. To better understand the genetic basis of the MHC susceptibility loci, we genotyped 7,264 MHC SNPs in 22,647 AS cases and controls of European descent. We impute SNPs, classical HLA alleles and amino-acid residues within HLA proteins, and tested these for association to AS status. Here we show that in addition to effects due to HLA-B*27 alleles, several other HLA-B alleles also affect susceptibility. After controlling for the associated haplotypes in HLA-B, we observe independent associations with variants in the HLA-A, HLA-DPB1 and HLA-DRB1 loci. We also demonstrate that the ERAP1 SNP rs30187 association is not restricted only to carriers of HLA-B*27 but also found in HLA-B*40:01 carriers independently of HLA-B*27 genotype. PMID:25994336

  4. Long-term safety and efficacy of infliximab for the treatment of ankylosing spondylitis

    PubMed Central

    Elalouf, Ofir; Elkayam, Ori

    2015-01-01

    The introduction of TNFα blockers has revolutionized the treatment of ankylosing spondylitis (AS). The objectives of this review are to summarize the most up-to-date data on long-term efficacy and safety of infliximab in AS, with special emphasis on axial and extra-articular disease, predictors of response, and radiological response. The general consensus of this literature search was that infliximab is highly efficacious in the treatment of AS. Most studies have demonstrated good clinical outcomes after 3 years of treatment, as measured by Spondyloarthritis International Society response in 75%–85% of treated AS patients. Reports on the long-term effects of infliximab as documented by radiological findings, however, are controversial. While some studies reported a similar progression rate as that of the historical OASIS cohort, others have suggested that infliximab may halt new bone formation. The long-term safety of infliximab is well known, mainly from data stored in national registries. While it has been suggested that side effects of infliximab may be fewer in AS compared to rheumatoid arthritis, data on this issue are sparse, with most of the information on long-term safety pertaining to rheumatoid arthritis. It can however be concluded that the long-term efficacy of infliximab is apparently maintained in AS and with an acceptable safety profile. PMID:26640380

  5. Can innominate motion be used to identify persons with ankylosing spondylitis? A pilot study.

    PubMed

    Bussey, Melanie D; Milosavljevic, Stephan

    2013-04-01

    Innominate movements during hip abduction and external rotation have recently been described in healthy individuals. In the present study the aim was to determine whether these hip movement tests could discriminate altered movement patterns in people with specific pelvic girdle pain (PGP) disorder. This pilot study is the first step in determining the usefulness of prone hip abduction and external rotation in the differential diagnosis of PGP disorders. A cross-sectional comparison between a convenient sample of 6 individuals who had been referred for exercise and advice following diagnosis of ankylosing spondylitis (AS) via a Medical/Rheumatological pathway and 18 healthy age and gender matched controls. Transverse and sagittal plane innominate motion was measured using a palpation and digitizing technique with a magnetic tracking device. Data analysis involved applying best-fit equations to the data and visual inspection of the produced graphs as well as conditional logistical regression for each test position to determine our ability to predict group association. Graphical comparisons demonstrate a distinction between the patients with AS and the healthy controls. Further, for all three hip conditions the innominate angle was a significant predictor of group association (p = 0.002 for AB, p = 0.005 for AB + ER and p = 0.007 for ER). PMID:22964081

  6. Sweet's syndrome in a patient with acute Crohn's colitis and longstanding ankylosing spondylitis.

    PubMed

    Petermann, A; Tebbe, B; Distler, A; Sieper, J; Braun, J

    1999-01-01

    Acute neutrophilic dermatosis, also referred to as Sweet's syndrome according to the first description in 1964, occurs not only as an isolated phenomenon but also in the context of neoplastic and inflammatory diseases, occasionally including arthritides. Recently Sweet's syndrome has been reported in a small number of patients with chronic inflammatory bowel disease, mostly in advanced stages of the disease. Here, we describe the sudden outbreak of acute neutrophilic dermatosis in coincidence with the onset of severe Crohn's disease (CD) in a patient with long-standing ankylosing spondylitis (AS). This condition has not been described before and therefore Sweet's syndrome should be added to the spectrum of skin manifestations the rheumatologist has to think about in the context of the spondylarthropathies (SpA). Furthermore, this case report is of interest because the skin lesions of Sweet's syndrome are somewhat similar to psoriasis, which is a rather frequent feature of the spondylarthropathies. This article intends to clarify the clinical and histological differentiation between Sweet's syndrome, psoriatic skin lesions and erythema nodosum for the rheumatologist and stresses that these conditions must each be treated in a completely different manner. PMID:10544847

  7. Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes--an Indian perspective.

    PubMed

    Aggarwal, Rohit; Malaviya, Anand N

    2009-03-01

    This study focuses on the causes and consequences of delay in diagnosis of ankylosing spondylitis (AS). Seventy consecutive patients presenting at a rheumatology clinic in India were studied. Mean (+/-S.D) delay in diagnosis was 6.9 (+/-5.2) years. The main cause of delay was incorrect diagnosis as non-specific back pain (19/54, 35.1%), degenerative disc disease (14/54, 25.9%), rheumatoid arthritis (11/54, 20.37%), and tuberculosis of spine (9/54, 16.6%) in that order, for which the patient received prolonged treatment. Absence of extra-articular manifestations and juvenile age also significantly correlated with diagnostic delay. Delay in diagnosis resulted in significantly worse disease activity index (BASDAI), functional index (BASFI), and damage index (BASMI). Most incorrect initial diagnoses were made by orthopedicians (75.9%), followed by general physician (50%), and rheumatologist (12%). Continuing medical education workshops with a focus on clinical diagnosis of inflammatory back pain may help in early diagnosis of AS. PMID:19052836

  8. The Link between Ankylosing Spondylitis, Crohn's Disease, Klebsiella, and Starch Consumption

    PubMed Central

    Rashid, Taha; Wilson, Clyde; Ebringer, Alan

    2013-01-01

    Both ankylosing spondylitis (AS) and Crohn's disease (CD) are chronic and potentially disabling interrelated conditions, which have been included under the group of spondyloarthropathies. The results of a large number of studies support the idea that an enteropathic pathogen, Klebsiella pneumoniae, is the most likely triggering factor involved in the initiation and development of these diseases. Increased starch consumptions by genetically susceptible individuals such as those possessing HLA-B27 allelotypes could trigger the disease in both AS and CD by enhancing the growth and perpetuation of the Klebsiella microbes in the bowel. Exposure to increased levels of these microbes will lead to the production of elevated levels of anti-Klebsiella antibodies as well as autoantibodies against cross-reactive self-antigens with resultant pathological lesions in the bowel and joints. Hence, a decrease of starch-containing products in the daily dietary intake could have a beneficial therapeutic effect on the disease especially when used in conjunction with the currently available medical therapies in the treatment of patients with AS and CD. PMID:23781254

  9. Spine injury following a low-energy trauma in ankylosing spondylitis: a study of two cases.

    PubMed

    Savall, Frederic; Mokrane, Fatima-Zohra; Dedouit, Fabrice; Capuani, Caroline; Guilbeau-Frugier, Céline; Rougé, Daniel; Telmon, Norbert

    2014-08-01

    We report two cases of spine injury following a low-energy trauma in persons with ankylosing spondylitis (AS) and discuss the forensic considerations. A 60-year-old man presented with a wide anterior fracture of the superior endplate of T8 after an accidental fall down three wooden steps. A 93-year-old man presented with disjunction between C6 and C7 and 90-degree spinal angulation after a fall from a standing height or a fall from a bed. Post-mortem multislice computed tomography (MSCT) was performed before autopsy in both the cases. MSCT and autopsy findings were in agreement with a past medical history of AS. A spine injury occurring after a low-energy trauma is unusual and could be suspicious. In the forensic literature we found only a single case, which concerned multiple spinal fractures after a fall from a bicycle at low speed. Such specific mechanisms must be studied and known to the forensic expert. In this context, MSCT is a useful tool to investigate the spine and knowledge of the victim's entire past medical history is essential. PMID:24911528

  10. Early Cardiac Valvular Changes in Ankylosing Spondylitis: A Transesophageal Echocardiography Study

    PubMed Central

    Park, So-Hee; Joe, Byung-Hyun; Hwang, Hui-Jeong; Park, Chang-Bum; Jin, Eun-Sun; Cho, Jin-Man; Kim, Chong-Jin; Bae, Jong-Hoa; Lee, Sang-Hoon

    2012-01-01

    Background This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. Methods A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (≥ 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. Results The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. Conclusion Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution. PMID:22509436

  11. Ultrasonographic Evaluation of Femoral Cartilage Thickness in Patients with Ankylosing Spondylitis

    PubMed Central

    Batmaz, İ; Kara, M; Tiftik, T; Çapkin, E; Karkucak, M; Serdar, ÖF; Kartal, F; Sarıyıldız, MA; Özçakar, L

    2014-01-01

    Objective: To evaluate femoral cartilage thickness in patients with ankylosing spondylitis (AS) by using ultrasonography. Methods: Eighty-four patients (55 M, 29 F) with a diagnosis of AS and 84 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients including disease duration, morning stiffness and medications were recorded. The femoral cartilage thicknesses of both knees were measured with a 7–12 MHz linear probe while subjects' knees were held in maximum flexion. Three mid-point measurements were taken from both knees (lateral femoral condyle (LFC), intercondylar area (ICA) and medial femoral condyle (MFC)). Results: Concerning both ICA (p < 0.001) and left MFC (p = 0.013), cartilage measurements were significantly thicker in AS patients than control subjects. In a subgroup analysis (anti-tumour necrosis factor (TNF) users vs anti-TNF naive) cartilage thickness measurements – bilateral ICA (p = 0.000) and left MFC (p = 0.017) – were found to be greater in AS patients under anti-TNF treatment (n = 65) when compared with those of healthy controls. Conclusion: We imply that AS patients seem to have thicker femoral cartilage, which could be related to anti-TNF treatment. PMID:25429476

  12. Major histocompatibility complex associations of ankylosing spondylitis are complex and involve further epistasis with ERAP1.

    PubMed

    Cortes, Adrian; Pulit, Sara L; Leo, Paul J; Pointon, Jenny J; Robinson, Philip C; Weisman, Michael H; Ward, Michael; Gensler, Lianne S; Zhou, Xiaodong; Garchon, Henri-Jean; Chiocchia, Gilles; Nossent, Johannes; Lie, Benedicte A; Førre, Øystein; Tuomilehto, Jaakko; Laiho, Kari; Bradbury, Linda A; Elewaut, Dirk; Burgos-Vargas, Ruben; Stebbings, Simon; Appleton, Louise; Farrah, Claire; Lau, Jonathan; Haroon, Nigil; Mulero, Juan; Blanco, Francisco J; Gonzalez-Gay, Miguel A; Lopez-Larrea, C; Bowness, Paul; Gaffney, Karl; Gaston, Hill; Gladman, Dafna D; Rahman, Proton; Maksymowych, Walter P; Crusius, J Bart A; van der Horst-Bruinsma, Irene E; Valle-Oñate, Raphael; Romero-Sánchez, Consuelo; Hansen, Inger Myrnes; Pimentel-Santos, Fernando M; Inman, Robert D; Martin, Javier; Breban, Maxime; Wordsworth, Bryan Paul; Reveille, John D; Evans, David M; de Bakker, Paul I W; Brown, Matthew A

    2015-01-01

    Ankylosing spondylitis (AS) is a common, highly heritable, inflammatory arthritis for which HLA-B*27 is the major genetic risk factor, although its role in the aetiology of AS remains elusive. To better understand the genetic basis of the MHC susceptibility loci, we genotyped 7,264 MHC SNPs in 22,647 AS cases and controls of European descent. We impute SNPs, classical HLA alleles and amino-acid residues within HLA proteins, and tested these for association to AS status. Here we show that in addition to effects due to HLA-B*27 alleles, several other HLA-B alleles also affect susceptibility. After controlling for the associated haplotypes in HLA-B, we observe independent associations with variants in the HLA-A, HLA-DPB1 and HLA-DRB1 loci. We also demonstrate that the ERAP1 SNP rs30187 association is not restricted only to carriers of HLA-B*27 but also found in HLA-B*40:01 carriers independently of HLA-B*27 genotype. PMID:25994336

  13. A polymorphism in ERAP1 is associated with susceptibility to ankylosing spondylitis in a Turkish population.

    PubMed

    Cinar, Muhammet; Akar, Hatice; Yilmaz, Sedat; Simsek, Ismail; Karkucak, Mutlu; Sagkan, Rahsan Ilıkci; Pekel, Aysel; Erdem, Hakan; Avci, Ismail Yasar; Acikel, Cengizhan; Musabak, Ugur; Tunca, Yusuf; Pay, Salih

    2013-11-01

    We assessed the role played by the ERAP1 gene in Turkish patients with ankylosing spondylitis (AS) in terms of disease susceptibility, clinical manifestations, and disease severity. We included 150 consecutive AS patients who met the modified New York classification criteria and 150 healthy controls. We documented the presence of 10 ERAP1 single-nucleotide polymorphisms (SNPs) and HLA-B27 in these patients. ERAP1 SNPs were genotyped using competitive allele-specific polymerase chain reaction. Differences between genotype and allele frequencies were compared using the Pearson's Chi-square test. The associations between ERAP1 SNPs, on the one hand, and with disease severity and clinical findings, on the other, were determined. One SNP, rs26653, was significantly associated with AS susceptibility (OR 1.609, 95% CI 1.163-2.226; p = 0.004). The population-attributable risk of possession of the rs26653 SNP allele was 23.4%. No relationship was noted between HLA-B27 positivity and the distribution of rs26653 genotype frequency. No associations were seen between disease severity measures and clinical manifestations of AS. In summary, an ERAP1 polymorphism was associated with AS in a Turkish population. The contributions of HLA-B27 and the rs26653 SNP to AS pathogenesis appear to be independent. PMID:23864143

  14. Functionally distinct ERAP1 allotype combinations distinguish individuals with Ankylosing Spondylitis.

    PubMed

    Reeves, Emma; Colebatch-Bourn, Alexandra; Elliott, Tim; Edwards, Christopher J; James, Edward

    2014-12-01

    For more than 40 y, expression of HLA-B27 has been strongly associated with the chronic inflammatory disease Ankylosing Spondylitis (AS); however, the mechanisms underlying this association are still unknown. Single nucleotide polymorphisms within the aminopeptidase endoplasmic reticulum aminopeptidase 1 (ERAP1), which is essential for trimming peptides before they are presented to T cells by major histocompatibility complex (MHC) class I molecules, have been linked with disease. We show that ERAP1 is a highly polymorphic molecule comprising allotypes of single nucleotide polymorphisms. The prevalence of specific ERAP1 allotypes is different between AS cases and controls. Both chromosomal copies of ERAP1 are codominantly expressed, and analysis of allotype pairs provided clear stratification of individuals with AS versus controls. Functional analyses demonstrated that ERAP1 allotype pairs seen in AS cases were poor at generating optimal peptide ligands for binding to murine H-2K(b) and -D(b) and the AS-associated HLA-B*2705. We therefore provide strong evidence that polymorphic ERAP1 alters protein function predisposing an individual to AS via its influence on the antigen processing pathway. PMID:25422414

  15. ERAP1 structure, function and pathogenetic role in ankylosing spondylitis and other MHC-associated diseases.

    PubMed

    Alvarez-Navarro, Carlos; López de Castro, José A

    2014-01-01

    The endoplasmic reticulum aminopeptidase 1 (ERAP1) is a multifunctional enzyme involved in the final processing of Major Histocompatibility Complex class I (MHC-I) ligands and with a significant influence in the stability and immunological properties of MHC-I proteins. ERAP1 polymorphism is associated with ankylosing spondylitis among HLA-B27-positive individuals and the altered enzymatic activity of natural variants has significant effects on the HLA-B27 peptidome, suggesting a critical pathogenetic role of peptides in this disease. Likewise, the association of ERAP1 with other MHC-I associated disorders and its epistasis with their susceptibility MHC alleles point out to a general role of the MHC-I peptidome in these diseases. The functional interaction between ERAP1 and HLA-B27 or other MHC-I molecules may be related to the processing of specific epitopes, or to a more general peptide-dependent influence on other biological features of the MHC-I proteins. In addition, from a consideration of the reported functions of ERAP1, including its involvement in angiogenesis and macrophage activation, a more complex and multi-level influence in the inflammatory and immune pathways operating in these diseases cannot be ruled out. PMID:23916068

  16. Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: a longitudinal analysis

    PubMed Central

    Ramiro, Sofia; Landewé, Robert; van Tubergen, Astrid; Boonen, Annelies; Stolwijk, Carmen; Dougados, Maxime; van den Bosch, Filip; van der Heijde, Désirée

    2015-01-01

    Objectives To investigate the complex relationship between inflammation, mechanical stress and radiographic progression in patients with ankylosing spondylitis (AS), using job type as a proxy for continuous mechanical stress. Methods Patients from the Outcome in Ankylosing Spondylitis International Study were followed up for 12 years, with 2-yearly assessments. Two readers independently scored the X-rays according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Disease activity was assessed by the AS Disease Activity Score C reactive protein (ASDAS-CRP). The relationship between ASDAS and spinal radiographic progression was investigated with longitudinal analysis, with job type at baseline (physically demanding (‘blue-collar’) versus sedentary (‘white-collar’) labour) as a potential factor influencing this relationship. The effects of smoking status and socioeconomic factors were also investigated. Results In total, 184 patients were included in the analyses (70% males, 83% human leucocyte antigen-B27 positive, 39% smokers, 48% blue-collar workers (65/136 patients in whom data on job type were available)). The relationship between disease activity and radiographic progression was significantly and independently modified by job type: In ‘blue-collar’ workers versus ‘white-collar’ workers, every additional unit of ASDAS resulted in an increase of 1.2 versus 0.2 mSASSS-units/2-years (p=0.014 for the difference between blue-collar and white-collar workers). In smokers versus non-smokers, every additional unit of ASDAS resulted in an increase of 1.9 versus 0.4 mSASSS-units/2-years. Conclusions Physically demanding jobs may amplify the potentiating effects of inflammation on bone formation in AS. Smoking and socioeconomic factors most likely confound this relationship and may have separate effects on bone formation. PMID:26535153

  17. The Incidence and Management of Dural Tears and Cerebrospinal Fluid Leakage during Corrective Osteotomy for Ankylosing Spondylitis with Kyphotic Deformity

    PubMed Central

    Jo, Dae-Jean; Kim, Ki-Tack; Lee, Sang-Hun; Cho, Myung-Guk

    2015-01-01

    Objective To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. Methods A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. Results The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures (PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to 221 mm2. A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. Conclusion The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft. PMID:26279815

  18. Polymorphism of tumour necrosis factor-alpha (TNF-alpha) at position -308 in relation to ankylosing spondylitis.

    PubMed Central

    Verjans, G M; Brinkman, B M; Van Doornik, C E; Kijlstra, A; Verweij, C L

    1994-01-01

    In addition to HLA-B27, other genetic factors are thought to be involved in the pathogenesis of ankylosing spondylitis (AS). Because of the localization, in the proximity of the HLA-B locus, and the biological activities of TNF-alpha, we investigated the association between AS and a single base polymorphism located at position -308 of the TNF-alpha gene. An allele-specific polymerase chain reaction was developed to monitor this polymorphism. The frequency of the TNF-alpha alleles was determined in 66 AS patients and 37 healthy controls. The TNF-alpha allele frequency was not significantly different between AS patients and controls. PMID:8033419

  19. Biologics Use in Asian Indian Patients with Ankylosing Spondylitis: A Physician’s Perspective

    PubMed Central

    Bhakuni, Darshan; Marwaha, Vishal; Hande, Vivek; Bagga, Garvit

    2016-01-01

    Introduction Ankylosing Spondylitis (AS) with non-steroidal anti-inflammatory drug (NSAID) therapeutic failure is treated with biologics. Aim To compare the clinical outcomes of different biologics for Asian Indian patients with AS who have NSAID therapeutic failure. Materials and Methods Thirty-five AS patients with NSAID failure were administered Etanercept (n=15) (50mg SQ, weekly) or Infliximab (n=20) (5mg/kg IV every 2nd month) based on patient convenience or physician discretion as per 2015 ACR/SAA/SPARTAN recommendations. Baseline demographic details, time to diagnosis, disease duration, presence of low backache, early morning stiffness, peripheral joint and extraarticular involvement, ESR, CRP values and HLA-B27 score were obtained. Baseline values of scores of BASMI-3 and MASES were calculated. To monitor the disease activity, BASDAI and ASDAS-ESR scores were recorded at baseline, and after 6 months and 12 months of therapy initiation. Statistical Analysis Comparison of means: independent samples t-test; comparison of parameters over time: repeated measures ANOVA. Results Both groups were comparable in all parameters at therapy initiation except in the baseline BASMI-3 score which was significantly higher in patients who received Etanercept. Over 12 months of treatment, the reduction in disease activity, as evidenced by reduction in the mean BASDAI and ASDAS-ESR scores was statistically significant for all patients when considered together, as well as when Etanercept and Infliximab were considered separately (p<0.0001 in all cases). However, there was no statistically significant difference in the magnitude of reduction in the mean BASDAI and ASDAS-ESR scores between patients who received Etanercept and those who received infliximab (p=0.696 and 0.618 respectively). Conclusion Etanercept and Infliximab offer statistically similar reduction in disease severity in Asian Indian AS patients with NSAID failure. Further studies with larger sample size are

  20. Association of variants in 21q22 with ankylosing spondylitis in the Chinese Guangxi Zhuang population.

    PubMed

    Yang, Jinsong; Zhao, Qian; Han, Chuangye; Zhao, Chunjie; Zheng, Li; Zhang, Xin; Liu, Liumei; Wei, Heyu; Zeng, Fanyue; Yang, Yuan; Su, Wei; Hua, Qikai; Zhan, Xinli; Chen, Qianfen; Li, Tingsong; Liao, Jun; Wu, Hao; Zhao, Jinmin

    2014-09-01

    Genome-wide association study has reported a number of genes as being associated with ankylosing spondylitis (AS) in Caucasian European populations and Chinese Han population. The aim of the study was to investigate whether single nucleotide polymorphisms (SNPs) covering the 21q22 region are associated with AS in the Chinese Guangxi Zhuang population. A case-control study was performed in unrelated patients with AS (n = 315) and age-, sex-, and ethnicity-matched controls (n = 630) from Guangxi Zhuang ethnic group. All patients met the modified New York criteria for AS. TaqMan genotyping assay was used to genotype cases and controls for 17 tag SNPs covering 21q22. After multiple-testing correction, significant association with AS was not observed in all SNP, but one block haplotype was significantly associated with AS. The pairwise analysis of the rs8126528/rs2150414/rs6517532 alleles found that the G-A-A haplotype (OR 2.92, 95 % CI 1.48-3.55; p = 0.0002, permuted p = 0.0332) significantly increased the risk of AS in comparison with the G-A-G, A-A-A and G-G-A carriers. In conclusion, the study results define a novel risk haplotypes in 21q22 that was associated with AS in the Chinese Guangxi Zhuang population. The findings was consistent with previous genetic and functional studies that point at variants of the BRWD1 and/or PSMG1 loci as interesting genetic factors contributing to AS. PMID:24643394

  1. Tim-3 polymorphism downregulates gene expression and is involved in the susceptibility to ankylosing spondylitis.

    PubMed

    Wang, Mingfei; Ji, Bin; Wang, Jian; Cheng, Xiangyu; Zhou, Qiang; Zhou, Junjie; Cao, Chengfu; Guo, Qunfeng

    2014-10-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily affecting the sacroiliac joints and the spine. T-cell immunoglobulin- and mucin-domain-containing molecule 3 (TIM-3) has been established as a negative regulatory molecule that plays a critical role in controlling inflammation. Studies have shown that polymorphisms in TIM-3 gene may be associated with inflammatory diseases. The current study investigated the association between polymorphisms in the TIM-3 gene and susceptibility to AS, and it examined the effects of these polymorphisms on gene expression. Two polymorphisms in TIM-3 -574G/T and +4259T/G polymorphisms were identified by polymerase chain reaction-restriction fragment length polymorphism in 282 AS patients and 298 healthy controls. Results showed that frequency of the TIM-3 -574GT genotype was significantly increased in cases than in controls (Odd ratio [OR]=2.50, 95% confidence interval [CI]: 1.39-4.48, p=0.002). Similarly, TIM-3 -574T allele revealed a positive association with the disease (OR=2.39, p=0.002). The TIM-3 +4259T/G polymorphism did not show any correlation with AS. We further evaluated TIM-3 mRNA and protein levels in CD4(+) T cells, CD8(+) T cells, and monocytes from subjects carrying different TIM-3 genotypes. Results revealed that subjects carrying polymorphic -574GT genotype had significantly lower TIM-3 mRNA and protein levels in CD4(+) T cells, CD8(+) T cells, and monocytes than those with wild-type GG genotype. These data suggest that TIM-3 polymorphism is associated with increased susceptibility to AS possibly by downregulating gene expression. PMID:24905803

  2. Tumor necrosis factor receptor-II nt587 polymorphism in Chinese Han patients with ankylosing spondylitis.

    PubMed

    Li, X; Wang, M; Ma, R; Zhang, T; Liu, J; Chen, J W; Peng, W

    2014-01-01

    We aimed to explore the association between the onset of ankylosing spondylitis (AS) and nt587 polymorphisms of the tumor necrosis factor receptor II (TNFRII) gene in the Han population of Hunan Province, China. Correlation analysis was performed in a case-control study involving 100 AS cases and 100 healthy controls. The nt587 single nucleotide polymorphism of the TNFRII gene was examined by polymerase chain reaction-restriction fragment length polymorphism. The relationship between AS and the frequencies of genotypes and alleles in TNFRII nt587 were analyzed using the SPSS software. There were 43 cases with the TNFRII nt587 T/T genotype, 32 cases with the TNFRII nt587 T/G genotype, and 25 cases with the TNFRII nt587 G/G genotype. In the 100 healthy controls, 56 subjects had the TNFRII nt587 T/T genotype, 34 had the TNFRII nt587 T/G genotype, and 10 had the TNFRII nt587 G/G genotype. The G allele frequency of the AS group was significantly higher (χ(2) = 8.734, P = 0.003) than that in the control group (41.0 vs 27.0%). The odds ratio (OR) in AS cases with the TNFRII nt587 G/G genotype was 3.256, which was obviously higher than in those with T/G (OR = 1.226) and T/T (OR = 1.0) genotype. The polymorphism at position nt587 of the TNFRII gene was found to be associated with AS, and the TNFRII nt587 G allele may play an important role in AS susceptibility. The TNFRII nt587 G/G genotype may increase the risk of developing AS in the Hunan population. PMID:25061744

  3. Genetic Dissection of Acute Anterior Uveitis Reveals Similarities and Differences in Associations observed with Ankylosing Spondylitis

    PubMed Central

    Robinson, Philip C.; Claushuis, Theodora A.M.; Cortes, Adrian; Martin, Tammy M.; Evans, David M.; Leo, Paul; Mukhopadhyay, Pamela; Bradbury, Linda A.; Cremin, Katie; Harris, Jessica; Maksymowych, Walter P.; Inman, Robert D.; Rahman, Proton; Haroon, Nigil; Gensler, Lianne; Powell, Joseph E.; van der Horst-Bruinsma, Irene E.; Hewitt, Alex W.; Craig, Jamie E.; Lim, Lyndell L.; Wakefield, Denis; McCluskey, Peter; Voigt, Valentina; Fleming, Peter; Degli-Esposti, Mariapia; Pointon, Jennifer J.; Weisman, Michael H.; Wordsworth, B. Paul; Reveille, John D.; Rosenbaum, James T.; Brown, Matthew A.

    2015-01-01

    Objective To use high density genotyping to investigate the genetic associations of acute anterior uveitis (AAU) in patients both with and without ankylosing spondylitis (AS). Method We genotyped 1,711 patients with AAU (either primary or with AAU and AS), 2,339 AS patients without AAU, and 10,000 controls on the Illumina Immunochip Infinium microarray. We also used data on AS patients from previous genomewide association studies to investigate the AS risk locus ANTXR2 for its putative effect in AAU. ANTXR2 expression in mouse eyes was investigated by RT-PCR. Results Comparing all AAU cases with HC, strong association was seen over HLA-B corresponding to the HLA-B27 tag SNP rs116488202. Three non-MHC loci IL23R, the intergenic region 2p15 and ERAP1 were associated at genome-wide significance (P < 5×10−8). Five loci harboring the immune-related genes IL10-IL19, IL18R1-IL1R1, IL6R, the chromosome 1q32 locus harboring KIF21B, as well as the eye related gene EYS, were also associated at a suggestive level of significance (P < 5×10−6). A number of previously confirmed AS associations demonstrated significant differences in effect size between AS patients with AAU and AS patients without AAU. ANTXR2 expression was found to vary across eye compartments. Conclusion These findings, with both novel AAU specific associations, and associations shared with AS demonstrate overlapping but also distinct genetic susceptibility loci for AAU and AS. The associations in IL10 and IL18R1 are shared with inflammatory bowel disease, suggesting common etiologic pathways. PMID:25200001

  4. Ankylosing spondylitis is associated with the anthrax toxin receptor 2 gene (ANTXR2)

    PubMed Central

    Karaderi, T; Keidel, S M; Pointon, J J; Appleton, L H; Brown, M A; Evans, D M; Wordsworth, B P

    2014-01-01

    Objectives ANTXR2 variants have been associated with ankylosing spondylitis (AS) in two previous genome-wide association studies (GWAS) (p∼9×10−8). However, a genome-wide significant association (p<5×10−8) was not observed. We conducted a more comprehensive analysis of ANTXR2 in an independent UK sample to confirm and refine this association. Methods A replication study was carried out with 2978 cases and 8365 controls. Then, these were combined with non-overlapping samples from the two previous GWAS in a meta-analysis. Human leukocyte antigen (HLA)-B27 stratification was also performed to test for ANTXR2-HLA-B27 interaction. Results Out of nine single nucleotide polymorphisms (SNP) in the study, five SNPs were nominally associated (p<0.05) with AS in the replication dataset. In the meta-analysis, eight SNPs showed evidence of association, the strongest being with rs12504282 (OR=0.88, p=6.7×10−9). Seven of these SNPs showed evidence for association in the HLA-B27-positive subgroup, but none was associated with HLA-B27-negative AS. However, no statistically significant interaction was detected between HLA-B27 and ANTXR2 variants. Conclusions ANTXR2 variants are clearly associated with AS. The top SNPs from two previous GWAS (rs4333130 and rs4389526) and this study (rs12504282) are in strong linkage disequilibrium (r2≥0.76). All are located near a putative regulatory region. Further studies are required to clarify the role played by these ANTXR2 variants in AS. PMID:25169729

  5. Elevated serum anti-flagellin antibodies implicate subclinical bowel inflammation in ankylosing spondylitis: an observational study

    PubMed Central

    2013-01-01

    Introduction Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) share genetic and clinical features. IBD is associated with the presence of antibodies to a variety of commensal microorganisms including anti-Saccharomyces cerevesiae antibodies (ASCA), antineutrophil cytoplasmic antibodies (ANCA), anti-I2 (associated with anti-Pseudomonas activity), anti-Eschericia coli outer membrane porin C (anti-OmpC) and anti-flagellin antibodies (anti-CBir1). Subclinical intestinal inflammation may be present in up to 65% of patients with AS. This study evaluated the presence of antimicrobial antibodies in patients with AS alone, patients with AS and concomitant IBD (AS-IBD) and a control group of patients with mechanical back pain (MBP). Methods Sera were tested by ELISA for ASCA IgG and IgA, anti-OmpC, anti-CBir1 and ANCA in 76 patients with AS alone, 77 patients with AS-IBD and 48 patients with MBP. Antibody positivity rates, median quantitative antibody levels and the proportion of patients with antibody levels in the 4th quartile of a normal distribution were compared between the three groups of patients. Results Patients with AS alone demonstrated higher anti-CBir1 antibody positivity rates and median antibody levels than MBP patients. Anti-CBir1 positivity in AS was associated with elevation of acute phase reactants. AS-IBD patients demonstrated elevated responses when compared to AS alone for ASCA, anti-OmpC and anti-CBir1. Quartile analysis confirmed the findings. Conclusions These data suggest that adaptive immune responses to microbial antigens occur in AS patients without clinical IBD and support the theory of mucosal dysregulation as a mechanism underlying the pathophysiology of AS. PMID:24286190

  6. Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF α treatment.

    PubMed

    Tarhan, Figen; Orük, Gonca; Niflioğlu, Ozgür; Ozer, Serhat

    2013-04-01

    Association between rheumatological and autoimmune thyroid disorders has been demonstrated by many studies. However, a few data exist indicating the association between thyroid disorders and ankylosing spondylitis (AS). In this study, the frequency of thyroid disorders in patients with AS and the impact of anti-TNF α therapy on this were investigated. Data of 108 patients (female/male (F/M) 27/81) were analyzed. Data on free T3, free T4, thyroid-stimulating hormone, anti-thyroid peroxidase antibodies (TPO), anti-thyroglobulin antibodies, and thyroid ultrasound were assessed retrospectively. 44 (F/M 15/29) patients were receiving anti-TNF α, while 64 (F/M 12/52) were receiving other drugs [(sulfasalazine, anti-inflammatory drug (NSAIDs)]. Among those not receiving anti-TNF α therapy, TPO level was high in 23 patients (mean TPO value 86.69 ± 65.28 U/ml), while it was high only in nine receiving anti-TNF α (mean TPO 36.61 ± 14.02 U/ml) (p < 0.05). Investigating the data regarding gender in both populations, autoimmune thyroid disease frequency was found to be lower in the patient group receiving anti-TNF α treatment. Subclinical hyperthyroidism was discovered in three patients (one female two male), and subclinical hypothyroidism in two (two male). Thyroid nodule was detected in 29 patients. It was concluded that the frequency of thyroid autoimmune disease was higher in our study than that reported in the literature, and the frequency of thyroid disorder in patients with AS was lower in those receiving anti-TNF α compared to those not. This may arise from the role of TNF α on pathogenesis of thyroid disorders. PMID:22614219

  7. Surgical Stabilization Improves Survival of Spinal Fractures Related to Ankylosing Spondylitis

    PubMed Central

    Robinson, Yohan; Willander, Johan; Olerud, Claes

    2015-01-01

    Study Design. National registry cohort study. Objective. The aim of this study was to investigate the effect of surgical stabilization on survival of spinal fractures related to ankylosing spondylitis (AS). Summary of Background Data. Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilization in these patients. Methods. In the Swedish patient registry, all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analyzed for epidemiological purposes. Results. Seventeen thousand two hundred ninety-seven individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. Nine hundred ninety patients with AS (age 66 ± 14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. Thirteen percent had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated nonsurgically [hazard ratio (HR) 0.79, P = 0.029]. Spinal cord injury was the major factor contributing to mortality in this cohort (HR 1.55, P < 0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, P < 0.001) and was 64% throughout the observed years. Conclusions. Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS. Level of Evidence: 3 PMID:26267824

  8. Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients

    PubMed Central

    Ji, Shu-Xing; Yin, Xiao-Lei; Yuan, Rong-Di; Zheng, Zheng; Huo, Yan; Zou, Huan

    2012-01-01

    AIM To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS There were 203 patients diagnosed with AS associated uveitis. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35±12 (range 18–50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior uveitis was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases. PMID:22762042

  9. Integrated Genomics Identifies Convergence of Ankylosing Spondylitis with Global Immune Mediated Disease Pathways

    PubMed Central

    Uddin, Mohammed; Codner, Dianne; Mahmud Hasan, S M; Scherer, Stephen W; O’Rielly, Darren D; Rahman, Proton

    2015-01-01

    Ankylosing spondylitis(AS), a highly heritable complex inflammatory arthritis. Although, a handful of non-HLA risk loci have been identified, capturing the unexplained genetic contribution to AS pathogenesis remains a challenge attributed to additive, pleiotropic and epistatic-interactions at the molecular level. Here, we developed multiple integrated genomic approaches to quantify molecular convergence of non-HLA loci with global immune mediated diseases. We show that non-HLA genes are significantly sensitive to deleterious mutation accumulation in the general population compared with tolerant genes. Human developmental proteomics (prenatal to adult) analysis revealed that proteins encoded by non-HLA AS risk loci are 2-fold more expressed in adult hematopoietic cells.Enrichment analysis revealed AS risk genes overlap with a significant number of immune related pathways (p < 0.0001 to 9.8 × 10-12). Protein-protein interaction analysis revealed non-shared AS risk genes are highly clustered seeds that significantly converge (empirical; p < 0.01 to 1.6 × 10-4) into networks of global immune mediated disease risk loci. We have also provided initial evidence for the involvement of STAT2/3 in AS pathogenesis. Collectively, these findings highlight molecular insight on non-HLA AS risk loci that are not exclusively connected with overlapping immune mediated diseases; rather a component of common pathophysiological pathways with other immune mediated diseases. This information will be pivotal to fully explain AS pathogenesis and identify new therapeutic targets. PMID:25980808

  10. Predictors of Switching Anti-Tumor Necrosis Factor Therapy in Patients with Ankylosing Spondylitis

    PubMed Central

    Lee, Jeong-Won; Kang, Ji-Hyoun; Yim, Yi-Rang; Kim, Ji-Eun; Wen, Lihui; Lee, Kyung-Eun; Park, Dong-Jin; Kim, Tae-Jong; Park, Yong-Wook; Lee, Shin-Seok

    2015-01-01

    The aim of this study was to investigate the potential predictors of switching tumor necrosis factor (TNF)-α inhibitors in Korean patients with ankylosing spondylitis (AS). The patients who had been treated with TNF-α inhibitors were divided into two groups depending on whether they had switched TNF-α inhibitors. Demographic, clinical, laboratory, and treatment data at the time of initiation of TNF-α inhibitor treatment were compared between switchers and non-switchers, and within switchers according to the reasons for switching. Of the 269 patients, 70 (23%) had switched TNF-α inhibitors once; of these, 11 switched again. The median follow-up time was 52.7 months. Three- and five-year drug survival rates were 52%/48% for infliximab, 62%/42% for etanercept, and 71%/51% for adalimumab, respectively. Switchers were more likely to be prescribed disease-modifying anti-rheumatic drugs than non-switchers. A history of joint surgery and complete ankylosis of the sacroiliac joint was more frequent in switchers. Multivariate Cox’s proportional hazard analysis showed that the use of adalimumab as the first TNF-α inhibitor was less likely to lead to switching and complete ankylosis of the sacroiliac joints was more likely to lead to switching. The principal reasons for switching were drug inefficacy and adverse events, but the differences in the clinical data of these two groups of switchers were not significant. In AS patients who are candidates for TNF-α inhibitor therapy, switching may improve the therapeutic outcome based on clinical information. PMID:26176701

  11. Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis

    PubMed Central

    Karaarslan, Ahmet; Yilmaz, Hatice; Aycan, Hakan; Orman, Mehmet; Kobak, Senol

    2015-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9%) were diagnosed as late onset AS and 312 (92.3%) patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001). Higher levels of acute phase reactants and more methotrexate (MTX) use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively). Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage. PMID:26295296

  12. Effect of Tumor Necrosis Factor Inhibitor Therapy on Osteoclasts Precursors in Ankylosing Spondylitis

    PubMed Central

    Caetano-Lopes, Joana; Vieira-Sousa, Elsa; Campanilho-Marques, Raquel; Ponte, Cristina; Canhão, Helena; Ainola, Mari; Fonseca, João E.

    2015-01-01

    Introduction Ankylosing Spondylitis (AS) is characterized by excessive local bone formation and concomitant systemic bone loss. Tumor necrosis factor (TNF) plays a central role in the inflammation of axial skeleton and enthesis of AS patients. Despite reduction of inflammation and systemic bone loss, AS patients treated with TNF inhibitors (TNFi) have ongoing local bone formation. The aim of this study was to assess the effect of TNFi in the differentiation and activity of osteoclasts (OC) in AS patients. Methods 13 AS patients treated with TNFi were analyzed at baseline and after a minimum follow-up period of 6 months. 25 healthy donors were recruited as controls. Blood samples were collected to assess receptor activator of nuclear factor kappa-B ligand (RANKL) surface expression on circulating leukocytes and frequency and phenotype of monocyte subpopulations. Quantification of serum levels of bone turnover markers and cytokines, in vitro OC differentiation assay and qRT-PCR for OC specific genes were performed. Results RANKL+ circulating lymphocytes (B and T cells) and IL-17A, IL-23 and TGF-β levels were decreased after TNFi treatment. We found no differences in the frequency of the different monocyte subpopulations, however, we found decreased expression of CCR2 and increased expression of CD62L after TNFi treatment. OC number was reduced in patients at baseline when compared to controls. OC specific gene expression was reduced in circulating OC precursors after TNFi treatment. However, when cultured in OC differentiating conditions, OC precursors from AS TNFi-treated patients showed increased activity as compared to baseline. Conclusion In AS patients, TNFi treatment reduces systemic pro osteoclastogenic stimuli. However, OC precursors from AS patients exposed to TNFi therapy have increased in vitro activity in response to osteoclastogenic stimuli. PMID:26674064

  13. Incidence and predictors of morphometric vertebral fractures in patients with ankylosing spondylitis

    PubMed Central

    2014-01-01

    Introduction Ankylosing spondylitis (AS) is associated with an increased incidence of vertebral fractures (VFs); however the actual incidence and predictors of morphometric VFs are unknown. The present study examined the incidence and predictors of new VFs in a large AS cohort. Methods In total, 298 AS patients who fulfilled the modified New York criteria were enrolled and spinal radiographs were evaluated biennially. Clinical and laboratory data and radiographic progression were assessed according to the Bath AS Disease Activity Index, erythrocyte sedimentation rate, C-reactive protein (CRP), and the Stoke AS spine score (SASSS). VF was defined according to the Genant criteria. The incidence of VFs at 2 and 4 years was evaluated using the Kaplan-Meier method. The age-specific standardized prevalence ratio (SPR) for AS patients in comparison with the general population was calculated. Results Of 298 patients, 31 (10.8%) had previous VFs at baseline. A total of 30 new VFs occurred in 26 patients over 4 years. The incidence of morphometric VFs was 4.7% at 2 years and 13.6% at 4 years. Multivariate logistic regression analysis showed that previous VFs at baseline and increased CRP levels at 2 years were predictors of new VFs (odds ratio (OR) =12.8, 95% confidence interval (CI) = 3.6-45.3 and OR = 5.4, 95% CI = 1.4–15.9). The age-specific specific standardized prevalence ratio of morphometric VFs in AS was 3.3 (95% CI 2.1–4.5). Conclusions The incidence of morphometric VFs increased in AS. Previous VFs and increased CRP levels predicted future VFs. Further studies are needed to identify the effects of treatment interventions on the prevention of new VFs. PMID:24935156

  14. Fecal calprotectin is associated with disease activity in patients with ankylosing spondylitis.

    PubMed

    Duran, Arzu; Kobak, Senol; Sen, Nazime; Aktakka, Seniha; Atabay, Tennur; Orman, Mehmet

    2016-01-01

    Calprotectin is one of the major antimicrobial S100 leucocyte proteins. Serum calprotectin levels are associated with certain inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus and inflammatory bowel disease. The aim of this study was to investigate serum and fecal calprotectin levels in patients with ankylosing spondylitis (AS) and show their potential relations to the clinical findings of the disease. Fifty-one patients fulfilling the New York criteria of AS and 43 healthy age- and gender-matched volunteers were included in the study. Physical and locomotor system examinations were performed and history data were obtained for all patients. Disease activity parameters were assessed together with anthropometric parameters. Routine laboratory examinations and genetic testing (HLA-B27) were performed. Serum calprotectin levels and fecal calprotectin levels were measured by an enzyme-linked immunosorbent assay. The mean age of the patients was 41.5 years, the mean duration of the disease was 8.6 years, and the delay in diagnosis was 4.2 years. Serum calprotectin levels were similar in both AS patients and in the control group (p=0.233). Serum calprotectin level was correlated with Bath AS disease activity index (BASDAI) and Bath AS functional index (BASFI) (p=0.001, p=0.002, respectively). A higher level of fecal calprotectin was detected in AS patients when compared with the control group. A statistically significant correlation between fecal calprotectin level and BASDAI, BASFI, C-reactive protein and Erythrocyte sedimentation rate were detected (p=0.002, p=0.005, p=0.001, p=0.002, respectively). The results indicated that fecal calprotectin levels were associated with AS disease findings and activity parameters. Calprotectin is a vital disease activity biomarker for AS and may have an important role in the pathogenesis of the disease. Multi-centered prospective studies are needed in order to provide further insight. PMID:26773186

  15. Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis.

    PubMed

    Karaarslan, Ahmet; Yilmaz, Hatice; Aycan, Hakan; Orman, Mehmet; Kobak, Senol

    2015-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9%) were diagnosed as late onset AS and 312 (92.3%) patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001). Higher levels of acute phase reactants and more methotrexate (MTX) use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively). Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage. PMID:26295296

  16. Differences in cardiovascular manifestations between ankylosing spondylitis patients with and without kyphosis.

    PubMed

    Fu, Jun; Wu, Manyan; Liang, Yan; Song, Kai; Ni, Ming; Zhang, Yonggang; Chen, Jiying

    2016-08-01

    The objective of this study is to evaluate the differences in cardiovascular manifestations between ankylosing spondylitis (AS) patients with and without kyphosis. A retrospective review of consecutive AS patients treated at our hospital between June 2013 and June 2015 was performed. There were 122 patients who met all of the inclusion and exclusion criteria. Among these patients, there were 57 (ASK group) patients with global kyphosis (GK) > 40° and 65 (AS group) patients with GK < 40°. General information, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), electrocardiography, and echocardiography were record. ESR and CRP levels in the ASK group were significantly higher than the AS group (P < 0.05). Fifteen patients in ASK group but 3 patients in AS group suffered from a left ventricular high voltage (P < 0.05). Heart rate in ASK group was 83.91 ± 13.68 beats/min, and it was 73.88 ± 13.04 beats/min in AS group (P < 0.05). The E/A ratio was 1.13 ± 0.38 in ASK group and 1.32 ± 0.49 in AS group (P < 0.05). The mitral E-wave deceleration time and isovolumetric relaxation time were, respectively, 236.25 ± 34.26 ms and 101.86 ± 17.57 ms in ASK group, which were shorter in AS group (P < 0.05). This study showed that AS patients with kyphosis had a statistically increased incidence of cardiovascular complications including a more rapid heart rate, left ventricular high voltage, and left ventricular diastolic dysfunction. PMID:27271532

  17. Reducing work disability in Ankylosing Spondylitis – development of a work instability scale for AS

    PubMed Central

    Gilworth, Gill; Emery, Paul; Barkham, Nick; Smyth, M Glyn; Helliwell, Philip; Tennant, Alan

    2009-01-01

    Background The Work Instability Scale for Rheumatoid Arthritis (RA-WIS) is established and is used by physicians to identify patients at risk of job loss for rapid intervention. The study objective was to explore the concept of Work Instability (a mismatch between an individual's abilities and job demands) in Ankylosing Spondylitis (AS) and develop a Work Instability Scale specific to this population. Methods New items generated from qualitative interviews were combined with items from the RA-WIS to form a draft AS-WIS. Rasch analysis was used to examine the scaling properties of the AS-WIS using data generated through a postal survey. The scale was validated against a gold standard of expert assessment, a test-retest survey examined reliability. Results Fifty-seven participants who were in work returned the postal survey. Of the original 55 items 38 were shown to fit the Rasch model (χ2 37.5; df 38; p 0.494) and free of bias for gender and disease duration. Following analysis for discrimination against the gold standard assessments 20 items remained with good fit to the model (χ2 24.8; df 20; p 0.21). Test-retest reliability was 0.94. Conclusion The AS-WIS is a self-administered scale which meets the stringent requirements of modern measurement. Used as a screening tool it can identify those experiencing a mismatch at work who are at risk of job retention problems and work disability. Work instability is emerging as an important indication for the use of biologics, thus the AS-WIS has the potential to become an important outcome measure. PMID:19531252

  18. Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East.

    PubMed

    Rachid, Bahiri; El Zorkany, Bassel; Youseif, Ehab; Tikly, Mohammed

    2012-11-01

    Ankylosing spondylitis (AS) is the prototype for spondyloarthritis primarily affecting young men. Geographic and ethnic variations exist in the prevalence and severity of AS and relate to the wide disparity in the frequency of human leukocyte antigen (HLA)-B27, a major genetic risk factor. The strength of the disease association with HLA-B27 is lower in most Arab populations (25-75 %) than in Western European populations (>90 %), and there is no association in sub-Saharan Africa, where the prevalence of HLA-B27 is <1 %. Other epidemiologic differences between European and African populations are the apparent later age at presentation in sub-Saharan Africa, and the high rate of spondyloarthropathies associated with human immunodeficiency virus infection. Diagnosis of AS is often delayed 8-10 years; potential reasons for the delay in Africa and the Middle East include low awareness among physicians and patients, the requirement for radiographic evidence of sacroiliitis for diagnosis, and limited access to magnetic resonance imaging in some countries. Treatment should be initiated early to prevent or reduce skeletal deformity and physical disability. Nonsteroidal anti-inflammatory drugs are effective first-line treatment and anti-tumor necrosis factor-α drugs are indicated for patients who have an inadequate response to first-line therapy. In Africa and the Middle East, such treatments may be precluded either by cost or contraindicated because of the high prevalence of latent tuberculosis infection. Research is sorely needed to develop cost-effective tools to diagnose AS early as well as effective, inexpensive, and safe treatments for these developing regions. PMID:22903740

  19. Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis

    PubMed Central

    Wang, Y-X J; Griffith, J F; Deng, M; Li, T K; Tam, L-S; Lee, V W Y; Lee, K K C; Li, E K

    2012-01-01

    Objective To investigate the relative performance of T2 weighted short tau inversion–recovery (STIR) and fat-suppressed T1 weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS). Methods Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers. Results For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively. Conclusion While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms. PMID:22595499

  20. The economic burden of disease: comparison between rheumatoid arthritis and ankylosing spondylitis.

    PubMed

    Boonen, A; Mau, W

    2009-01-01

    During the last decade the economic burden of rheumatic diseases has been increasingly recognised. Even though more studies have been published on rheumatoid arthritis (RA) than ankylosing spondylitis (AS) sufficient data is available for comparison of some economic consequences. This overview addresses mainly the societal impact of RA and AS on (1) labour force participation, on (2) the costs of healthcare consumption and reduced productivity and on (3) health in terms of QALY.In order to examine labour force participation comparison with the general population is preferable. These studies demonstrate increased withdrawal from work in both diseases but more frequently in RA. Risk factors for reduced labour force participation in RA and AS are longer disease duration, lower education and unfavourable labour market conditions. The influence of the sex on employment depends on several factors such as the type of disease and the labour force participation of the general population.In RA overall mean direct costs of healthcare consumption and indirect costs of reduced productivity are above that of AS, particularly after long disease duration. Out-of-pocket expenditures costs were higher in females RA patients than in males while this was less clear in AS. The main cost driver in both diseases for all type of costs was reduced physical function.The societal valuation of health (utility) showed similar reductions of quality adjusted life years (QALYs) in RA and AS when compared with the general population.In conclusion, while the societal valuation of the impact of both diseases on health is similar, the decrease in worker participation is more pronounced in RA and direct as well as productivity costs are higher. However, since AS starts at an earlier age, the lifetime economic burden might be higher. There is a strong relation between physical function and each aspect of economic impact. PMID:19822056

  1. Does body mass index (BMI) influence the Ankylosing Spondylitis Disease Activity Score in axial spondyloarthritis?

    PubMed Central

    Rubio Vargas, Roxana; van den Berg, Rosaline; van Lunteren, Miranda; Ez-Zaitouni, Zineb; Bakker, Pauline A C; Dagfinrud, Hanne; Ramonda, Roberta; Landewé, Robert; Molenaar, Esmeralda; van Gaalen, Floris A; van der Heijde, Désirée

    2016-01-01

    Objective Obesity is associated with elevated C reactive protein (CRP) levels. The Ankylosing Spondylitis Disease Activity Score (ASDAS) combines patient-reported outcomes (PROs) and CRP. We evaluated the effect of body mass index (BMI) on CRP and on ASDAS, and studied if ASDAS can be used in obese axial spondyloarthritis (axSpA) patients to assess disease activity. Methods Baseline data of patients with chronic back pain of short duration included in the SPondyloArthritis Caught Early (SPACE) cohort were used. Collected data included BMI and ASDAS. Patients were classified according to the ASAS axSpA classification criteria and BMI (overweight ≥25 and obese ≥30). Correlation and linear regression analyses were performed to assess the relation between BMI and ASDAS. Linear regression models were performed to assess if age or gender were effect modifiers in the relation between BMI and CRP, and between BMI and ASDAS. Results In total, 428 patients were analysed (n=168 axSpA; n=260 no-axSpA). The mean age was 31.1 years, 36.9% were male, 26.4% were overweight and 13.3% obese, median CRP was 3 mg/L and the mean ASDAS was 2.6. Gender was the only factor modifying the relationship between BMI and CRP as BMI had an influence on CRP only in females (β=0.35; p<0.001). Correlations between BMI and CRP or PROs were generally weak, and only significant for CRP in female patients. BMI was not related to ASDAS in axSpA patients. Conclusions ASDAS is not affected by BMI in axSpA patients. Therefore, based on our data it is not necessary to take BMI in consideration when assessing disease activity using ASDAS in axSpA patients. PMID:27403336

  2. Fecal calprotectin is associated with disease activity in patients with ankylosing spondylitis

    PubMed Central

    Duran, Arzu; Kobak, Senol; Sen, Nazime; Aktakka, Seniha; Atabay, Tennur; Orman, Mehmet

    2016-01-01

    Calprotectin is one of the major antimicrobial S100 leucocyte proteins. Serum calprotectin levels are associated with certain inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus and inflammatory bowel disease. The aim of this study was to investigate serum and fecal calprotectin levels in patients with ankylosing spondylitis (AS) and show their potential relations to the clinical findings of the disease. Fifty-one patients fulfilling the New York criteria of AS and 43 healthy age- and gender-matched volunteers were included in the study. Physical and locomotor system examinations were performed and history data were obtained for all patients. Disease activity parameters were assessed together with anthropometric parameters. Routine laboratory examinations and genetic testing (HLA-B27) were performed. Serum calprotectin levels and fecal calprotectin levels were measured by an enzyme-linked immunosorbent assay. The mean age of the patients was 41.5 years, the mean duration of the disease was 8.6 years, and the delay in diagnosis was 4.2 years. Serum calprotectin levels were similar in both AS patients and in the control group (p=0.233). Serum calprotectin level was correlated with Bath AS disease activity index (BASDAI) and Bath AS functional index (BASFI) (p=0.001, p=0.002, respectively). A higher level of fecal calprotectin was detected in AS patients when compared with the control group. A statistically significant correlation between fecal calprotectin level and BASDAI, BASFI, C-reactive protein and Erythrocyte sedimentation rate were detected (p=0.002, p=0.005, p=0.001, p=0.002, respectively). The results indicated that fecal calprotectin levels were associated with AS disease findings and activity parameters. Calprotectin is a vital disease activity biomarker for AS and may have an important role in the pathogenesis of the disease. Multi-centered prospective studies are needed in order to provide further insight. PMID:26773186

  3. Association Study of IL-12B Polymorphisms Susceptibility with Ankylosing Spondylitis in Mainland Han Population

    PubMed Central

    Liu, Li; Yang, Ting; Ding, Ning; Hu, Yanting; Cai, Guoqi; Wang, Li; Xin, Lihong; Xia, Qing; Li, Xiaona; Xu, Shengqian; Xu, Jianhua; Yang, Xiao; Zou, Yanfeng; Pan, Faming

    2015-01-01

    Objective This study aims to determine whether the genetic polymorphisms of IL-12B gene is a susceptibility factor to Ankylosing spondylitis (AS) in mainland Han Chinese population. Method Eight single-nucleotide polymorphisms (SNPs) (rs10045431, rs11167764, rs3212227, rs6556412, rs6556416, rs6871626, rs6887695 and rs7709212) in the IL-12B gene were genotyped by iMLDR Assay technology in 400 patients [96% (384/400) HLA-B27(+)] and 395 geographically and ethnically matched healthy controls in mainland Han Chinese population. The correlation between IL-12B genetic polymorphisms and AS activity index (BASDAI, BASFI) were tested. Results The significant difference was found in genotype distribution between AS and healthy controls (χ2 = 6.942, P-value = 0.031) of the SNP rs6871626. Furthermore, significant evidence was also detected under the recessive model for minor allele A. The AA genotype carrier had 1.830 fold risk compared with C allele carrier (with CC and AC genotypes) [OR (95% CI) = 1.830 (1.131-2.961), P-value = 0.014]. Nevertheless, the difference was no longer significant after Bonferroni correction. Subset analysis on cases with HLA-B27(+) did find the same results. Three genotypic groups (AA, CC and CA) in rs6871626 site was highly associated with the BASDAI and BASFI (P-value = 0.012 and P-value = 0.023, respectively), after adjustment for effect of age, sex, and disease duration, the P-value was 0.031 and 0.041, respectively. The AA genotype of rs6871626 was also significantly correlated with an increased BASDAI and BASFI compared to the AC and CC genotypes in AS patients. Conclusion Our findings suggest that rs6871626 may be associated AS susceptibility and with disease activity (BASDAI, BASFI) in mainland Han Chinese population. PMID:26103568

  4. Association between ERAP1 gene polymorphisms and ankylosing spondylitis susceptibility in Han population

    PubMed Central

    Wang, Jian; Li, Hang; Wang, Jianwei; Gao, Xiang

    2015-01-01

    Purposes: The present study was designed to investigate the relationship between endoplasmic reticulum amino peptidase 1 (ERAP1) gene polymorphisms and ankylosing spondylitis (AS) in Han population of Shaanxi province. Methods: 100 AS patients and 100 healthy people were enrolled in present study as case and control groups respectively, and the control group was matched with the case group by age and gender. ERAP1 gene rs27434 and rs7711564 polymorphisms were test by TaqMan probe genotyping method. SHEsis software was used to operate linkage disequilibrium (LD) and haplotype analysis between the two single nucleotide polymorphisms (SNPs). χ2 test was employed to compare the differences of the genotype, allele and haplotype frequencies between the case and control groups. Relative risk of AS was represented by odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: In ERAP1 rs27434 and rs7711564 polymorphisms, the frequencies of AA and CC genotypes in case group were significantly higher compared to those in control group (P=0.036; P=0.039), and so were the frequencies of A and C alleles (OR=1.589, 95% CI=1.070-2.359, P=0.028; OR=1.535, 95% CI=1.021-2.308, P=0.050). Linkage disequilibrium test and haplotype analysis of the alleles of the two SNPs showed that the frequency of A-C haplotype was higher in case group than that in control group (P=0.005), which indicated that A-C might be the susceptible haplotype to AS. Conclusions: ERAP1 gene rs27434 and rs7711564 polymorphisms may increase the risk of AS. PMID:26617903

  5. The genetic associations of acute anterior uveitis and their overlap with the genetics of ankylosing spondylitis.

    PubMed

    Robinson, P C; Leo, P J; Pointon, J J; Harris, J; Cremin, K; Bradbury, L A; Stebbings, S; Harrison, A A; Evans, D M; Duncan, E L; Wordsworth, B P; Brown, M A

    2016-01-01

    Acute anterior uveitis (AAU) involves inflammation of the iris and ciliary body of the eye. It occurs both in isolation and as a complication of ankylosing spondylitis (AS). It is strongly associated with HLA-B*27, but previous studies have suggested that further genetic factors may confer additional risk. We sought to investigate this using the Illumina Exomechip microarray, to compare 1504 cases with AS and AAU, 1805 with AS but no AAU and 21 133 healthy controls. We also used a heterogeneity test to test the differences in effect size between AS with AAU and AS without AAU. In the analysis comparing AS+AAU+ cases versus controls, HLA-B*27 and HLA-A*02:01 were significantly associated with the presence of AAU (P<10(-300) and P=6 × 10(-8), respectively). Secondary independent association with PSORS1C3 (P=4.7 × 10(-5)) and TAP2 (P=1.1 × 10(-5)) were observed in the major histocompatibility complex. There was a new suggestive association with a low-frequency variant at zinc-finger protein 154 in the AS without AAU versus control analysis (zinc-finger protein 154 (ZNF154), P=2.2 × 10(-6)). Heterogeneity testing showed that rs30187 in ERAP1 has a larger effect on AAU compared with that in AS alone. These findings also suggest that variants in ERAP1 have a differential impact on the risk of AAU when compared with AS, and hence the genetic risk for AAU differs from AS. PMID:26610302

  6. Assay of Peripheral Regulatory Vδ1 T Cells in Ankylosing Spondylitis and its Significance.

    PubMed

    Wang, Hongliang; Sun, Na; Li, Ka; Tian, Jiguang; Li, Jianmin

    2016-01-01

    BACKGROUND Ankylosing spondylitis (AS) involves inflammation at the sacroiliac joint and spine attachment site. This study aimed to observe the ratio and function of peripheral regulatory Vδ1 T cells in AS patients to investigate their roles in AS pathogenesis. MATERIAL AND METHODS Peripheral blood mononuclear cells (PBMC) were separated by density-gradient centrifugation from AS patients and healthy controls. Flow cytometry was used to determine the ratio between Vδ1 and CD4 T cells of PBMC in AS patients and controls. Flow cytometry sorting (FCS) was used to obtain Vδ1 and naïve CD4 T cells with purity higher than 90%. CFSE staining method was used to detect the effect of Vδ1 T cells on proliferation of naïve CD4 T cells. The effect of Vδ1 T cells on secretion of IFN-γ from naïve CD4 T cells and the ability to secrete IL-10 from Vδ1 T cells were determined by flow cytometry. RESULTS AS patients had significantly lower Vδ1 T cell ratio in PBMC compared to controls (p<0.05), but their CD4 T cell ratio was significantly elevated (p<0.05). Functional assay showed suppression of naïve CD4 T cell proliferation and IFN-γ secretion by peripheral Vδ1 T cells in AS patients (p<0.01). AS patients also had lower IL-10 secreting level from peripheral derived Vδ1 T cells (p<0.01). CONCLUSIONS The immune suppression of peripheral Vδ1 T cell in AS patient increases the ratio of peripheral CD4 T cells and IFN-γ level, leading to AS pathogenesis. This immune suppression is mainly due to suppressed IL-10 secretion. PMID:27598263

  7. The rate and significance of type 1/type 2 serum amyloid A protein gene polymorphisms in patients with ankylosing spondylitis and amyloidosis.

    PubMed

    Yildirim Cetin, Gozde; Ganiyusufoglu, Eda; Solmaz, Dilek; Cagatay, Yonca; Yılmaz Oner, Sibel; Erer, Burak; Sagliker, Hasan Sabit; Avci, Ali Berkant; Akar, Servet; Pamuk, Omer Nuri; Kılınc, Metin; Kasifoglu, Timucin; Direskeneli, Haner; Gul, Ahmet; Sayarlioglu, Mehmet

    2015-01-01

    A relationship between the presence of amyloidosis and SAA1 genotype has been shown in recent studies of (principally) familial Mediterranean fever patients. We found that the SAA1 rs12218 polymorphism was significantly more prevalent in ankylosing spondylitis patients with amyloidosis. PMID:26300108

  8. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility

    PubMed Central

    Evans, David M; Spencer, Chris C A; Pointon, Jennifer J; Su, Zhan; Harvey, David; Kochan, Grazyna; Oppermann, Udo; Dilthey, Alexander; Pirinen, Matti; Stone, Millicent A; Appleton, Louise; Moutsianas, Loukas; Leslie, Stephen; Wordsworth, Tom; Kenna, Tony J; Karaderi, Tugce; Thomas, Gethin P; Ward, Michael M; Weisman, Michael H; Farrar, Claire; Bradbury, Linda A; Danoy, Patrick; Inman, Robert D; Maksymowych, Walter; Gladman, Dafna; Rahman, Proton; Morgan, Ann; Marzo-Ortega, Helena; Bowness, Paul; Gaffney, Karl; Gaston, J S Hill; Smith, Malcolm; Bruges-Armas, Jacome; Couto, Ana-Rita; Sorrentino, Rosa; Paladini, Fabiana; Ferreira, Manuel A; Xu, Huji; Liu, Yu; Jiang, Lei; Lopez-Larrea, Carlos; Díaz-Peña, Roberto; López-Vázquez, Antonio; Zayats, Tetyana; Band, Gavin; Bellenguez, Céline; Blackburn, Hannah; Blackwell, Jenefer M; Bramon, Elvira; Bumpstead, Suzannah J; Casas, Juan P; Corvin, Aiden; Craddock, Nicholas; Deloukas, Panos; Dronov, Serge; Duncanson, Audrey; Edkins, Sarah; Freeman, Colin; Gillman, Matthew; Gray, Emma; Gwilliam, Rhian; Hammond, Naomi; Hunt, Sarah E; Jankowski, Janusz; Jayakumar, Alagurevathi; Langford, Cordelia; Liddle, Jennifer; Markus, Hugh S; Mathew, Christopher G; McCann, Owen T; McCarthy, Mark I; Palmer, Colin N A; Peltonen, Leena; Plomin, Robert; Potter, Simon C; Rautanen, Anna; Ravindrarajah, Radhi; Ricketts, Michelle; Samani, Nilesh; Sawcer, Stephen J; Strange, Amy; Trembath, Richard C; Viswanathan, Ananth C; Waller, Matthew; Weston, Paul; Whittaker, Pamela; Widaa, Sara; Wood, Nicholas W; McVean, Gilean; Reveille, John D; Wordsworth, B Paul; Brown, Matthew A; Donnelly, Peter

    2013-01-01

    Ankylosing spondylitis is a common form of inflammatory arthritis predominantly affecting the spine and pelvis that occurs in approximately 5 out of 1,000 adults of European descent. Here we report the identification of three variants in the RUNX3, LTBRTNFRSF1A and IL12B regions convincingly associated with ankylosing spondylitis (P < 5 × 10−8 in the combined discovery and replication datasets) and a further four loci at PTGER4, TBKBP1, ANTXR2 and CARD9 that show strong association across all our datasets (P < 5 × 10−6 overall, with support in each of the three datasets studied). We also show that polymorphisms of ERAP1, which encodes an endoplasmic reticulum aminopeptidase involved in peptide trimming before HLA class I presentation, only affect ankylosing spondylitis risk in HLA-B27–positive individuals. These findings provide strong evidence that HLA-B27 operates in ankylosing spondylitis through a mechanism involving aberrant processing of antigenic peptides. PMID:21743469

  9. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility.

    PubMed

    Evans, David M; Spencer, Chris C A; Pointon, Jennifer J; Su, Zhan; Harvey, David; Kochan, Grazyna; Oppermann, Udo; Opperman, Udo; Dilthey, Alexander; Pirinen, Matti; Stone, Millicent A; Appleton, Louise; Moutsianas, Loukas; Moutsianis, Loukas; Leslie, Stephen; Wordsworth, Tom; Kenna, Tony J; Karaderi, Tugce; Thomas, Gethin P; Ward, Michael M; Weisman, Michael H; Farrar, Claire; Bradbury, Linda A; Danoy, Patrick; Inman, Robert D; Maksymowych, Walter; Gladman, Dafna; Rahman, Proton; Morgan, Ann; Marzo-Ortega, Helena; Bowness, Paul; Gaffney, Karl; Gaston, J S Hill; Smith, Malcolm; Bruges-Armas, Jacome; Couto, Ana-Rita; Sorrentino, Rosa; Paladini, Fabiana; Ferreira, Manuel A; Xu, Huji; Liu, Yu; Jiang, Lei; Lopez-Larrea, Carlos; Díaz-Peña, Roberto; López-Vázquez, Antonio; Zayats, Tetyana; Band, Gavin; Bellenguez, Céline; Blackburn, Hannah; Blackwell, Jenefer M; Bramon, Elvira; Bumpstead, Suzannah J; Casas, Juan P; Corvin, Aiden; Craddock, Nicholas; Deloukas, Panos; Dronov, Serge; Duncanson, Audrey; Edkins, Sarah; Freeman, Colin; Gillman, Matthew; Gray, Emma; Gwilliam, Rhian; Hammond, Naomi; Hunt, Sarah E; Jankowski, Janusz; Jayakumar, Alagurevathi; Langford, Cordelia; Liddle, Jennifer; Markus, Hugh S; Mathew, Christopher G; McCann, Owen T; McCarthy, Mark I; Palmer, Colin N A; Peltonen, Leena; Plomin, Robert; Potter, Simon C; Rautanen, Anna; Ravindrarajah, Radhi; Ricketts, Michelle; Samani, Nilesh; Sawcer, Stephen J; Strange, Amy; Trembath, Richard C; Viswanathan, Ananth C; Waller, Matthew; Weston, Paul; Whittaker, Pamela; Widaa, Sara; Wood, Nicholas W; McVean, Gilean; Reveille, John D; Wordsworth, B Paul; Brown, Matthew A; Donnelly, Peter

    2011-08-01

    Ankylosing spondylitis is a common form of inflammatory arthritis predominantly affecting the spine and pelvis that occurs in approximately 5 out of 1,000 adults of European descent. Here we report the identification of three variants in the RUNX3, LTBR-TNFRSF1A and IL12B regions convincingly associated with ankylosing spondylitis (P < 5 × 10(-8) in the combined discovery and replication datasets) and a further four loci at PTGER4, TBKBP1, ANTXR2 and CARD9 that show strong association across all our datasets (P < 5 × 10(-6) overall, with support in each of the three datasets studied). We also show that polymorphisms of ERAP1, which encodes an endoplasmic reticulum aminopeptidase involved in peptide trimming before HLA class I presentation, only affect ankylosing spondylitis risk in HLA-B27-positive individuals. These findings provide strong evidence that HLA-B27 operates in ankylosing spondylitis through a mechanism involving aberrant processing of antigenic peptides. PMID:21743469

  10. Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial.

    PubMed

    Şilte Karamanlioğlu, Duygu; Aktas, Ilknur; Ozkan, Feyza Unlu; Kaysin, Meryem; Girgin, Nuray

    2016-05-01

    The aim of our study was to evaluate effectiveness of ultrasound treatment applied with exercise therapy in patients with ankylosing spondylitis. Fifty-two patients, who were diagnosed according to modified New York criteria, were aged 25-60, and have spine pain, were randomly assigned to two groups. Ultrasound (US) and exercise therapy were applied to treatment group (27); placebo US treatment and exercise therapy were applied to control group (25). Patients were evaluated before treatment, at the end of treatment, and 4 weeks after the treatment. Daily and night pain, morning stiffness, patient global assessment (PGA), doctor global assessment (DGA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, Ankylosing Spondylitis Disease Activity Score (ASDAS) erythrocyte sedimentation rate (ESR), and ASDAS C-reactive protein (CRP) were used as clinical parameters. In US group, all parameters showed significant improvements at 2 and 6 weeks, in comparison with the baseline. In placebo US group, significant improvement was obtained for all parameters (except tragus-to-wall distance and modified Schober test at 2 weeks and lumbar side flexion and modified Schober test at 6 weeks). Comparison of the groups showed significantly superior results of US group for parameters of BASMI (p < 0.05), tragus-wall distance (p < 0.05), PGA (p < 0.01), and DGA (p < 0.05) at 2 weeks as well as for the parameters of daily pain (p < 0.01), PGA (p < 0.05), DGA (p < 0.01), BASDAI (p < 0.05), ASDAS-CRP (p < 0.05), ASDAS-ESR (p < 0.01), lumbar side flexion (p < 0.01), the modified Schober test (p < 0.01), and ASQoL (p < 0.05) at 6 weeks. Our study showed that ultrasound treatment increases the effect of exercise in patients with ankylosing spondylitis. PMID:26923690