Note: This page contains sample records for the topic arthritis ankylosing spondylitis from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: November 12, 2013.
1

Ankylosing Spondylitis  

MedlinePLUS

Ankylosing spondylitis is a type of arthritis of the spine. It causes swelling between your vertebrae, which are the ... the joints between your spine and pelvis. Ankylosing spondylitis is an immune disease. The disease is more ...

2

Etiopathogenesis of ankylosing spondylitis and reactive arthritis.  

PubMed

In ankylosing spondylitis and reactive arthritis, an interplay of microbe and major histocompatibility complex initiates a sequence of events resulting in chronic inflammation. With the use of molecular probes as direct evidence and immune response patterns as indirect evidence, a strong case has been made for a central role of local microbial antigen in reactive arthritis. Cofactors such as gender, persistent gut inflammation, and antibiotic treatment may contribute to this process. Studies of transgenic rats and of familial spondylitis implicate B27 itself as the critical host variable. The results of recent studies point to intimate B27-bacteria interrelationships. HLA-B27 and proteins from enteric bacteria are structurally related, in a manner that may affect T cell response to enteric pathogens. B27 also may directly affect host-microbe interactions by modulating the invasive potential of these bacteria into target cells. Studies are in progress to apply the predictions of these in vitro systems to the in vivo situations of these diseases. The insights of research in the spondyloarthropathies may find broad applications in the rheumatic diseases. PMID:8068507

Inman, R D; Scofield, R H

1994-07-01

3

Ankylosing spondylitis  

MedlinePLUS

Rheumatoid spondylitis; Spondylitis; Spondylarthropathy ... The cause of ankylosing spondylitis is unknown, but genes seem to play a role. The disease most often begins between ages 20 and 40, but ...

4

Rheumatoid arthritis and ankylosing spondylitis - pathology of acute inflammation.  

PubMed

Histomorphological analysis of inflammatory lesions in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) display similarities but also major differences. Ankylosing spondylitis is characterised by two key pathological findings: sacroiliac joint and spinal inflammation and new bone formation with the possible consequence of bone fusion, usually in the axial skeleton. In AS the primary site of inflammation is located at the enthesis or subchondral bone marrow with bone marrow oedema, lymphocytic infiltrates, increased osteoclast density and increased microvessel density are typical findings in acute inflammation. In RA joint inflammation has its origin in the synovial membrane of peripheral joints. Osteitis in the subchondral bone marrow reveals similar findings compared to AS and it is suggested to occur secondary to inflammation in the synovial membrane. Structural damage defines the outcome in both diseases. However, in AS it is defined by new bone formation and in RA by the destruction of cortical bone. PMID:19822040

Appel, H; Loddenkemper, C; Miossec, P

5

Symptoms of Ankylosing Spondylitis  

MedlinePLUS

Ankylosing Spondylitis (AS): Quick Links Overview >>> Symptoms >>> Diagnosis >>> Treatment >>> Medication >>> Doctor Q&A From Spondylitis Plus >>> ANKYLOSING SPONDYLITIS Most Common Symptoms It is important to note ...

6

Biologics in the treatment of rheumatoid arthritis and ankylosing spondylitis.  

PubMed

There are clear differences in the clinical picture and in the pathogenesis between rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Biologic agents targeting TNF-alpha are efficacious in both diseases, with some tendency to work even better in spondyloarthritides (SpA) on a clinical basis. However, anti-TNF therapy was shown to inhibit radiographic progression in RA but not in AS. This is probably due to the outstanding difference in pathogenesis: while in RA osteodestructive lesions such as erosions predominate, AS patients will rather develop osteoproliferative changes such as syndesmophytes. There is some evidence that anti-TNF agents may show longterm efficacy and acceptable safety profiles over 5-10 years. There are some differences between the agents.Whether the recent developments of targeted therapies in RA with agents such as rituximab, abatacept and tocilizumab will also work for AS is unknown at present. PMID:19822066

Braun, J; Kalden, J R

7

Ankylosing Spondylitis  

Microsoft Academic Search

Ankylosing spondylitis is the product of an interaction between environmental triggers, susceptibility and severity genes, gender, age and ethnic background. It is the prototypical disease of the spondyloarthropathies, a group of disorders characterized by:•involvement of the sacroiliac joints•peripheral arthropathy•absence of rheumatoid factor•pathological changes at the sites of insertion of ligaments or tendons (enthesopathy)•involvement of the heart, lung, skin and eye

Andrei Calin

2002-01-01

8

Ankylosing Spondylitis  

Microsoft Academic Search

\\u000a Ankylosing spondylitis (AS) is a chronic inflammatory disease of the sacroiliac joints and spine that may be associated with\\u000a a variety of extraspinal lesions involving the eye, bowel, and heart. AS usually begins in young adulthood. The natural history\\u000a of AS involves progressive stiffening of the spine, with ankylosis (fusion of some or all spinal joints) occurring after some\\u000a years

DÉSIRÉE VAN DER HEIJDE

9

Clinical measures in rheumatoid arthritis and ankylosing spondylitis.  

PubMed

Except for morning stiffness, the clinical symptoms and the history of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) usually differ: the location in RA is mostly the hands and feet, and in AS rather the back. Patients with RA tend to be older (>50 years) and female, while in AS there are somewhat more often male and younger (<30 years) at onset of inflammatory back pain, the leading clinical symptom. The clinical examination of patients in the early phase of the disease is usually easier in RA, although arthralgia and arthritis may be difficult to differentiate. Joint counts are useful in states of high disease activity with polyarticular flares and more established disease. In comparison, in AS, young patients with back pain frequently show normal physical examens, a reduction of lateral spinal flexion and chest expansion are often the earliest signs which are also sensitive to change on therapy with biologics. The cervical spine may be affected in RA and AS - more frequently in advanced disease stages but rather early cases have been reported. PMID:19822051

Fendler, C; Braun, J

10

Behçet's disease: immunological relevance with arthritis of ankylosing spondylitis.  

PubMed

Behçet's disease (BD) is a multi-system inflammatory disorder, in which cytokine balance is polarized to Th1. In this study, the cell surface molecule expression, Th1/Th2, inflammatory cytokine levels in blood, and synovial fluid of CD3(+) T lymphocytes in BD were investigated. The study group consisted of 10 BD, 10 ankylosing spondylitis (AS) patients with peripheral arthritis, and 10 healthy subjects. Expression of cell surface molecules, intracellular IL-2, IL-5, IL-8, IL-10, IL-12, IFN-?, and TNF-? levels in CD3(+) T lymphocytes were determined by flow cytometry in synovial and peripheral blood mononuclear cells (PBMCs). Synovial and plasma cytokine levels were measured by ELISA and CBA. In PBMCs, CD4, CD25, HLA-DR expression and intracellular IL-12, and TNF-? levels of CD3(+) T lymphocytes were statistically increased in BD patients compared to healthy subjects. Compare to AS patients, CD25 and HLA-DR surface expression and intracellular IFN-? and TNF-? levels in T cells were significantly elevated in BD patients. In BD patients, there was an increase in IL-8 secretion; however, in AS patients, both Th1- and Th2-type cytokines were increased compare to healthy subjects. Intracellular cytokine expression did not show any difference in BD patients; however, IL-12 content of synovial fluid was significantly increased compared to AS patients. Our findings revealed that Th1 polarization occurred in both peripheral blood and synovial fluid of BD patients with arthritis. It is found no difference between synovial fluid analysis of BD and AS patients, showing the similarities in the pathogenesis of both diseases. PMID:22576660

Aktas Cetin, Esin; Cosan, Fulya; Kucuksezer, Umut Can; Bilgic, Sema; Cagatay, Yonca; Gul, Ahmet; Deniz, Gunnur

2012-05-11

11

Genetics of ankylosing spondylitis.  

PubMed

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

Robinson, Philip C; Brown, Matthew A

2013-07-31

12

Classification criteria for rheumatoid arthritis and ankylosing spondylitis.  

PubMed

The history of classification and diagnostic criteria for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is similar and different. Important criteria sets have been published for both disease in the mid eighties, for AS in 1984 and for RA in 1987. The leading clinical symptoms, inflammatory back pain (IBP) in AS and the predominant polyarticular symmetric involvement of the hands in RA were, of course, central, and so was morning stiffness as a major clinical sign of an inflammatory disease state. In RA, there was more focus on laboratory parameters (rheumatoid factor), while this could have been the case also in AS (HLA B27) but this was not recognized at this point in time. In contrast, imaging has played a more important role in AS - especially because the sacroiliac joints are involved in the vast majority of AS patients, while in RA radiographic changes of the joints of hands and feet may contribute to the diagnosis. However, in both diseases, early structural changes visualized by conventional radiography rather have prognostic impact since these patients are much more likely to progress in comparison to others who do not have cartilage and joint damage early in the course of the disease. Further developments of criteria for AS have broadened the spectrum of AS to spondyloarthritis (SpA) and axial SpA which covers most early forms. The leading clinical symptom is chronic back pain in young adults and IBP. New criteria for RA which include more patients with early disease and anti-CCP antibodies as new markers are being developed. This is important since early treatment strategies are increasingly and successfully used to treat inflammatory diseases more efficiently. PMID:19822049

Braun, J; Sieper, J

13

Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report  

PubMed Central

Introduction Concurrent rheumatoid factor seropositivity is occasionally detected in ankylosing spondylitis and often causes confusion in clinical routine. Overlap between various seronegative arthritides is a known but uncommon association. Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly. Case presentation Here, we report the case of a 47-year-old Sri Lankan man who had a long history of intermittent joint pains worsening following a recent episode of self-resolving non-bloody diarrhea. Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis. He had classical radiological evidence of ankylosing spondylosis (previously undiagnosed) associated with human leukocyte antigen B27 antigen, but was positive for rheumatoid factor. Conclusions A disease flare of ankylosing spondylitis prompted by a minor diarrheal illness showing well documented features of reactive arthritis is remarkable. The prognostic implications of seropositivity in spondyloarthritis are discussed.

2012-01-01

14

Atopic disorders in ankylosing spondylitis and rheumatoid arthritis  

PubMed Central

Background: The prevalence of atopic disorders in ankylosing spondylitis (AS) is unknown. AS and rheumatoid arthritis (RA) exhibit divergent T helper (Th) cell cytokine patterns. Objective: To test the hypothesis that Th2 polarised atopic disorders may be decreased in Th1 polarised RA but increased in AS, which is characterised by an impaired Th1 cytokine pattern, by assessing the prevalence of atopic disorders in AS and RA. Methods: 2008 subjects (380 patients with AS, 728 patients with RA, 900 controls) from Berlin, Germany, were considered in this cross sectional study. A questionnaire incorporating questions from the European Community Respiratory Health Service (ECRHS) and the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was mailed to all subjects. Disease severity was assessed by the modified Health Assessment Questionnaire (mHAQ). Results: 1271 (63.3%) people responded to the questionnaire. The prevalence of any atopic disorder was 24.6% (61/248) in patients with AS, 20.7% (111/536) in controls, and 13.1% (64/487) in patients with RA (p=0.0009 for AS v RA; p=0.001 for controls v RA). Hay fever was reported by 40/248 (16.1%) patients with AS, 82/536 (15.3%) controls, and 42/487 (8.6%) patients with RA (p=0.002 for AS v RA; p=0.001 for controls v RA). Atopic dermatitis was reported by 19/248 (7.7%) patients with AS, 26/536 (4.9%) controls, and 14/487 (2.9%) patients with RA (p=0.003 for AS v RA), and asthma by 18/248 (7.3%) patients with AS, 35/536 (6.5%) controls, and 21/487 (4.3%) patients with RA. The differences were related neither to age nor to drugs. Disease severity was less in atopic patients with RA who had the atopic disorder before the onset of RA (median mHAQ 0.75) than in patients in whom RA preceded the atopic disorder (median mHAQ 1.75; p=0.027). Conclusions: Atopic disorders are decreased in RA but only slightly and non-significantly increased in AS. This may imply that atopy confers some protection from RA but only little if any susceptibility to AS. It may further indicate that the cytokine deviation towards an impaired Th1 pattern in AS is less strong than the cytokine deviation towards Th1 in RA, a finding which may affect future therapeutic approaches.

Rudwaleit, M; Andermann, B; Alten, R; Sorensen, H; Listing, J; Zink, A; Sieper, J; Braun, J

2002-01-01

15

Factors Affecting the Sexual Satisfaction of Patients with Rheumatoid Arthritis and Ankylosing Spondylitis  

Microsoft Academic Search

This descriptive study was conducted to determine the sexual satisfaction of patients with rheumatoid arthritis (RA) and ankylosing\\u000a spondylitis (AS) and the factors affecting same. A demographic questionnaire and the evaluation form of sexual satisfaction\\u000a were completed by 33 patients. The patients’ disease activity and functional condition were also evaluated with DAS28 and\\u000a HAQ for RA and the BASDAI and

Yeliz Akku?; Dilek Nakas; Umut Kalyoncu

2010-01-01

16

Anti-agalactosyl IgG antibody in ankylosing spondylitis and psoriatic arthritis  

Microsoft Academic Search

Anti-agalactosyl IgG antibody (anti-Gal(0) IgG) has been regarded as a useful serological marker for rheumatoid arthritis\\u000a (RA). It is unknown whether it is also elevated in serum and implicated in the pathogenesis of joint inflammation in seronegative\\u000a spondyloarthropathy (SpA) such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Sera were collected from 43 patients\\u000a with AS or PsA with axial

Chen-Liang Chou; Min-Jung Wu; Chia-Li Yu; Ming-Chi Lu; Song-Chou Hsieh; Tsai-Hung Wu; Chung-Tei Chou; Chang-Youh Tsai

2010-01-01

17

Common bone turnover markers in rheumatoid arthritis and ankylosing spondylitis: a literature review.  

PubMed

We studied the impact of inflammatory rheumatism and its treatment on the most common bone turnover markers, based on six previously defined questions in a systematic literature review in order to define their place in daily clinical practice. The role of bone is currently considered of particular importance concerning cartilage damage in inflammatory rheumatism (rheumatoid arthritis and ankylosing spondylitis) and the new concept of osteoimmunology has emerged. Some bone turnover markers are available in clinical practice. In spite of rich and extensive literature on bone turnover markers, their use in inflammatory rheumatism or even osteoporosis is not clear, and a systematic literature review became necessary. In spite of a large number of different markers used in literature, few of them that are useful in common practice have been studied in the field of inflammatory rheumatism such as rheumatoid arthritis and ankylosing spondylitis. Although their study enables understanding of the physiopathological mechanisms of osteoporosis in inflammatory rheumatism, their use in current common practice cannot be recommended. Interesting data on the forecast of the structural evolution of rheumatoid arthritis has been found within the framework of clinical research, without any real practical impact today. PMID:23142254

Coiffier, Guillaume; Bouvard, Béatrice; Chopin, Florance; Biver, Emmanuel; Funck-Brentano, Thomas; Garnero, Patrick; Guggenbuhl, Pascal

2012-11-09

18

Recommendations of the French Society for Rheumatology regarding TNF? antagonist therapy in patients with ankylosing spondylitis or psoriatic arthritis: 2007 update  

Microsoft Academic Search

ObjectiveTo update French Society for Rheumatology guidelines regarding the use of tumor necrosis factor ? (TNF?) antagonists for treating patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA).

Thao Pham; Bruno Fautrel; Emmanuelle Dernis; Philippe Goupille; Francis Guillemin; Xavier Le Loët; Philippe Ravaud; Pascal Claudepierre; Corinne Miceli-Richard; Michel de Bandt; Maxime Breban; Jean-Francis Maillefert; Charles Masson; Alain Saraux; Thierry Schaeverbeke; Daniel Wendling; Xavier Mariette; Bernard Combe

2007-01-01

19

A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments  

PubMed Central

Objective: : To analyse the disease course of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) during and after pregnancy by validated clinical instruments for measurement of disease activity, and assess their usefulness in pregnant patients. Methods: Included were 10 patients with RA and 9 with AS (10 pregnancies). Clinical examination and blood/urine sampling was performed before conception, at each trimester, and weeks 6, 12, and 24 post partum. Assessment of RA was by the RA Disease Activity Index (RADAI), the 44 joint count, and the Health Assessment Questionnaire; assessment of AS by the Bath Ankylosing Spondylitis Activity Index (BASDAI), the Dougados Functional and Articular Index, and a night pain index. Common for all patients were the patient's and physician's global assessment. Results: : Most patients with RA showed sustained or increased improvement of disease activity during pregnancy. Higher disease activity scores were found in the patients with AS with a frequent increase of disease activity in the second trimester and mitigation of symptoms in the third trimester. Analysis specifically for the patient's assessment of pain showed continuously higher pain scores in the patients with AS than in those with RA. Rank correlation showed good to moderate correlation between most clinical measurements and RADAI or BASDAI, respectively. Functional indices were confounded by physiological changes of late pregnancy. Conclusion: RA can be monitored during and after pregnancy by the swollen joint count and RADAI without interference from pregnancy related symptoms, whereas usual measures of disease activity are not always applicable in pregnant patients with AS.

Ostensen, M; Fuhrer, L; Mathieu, R; Seitz, M; Villiger, P

2004-01-01

20

Imaging in ankylosing spondylitis  

PubMed Central

Imaging is an integral part of the management of patients with ankylosing spondylitis and axial spondyloarthritis. Characteristic radiographic and/or magnetic resonance imaging (MRI) findings are key in the diagnosis. Radiography and MRI are also useful in monitoring the disease. Radiography is the conventional, albeit quite insensitive, gold standard method for assessment of structural damage in spine and sacroiliac joints, whereas MRI has gained a decisive role in monitoring disease activity in clinical trials and practice. MRI may also, if ongoing research demonstrates a sufficient reliability and sensitivity to change, become a new standard method for assessment of structural damage. Ultrasonography allows visualization of peripheral arthritis and enthesitis, but has no role in the assessment of axial manifestations. Computed tomography is a sensitive method for assessment of structural changes in the spine and sacroiliac joints, but its clinical utility is limited due to its use of ionizing radiation and lack of ability to assess the soft tissues. It is exciting that with continued dedicated research and the rapid technical development it is likely that even larger improvements in the use of imaging may occur in the decade to come, for the benefit of our patients.

Lambert, Robert G.W.

2012-01-01

21

Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?  

PubMed Central

OBJECTIVE—In 1971 McEwen and colleagues suggested that the radiological changes of classic ankylosing spondylitis (AS), and the changes of the spondylitis associated with inflammatory bowel disease differ in several respects from the radiological features of psoriatic and reactive spondylitis. The findings of this study have never been confirmed. The aim of this study was to replicate the McEwen study comparing films blinded to diagnostic group.?METHODS—The study population comprised 91 patients with classic AS, 15 patients with regional enteritis, 16 patients with ulcerative colitis, five patients with sexually acquired reactive arthritis, two with post-dysenteric arthritis, and 34 with psoriatic arthritis. Blinded reading of spinal radiographs was undertaken, scoring for severity, symmetry, paravertebral ossification, size of syndesmophytes, ligamentous calcification, squaring, discitis, pseudo-fractures, zygoapophyseal joint involvement, and complete ankylosis.?RESULTS—Comparison of the four groups—classic, enteropathic, psoriatic, and reactive AS— showed differences with respect to symmetry of sacroiliitis, symmetry of lumbar spinal involvement, and frequency and size of syndesmophytes. Zygoapophyseal joint involvement was more frequent in the lumbar spine in classic and enteropathic spondylitis but no between group differences were found with respect to symphisitis, squaring, apophyseal joint involvement and ligamentous calcification in the lumbar spine, and other areas.?CONCLUSIONS—Some of the radiological differences described by McEwen et al, notably the asymmetry, the less severe changes, and the distinctive syndesmophytes in psoriasis, have been confirmed. A number of hypotheses are proposed to explain these differences including biomechanical, biochemical, and genetic factors.?? Keywords: psoriatic arthritis; ankylosing spondylitis; reactive arthritis; inflammatory bowel disease

Helliwell, P; Hickling, P; Wright, V

1998-01-01

22

Cardiovascular manifestations of ankylosing spondylitis.  

PubMed

The incidence of cardiovascular lesions in 97 patients with ankylosing spondylitis (AS) was found to be 14%; 8 patients had isolated aortic insufficiency (AI), 3 had isolated heart block, 2 had combined AI and heart block, and 1 had mitral insufficiency. In comparison with control groups of 81 patients with rheumatoid arthritis and 99 random hospital patients there was no increased incidence of isolated heart block in patients with AS. Clinical and postmortem findings indicated that the cardiovascular lesions of some patients with AS may antedate articular disease and may regress spontaneously. In addition, the unusual occurrence of AI in two patients with psoriatic spondylitis and in one with AS and regional enteritis is documented. PMID:4442013

Kinsella, T D; Johnson, L G; Ian, R

1974-12-21

23

Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age  

PubMed Central

Objective: To investigate the relationship between work and quality of life (QOL) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) aged 16–59. Methods: 1056 patients with RA and 658 with AS were included in the study. Data were obtained by postal questionnaire, which included several generic and disease related QOL instruments. Separate dimensions and physical and mental summary scores from the SF-36 were compared. Stepwise multiple regression was performed to study the relationship between work and physical and mental health related QOL, including disease related factors, coping, and fatigue. Results: Physical health related QOL was reported to be worse, and mental health related QOL better, in RA than in AS in people of working age. No differences between RA and AS were found in somatic pain, physical role functioning, social functioning, emotional role functioning, vitality, or general health perception; nor were there any significant differences in fatigue and behavioural coping styles. Work was positively associated with physical health related QOL in both groups and, after disease characteristics, was the most important determinant. No association was found with mental health related QOL. Conclusions: Although physical health related QOL was worse in patients with RA, the impact on several dimensions of health related QOL in patients with RA and AS of working age under rheumatological care was comparable. Patients with RA and AS experienced similar limitations in physical role functioning, including work. Work is an important independent external determinant of physical health related QOL, but not of mental health related QOL.

Chorus, A; Miedema, H; Boonen, A; van der Linden, S.

2003-01-01

24

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

PubMed

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are autoimmune, inflammatory diseases with substantial genetic contributions. Matrix metalloproteinase (MMP)-2, tumor necrosis factor (TNF)-? and NLR family pyrin domain-containing 1 (NLRP1) play important roles in the immune response. We studied the MMP-2 rs243865 C/T, TNF-? 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-? 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

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

2013-09-25

25

Antibody responses to gut bacteria in ankylosing spondylitis, rheumatoid arthritis, Crohn's disease and ulcerative colitis  

Microsoft Academic Search

Specific immunoreactive anti-Klebsiella antibodies are found in patients with ankylosing spondylitis (AS), a significant proportion of whom have occult inflammatory\\u000a bowel disease. Molecular mimicry between Klebsiella or other bacterial antigens and HLA-B27 has been suggested in the pathogenesis of AS. The specificity of increased immunoreactivity\\u000a against Klebsiella remains to be assessed against the abundant anaerobic bacterial flora, present either in

H. Tiwana; C. Wilson; R. S. Walmsley; A. J. Wakefield; M. S. N. Smith; N. L. Cox; M. J. Hudson; A. Ebringer

1997-01-01

26

Antibody responses to gut bacteria in ankylosing spondylitis, rheumatoid arthritis, Crohn's disease and ulcerative colitis.  

PubMed

Specific immunoreactive anti-Klebsiella antibodies are found in patients with ankylosing spondylitis (AS), a significant proportion of whom have occult inflammatory bowel disease. Molecular mimicry between Klebsiella or other bacterial antigens and HLA-B27 has been suggested in the pathogenesis of AS. The specificity of increased immunoreactivity against Klebsiella remains to be assessed against the abundant anaerobic bacterial flora, present either in healthy controls or in patients with ulcerative colitis (UC) and Crohn's disease (CD). Total immunoglobulin (Ig; IgG, IgA, IgM) immunoreactivity was measured by ELISA against Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli and ten anaerobic isolates of the predominant normal bowel flora in 35 patients with active AS, 60 patients with inflammatory bowel disease (30 CD, 30 UC), 60 patients with active rheumatoid arthritis (RA) and 60 healthy controls. Ig immunoreactivity to K. pneumoniae was significantly elevated in AS (P < 0.001), CD (P < 0.001) and UC (P < 0.001) patients compared with RA patients and healthy controls. Furthermore, Ig immunoreactivity to P. mirabilis was significantly elevated only in RA patients, compared with the other inflammatory groups (P < 0.001) and controls (P < 0.001). There was no significant antibody response against E. coli or the ten obligate anaerobes in any of the test groups. The data suggested an increased immune response to Klebsiella in patients with AS, UC, CD and to Proteus in patients with RA. The specificity of these responses in some patients supported a possible role for enteric Klebsiella in the pathogenesis of AS and Proteus in RA. The role of Klebsiella in inflammatory bowel disease requires further study. PMID:9194209

Tiwana, H; Wilson, C; Walmsley, R S; Wakefield, A J; Smith, M S; Cox, N L; Hudson, M J; Ebringer, A

1997-01-01

27

Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?  

Microsoft Academic Search

OBJECTIVEIn 1971 McEwen and colleagues suggested that the radiological changes of classic ankylosing spondylitis (AS), and the changes of the spondylitis associated with inflammatory bowel disease differ in several respects from the radiological features of psoriatic and reactive spondylitis. The findings of this study have never been confirmed. The aim of this study was to replicate the McEwen study comparing

P S Helliwell; P Hickling; V Wright

1998-01-01

28

The spectrum of ankylosing spondylitis.  

PubMed

Sacroiliac involvement is an early hallmark, but even so, patients with ankylosing spondylitis present a remarkable spectrum of disease. Research probing associations among spondylitis, enteric bacterial infection, and host expression of HLA-B27 may offer etiologic clues and point the way to disease-specific therapies. PMID:7601896

Harley, J B; Scofield, R H

1995-07-15

29

Ankylosing spondylitis associated with Trichomonas vaginalis infection.  

PubMed Central

A patient is described who developed signs and symptoms of ankylosing spondylitis after prostatitis due to Trichomonas vaginalis. Chronic prostatitis of unknown cause had previously been reported as being common in patients with ankylosing spondylitis. The observations in this case raise the possibility that T. vaginalis might play a role in the prostatitis and pathogenesis of ankylosing spondylitis in some patients.

Kuberski, T T

1981-01-01

30

Cell-mediated immune responses of synovial mononuclear cells to sexually transmitted, enteric and mumps antigens in patients with Reiter's syndrome, rheumatoid arthritis and ankylosing spondylitis.  

PubMed

3H-thymidine uptake responses by synovial mononuclear cells to stimulation with sexually transmitted, enteric and mumps antigens were studied in 12 patients with "sexually transmitted Reiter's syndrome", 5 with "enteric Reiter's syndrome", 5 with rheumatoid arthritis, 4 with ankylosing spondylitis and 10 with "indolent arthritis of one knee." The "sexually transmitted" and salmonella cases were distinguishable by the responses. Synovial responses were sometimes marked when peripheral blood responses were negligible. PMID:6785434

Ford, D K; da Roza, D M; Shah, P

31

Fibromyalgia in women with ankylosing spondylitis  

Microsoft Academic Search

Fibromyalgia (FM), pre-dominantly found in women, may accompany other pre-existing rheumatic diseases. The association between\\u000a FM and ankylosing spondylitis (AS) is uncertain. We evaluated FM in women with AS. Eighteen women with AS were compared with\\u000a 18 men with AS (controls) for age, duration of symptoms, time to diagnosis, degree of sacroiliac involvement, history of peripheral\\u000a arthritis, patient global assessment,

Valerie Aloush; Jacob N. Ablin; Tatiana Reitblat; Dan Caspi; Ori Elkayam

2007-01-01

32

Health-related quality of life in patients with rheumatoid arthritis and in patients with ankylosing spondylitis.  

PubMed

In this review the influence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) on a wide range of health-related quality of life (HRQoL) domains will be described. The domains most frequently studied are pain, functional disability, fatigue and mental problems. In addition, age and socio-economic aspects such as employment and economic status as well as education affect patient-reported HRQoL.Although many studies have assessed the impact on HRQoL of a single disease state, either RA or AS, few studies have focused on a direct comparison between those both diagnostic groups. In general, patients with RA and AS report significant decrements in HRQoL in comparison with the general population. It has been shown that the magnitude of the impairment is similar among both patients group. PMID:19822055

Kiltz, U; van der Heijde, D

33

Ankylosing spondylitis: an overview  

PubMed Central

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 ? 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.

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

2002-01-01

34

IgM, IgG and IgA class enterobacterial antibodies in serum and synovial fluid in patients with ankylosing spondylitis and rheumatoid arthritis  

Microsoft Academic Search

SUMMARY IgM, IgG and IgA class antibodies against three Klebsiella pneumoniae capsular types, Escherichia coli and Proteus mirabilis, as well as total immunoglobulin concentrations, were measured by enzyme immunoassay and radial immunodiÄusion tech- nique, respectively, in paired serum and synovial fluid samples from eight patients with ankylosing spondylitis and 10 with rheumatoid arthritis. No clear evidence for intra-articular antibody production

O. MAKI-IKOLA; M. PENTTINEN; R. VON ESSEN; C. GRIPENBERG-LERCHE; H. ISOMAKI; K. GRANFORS

1997-01-01

35

Efficacy of cyclo-oxygenase-2 inhibition by etoricoxib and naproxen on the axial manifestations of ankylosing spondylitis in the presence of peripheral arthritis  

Microsoft Academic Search

Objective: The combined efficacy of selective and non-selective cyclo-oxygenase-2 (COX-2) inhibition on the axial manifestations of ankylosing spondylitis (AS) in the presence or absence of chronic peripheral arthritis was evaluated.Methods: In a post hoc subgroup analysis of a 6 week, randomised, double blind, placebo controlled trial, 387 patients with active axial AS were randomised to receive etoricoxib 90 mg or

L Gossec; D van der Heijde; A Melian; D A Krupa; M K James; P F Cavanaugh; A S Reicin; M Dougados

2005-01-01

36

[Antibodies to Klebsiella pneumoniae in ankylosing spondylitis].  

PubMed

The authors investigated the incidence of antibodies against Klebsiella pneumoniae and E. coli in a group of patients with ankylosing spondylitis and in a group of healthy controls in all main immunoglobulin classes. The results revealed that in patients with ankylosing spondylitis there is a significantly higher incidence of specific antibodies of class IgA against Klebsiella pneumoniae and E. coli. This supports the thesis on the aetiopathogenetic interrelationship between enteric bacteria and the development of ankylosing spondylitis. PMID:2676185

Mateicka, F; Kozáková, D; Cebecauer, L; Ondrasík, M; Bosmanský, K

1989-01-27

37

Fibromyalgia in women with ankylosing spondylitis.  

PubMed

Fibromyalgia (FM), pre-dominantly found in women, may accompany other pre-existing rheumatic diseases. The association between FM and ankylosing spondylitis (AS) is uncertain. We evaluated FM in women with AS. Eighteen women with AS were compared with 18 men with AS (controls) for age, duration of symptoms, time to diagnosis, degree of sacroiliac involvement, history of peripheral arthritis, patient global assessment, Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, level of diffuse pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Physical examination included the number of tender points and enthesitis sites, Schober test, distance between occiput and wall, chest expansion, lateral spinal flexion, and intermalleolar distance. Inflammatory activity was measured by the erythrocyte sedimentation rate (ESR). Of all tested parameters, the ones with significant differences between the groups were time between symptom onset and AS diagnosis (longer for women), FM incidence and the number of tender points and enthesitis sites (higher for women), BASDAI (higher in women and correlated with FM and the number of tender points but not with ESR), and BASFI and BASDAI scores (increased in FM patients). FM was present in 50% of women with AS and associated with higher disease activity indices (BASDAI and BASFI) and not related to severity of physical findings or ESR. The reliability of well-accepted assessment tools of AS, such as BASDAI and BASFI, in evaluating AS activity in women may be called into question due to a confounding effect of FM. PMID:17476510

Aloush, Valerie; Ablin, Jacob N; Reitblat, Tatiana; Caspi, Dan; Elkayam, Ori

2007-05-03

38

Celecoxib: a review of its use for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.  

PubMed

Celecoxib (Celebrex®) was the first cyclo-oxygenase (COX)-2 selective inhibitor (coxib) to be introduced into clinical practice. Coxibs were developed to provide anti-inflammatory/analgesic activity similar to that of nonselective NSAIDs, but without their upper gastrointestinal (GI) toxicity, which is thought to result largely from COX-1 inhibition. Celecoxib is indicated in the EU for the symptomatic treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in adults. This article reviews the clinical efficacy and tolerability of celecoxib in these EU-approved indications, as well as overviewing its pharmacological properties. In randomized controlled trials, celecoxib, at the recommended dosages of 200 or 400?mg/day, was significantly more effective than placebo, at least as effective as or more effective than paracetamol (acetaminophen) and as effective as nonselective NSAIDs and the coxibs etoricoxib and lumiracoxib for the symptomatic treatment of patients with active osteoarthritis, rheumatoid arthritis or ankylosing spondylitis. Celecoxib was generally well tolerated, with mild to moderate upper GI complaints being the most common body system adverse events. In meta-analyses and large safety studies, the incidence of upper GI ulcer complications with recommended dosages of celecoxib was significantly lower than that with nonselective NSAIDs and similar to that with paracetamol and other coxibs. However, concomitant administration of celecoxib with low-dose cardioprotective aspirin often appeared to negate the GI-sparing advantages of celecoxib over NSAIDs. Although one polyp prevention trial noted a dose-related increase in cardiovascular risk with celecoxib 400 and 800?mg/day, other trials have not found any significant difference in cardiovascular risk between celecoxib and placebo or nonselective NSAIDs. Meta-analyses and database-derived analyses are inconsistent regarding cardiovascular risk. At recommended dosages, the risks of increased thrombotic cardiovascular events, or renovascular, hepatic or hypersensitivity reactions with celecoxib would appear to be small and similar to those with NSAIDs. Celecoxib would appear to be a useful option for therapy in patients at high risk for NSAID-induced GI toxicity, or in those responding suboptimally to or intolerant of NSAIDs. To minimize any risk, particularly the cardiovascular risk, celecoxib, like all coxibs and NSAIDs, should be used at the lowest effective dosage for the shortest possible duration after a careful evaluation of the GI, cardiovascular and renal risks of the individual patient. PMID:22141388

McCormack, Paul L

2011-12-24

39

Diagnosis of Ankylosing Spondylitis  

MedlinePLUS

... may not be of much help. A simple ESR (erythrocyte sedimentation rate), also known as sed rate, ... 70% of people with AS have a raised ESR level. Finally, there is no association with ankylosing ...

40

Animal models of ankylosing spondylitis  

Microsoft Academic Search

The pathology of ankylosing spondylitis (AS) and related spondyloarthropathies (SpA) characteristically involve a sacroiliitis\\u000a and inflammation of the intervertebral discs (IVD) in the lumbar spine, and an enthesitis at sites of ligamentous insertions\\u000a into bone. The proteoglycans aggrecan and versican are large molecules that aggregate with hyaluronic via a globular 1 domain.\\u000a These domains share significant homology at the level

Yiping Zhang; Shuilang Shi; Christina Ciurli; A. Robin Poole

2002-01-01

41

[Renal abnormalities in ankylosing spondylitis].  

PubMed

We will study the epidemiologic, clinical, biological, therapeutic, prognostic characteristics and predictive factors of development of nephropathy in ankylosing spondylitis patients. We retrospectively reviewed the medical record of 32 cases with renal involvement among 212 cases of ankylosing spondylitis followed in our service during the period spread out between 1978 and 2006. The renal involvement occurred in all patients a mean of 12 years after the clinical onset of the rheumatic disease. Thirty-two patients presented one or more signs of renal involvement: microscopic hematuria in 22 patients, proteinuria in 23 patients, nephrotic syndrome in 11 patients and decreased renal function in 24 patients (75%). Secondary renal amyloidosis (13 patients), which corresponds to a prevalence of 6,1% and tubulointerstitial nephropathy (7 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (4 patients). Seventeen patients evolved to the end stage renal disease after an average time of 29.8 ± 46 months. The average follow-up of the patients was 4,4 years. By comparing the 32 patients presenting a SPA and renal disease to 88 with SPA and without nephropathy, we detected the predictive factors of occurred of nephropathy: tobacco, intense inflammatory syndrome, sacroileite stage 3 or 4 and presence of column bamboo. The finding of 75% of the patients presented a renal failure at the time of the diagnosis of renal involvement suggests that evidence of renal abnormality involvement should be actively sought in this disease. PMID:22520483

Samia, Barbouch; Hazgui, Faiçal; Abdelghani, Khaoula Ben; Hamida, Fethi Ben; Goucha, Rym; Hedri, Hafedh; Taarit, Chokri Ben; Maiz, Hedi Ben; Kheder, Adel

2012-04-18

42

Spine fractures in ankylosing spondylitis.  

PubMed

Patients with ankylosing spondylitis are susceptible to spine fracture, usually in the cervical spine. Less frequently, the thoracic and lumbar spine is affected. The fracture line may involve anterior and posterior elements. Frequently, it extends through the entire width of the spine. As a result the fracture tends to be unstable and may cause neurologic damage. Prompt immobilization and reduction of the dislocated spine followed by stabilization may prevent neurologic damage. We report a 45-year-old man who fell and sustained a fracture dislocation of L2 vertebra. The patient was operated and stabilized with Harrington rods. A deep wound infection developed, which did not respond to antibiotic therapy and led to removal of the rods. In spite of bed immobilization with a body jacket the fracture remained unstable and dislocated. As a result the patient sustained severe neurologic damage. Many fractures in patients with ankylosing spondylitis occur following minor trauma. We feel that a very important aspect of ankylosing spondylitis management is prevention of these fractures. Alerting patients of their spine fragility and teaching then how to evade situations leading to spinal trauma may help in avoiding this situation. PMID:3767633

Fast, A; Parikh, S; Marin, E L

1986-09-01

43

[Some aspects of pathogenesis of ankylosing spondylitis].  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease of the spine (spondylitis) and sacroiliac joints (sacroileitis) associated in many cases with inflammatory affection of the peripheral joints (arthritis), entesises (entesitis), eyes (uveitis), intestine (enteritis) and aortic root (aortitis). AS is considered now as a prototype of diseases from the group of seronegative spondyloarthritis. AS is a hereditary disease. Predisposition to AS (90%) is associated with genetic factors the key gene of which is HLA-B27. As pathogenesis of AS is not still verified, three hypotheses are considered basing on HLA-B27 biology. The role of environmental factors involved in AS development (tension in enteses and infection) are discussed. PMID:21780658

Erdes, Sh

2011-01-01

44

Definition of disease duration in ankylosing spondylitis: reassessing the concept  

PubMed Central

The concept and definition of disease duration in patients with ankylosing spondylitis is ambiguous, and often many years pass between the onset of symptoms and diagnosis. Members of the Assessment in Ankylosing Spondylitis (ASAS) International Working Group by consensus recently recommended identifying specific components of the medical history to better define and document the concept of disease duration. These include (1) the time of onset of the first symptoms of axial manifestations (including inflammatory back pain); (2) the time of onset of the first symptoms of each individual manifestation, which may be an extra?axial sign or symptom of ankylosing spondylitis, such as peripheral arthritis and enthesitis; (3) the time of onset of associated diseases belonging to the spondyloarthritides, in particular acute anterior uveitis, inflammatory bowel disease and psoriasis; and (4) the time since actual diagnosis by a healthcare provider. Such uniformity in data collection will ensure comparability across studies and facilitate future research.

Davis, J C; Dougados, M; Braun, J; Sieper, J; van der Heijde, D; van der Linden, S

2006-01-01

45

Neurological complications of ankylosing spondylitis: neurophysiological assessment  

Microsoft Academic Search

Studies examined the neurological involvement of ankylosing spondylitis (AS) are limited. This study aimed to assess the frequency\\u000a of myelopathy, radiculopathy and myopathy in AS correlating them to the clinical, radiological and laboratory parameters.\\u000a Included were 24 patients with AS. Axial status was assessed using bath ankylosing spondylitis metrology index (BASMI). Patients\\u000a underwent (a) standard cervical and lumbar spine and

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

2009-01-01

46

Skeletal Status of Men with Early and Late Ankylosing Spondylitis fn1 fn1 Supported by Northern California Arthritis Foundation, the Bartman Foundation Fund for Ankylosing Spondylitis Research, and the Research Service, Department of Veterans Affairs  

Microsoft Academic Search

PURPOSE: To assess the influence of extent of disease on the skeletal status of men with ankylosing spondylitis (AS).PATIENTS AND METHODS: Fourteen men with AS were studied at entry and again after 15 months. Bone mineral density (BMD) was assessed by single photon absorptiometry (SPA), dual energy x-ray absorptiometry (DXA), and quantitative computed tomography (QCT). Calciotropic hormones and bone turnover

1997-01-01

47

Are there new emerging drugs for ankylosing spondylitis or spondyloarthritis?  

PubMed

New emerging drugs in the treatment of ankylosing spondylitis (AS), and spondyloarthritis in general, should be compared to anti-TNF agents, which provided clear evidence of efficacy in these conditions. To date, other biologic agents used in rheumatoid arthritis failed to demonstrate efficacy in AS, even in anti-TNF naïve patients. Some new potential options may target cytokines such as IL-17, or molecules involved in entheseal ossification or signaling pathways, but need confirmatory evaluation. PMID:23216081

Wendling, Daniel

2012-12-07

48

Conventional treatments for ankylosing spondylitis  

PubMed Central

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.

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

2002-01-01

49

Conventional treatments for ankylosing spondylitis.  

PubMed

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

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

2002-12-01

50

Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome.  

PubMed

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

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

2013-05-21

51

Serum nitrate and nitrite levels in patients with rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis  

PubMed Central

Methods: Thirty five patients with RA, 32 patients with AS, and 36 patients with OA were entered into this study. In addition, 30 healthy volunteers acted as a control group. Concentrations of nitrate and nitrite in serum were determined by direct and indirect Griess reactions. C reactive protein and erythrocyte sedimentation rate levels were determined as markers of systemic activity of disease (SAD) in RA and AS groups. Results: Serum nitrate and nitrite levels were found to be higher in patients with AS and RA than in the OA group (p<0.01). In addition, serum nitrate and nitrite levels were higher in all three groups than in the control group (p<0.01). Moreover, serum nitrate and nitrite levels were higher in patients who had SAD than in those who had not in the RA and AS groups (p<0.01 and p<0.05, respectively), and there was a correlation between serum nitrate and nitrite concentrations and SAD variables in patients with RA (Spearman's rs=0.414, p<0.05 and rs=0.408, p<0.05, respectively) and AS (rs=0.421, p<0.05 and rs=0.412, p<0.05, respectively). Conclusion: The findings suggest that nitrate and nitrite production is enhanced in patients with inflammatory arthritis compared with OA. In addition, serum nitrate and nitrite levels are enhanced in patients with RA, AS, and OA compared with healthy subjects. Furthermore, there is a correlation between the SAD variables and serum nitrate and nitrite levels in patients with RA and AS.

Ersoy, Y; Ozerol, E; Baysal, O; Temel, I; MacWalter, R; Meral, U; Altay, Z

2002-01-01

52

Sexual functions in ankylosing spondylitis.  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse. PMID:20238218

Bal, Serpil; Bal, Kaan; Turan, Yasemin; Deniz, Gonca; Gürgan, Alev; Berkit, I??l Karata?; Sendur, Omer Faruk

2010-03-18

53

Treat Ankylosing Spondylitis with Methazolamide  

PubMed Central

Background: Increased bone resorption and new bone information are two characteristics of ankylosing spondylitis (AS). Much evidence has shown that carbonic anhydrase inhibitors can restrain bone resorption. We had detected increased expression of carbonic anhydrase I (CA1) in synovium of patients with AS. This study aimed to evaluate the effectiveness and safety of methazolamide, an anti-carbonic anhydrase drug, for treating patients with AS. Methods: Two patients, called as S and L, were diagnosed with active AS based on BASDAI and BASFI assessments, radiographic data and other clinical indices. They took methazolamide tablets at a dose of 25 mg twice every day. Results: Patient S's BASDAI score fell from 5.4 to 4.4, while patient L's BASDAI fell from 2.4 to 2. Patient S's BASFI score change from 2.7 to 2.9, while patient L's BASFI score fell from 1.2 to 0.2. The ESR values of patient S were considerably reduced, while the ESR value of patient L remained unchanged and in the normal range. The calcium concentration of patient S decreased from 3.05 mmol/L to 2.39 mmol/L. The CT evidence indicates that the articular surfaces of the erosive sacroiliac joints became clearer and the area of the calcium deposits began decreased. No significant systemic side effects were observed in either patient. Conclusions: The above results indicate that methazolamide was effective for active AS. Methazolamide may improve AS symptoms by inhibiting carbonic anhydrase activity during the processes of bone reporption and new bone formation.

Chang, Xiaotian; Yan, Xinfeng; Zhang, Yunzhong

2011-01-01

54

Radiation-induced leukemias in ankylosing spondylitis  

SciTech Connect

Three cases of leukemia occurred in patients with ankylosing spondylitis treated by radiotherapy. In each case, the leukemic process exhibited bizarre features suggesting that radiation is likely to induce atypical forms of leukemia possessing unusual attributes not shared by spontaneously developing leukemia. The likely distinctive aspects of radiation-induced leukemia are discussed.

Toolis, F. (Royal Infirmary, Edinburgh, UK); Potter, B.; Allan, N.C.; Langlands, A.O.

1981-10-01

55

Breakthroughs in genetic studies of ankylosing spondylitis  

Microsoft Academic Search

Ankylosing spondylitis (AS), the prototypic seronegative arthropathy, is known to be highly heritable, with >90% of the risk of developing the disease determined genetically. As with most common heritable diseases, progress in identifying the genes involved using family-based or candidate gene approaches has been slow. The recent development of the genome-wide association study approach has revolutionized genetic studies of such

M. A. Brown

2008-01-01

56

[Radon within therapeutic strategies of ankylosing spondylitis].  

PubMed

For more than fifty years patients with rheumatic diseases have been treated in the thermal gallery of Bad Gastein, main indication is ankylosing spondylitis. Experiences of this kind of spa treatment on several hundred patients and randomised controlled clinical trials document the positive treatment effect of spa therapy with Radon which lasts for up to 40 weeks. PMID:18500473

Herold, Manfred; Lind-Albrecht, Gudrun

2008-01-01

57

Urolithiasis in ankylosing spondylitis: Correlation with Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis metrology index (BASMI)  

PubMed Central

Background: Increased incidence of renal stone has been reported in ankylosing spondylitis (AS), but unlike some well-known renal involvements, they have not been fully studied. The aim of this study was to investigate the association of AS with urolithiasis and also the relation between urinary stone and severity markers. Methods: One hundred-sixty three AS patients were included in a cross-sectional study from Iranian AS association, Iran Rheumatology Center and Rheumatology Clinic of Shariati Hospital in Tehran. Prevalence of urolithiasis in AS patients was compared with results of a nationwide survey in Iran. Bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI) and bath ankylosing spondylitis metrology index (BASMI) were determined for assessment of disease severity. Results: Urolithiasis was observed in 11.7% of AS patients versus 5.7% of normal population (p=0.001). After the elimination of corticosteroid effect, the prevalence of urolithiasis was still higher in AS patients than normal population but without maintaining significant difference. Significant higher values of BASFI, BASMI, BASDAI scores were observed in AS with urolithiasis than AS without urolithiasis. Conclusion: The results confirmed the association of AS with urolithiasis. However, this may be partly due to the effect of other factors such as corticosteroid. Moreover, urolithiais is accompanied with more severe diseases.

Fallahi, Sasan; Jamshidi, Ahmad Reza; Gharibdoost, Farhad; Mahmoud, Mahdi i; Paragomi, Pedram; Nicknam, Mohammad Hossein; Farhadi, Elham; Qorbani, Mostafa

2012-01-01

58

[Rehabilitation and outpatient physiotherapy in rheumatic disease patients. Results of cross-sectional studies of patients with rheumatoid arthritis or ankylosing spondylitis and rheumatologists].  

PubMed

Rehabilitation and outpatient physiotherapy were investigated from the perspectives of patients suffering from rheumatoid arthritis (RA) or ankylosing spondylitis (AS) and of rheumatologists. In 2007, 204 outpatients with RA and 47 with AS at the Arthritis Center in Halle, Germany, and 117 rheumatologists from all over the country participated in two questionnaire surveys. Patients and rheumatologists gave predominantly positive judgements of physiotherapy, psychological interventions, and patient education programs. However, outpatient care including these interventions was judged to be mainly limited by fixed budgets and other formal restrictions. Even though these therapeutic options are part of (primarily inpatient) rehabilitation programs, the estimate of the need for multidisciplinary rehabilitation programs varied widely among the rheumatologists. Significant objections against rehabilitation include reluctance of the patients, administrative burden for the physicians, payers' rejections, and limited choice of rehabilitation clinic. Despite major functional limitations, a substantial portion of the patients received no multidisciplinary medical rehabilitation, outpatient physiotherapy, psychological interventions, or patient education. Recommendations for the improvement of care are derived from these data. PMID:18825393

Mau, W; Müller, A

2008-11-01

59

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

PubMed Central

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.

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; F?rre, ?ystein; 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-Onate, Raphael; Romero-Sanchez, 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

60

Spinal fractures in patients with ankylosing spondylitis  

Microsoft Academic Search

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60±11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in

C. Olerud; A. Frost; J. Bring

1996-01-01

61

Socioeconomic impact of ankylosing spondylitis in Morocco  

Microsoft Academic Search

The goal of this study was to determine the impact of ankylosing spondylitis (AS) on the socioeconomic well-being of Moroccan\\u000a patients. One hundred (100) consecutive AS patients (71 men, 29 women) were included. The socioeconomic consequences were\\u000a studied by measuring direct costs, indirect costs (consequences on work capacity), and intangible costs (social impact) of\\u000a AS. The mean age at AS

Hanan Rkain; Fadoua Allali; Aziza Bentalha; Noufissa Lazrak; Redouane Abouqal; Najia Hajjaj-Hassouni

2007-01-01

62

Treatment of ankylosing spondylitis: focus on etanercept  

PubMed Central

Ankylosing spondylitis is a chronic inflammatory condition which preferentially affects the axial skeleton, often beginning in the sacroiliac joints. The etiology of the pathologic lesions of this condition including enthesitis, erosive articular changes, osteitis, and fibrous ankylosis, as well as changes which occur in the eye, gastrointestinal tract, cardiovascular system, and lungs is unknown; however, there is a strong association with HLA-B27, which indicates altered immunity. One of the major mediators of the immune response is TNF-?, which functions as a pleiotrophic soluble messenger primarily from macrophages. TNF-? is principally involved with activation of both normal and transformed cells, including endothelium, synoviocytes, osteoclasts, chondrocytes, and fibroblasts. The cornerstone of medical management of ankylosing spondylitis includes intensive physical therapy and nonsteroidal anti-inflammatories for symptomatic relief. However, it is becoming increasingly recognized that TNF-? blockade has an important role in the reduction of spine and joint inflammation. This review discusses the data that supports use of etanercept in the treatment of ankylosing spondylitis.

Frech, Tracy

2007-01-01

63

Imbalance between HAT and HDAC Activities in the PBMCs of Patients with Ankylosing Spondylitis or Rheumatoid Arthritis and Influence of HDAC Inhibitors on TNF Alpha Production  

PubMed Central

Objective Acetylation or deacetylation of histone proteins may modulate cytokine gene transcription such as TNF alpha (TNF). We evaluated the balance between histone deacetytlase (HDAC) and histone acetyltransferase (HAT) in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) compared to healthy controls (HC) and determined the influence of HDAC inhibitors (trichostatin A -TSA- or Sirtinol -Sirt-) on these enzymatic activities and on the PBMC production of TNF. Methods 52 patients with RA, 21 with AS and 38 HC were evaluated. HAT and HDAC activities were measured on nuclear extracts from PBMC using colorimetric assays. Enzymatic activities were determined prior to and after ex vivo treatment of PBMC by TSA or Sirt. TNF levels were evaluated in PBMC culture supernatants in the absence or presence of TSA or Sirt. Results HAT and HDAC activities were significantly reduced in AS, while these activities reached similar levels in RA and HC. Ex vivo treatment of PBMC by HDACi tended to decrease HDAC expression in HC, but Sirt significantly reduced HAT in RA. TNF production by PBMC was significantly down-regulated by Sirt in HC and AS patients. Conclusion HAT and HDAC were disturbed in AS while no major changes were found in RA. HDACi may modulate HDAC and HAT PBMC expression, especially Sirt in RA. Sirtinol was able to down regulate TNF production by PBMC in HC and AS. An imbalance between HAT and HDAC activities might provide the rationale for the development of HDACi in the therapeutic approach to inflammatory rheumatic diseases.

Toussirot, Eric; Abbas, Wasim; Khan, Kashif Aziz; Tissot, Marion; Jeudy, Alicia; Baud, Lucile; Bertolini, Ewa; Wendling, Daniel; Herbein, Georges

2013-01-01

64

Safety of tumor necrosis factor inhibitors use for rheumatoid arthritis and ankylosing spondylitis in Africa, the Middle East, and Asia: focus on severe infections and tuberculosis.  

PubMed

Multiple studies of patients in Western countries with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have indicated increased risk for active tuberculosis (TB) and other infections among these individuals. It has also been consistently reported that patients receiving tumor necrosis factor (TNF) inhibitors for these conditions have higher rates of active TB and other infections than RA or AS patients not receiving these medications. These issues have been studied less extensively in the Asia and Africa-Middle East regions, and information from these regions is important because of higher rates of TB in the general population. This paper reviews studies of RA and AS patients from Asia, Africa, and the Middle East who received TNF inhibitors. A literature search was conducted using http://www.ncbi.nlm.nih.gov/pubmed to collect and report these data. The years included in the PubMed literature search ranged from January 2000 to October 2011. Additionally, information from the China Hospital Knowledge Database was used to report data from Chinese patients with RA and AS treated with TNF inhibitors. Results from these studies indicate that the risk for active TB and other infections in AS and RA patients from Asia, Africa, and the Middle East are increased in patients receiving TNF inhibitors and that the risk is higher among those treated with monoclonal antibodies versus soluble TNF receptor. PMID:23242389

Hammoudeh, Mohammed; Alarfaj, Abdurhman; Chen, Der-Yuan; Djoudi, Hachemi; Youseif, Ehab; Zhu, Jian

2012-12-15

65

Acute-phase proteins and serum immunoglobulins in ankylosing spondylitis.  

PubMed Central

The erythrocyte sedimentation rate (ESR) and the serum acute-phase proteins (APP), C-reactive protein (CRP), fibrinogen, 9th component of complement (C9), and alpha, antitrypsin were measured on 231 occasions in 80 patients with ankylosing spondylitis and compared with those in 30 controls. APP levels did not correlate with clinical assessment of disease activity. However, there were significant correlations between CRP, C9, and fibrinogen (p = less than 0.01), suggesting that these APP may be more reliable indicators of disease activity. The mean values of the APP in those patients with a peripheral arthritis were significantly higher than in those with pelvospondylitis alone for ESR (p less than 0.01), CRP (p less than 0.01), and fibrinogen (p less than 0.05). The only significant difference between those patients with an iritis and those with only pelvospondylitis was an elevated CRP in the iritis group (p less than 0.01). This suggests that a peripheral arthritis is the most important cause of an elevated ESR or APP in ankylosing spondylitis. Serum immunoglobulins were also measured and they showed a significant elevation of IgA in all 3 patients groups, there being no difference between each group. Serum IgG was raised only in those patients with an iritis or peripheral arthritis, the IgM levels being within the normal range for all patient groups.

Laurent, M R; Panayi, G S

1983-01-01

66

Surgical outcome after spinal fractures in patients with ankylosing spondylitis  

Microsoft Academic Search

BACKGROUND: Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture.

George Sapkas; Konstantinos Kateros; Stamatios A Papadakis; Spyros Galanakos; Emmanuel Brilakis; George Machairas; Pavlos Katonis

2009-01-01

67

Cutaneous vasculitis and IgA glomerulonephritis in ankylosing spondylitis.  

PubMed Central

Two patients with ankylosing spondylitis were found to have IgA nephropathy and leucocytoclastic cutaneous vasculitis. Immunofluorescence showed perivascular deposition of IgA in the skin of one patient and in the mesangium of both patients. Such an association has been reported only once before. This supports the concept of abnormal IgA immune stimulation in the pathogenesis of ankylosing spondylitis.

Beauvais, C; Kaplan, G; Mougenot, B; Michel, C; Marinho, E

1993-01-01

68

Alternative Treatments for Ankylosing Spondylitis  

MedlinePLUS

... it can be a beneficial tool for pain relief and stress reduction. If a massage therapist is aware of a person's spondylitis and understands the disease and any potential ... It may provide temporary relief of pain or stiffness, and in some cases ...

69

Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis  

Microsoft Academic Search

Objective. To develop criteria for symptomatic improvement in patients with ankylosing spondylitis (AS), using outcome domain data from placebo- controlled clinical trials of nonsteroidal antiinflamma- tory drugs (NSAIDs). Methods. Patient data from 5 short-term, ran- domized, controlled trials were used to assess equiva- lence, reliability, and responsiveness of multiple items in the 5 outcome domains for AS treatment: physical function,

Jennifer J. Anderson; Gabriel Baron; Desiree Van Der Heijde; David T. Felson; Maxime Dougados

2001-01-01

70

IgA antibody response to klebsiella in ankylosing spondylitis measured by immunoblotting  

Microsoft Academic Search

IgA antibodies to Klebsiella pneumoniae var oxytoca and Proteus mirabilis were measured in 66 patients with ankylosing spondylitis (AS) and 31 with rheumatoid arthritis (RA) and in 51 healthy control subjects, using an immunoblotting technique. The number of antigenic bands to klebsiella on nitrocellulose membrane was higher in 28 patients with active AS than in 38 patients with inactive AS,

F Shodjai-Moradi; A Ebringer; I Abuljadayel

1992-01-01

71

[New pathogenetic aspects of ankylosing spondylitis].  

PubMed

Ankylosing spondylitis is one of the oldest diseases in humans; however, it is still one of the most fascinating and mysterious in human pathology. The unusual combination of both fundamental pathological processes: inflammation and ossification (which are mostly independent in respect to time and place) is unique. Until 1973, ankylosing spondylitis did not attract much immunological research. After the detection of an association between HLA B27 and the disease, clinical and immunological research was stimulated. It was supposed that HLA B27 may be a pathogenic factor. Meanwhile, it has become well known that HLA B27 itself is not required for development of the disease; however, discovery of immunological cross-reactivity between HLA B27 and some Klebsiella antigens inspired pathogenic considerations. It is discussed that the structural similarities between enteric bacteria and HLA B27 induce autoantibodies, or that HLA B27 plays a role in antigen recognition. Possibly, HLA B27 may also act as a receptor for infectious agents and their products. Fascinating, but controversely discussed is the hypothesis that bacterial products modify the B27 molecule and, in this way, trigger the disease. All present theories about pathogenesis of ankylosing spondylitis are unsatisfactory, because many important questions cannot be answered. There are no explanations for the unusual affinity of possible pathogenic immune reactions to the spine and other organs, the induction of ossification, the merging of cartilage, or the development of sacroilitis. Especially, we do not know the important bridge (if one exists) between inflammation and ossification. The typical ossification of the spine is of dramatic consequence for the patient in respect to function and mobility.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1872044

Schmidt, K L

72

Neurological complications of ankylosing spondylitis: neurophysiological assessment.  

PubMed

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

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

2009-01-20

73

Diagnosis of "rheumatoid variants" ankylosing spondylitis, the arthritides of gastrointestinal diseases and psoriasis, and Reiter's syndrome.  

PubMed

Four rheumatic diseases-ankylosing spondylitis, the arthritis accompanying ulcerative colitis or regional enteritis, psoriatic arthropathy, and Reiter's syndrome-formerly considered to be forms of rheumatoid arthritis, are now distinguished from that disorder and should be recognized by the physician as entities. These arthritides may be distinguished from each other by a number of clinical and radiographic characteristics, principally (1) the roentgenographic appearance of the spine when spondylitis is present, (2) the location of periosteal new bone formation, (3) the location of arthritis in the joints of the limbs, and (4) the presence of characteristic skin lesions. PMID:4845921

Reynolds, M D; Rankin, T J

1974-06-01

74

A comparison of telephone and paper self-completed questionnaires of main patient-related outcome measures in patients with ankylosing spondylitis and psoriatic arthritis.  

PubMed

A cross-sectional study was performed to assess the correlation between telephone and self-administration of patient-related outcomes (PROs) used in the assessment of ankylosing spondylitis (AS) patients. Participants underwent a telephone interview in which the following measures were evaluated: numerical rating scales (NRSs) for global health, pain intensity, global pain, back pain, and back pain at night; BASDI, BASFI, Health Assessment Questionnaire (HAQ), ASQoL, EuroQol, SF-12, and Work Productivity and Activity Impairment (WPAI) questionnaire. Within 48 h after the telephone interview, patients were appointed for a clinical visit in which the same questionnaires and in the same order were self-administered. The degree of correlation of outcomes measures between telephone interview and self-administration was assessed with the intraclass correlation coefficient (ICC). The two modes of assessing PROs were highly reliable, with ICC of 0.81 for BASDAI, 0.82 for BASFI, and 0.75 for HAQ. NRSs for global health, global pain intensity, back pain, and back pain at night also showed ICCs between 0.51 and 0.70, and only NRS for global disease activity showed an ICC of 0.45. This results were similar in patients with AS and patients with psoriatic arthritis. Social functioning and mental health domains of the SF-12 as well as EuroQol had poor correlations. The ICCs for WPAI outcomes were very good or good. We conclude that PROs in AS patients are comparable in both self-administered paper questionnaires and via a telephone interview. Different modes of assessing PRO measures facilitate the assessment of patients with AS in routine practice. PMID:23793389

Ariza-Ariza, Rafael; Hernández-Cruz, Blanca; Navarro-Compán, Victoria; Leyva Pardo, Christian; Juanola, Xavier; Navarro-Sarabia, Federico

2013-06-21

75

Cross-reacting bacterial determinants in ankylosing spondylitis.  

PubMed

The importance of the association between the human histocompatibility antigen human leukocyte antigen-B27 and ankylosing spondylitis is undisputed, but its biologic significance remains unresolved. We have demonstrated specific cross reactivity between a range of enteric bacteria and a specific determinant found only on the surfaces of cells from human leukocyte antigen-B27-positive persons with ankylosing spondylitis. We have proposed that the genetic element coding for this cross-reactive determinant is mobile and that its acquisition by B27-positive cells in vivo represents an important step in the eventual development of ankylosing spondylitis. PMID:2462351

Sullivan, J S; Prendergast, J K; Geczy, A F; Edmonds, J P; McGuigan, L E; Edwards, C M

1988-12-23

76

Defining disease status in ankylosing spondylitis: validation and cross-cultural adaptation of the Arabic Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Global score (BASG)  

Microsoft Academic Search

The Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity index (BASDAI), and Global assessment (BASG) are\\u000a the most commonly used instruments to assess patients suffering from ankylosing spondylitis (AS). The aim of this study was\\u000a to translate, adapt, and validate these instruments into the Arabic language. Seventy-three AS patients were included in this\\u000a study. One question in the BASFI questionnaire

Yasser El Miedany; Sally Youssef; Annie Mehanna; Naglaa Shebrya; Sherif Abu Gamra; Maha El Gaafary

2008-01-01

77

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

PubMed Central

To date, anti-tumor necrosis factor alfa (anti-TNF-?) 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 therapy in patients with ankylosing spondylitis.

Senabre-Gallego, Jose Miguel; Santos-Ramirez, Carlos; Santos-Soler, Gregorio; Salas-Heredia, Esteban; Sanchez-Barrioluengo, Mabel; Barber, Xavier; Rosas, Jose

2013-01-01

78

Antibodies to Enterobacteriaceae in ankylosing spondylitis.  

PubMed

Serological studies on ankylosing spondylitis (AS; N = 82) show that although statistically more AS patients than controls (N = 24) may possess elevated serum titres to enterobacteria such as Salmonella, Shigella and Yersinia, this does not necessarily imply enterobacterial involvement in AS, as other groups without enteritis or arthropathies that frequent health care facilities (N = 72) may also display this phenomenon, presumably due to increased exposure. Moreover, an inventory of all detectable antibody reactivities to the separated cell envelope antigens of five enterobacterial species suspected of involvement in AS (notably Enterobacter, Klebsiella, Salmonella, Shigella and Yersinia) failed to reveal statistical associations with AS. This might be explained, assuming that the aetiology of AS entails a set of enterobacteria rather than a few individual species. It is proposed that serological studies on AS should be supported by additional information, e.g. that of the faecal carriage, and that these combined studies encompassing other enterobacteria, in addition to Klebsiella, might be fruitful. PMID:3092349

van Bohemen, C G; Nabbe, A J; Goei The, H S; Dekker-Saeys, A J; Zanen, H C

1986-01-01

79

Rehabilitation and surgical management of ankylosing spondylitis.  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory disease which, if untreated, may progress to severe damage of the spine with functional impairment, disability and poor quality of life. An increased mortality has been reported in AS patients compared to the general population. AS requires combined management (pharmacological and non-pharmacological) and advice by different health professionals. Even the pharmacological treatment in the last decade has dramatically changed the outcome, the severity of the disease might require a surgical approach for the hip involvement with total hip replacement, or the corrective spinal surgery. However, this surgery deserves some careful approaches since the complexity of the disease. Rehabilitation still represents a cornerstone of the global management of AS patients. The present review summarizes the state of art of surgical management of these two diseases. PMID:23949941

Lubrano, E; Astorri, D; Taddeo, M; Salzmann, A; Cesarano, E; Brunese, L; Giganti, M; Spadaro, A

2013-08-15

80

Temporomandibular joint involvement in ankylosing spondylitis.  

PubMed

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

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

2013-05-02

81

A systematic MEDLINE analysis of therapeutic approaches in ankylosing spondylitis.  

PubMed

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

Goh, L; Samanta, A

2009-06-28

82

HLA B27 in regional enteritis with and without ankylosing spondylitis or sacroiliitis.  

PubMed

The incidence of B27 in patients with ankylosing spondylitis associated with regional enteritis was significantly lower than in ankylosing spondylitis without inflammatory bowel disease. It was significantly higher, however, than in a control group of blood donors. The incidence of B27 was found to be nil in patients with regional entertitis without ankylosing spondylitis, as well as in patients with regional enteritis and asymptomatic radiographic sacroilitis. Conversely, all patients with regional enteritis, positive for B27, developed ankylosing spondylitis. PMID:266600

Huaux, J P; Fiasse, R; De Bruyere, M; Nagant de Deuxchaisnes, C

1977-01-01

83

Treatment trials in ankylosing spondylitis: current and future considerations  

PubMed Central

Emerging treatment options in ankylosing spondylitis (AS) are giving new hope to patients with this chronic and potentially disabling disease. Clinical development of new treatments requires that rigorous and well controlled trials be conducted to demonstrate safety and efficacy. A number of classification systems have been developed in recent years as a result of enhanced understanding of the pathogenesis of AS. Although new outcome measures have been developed and a consensus has been reached on the use of assessment instruments in clinical trials, there is still need for improvement and implementation. The ASsessments in Ankylosing Spondylitis (ASAS) Working Group has addressed some of these dilemmas by establishing a core set of domains for the evaluation of AS and by selecting specific assessment methods for each domain. They have also published improvement criteria for assessing short term improvement with symptom modifying antirheumatic drugs and are presently in the process of developing response criteria for disease controlling antirheumatic treatment. Various experts are also currently examining discrepancies and inadequacies of classification systems for AS. Imaging studies, magnetic resonance imaging, in particular, may provide better classification criteria in the near future. In addition to consensus on outcome assessment and classification of AS, lessons learnt from clinical trials in rheumatoid arthritis (RA) may serve as a template for AS. Guidance provided by the United States Food and Drug Administration (FDA) for clinical trials in RA may be of particular use. The FDA has defined the claims that sponsors can receive for RA products and the clinical trial data that would be expected to be submitted to support such claims.

van der Heijde, D; Braun, J; McGonagle, D; Siegel, J

2002-01-01

84

Ankylosing spondylitis monocytes show upregulation of proteins involved in inflammation and the ubiquitin proteasome pathway  

Microsoft Academic Search

Objectives:To determine if peripheral blood monocytes from patients with ankylosing spondylitis (AS) differed in protein expression compared to rheumatoid arthritis (RA) and healthy controls (HC).Methods:Monocyte protein expression was characterised by 2D gel electrophoresis and by label-free quantitative expression profiling, using nano-ultra performance liquid chromatography coupled to electrospray ionisation mass spectrometry (ESI-MSE, where E refers to low\\/high collision energy switching). Data

C Wright; M Edelmann; K diGleria; S Kollnberger; H Kramer; S McGowan; K McHugh; S Taylor; B Kessler; P Bowness

2009-01-01

85

Early diagnosis of ankylosing spondylitis: an introduction to the newly designed Iran criteria for ankylosing spondylitis.  

PubMed

More than 14 years of clinical practice in rheumatology led the author to develop his experience-based criteria for early ankylosing spondylitis (AS) diagnosis. This study aims to introduce this new set of criteria, Iran criteria for ankylosing spondylitis, and to assess its sensitivity in comparison with 1984 modified New York criteria. A cost-effective diagnostic approach towards AS diagnosis is also proposed. The criteria score the patients according to the findings in history and physical examination, imagings and HLA-B27 testing. Sensitivity analysis was performed in a retrospective manner after reviewing the medical records of 120 patients at the outpatient Rheumatology Clinic of the author (private sector), regarding clinical diagnosis by a single rheumatologist as the gold standard. The sensitivity was separately measured for disease durations of 2, 2-5, 5-10 and more than 10 years. Iran criteria for AS recorded a sensitivity of 100 % in all disease durations. However, the sensitivity of 1984 modified New York criteria was 48.39 % in early stages of the disease and increased to 92.10 % for disease duration of more than 10 years. Iran criteria for AS provide a highly sensitive instrument for detecting AS in its early and late, clinical and subclinical, radiographic and pre-radiographic stages as well as atypical forms. PMID:23129429

Salehi-Abari, Iraj; Khazaeli, Shabnam; Khak, Mohammad

2012-11-06

86

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

Microsoft Academic Search

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

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

2011-01-01

87

Integrative Structural Biomechanical Concepts of Ankylosing Spondylitis  

PubMed Central

Ankylosing spondylitis (AS) is not fully explained by inflammatory processes. Clinical, epidemiological, genetic, and course of disease features indicate additional host-related risk processes and predispositions. Collectively, the pattern of predisposition to onset in adolescent and young adult ages, male preponderance, and widely varied severity of AS is unique among rheumatic diseases. However, this pattern could reflect biomechanical and structural differences between the sexes, naturally occurring musculoskeletal changes over life cycles, and a population polymorphism. During juvenile development, the body is more flexible and weaker than during adolescent maturation and young adulthood, when strengthening and stiffening considerably increase. During middle and later ages, the musculoskeletal system again weakens. The novel concept of an innate axial myofascial hypertonicity reflects basic mechanobiological principles in human function, tissue reactivity, and pathology. However, these processes have been little studied and require critical testing. The proposed physical mechanisms likely interact with recognized immunobiological pathways. The structural biomechanical processes and tissue reactions might possibly precede initiation of other AS-related pathways. Research in the combined structural mechanobiology and immunobiology processes promises to improve understanding of the initiation and perpetuation of AS than prevailing concepts. The combined processes might better explain characteristic enthesopathic and inflammatory processes in AS.

Masi, Alfonse T.; Nair, Kalyani; Andonian, Brian J.; Prus, Kristina M.; Kelly, Joseph; Sanchez, Jose R.; Henderson, Jacqueline

2011-01-01

88

Ankylosing Spondylitis: From Cells to Genes  

PubMed Central

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.

Zambrano-Zaragoza, Jose Francisco; Agraz-Cibrian, Juan Manuel; Gonzalez-Reyes, Christian; Duran-Avelar, Ma. de Jesus; Vibanco-Perez, Norberto

2013-01-01

89

Surgical orodental implications in ankylosing spondylitis.  

PubMed

Temporomandibular joint and the pelvic complex are bidirectionally related. Ankylosing spondylitis (AS) is a seronegative arthropathy with the key feature of bony fusion of lumbar vertebrae. A 39 year old known case of AS was presented to private office for left lower impacted third molar surgical removal. Previously, he was rejected to receive oral care for pulpectomy and extraction due to limited mouth opening. Prior to the surgery, lateral neck radiography was obtained to exclude any subluxation of fracture of cervical vertebrae. Neck was supported to insure neck stability during surgical forces. In addition, considering consumption of immunosuppressive medications including corticosteroids, procedure was performed with a great care, with attention to higher possibility of infection and fracture. Access to the surgical site was not desirable, though surgery accomplished without any significant event and the patient discharged with routine analgesic and antibiotics recommendation. Sometimes, impaired access to the oral cavity in patients with AS leads to receive suboptimal or minimal orodental care. Long list of dental implications in these patients may be simplified by considering of careful neck and jaw support, applying at least possible forces and great attention to the infection control rules. It is wised to be performed under patient and skilled hands. PMID:23559963

Mehdizadeh, Mohammad; Poorsattar, Bejeh Mir A

2012-11-01

90

Association of the programmed cell death 1 (PDCD1) gene polymorphism with ankylosing spondylitis in the Korean population  

Microsoft Academic Search

The PD-1 (programmed death 1) molecule is a negative regulator of T cells. PDCD1 (programmed cell death 1) has been reported to have a genetic association in systemic lupus erythematosus and rheumatoid arthritis in Caucasians. However, there are no reports on the association between this gene and ankylosing spondylitis (AS). The present study investigated the association of the PD-1 polymorphisms

Sang-Hoon Lee; Yeon-Ah Lee; Doo-Hyun Woo; Ran Song; Eun-Kyung Park; Mi-Hyun Ryu; Young-Hoon Kim; Kyoung-Soo Kim; Seung-Jae Hong; Myung Chul Yoo; Hyung-In Yang

2006-01-01

91

Gli autoanticorpi antinucleo, anti-dsDNA anti-ENA nei pazienti con artrite reumatoide o spondilite anchilosante in trattamento con infliximab Antinuclear, anti-dsDNA and anti-ENA antibodies in patients affected with rheumatoid arthritis or ankylosing spondylitis during treatement with infliximab  

Microsoft Academic Search

SUMMARY Objective: We evaluated the induction and clinical significance of ANA, anti-dsDNA and anti-ENA during infliximab therapy in patients with Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS). Methods: We tested sera from 30 RA and 30 AS patients before and during treatment with infliximab. ANA and anti- dsDNA were determined by indirect immunofluorescence and anti-ENA by an \\

A. Hoxha; A. Ruffatti; P. Grypiotis; M. Podswiadek; C. Botsios; U. Fiocco; L. Punzi; S. Todesco

92

Abnormal autonomic cardiovascular control in ankylosing spondylitis  

PubMed Central

OBJECTIVE—This study was aimed at assessing the contribution of the autonomic nervous system to adjustments of cardiovascular function in patients with ankylosing spondylitis (AS).?METHODS—In 18 AS patients (mean age: 34.9; mean disease duration: 6.4 years) and 13 healthy controls (mean age: 31.7) the changes of heart rate (HR) with deep breathing (E/I ratio) and standing up (30/15 ratio) were recorded. The slope of cardiac baroreflex, the times series of blood pressure and HR values upon lying and standing, and venous plasma concentrations of catecholamines were also analysed. Erythrocyte sedimentation rate (ESR), plasma C reactive protein (CRP) concentration and a clinical index (BASDAI score) were used to assess the degree of disease activity in patients.?RESULTS—In the standing patients, blood pressure was found to decrease progressively (p< 0.001). Furthermore, the patients with a BASDAI score > 5 had a higher heart rate than patients with a BASDAI score < 5 (p<0.02), and there was a trend for a similar difference when patients were classified according to their ESR and CRP. Plasma catecholamine concentrations and the E/I ratio were not different in patients from controls. The 30/15 ratio and the slope of the spontaneous baroreflex during standing were both lower in AS patients than controls (p< 0.01).?CONCLUSIONS—This study demonstrated a change in autonomic nervous system function of AS patients, with a decreased parasympathetic activity, as evidenced by higher HR and lower baroreflex slope. As these significant deviances were mainly observed in patients with more active (or more inflammatory) disease, the autonomic nervous system involvement could be related to the inflammatory process. This autonomic strain may be related to the cardiac involvement in AS patients.??

Toussirot, E.; Bahjaoui-Bouhaddi, M.; Poncet, J.; Cappelle, S.; Henriet, M.; Wendling, D.; Regnard, J.

1999-01-01

93

Chlamydia trachomatis serology in ankylosing spondylitis.  

PubMed

Demonstration of chlamydial antibodies in patients with ankylosing spondylitis (AS) could show an etiological role of Chlamydia trachomatis in this condition. We studied serum specimens from 50 HLA-B27 positive patients with AS (Group I), 34 HLA-B27 positive patients with other rheumatic diseases (Group II), 67 HLA-B27 positive healthy blood donors (Group III) and 37 healthy untyped blood donors. (Group IV). Measured by an immunoperoxidase assay (IPA) chlamydial IgA (titre greater than or equal to 1:20) was more prevalent in the HLA-B27 positive persons than in the healthy controls not selected for HLA-group (Groups I + II + III vs IV : p less than 0.02). Chlamydia trachomatis IgA-IPA containing sera also had specific IgG-IPA antibodies (greater than or equal to 1:80) in 29 (96%) out of 30 sera from HLA-B27 positive individuals and controls. Conversely, 45% of specific IgG-positive (greater than or equal to 1:80) AS sera, 27.7% sera in Group II, 39.4% Group III sera vs. 11.1% of sera in Group IV had concomitant chlamydial IgA (greater than or equal to 1:20). The differences in the prevalence of specific IgA were statistically significant: Group I vs. IV : p less than 0.01; Group III vs. IV :p less than 0.05 and Gr. I + II + III vs. IV: p less than 0.05. Our data suggest an enhanced antibody production against Chlamydia trachomatis among the HLA-B27 positive individuals whether they have AS or are healthy. PMID:3327642

Csángó, P A; Upsahl, M T; Romberg, O; Kornstad, L; Sarov, I

1987-09-01

94

The relationship between inflammation and new bone formation in patients with ankylosing spondylitis  

Microsoft Academic Search

INTRODUCTION: Spinal inflammation as detected by magnetic resonance imaging and new bone formation as identified by conventional radiographs are characteristic of ankylosing spondylitis. Whether and how spondylitis and syndesmophyte formation are linked are unclear. Our objective was to investigate whether and how spinal inflammation are associated with new bone formation in ankylosing spondylitis. METHODS: Spinal magnetic resonance images and conventional

Xenofon Baraliakos; Joachim Listing; Martin Rudwaleit; Joachim Sieper; Juergen Braun

2008-01-01

95

Functional disability predicts total costs in patients with ankylosing spondylitis  

Microsoft Academic Search

Objective. To describe the composition and distri- bution of total costs of ankylosing spondylitis (AS), and to identify predictors of high total costs among patients with AS. Methods. In a prospective longitudinal study, 241 patients with AS reported information on health status, health care utilization, treatments, and work limitations on biannually mailed questionnaires. Annual direct costs were estimated on the

Michael M. Ward

2002-01-01

96

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

PubMed Central

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.

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; Diaz-Pena, Roberto; Lopez-Vazquez, Antonio; Zayats, Tetyana; Band, Gavin; Bellenguez, Celine; 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

97

Gender and disease features in Moroccan patients with ankylosing spondylitis.  

PubMed

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 our AS patients. PMID:21796348

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

2011-07-28

98

The role of bone morphogenetic proteins in ankylosing spondylitis.  

PubMed

Ankylosing spondylitis (AS), the best-known form of spondyloarthritis (SpA), is a remodelling arthritis characterized by chronic inflammation and bone formation. Ankylosis of the axial skeleton and sacroiliac joints leads to an impairment of spinal mobility, progressive spinal fusion and an increased risk of spinal fractures. The nature of the relationship between inflammation and new bone formation in AS has been controversial and questions remain as to whether there is a direct relationship between inflammation and new bone formation. Like others, we have hypothesized that the molecular pathways underlying ankylosis recapitulate the process of endochondral bone formation and that bone morphogenetic proteins (BMPs) play a key role in this process in AS. Furthermore, we discuss the entheseal stress hypothesis, which proposes that inflammation and ankylosis are linked but largely independent processes, and consider observations from mouse models and other human diseases which also imply that biomechanical factors contribute to the pathogenesis of AS. As current therapeutics, such as tumour necrosis factor inhibitors do not impede disease progression and ankylosis in AS, it is the pathways discussed in this review that are the now the focus for the identification of future drug targets. PMID:22859928

Carter, Shea; Braem, Kirsten; Lories, Rik J

2012-08-01

99

The role of bone morphogenetic proteins in ankylosing spondylitis  

PubMed Central

Ankylosing spondylitis (AS), the best-known form of spondyloarthritis (SpA), is a remodelling arthritis characterized by chronic inflammation and bone formation. Ankylosis of the axial skeleton and sacroiliac joints leads to an impairment of spinal mobility, progressive spinal fusion and an increased risk of spinal fractures. The nature of the relationship between inflammation and new bone formation in AS has been controversial and questions remain as to whether there is a direct relationship between inflammation and new bone formation. Like others, we have hypothesized that the molecular pathways underlying ankylosis recapitulate the process of endochondral bone formation and that bone morphogenetic proteins (BMPs) play a key role in this process in AS. Furthermore, we discuss the entheseal stress hypothesis, which proposes that inflammation and ankylosis are linked but largely independent processes, and consider observations from mouse models and other human diseases which also imply that biomechanical factors contribute to the pathogenesis of AS. As current therapeutics, such as tumour necrosis factor inhibitors do not impede disease progression and ankylosis in AS, it is the pathways discussed in this review that are the now the focus for the identification of future drug targets.

Carter, Shea; Braem, Kirsten

2012-01-01

100

Imaging of axial spondyloarthritis including ankylosing spondylitis.  

PubMed

New bone formation of the vertebral column is pathognomonic for ankylosing spondylitis (AS), while acute and/or chronic changes in the sacroiliac joints are relevant for diagnosis. The 'gold standard' for assessment of structural changes in AS are conventional radiographs, while MRI is useful to assess inflammation. Recent MRI studies have shown that the lower half of the thoracic spine is most commonly affected in AS. Scoring tools for spinal inflammation such as the ASspiMRI-a have been proposed, successfully used in large clinical trials and compared in a multireader experiment; none was finally preferred by OMERACT. Quantification of structural spinal AS changes is performed by the modified Stokes AS Spine Score (mSASSS), which evaluates lateral cervical and lumbar radiographs. Two years was identified as the shortest possible follow-up time based on the reliability and sensitivity to change of the mSASSS. A potential disadvantage of the mSASSS is that the thoracic spine is not included. Recent data based on the mSASSS have suggested that tumour necrosis factor blockers do not inhibit radiographic progression in AS. Since the mean radiographic change is reported to be less than 1 syndesmophyte over 2 years, the sensitivity to change of the mSASSS has been questioned. However, in one study where continuous non-steroidal anti-inflammatory drugs use was compared with on-demand use, a difference between these two methods of drug intake was reported. The face and construct validity of the mSASSS has been criticised because a score of ´1´ contains a mixture of osteodestructive (erosions) and osteoproliferative changes (squaring and sclerosis). A new scoring system, the RASSS, which concentrates only on bone formation and which includes the lower part of the thoracic spine is currently being evaluated. The relationship between inflammation and new bone formation in AS has recently been investigated. Low sclerostin and DKK-1 serum levels, both inhibitors of bone formation, were found to be associated with syndesmophyte formation in patients with AS. PMID:21339229

Braun, J; Baraliakos, X

2011-03-01

101

Ankylosing Spondylitis and Allied Diseases in Adults and Children  

Microsoft Academic Search

615 Ankylosing spondylitis (AS) is a human leukocyte anti- gen (HLA)-B27-associated disease that is character- ized by chronic progressive inflammation in the axial joints and entheses (the ligaments and tendon attach- ments in bone). The disease has late involvement in other organs including the eyes, lungs, skin and kid- ney. Juvenile-onset spondyloarthropathies (JSpAs) are a group of HLA-B27-associated disorders in

Chang-Youh Tsai

2009-01-01

102

A systematic medline analysis of therapeutic approaches in ankylosing spondylitis  

Microsoft Academic Search

Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently\\u000a the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of\\u000a effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available\\u000a that provide persistent

L. Goh; A. Samanta

2009-01-01

103

Infection and work stress are potential triggers of ankylosing spondylitis  

Microsoft Academic Search

The objective of the study was to investigate potential triggering events for the onset of ankylosing spondylitis (AS). A large retrospective population survey of 1,080 AS patients was carried out by multi-faceted questionnaire. A nested case–control study compared the cohort to 102 patients with lumbar disc prolapse. Participants with AS had a mean age of 49.8 years, mean age of disease

Jane Zochling; Martin H. J. Bohl-Bühler; Xenofon Baraliakos; Ernst Feldtkeller; Jürgen Braun

2006-01-01

104

Ankylosing spondylitis is linked to Klebsiella —the evidence  

Microsoft Academic Search

Ankylosing spondylitis (AS) is a chronic inflammatory spinal and large-joint arthritic and potentially disabling condition,\\u000a mainly affecting males of young age groups. Extensive literature based on the results of various genetic, microbiological,\\u000a molecular and immunological studies carried out by independent research groups suggests that Klebsiella pneumoniae is the main microbial agent being implicated as a triggering and\\/or perpetuating factor in

Taha Rashid; Alan Ebringer

2007-01-01

105

MRI and CT of ankylosing spondylitis with vertebral scalloping.  

PubMed

Three cases of cauda equina syndrome in long-standing ankylosing spondylitis are reported. In all, vertebral scalloping and dural ectasia were confirmed by magnetic resonance imaging and computed tomography. MRI showed widening of the dural sac with signal intensity corresponding to cerebrospinal fluid. CT demonstrated asymmetrical lesions of the posterior elements of the lumbar spine. Myelography was not felt necessary to confirm the findings. PMID:3405419

Abelló, R; Rovira, M; Sanz, M P; Gili, J; Capdevila, A; Escalada, J; Peri, J

1988-01-01

106

A case of ankylosing spondylitis and discussion of the literature.  

PubMed

Ankylosing spondylitis (AS) is a systemic inflammatory disease. Its pathogenesis has not been completely understood, but the HLA-B 27 positive immune cells are thought to be involved. Nonsteroidal anti-inflammatory agents are the first line drugs and they effectively relieve the symptoms. Biological agents such as Infliximab may help in targeting the underlying inflammatory process and have been used recently. Here, we are reporting a case of AS with established classical skeletal deformities. PMID:23905135

Ranjith, M P; Divya, R

2013-06-01

107

Decrease in serum nucleotide pyrophosphatase activity in ankylosing spondylitis  

Microsoft Academic Search

Objective. Ankylosing spondylitis (AS) is a prototype of a group of rheumatic diseases referred to as spondyloarthropathy. AS patients show marked ectopic ossification in the spine, occasionally resulting in so-called bamboo spine. Although a strong association with HLA-B27 has been reported, its aetiology remains undetermined. Another rheumatic disease, ossification of the posterior longitudinal ligament of the spine (OPLL), demonstrates ectopic

K. Mori; T. Chano; T. Ikeda; S. Ikegawa; Y. Matsusue; H. Okabe; Y. Saeki

2003-01-01

108

Non-B27 MHC associations of ankylosing spondylitis  

Microsoft Academic Search

Ankylosing spondylitis (AS) has been associated with human leukocyte antigen (HLA)-B27 for over 30 years; however, the mechanism of action has remained elusive. Although many studies have reported associations between AS and other genes in the major histocompatibility complex (MHC) in AS, no conclusive results have emerged. To investigate the contribution of non-B27 MHC genes to AS, a large cohort

A-M Sims; M Barnardo; I Herzberg; L Bradbury; A Calin; B P Wordsworth; C Darke; M A Brown

2007-01-01

109

The potential importance of Toll-like receptors in ankylosing spondylitis  

PubMed Central

Cells involved in innate immunity scan for pathogens via extracellular and intracellular (endosomal) pattern recognition receptors (PRRs). Engagement of PRRs by a specific ligand results in downstream activation of intracellular inflammatory cascades. There is emerging evidence indicating that one class of PRR, the Toll-like receptor (TLR) plays a potential role in the pathogenesis of spondyloarthropathies. Since certain Gram-negative bacteria are known to act as triggers for reactive arthritis, there has been much interest in studying the role of TLRs in spondyloarthropathies. In this article, we introduce the immunology of TLRs followed by a discussion of their potential role in ankylosing spondylitis.

Tan, Filemon K; Farheen, Kiran

2012-01-01

110

18 F-Fluoride PET\\/CT for detection of sacroiliitis in ankylosing spondylitis  

Microsoft Academic Search

Purpose  The aim of this study was to evaluate the performance of 18F-fluoride-PET\\/CT (PET\\/CT) for the diagnosis of sacroiliac joint (SIJ) arthritis in patients with active ankylosing spondylitis\\u000a (AS).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Included in the study were 15 patients with AS according to the modified New York criteria (AS group) and with active disease\\u000a and 13 patients with mechanical low back pain (MLBP; control

Klaus Strobel; Dorothee R. Fischer; Giorgio Tamborrini; Diego Kyburz; Katrin D. M. Stumpe; Rolf G. X. Hesselmann; A. Johayem; Gustav K. von Schulthess; Beat A. Michel; Adrian Ciurea

2010-01-01

111

Ankylosing spondylitis and inflammatory bowel disease. I. Prevalence of inflammatory bowel disease in patients suffering from ankylosing spondylitis.  

PubMed

To establish the prevalence of inflammatory bowel disease in ankylosing spondylitis (AS), 79 AS patients underwent detailed medical screening, including sigmoidoscopic and roentgenological examination, 48 had gastrointestinal symptoms and the others did not. In 3 patients a diagnosis of Crohn's disease was made which was previously established. In all other patients inflammatory bowel disease could be excluded. The prevalence of inflammatory bowel disease in this series of patients with AS therefore was 3.8%. PMID:629600

Meuwissen, S G; Dekker-Saeys, B J; Agenant, D; Tytgat, G N

1978-02-01

112

Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument?  

Microsoft Academic Search

Objective. Disease activity has been defined using a self-administered instrument, focusing on fatigue, axial pain, peripheral pain, enthesopathy and morning stiVness (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI )). This validated instrument is simple and takes 40 s to complete, but whether the index is an accurate expression of the component parts, or whether additional weighting would enhance its eYcacy,

A. Calin; P. Nakache; A. Gueguen; H. Zeidler; H. Mielants; M. Dougados

1999-01-01

113

Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression  

Microsoft Academic Search

The objective of this non-randomised controlled trial was to evaluate the impact of group-based exercise programme and a home-based\\u000a exercise programme on Bath Ankylosing Spondylitis Indices, depression and quality of life in patients with ankylosing spondylitis\\u000a (AS). Approximately 41 patients in a rehabilitation unit were divided into two groups, either group- or home-based exercise\\u000a programme. Exercise sessions were performed three

Hale Karapolat; Ye?im Akkoc; ?smail Sar?; Sibel Eyigor; Servet Akar; Ye?im Kirazl?; Nurullah Akkoc

2008-01-01

114

Sulphasalazine in ankylosing spondylitis. A radiological, clinical and laboratory assessment  

Microsoft Academic Search

Summary In a 12-month double-blind placebo-controlled trial, the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis. The treatment group showed significant improvement in pain, stiffness, sleep disturbance (p<0.05), finger\\/floor distance, erythrocyte sedimentation rate, C-reactive protein, orosomucoid and IgA levels (p<0.01). There was improvement in sleep disturbance (p<0.05), finger\\/floor distance and erythrocyte sedimentation rate (p<0.01) in the placebo

H. G. Taylor; E. J. Beswick; P. T. Dawes

1991-01-01

115

Surgical outcome after spinal fractures in patients with ankylosing spondylitis  

PubMed Central

Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed. Conclusion The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.

Sapkas, George; Kateros, Konstantinos; Papadakis, Stamatios A; Galanakos, Spyros; Brilakis, Emmanuel; Machairas, George; Katonis, Pavlos

2009-01-01

116

IgA antibodies in HLA-B27 associated acute anterior uveitis and ankylosing spondylitis.  

PubMed

Acute anterior uveitis (AAU) and ankylosing spondylitis (AS) are, like reactive arthritis (ReA), strongly associated with HLA-B27. Mucosal infections play a role in the pathogenesis of ReA. To investigate whether these microorganisms are also involved in the pathogenesis of AAU and AS, we examined blood samples from patients with AAU, AS or both, and healthy controls for presence of antibodies against Klebsiella pneumoniae (K 30), Salmonella enteritidis and S. typhimurium, Chlamydia trachomatis, Proteus mirabilis and Borrelia burgdorferi. The IgA, IgG and IgM classes of these antibodies were measured using an enzyme-linked immunosorbent assay. No significant differences were found in the frequency in which these antibodies occurred in HLA-B27 positive patients with AAU or AS and healthy controls. However, IgA antibodies against K. pneumoniae (p < 0.01) and IgA and IgG antibodies against P. mirabilis (p < 0.01 and p < 0.05) were detected more frequently in HLA-B27 negative patients with AAU than in healthy controls. The results of this study are in contrast with various earlier reports in which antibodies against Klebsiella strains were more frequently found in patients with HLA-B27 associated ankylosing spondylitis than in healthy controls. PMID:8835504

Sprenkels, S H; Uksila, J; Vainionpää, R; Toivanen, P; Feltkamp, T E

1996-01-01

117

Systemic and mucosal antibodies to Klebsiella in patients with ankylosing spondylitis and Crohn's disease.  

PubMed Central

Whole gut lavage fluid is a useful source of material for the study of intestinal immunity and inflammation in humans. Systemic and mucosal antibodies to Klebsiella pneumoniae were measured by enzyme linked immunosorbent assay (ELISA) in serum samples and whole gut lavage fluid from 14 patients with ankylosing spondylitis, 14 with Crohn's disease, and 16 immunologically normal controls. As the concentration of IgG in whole gut lavage fluid reflects disease activity in Crohn's disease, this approach was used to detect intestinal inflammation in patients with ankylosing spondylitis who also had disease activity and use of non-steroidal anti-inflammatory drugs (NSAIDs) recorded. Small intestinal permeability to cellobiose and mannitol was also studied. In serum samples, levels of IgA antibody to klebsiella were high in patients with Crohn's disease and in patients with active ankylosing spondylitis, and were significantly correlated with the erythrocyte sedimentation rate in patients with ankylosing spondylitis. Levels of IgG antibody to klebsiella were also high in patients with Crohn's disease. Studies of whole gut lavage fluid showed similar levels of IgA antibody to klebsiella in the three study groups, but levels of whole gut lavage fluid IgM and IgG antibodies to klebsiella were high in patients with Crohn's disease. Levels of IgG in whole gut lavage fluid were high in patients with Crohn's disease but in only one patient with ankylosing spondylitis, though the cellobiose/mannitol permeability ratio was abnormal in eight of 13 patients with ankylosing spondylitis. It is concluded that high levels of serum IgA antibody to klebsiella are not specific to ankylosing spondylitis, and that there is no evidence of an abnormal intestinal IgA antibody response to klebsiella in patients with ankylosing spondylitis.

O'Mahony, S; Anderson, N; Nuki, G; Ferguson, A

1992-01-01

118

Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis  

Microsoft Academic Search

OBJECTIVE--To determine the prevalence of vertebral compression fractures due to osteoporosis in patients with ankylosing spondylitis. DESIGN--Prospective study of 111 consecutive patients; patients with vertebral compression fractures were entered into a case-control study. SETTING--Outpatient clinic at the centre for rheumatic diseases, Glasgow. PATIENTS--111 Consecutive patients with ankylosing spondylitis. Patients with compression fractures were matched for age and sex with two

S H Ralston; G D Urquhart; M Brzeski; R D Sturrock

1990-01-01

119

Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system  

Microsoft Academic Search

Objective: To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS).Methods: The Stoke Ankylosing Spondylitis Spinal Score (SASSS) was modified by adding a score for the cervical spine and defining squaring. This modified SASSS (mSASSS) is the sum of the lumbar and cervical spine score (range 0–72). 370 lateral views of the lumbar and cervical spine were

M. C. W. Creemers; M. J. A. M. Franssen; M A van ’t Hof; F. W. J. Gribnau

2005-01-01

120

Acute anterior uveitis, ankylosing spondylitis, back pain, and HLA-B27  

Microsoft Academic Search

One hundred and sixty-nine patients with acute anterior uveitis were studied for the presence of HLA-B27 tissue type, radiological evidence of ankylosing spondylitis, and a history of back pain. 60% were male; 45% were HLA-B27+. The male:female ratio in the HLA-B27+ group was the same as in the whole group. 24% had radiological evidence of ankylosing spondylitis, and, of these,

A. B. Beckingsale; J. Davies; J. M. Gibson; A. R. Rosenthal

1984-01-01

121

Arachnoid ossificans of thoracolumbosacral spine in the advanced ankylosing spondylitis: a case report.  

PubMed

Arachnoid ossificans is a rare type of chronic arachnoiditis characterised by the presence of calcification or ossification of the dura and arachnoid. There are a few reports of these findings in relation to various disease entities, but only one case has been reported in relation to ankylosing spondylitis. We describe a 76-year-old man of ankylosing spondylitis with arachnoiditis ossificans, who has suffered from low back pain and neuropathic leg pain. PMID:22198660

Joo, Kyung Bin; Lee, Seunghun; Kang, Chang-Nam; Kim, Tae-Hwan

2011-12-25

122

Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance  

Microsoft Academic Search

This study was designed to evaluate (a) the frequency of fatigue and its multi-dimensional nature, and (b) its association\\u000a with demographic variables, disease-specific variables, and other variables, covering depression and sleep disturbance in\\u000a patients with ankylosing spondylitis (AS). Sixty-two patients with AS were included in the study. Fatigue was assessed by\\u000a the fatigue item of the Bath Ankylosing Spondylitis Disease

Rezzan Günaydin; Alt?nay Göksel Karatepe; Nesrin Çe?meli; Taciser Kaya

2009-01-01

123

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong  

Microsoft Academic Search

Methods. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index

T. Y. Zhu; L.-S. Tam; V. W.-Y. Lee; W. W. Hwang; T. K. Li; K. K. Lee; E. K. Li

2008-01-01

124

Golimumab administered subcutaneously every 4 weeks in ankylosing spondylitis: 104-week results of the GO-RAISE study  

PubMed Central

Objective To assess the efficacy and safety of golimumab over 104 weeks in patients with active ankylosing spondylitis. Methods At baseline, patients with active ankylosing spondylitis (n=356) were randomly assigned (1:1.8:1.8) to subcutaneous injections of placebo (group 1), golimumab 50 mg (group 2) or golimumab 100 mg (group 3) every 4 weeks. At week 16, patients in groups 1 and 2 with <20% improvement in total back pain and morning stiffness entered early escape to 50 or 100 mg, respectively. At week 24, patients still receiving placebo crossed over to golimumab 50 mg. Findings through week 24 were previously reported; those through week 104 are presented herein. Results At week 104, 38.5%, 60.1% and 71.4% of patients in groups 1, 2 and 3, respectively, had at least 20% improvement in the Assessment in SpondyloArthritis international Society response criteria (ASAS20); 38.5%, 55.8% and 54.3% had an ASAS40 response and 21.8%, 31.9% and 30.7% were in ASAS partial remission. Mean Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores were <3 at week 104 for all the treatment regimens. Golimumab safety through week 104 was similar to that through week 24. Conclusion Clinical response that was achieved by patients receiving golimumab through 24 weeks was sustained through 52 and 104 weeks. The golimumab safety profile appeared to be consistent with the known safety profile of tumour necrosis factor inhibitors.

Braun, Jurgen; Deodhar, Atul; Inman, Robert D; van der Heijde, Desiree; Mack, Michael; Xu, Stephen; Hsu, Benjamin

2012-01-01

125

Normal anti-Klebsiella lymphocytotoxicity in ankylosing spondylitis  

SciTech Connect

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.

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

1986-03-01

126

Staging of patients with ankylosing spondylitis: a preliminary proposal  

PubMed Central

Patients with ankylosing spondylitis (AS) are characterised by a wide range of clinical presentations, radiographic profiles, and outcomes, which are not well differentiated by current diagnostic and classification systems for the disorder. Inadequacies in these systems may limit clinicians' ability to manage their patients with AS appropriately and act as an obstacle to reasonable comparison of therapeutic trial results. A standardised staging system for AS is therefore proposed that would provide a more detailed categorisation of patients based on assessment of structural damage, peripheral joint and organ involvement, presence of concomitant diseases, and the severity and extent of disease activity and functional impairment. The proposed system needs to be evaluated closely and amended as needed to assure its usefulness in clinical and research settings.

Braun, J; van der Heijde, D; Dougados, M; Emery, P; Khan, M; Sieper, J; van der Linden, S.

2002-01-01

127

IgA antibody response to klebsiella in ankylosing spondylitis measured by immunoblotting.  

PubMed Central

IgA antibodies to Klebsiella pneumoniae var oxytoca and Proteus mirabilis were measured in 66 patients with ankylosing spondylitis (AS) and 31 with rheumatoid arthritis (RA) and in 51 healthy control subjects, using an immunoblotting technique. The number of antigenic bands to klebsiella on nitrocellulose membrane was higher in 28 patients with active AS than in 38 patients with inactive AS, 31 patients with RA, and 51 healthy control subjects; comparatively smaller increases were found against proteus. In two patients with AS the synovial fluid and the corresponding serum sample showed an identical antibody pattern. Increases in IgA antibodies to klebsiella in patients with AS confirm previous studies using other techniques. Images

Shodjai-Moradi, F; Ebringer, A; Abuljadayel, I

1992-01-01

128

Ankylosing Spondylitis: A Late Re-evaluation of 92 Cases  

PubMed Central

Ninety-two patients who satisfied the criteria proposed by Kellgren for the diagnosis of ankylosing spondylitis were re-evaluated by clinical, radiological and laboratory parameters after an average length of illness of 18.7 years. The following associated clinical lesions were studied: aortic insufficiency 8%, heart block 3%, iritis 11%, and other associated lesions. Long-term effects of x-ray therapy were evaluated by comparing irradiated and non-irradiated patients; no significant difference was noted in the clinical course of these two treatment groups. On serum protein electrophoresis no characteristic dysproteinemia was demonstrated; in no instance was there a marked hypergammaglobulinemia. Test results for rheumatoid factor, antinuclear factor and antithyroglobulin were all within the range expected for a normal population. In addition to bilateral sacroiliitis, several other characteristic radiological lesions, such as anterior spondylitis, were present in a high percentage of cases. It is suggested that the diagnostic criteria proposed by Kellgren, although useful, should be enlarged and refined.

Kinsella, T. Douglas; MacDonald, F. Robert; Johnson, Louis G.

1966-01-01

129

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

PubMed Central

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.

2012-01-01

130

Undifferentiated spondyloarthritis vs ankylosing spondylitis and psoriatic arthritis: a real-life prospective cohort study of clinical presentation and response to treatment.  

PubMed

Objective. SpA is a phenotypically heterogeneous disease, with AS and PsA as its best studied subtypes. This study aimed to investigate whether, despite a different phenotypic presentation, patients with undifferentiated SpA (uSpA) have similar disease activity and response to treatment to those with AS and PsA. Methods. 175 patients presenting at a dedicated SpA outpatient clinic were recruited in a real-life prospective cohort with follow-up every 3 months. Clinical characteristics, disease activity at presentation and response to treatment of uSpA were compared with AS and PsA. Results. Twenty-three per cent (n = 40) of the patients were classified as uSpA. These patients were younger and tended to have a shorter disease duration than AS and PsA patients. uSpA patients exhibited a mixed axial (inflammatory back pain in 87.5%) and peripheral (peripheral arthritis in 62.5%) phenotype, with almost half of the patients having low-grade sacroiliitis on conventional X-ray. The overall disease activity in uSpA was similar to AS and higher than in PsA, also when analysing only anti-TNF naive patients. Initiation of TNF blockade significantly decreased disease activity in uSpA, with a similar amplitude to that in AS and PsA. Conclusion. uSpA is a frequent, severe and anti-TNF-responsive phenotypic subtype of SpA. In agreement with the new ASAS classification criteria for axial and peripheral SpA and emerging data on TNF blockade in non-radiographic axial SpA and peripheral uSpA, these data emphasize the need for early diagnosis and optimal treatment of not only AS and PsA but also other SpA subforms. PMID:23861532

Paramarta, Jacqueline E; De Rycke, Leen; Ambarus, Carmen A; Tak, Paul P; Baeten, Dominique

2013-07-16

131

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

PubMed Central

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.

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

2006-01-01

132

Circulating levels of sialic acid and glycosaminoglycans: a diagnostic test for ankylosing spondylitis.  

PubMed Central

The circulating levels of sialic acid (N-acetylneuraminic acid) and glycosaminoglycans (GAGs) were measured in 69 patients with spinal disorders of orthopaedic interest (ankylosing spondylitis 17, osteofluorosis 6, idiopathic backache 10, osteoarthrosis 16, osteoporosis 20). The serum GAG levels showed no statistically significant change from control values in the five disorders investigated in the present study. Although osteoporosis and osteoarthrosis showed a decrease in serum sialic acid (SA) levels, the mean ratio (SA/GAG) demonstrated no change from control values. Idiopathic backache showed no difference in any of the parameters studied when compared with control values. Ankylosing spondylitis and osteofluorosis had a remarkable similarity in their clinical and radiological features, but a divergent mean value of ratio was noted. The mean ratio of both the conditions also showed a statistically significant difference from the control value. This suggests that the SA/GAG ratio can be used as a diagnostic test in ankylosing spondylitis.

Susheela, A K; Das, T K; Khurana, J S; Jayaswal, A; Dave, P K

1988-01-01

133

First update of the international ASAS consensus statement for the use of anti-TNF agents in patients with ankylosing spondylitis  

PubMed Central

Objective To update the international recommendations for use of anti?tumour necrosis factor (TNF) agents in the treatment of ankylosing spondylitis. Methods The published recommendations on anti?TNF treatment in ankylosing spondylitis formed the basis of the update. A questionnaire was sent to the ASAS (assessment in ankylosing spondylitis) members before the final decisions were agreed upon at an international meeting of the ASAS working group. Results Only minor changes to the original consensus statement were required. For the initiation of anti?TNF treatment, there should be: a diagnosis of definitive ankylosing spondylitis (normally based on modified New York criteria); active disease for at least four weeks, as defined by a sustained Bath ankylosing spondylitis disease activity index (BASDAI) of ?4 on a 0–10 scale and expert opinion based on clinical findings; refractory disease, defined by failure of at least two non?steroidal anti?inflammatory drugs during a three month period, failure of intra?articular steroids (if indicated), and failure of sulfasalazine in patients with predominantly peripheral arthritis; and application of the usual precautions and contraindications for biological treatment. For monitoring anti?TNF treatment: both the ASAS core set for clinical practice and the BASDAI should be followed after the initiation of treatment. Discontinuation of anti?TNF treatment in non?responders should be considered after 6–12?weeks. Response is defined by improvement of at least 50% or 2 units (on a 0–10 scale) of the BASDAI. Conclusions This updated consensus statement is recommended in guiding clinical practice and as a basis for developing national guidelines. Evaluation and regular update of this consensus statement is subject to further research by the ASAS group.

Braun, J; Davis, J; Dougados, M; Sieper, J; van der Linden, S; van der Heijde, D

2006-01-01

134

Elevated miR-29a expression is not correlated with disease activity index in PBMCs of patients with ankylosing spondylitis.  

PubMed

OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by new bone formation. Recent evidence suggests that new bone formation in AS may be due to upregulation of Wnt signaling in the osteoblastic pathway secondary to low serum Dickkopf homolog 1 (Dkk-1) levels. And miR-29a orchestrates osteoblast differentiation through direct targeting and negative regulation of Dkk-1. METHODS: We initially validated the expression levels of miR-29a in the peripheral blood mononuclear cells (PBMCs) of AS patients (n = 30), rheumatoid arthritis (RA) patients (n = 30) and healthy controls (n = 30) using real-time quantitative reverse transcription PCR (qRT-PCR). Correlation analysis was assessed between miR-29a level in PBMCs of AS patients and disease activity indexes, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis function index (BASFI) and modified Stoke ankylosing spondylitis spinal score (mSASSS). RESULTS: Significantly higher expression of miR-29a was observed in PBMCs of AS patients (Ct 9.18 ± 1.96) compared with that in RA patients (10.97 ± 0.70, p < 0.001) and healthy controls (Ct 11.45 ± 1.23, p < 0.001). There was no significant difference between RA patients and healthy controls in miR-29a expression (p > 0.05). Elevated miR-29a expression is not correlated with disease activity index (p > 0.05). A weak correlation was found between elevated miR-29a expression and mSASSS (r = -0.393, p = 0.032). CONCLUSIONS: We report for the first time elevated miR-29a expression in PBMCs of patients with ankylosing spondylitis, and miR-29a might be used as a useful diagnostic marker in new bone formation but cannot reflect disease activity. PMID:23632741

Huang, Jinxian; Song, Guoxiang; Yin, Zhihua; Luo, Xiuxia; Ye, Zhizhong

2013-04-30

135

Sexual activity in Moroccan men with ankylosing spondylitis.  

PubMed

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

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

2012-11-25

136

Management of acute spinal fractures in ankylosing spondylitis.  

PubMed

Ankylosing Spondylitis (AS) is a multifactorial and polygenic rheumatic condition without a well-understood pathophysiology (Braun and Sieper (2007)). It results in chronic pain, deformity, and fracture of the axial skeleton. AS alters the biomechanical properties of the spine through a chronic inflammatory process, yielding a brittle, minimally compliant spinal column. Consequently, this patient population is highly susceptible to unstable spine fractures and associated neurologic devastation even with minimal trauma. Delay in diagnosis is not uncommon, resulting in inappropriate immobilization and treatment. Clinicians must maintain a high index of suspicion for fracture when evaluating this group to avoid morbidity and mortality. Advanced imaging studies in the form of multidetector CT and/or MRI should be employed to confirm the diagnosis. Initial immobilization in the patient's preinjury alignment is mandatory to prevent iatrogenic neurologic injury. Both nonoperative and operative treatments can be employed depending on the patient's age, comorbidities, and fracture stability. Operative techniques must be individually tailored for this patient population. A multidisciplinary team approach is best with preoperative nutritional assessment and pulmonary evaluation. PMID:22389792

Chaudhary, Saad B; Hullinger, Heidi; Vives, Michael J

2011-06-30

137

Non-major-histocompatibility-complex genetics of ankylosing spondylitis.  

PubMed

There is strong evidence from twin and family studies indicating that a substantial proportion of the heritability of susceptibility to ankylosing spondylitis (AS) and its clinical manifestations is encoded by non-major-histocompatibility-complex genes. Efforts to identify these genes have included genomewide linkage studies and candidate gene association studies. One region, the interleukin (IL)-1 gene complex on chromosome 2, has been repeatedly associated with AS in both Caucasians and Asians. It is likely that more than one gene in this complex is involved in AS, with the strongest evidence to date implicating IL-1A. Identifying the genes underlying other linkage regions has been difficult due to the lack of obvious candidates and the low power of most studies to date to identify genes of the small to moderate magnitude that are likely to be involved. The field is moving towards genomewide association analysis, involving much larger datasets of unrelated cases and controls. Early successes using this approach in other diseases indicates that it is likely to identify genes in common diseases like AS, but there remains the risk that the common-variant, common-disease hypothesis will not hold true in AS. Nonetheless, it is appropriate for the field to be cautiously optimistic that the next few years will bring great advances in our understanding of the genetics of this condition. PMID:16777586

Brown, Matthew A

2006-06-01

138

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis  

PubMed Central

Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.

Heyde, Christoph-E; Fakler, Johannes K; Hasenboehler, Erik; Stahel, Philip F; John, Thilo; Robinson, Yohan; Tschoeke, Sven K; Kayser, Ralph

2008-01-01

139

Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis  

PubMed Central

Background Ankylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. The dorsal hyperkyphosis may induce the patients to stand in a stooped position with consequent restriction in patients’ daily living activities. The aim of this study was to develop a method for quantitatively and objectively assessing both balance and posture and their mutual relationship in ankylosing spondylitis subjects. Methods The data of 12 healthy and 12 ankylosing spondylitis subjects (treated with anti-TNF-? stabilized), with a mean age of 51.42 and 49.42?years; mean BMI of 23.08 and 25.44?kg/m2 were collected. Subjects underwent a morphological examination of the spinal mobility by means of a pocket compass needle goniometer, together with an evaluation of both spinal and hip mobility (Bath Ankylosing Spondylitis Metrology Index), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index). Quantitative evaluation of kinematics and balance were performed through a six cameras stereophotogrammetric system and a force plate. Kinematic models together with a test for evaluating balance in different eye level conditions were developed. Head protrusion, trunk flexion-extension, pelvic tilt, hip-knee-ankle flexion-extension were evaluated during Romberg Test, together with centre of pressure parameters. Results Each subject was able to accomplish the required task. Subjects’ were comparable for demographic parameters. A significant increment was observed in ankylosing spondylitis subjects for knee joint angle with the target placed at each eye level on both sides (p?ankylosing spondylitis subjects both hip (p?=?0.048) and ankle (p?=?0.029) joints angles differs significantly. When considering the posturographic parameters significant differences were observed for ellipse, center of pressure path and mean velocity (p?ankylosing spondylitis subjects. This methodology could help clinicians to plan rehabilitation treatments.

2012-01-01

140

Scoring radiographic progression in ankylosing spondylitis: should we use the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) or the Radiographic Ankylosing Spondylitis Spinal Score (RASSS)?  

PubMed Central

Introduction Radiographic damage is one of the core outcomes in axial SpA and is usually assessed with the modified Stoke Ankylosing Spondylitis (AS) Spine Score (mSASSS). Alternatively, the Radiographic AS Spinal Score (RASSS) is proposed, which includes the lower thoracic vertebrae, under the hypothesis that most progression occurs in these segments. We aimed to compare the mSASSS and RASSS with regard to performance. Methods Two-yearly spinal radiographs from patients followed in the Outcome in AS International Study (OASIS) were used (scored independently by two readers). A total of 195 patients had at least one radiograph (12-year follow-up) to be included. We assessed the accessibility of vertebral corners (VCs) for scoring, as well as status and 2-year progression scores of both scoring methods. To assess the potential additional value of including the thoracic segment in the score, the relative contribution (in %) to the 2-year total RASSS progression of each spinal segment (cervical, thoracic and lumbar) was determined, and compared to the expected contribution, under the assumption that a balanced segmental progression would occur, proportional to the number of sites per segment. Results The mSASSS could be scored in a total of 809 radiographs and the RASSS in 78% of these. In 58% of the latter, the score was based on one to two available thoracic VCs scores, and the remaining two to three were imputed because they were missing. There were 520 two-year mSASSS intervals available, and in 63% of them RASSS progression could be assessed. The mean (SD) 2-year interval progression score (330 intervals) was 2.0 (3.6) for the mSASSS and 2.4 (4.4) for the RASSS, yielding a similar effect size (mSASSS 0.57 and RASSS 0.55). Exclusive progression of the thoracic segment occurred in only 5% of the cases. There was no significant difference between the observed (14%) and expected (16%) contribution to progression of the thoracic segment (P = 0.70). Conclusions The determination of RASSS for radiographic damage of the spine is frequently impossible or strongly influenced by non-contributory imputation. In comparison to the mSASSS, the contribution of thoracic VCs in the RASSS method is negligible, and does not justify the additional scoring efforts.

2013-01-01

141

Angioimmunoblastic T cell lymphoma in an ankylosing spondylitis patient treated with etanercept.  

PubMed

Angioimmunoblastic T cell lymphoma (AITL) is a rare non-Hodgkin lymphoma that presents with profound immune dysfunction and immunodeficiency. The clinical and laboratory findings associated with AITL are similar to those of rheumatic disease, and AITL has been reported to be concurrent in patients with several rheumatic diseases. We present one case of AITL occurring in a patient with ankylosing spondylitis (AS) after treatment with etanercept. Constitutional symptoms and aggravation of peripheral arthritis in elderly AS patients may be due not only to flare-ups of AS but also to other complicating diseases, such as lymphoma. Although the occurrence of lymphoma in AS patients treated with etanercept has only rarely been reported, clinicians should keep in mind that instances of aggravation of peripheral arthritis in elderly AS patients occurring after immunosuppressant treatment may be due to other complicating systemic diseases such as AITL, rather than the rheumatic disease itself. Further study is needed in order to investigate whether or not using a TNF-? blocker such as etanercept increases the risk of lymphoma, especially for cases associated with Epstein-Barr virus. PMID:22791222

Jung, Kyong-Hee; Lim, Mie Jin; Kwon, Seong Ryul; Joo, Ko Woon; Yi, Hyeon Gyu; Choi, Suk Jin; Park, Won

2012-07-12

142

Regression of syndesmophyte after bone marrow transplantation for acute myeloid leukemia in a patient with ankylosing spondylitis: a case report  

PubMed Central

Introduction Disease progression of ankylosing spondylitis has been considered irreversible. However, we report a case of spontaneous regression of syndesmophyte development following allogeneic peripheral blood stem cell transplantation in a patient with acute myeloid leukemia, who was also diagnosed as having ankylosing spondylitis. To the best of our knowledge, this is the first case report presenting the partial radiologic regression of syndesmophytes. Case presentation A 39-year-old man with active ankylosing spondylitis achieved clinical remission and partial radiological regression of cervical spine syndesmophytes following a peripheral blood stem cell transplantation for acute myeloid leukemia. Our patient received an allogeneic peripheral blood stem cell transplantation following a pre-transplantation conditioning regimen of total body irradiation and cyclophosphamide. The donor was a human leukocyte antigen-matched 29-year-old man. Our patient has remained asymptomatic and has received no medication for ankylosing spondylitis for nearly three years. Conclusions Several explanations are proposed for the regression of syndesmophytes and clinical improvement in active ankylosing spondylitis observed in our patient, including changes in bone remodeling and immune reconstitution following stem cell transplantation, the effect of immunosuppressive agents, or fluctuation in the natural course of ankylosing spondylitis although further studies are required. The regression of syndesmophytes in ankylosing spondylitis in this case raises the possibility that stem cell transplantation might contribute to the development of a novel therapeutic strategy for treatment of the disease.

2012-01-01

143

Logistic transmission modeling of HLA and ankylosing spondylitis  

SciTech Connect

A nonparametric and general method of linkage analysis has been developed and used to evaluate histocompatibility (HLA) linkage to ankylosing spondylitis (AS) from the data of Berg & Moller. The conditional logistic function has been used to establish linkage by stepwise modelling of transmission from parent to progeny. Logistic transmission models have been explored to better understand the relationship of HLA to AS. The alleles at HLA-A and -B were determined in 38 families (32 monoplex and 6 multiplex). We have found that linkage is supported in this data over the random transmission of alleles at only HLA-B. Models constructed at HLA-B are powerful with, for example, coefficients for B27 of 1.9 (S.E. = 0.4) and B40 of 1.6 (S.E. = 0.8) contributing to a model with {chi}{sup 2} = 30 with 2 df and p < 3x10{sup -7}. No models are found supporting linkage at HLA-A and, therefore, the data at HLA-A does not add support for linkage beyond that present at HLA-B (e.g., {chi}{sup 2} for improvement < 1). These results establish that HLA-B is linked to AS. They further provide evidence that the gene responsible for AS is located nearer to HLA-B than it is to HLA-A. Also, the analysis shows that a number of HLA-B alleles may contribute to the risk of AS, beyond the B27 allele which has repeatedly been associated with AS.

Scofield, R.H.; Neas, B.R.; Harley, J.B. [Univ. of Oklahoma, Oklahoma City, OK (United States)

1994-09-01

144

Leukemia mortality after X-ray treatment for ankylosing spondylitis  

SciTech Connect

Leukemia mortality has been studied in 14,767 adult ankylosing spondylitis patients diagnosed between 1935 and 1957 in the United Kingdom, of whom 13,914 patients received X-ray treatment. By 1 January 1992, there were 60 leukemia deaths among the irradiated patients, almost treble that expected from national rates. Among those irradiated, the ratio of observed to expected deaths for leukemia other than chronic lymphocytic leukemia was greatest in the period 1-5 years after the first treatment (ratio = 11.01, 95% confidence interval 5.26-20.98) and decreased to 1.87 (95% confidence interval 0.94-3.36) in the 25+ year period. There was no significant variation in this ratio with sex or age at first treatment. The ratio for chronic lymphocytic leukemia was slightly but not significantly raised (ratio=1.44, 95% confidence interval 0.62-2.79). Most irradiated patients received all their exposure within a year. Based on 1 in 15 random sample, the mean total marrow dose was 4.38 Gy. Doses were nonuniform, with heaviest doses to the lower spine. The risk for nonchronic lymphocytic leukemia was adequately described by a linear-exponential model that allowed for cell sterilization in heavily exposed parts of the marrow and time since exposure. Ten years after first exposure, the linear component of excess relative risk was 12.37 per Gy (95% confidence interval 2.25-52.07), and it was estimated that cell sterilization reduced the excess relative risk by 47% at 1 Gy (95% confidence interval 17%-79%). The average predicted relative risk in the period 1-25 years after exposure to a uniform dose of 1 Gy was 7.00. 20 refs., 2 figs., 8 tabs.

Weiss, H.A.; Darby, S.C. [Univ. of Oxford (United Kingdom); Fearn, T. [Univ. College London (United Kingdom)] [and others

1995-04-01

145

Leukemia mortality after X-ray treatment for ankylosing spondylitis.  

PubMed

Leukemia mortality has been studied in 14,767 adult ankylosing spondylitis patients diagnosed between 1935 and 1957 in the United Kingdom, of whom 13,914 patients received X-ray treatment. By 1 January 1992, there were 60 leukemia deaths among the irradiated patients, almost treble that expected from national rates. Leukemia mortality was not increased among unirradiated patients. Among those irradiated, the ratio of observed to expected deaths for leukemia other than chronic lymphocytic leukemia was greatest in the period 1-5 years after the first treatment (ratio = 11.01, 95% confidence interval 5.26-20.98) and decreased to 1.87 (95% confidence interval 0.94-3.36) in the 25+ year period. There was no significant variation in this ratio with sex or age at first treatment. The ratio for chronic lymphocytic leukemia was slightly but not significantly raised (ratio = 1.44, 95% confidence interval 0.62-2.79). Most irradiated patients received all their exposure within a year. Based on a 1 in 15 random sample, the mean total marrow dose was 4.38 Gy. Doses were nonuniform, with heaviest doses to the lower spine. The risk for nonchronic lymphocytic leukemia was adequately described by a linear-exponential model that allowed for cell sterilization in heavily exposed parts of the marrow and time since exposure. Ten years after first exposure, the linear component of excess relative risk was 12.37 per Gy (95% confidence interval 2.25-52.07), and it was estimated that cell sterilization reduced the excess relative risk by 47% at 1 Gy (95% confidence interval 17%-79%). The average predicted relative risk in the period 1-25 years after exposure to a uniform dose of 1 Gy was 7.00. PMID:7899552

Weiss, H A; Darby, S C; Fearn, T; Doll, R

1995-04-01

146

MICA, a gene contributing strong susceptibility to ankylosing spondylitis.  

PubMed

OBJECTIVE: The human major histocompatibility complex class I chain-related gene A (MICA) controls the immune process by balancing activities of  natural killer cells, ?? T cells and ?? CD8 T cells, and immunosuppressive CD4 T cells. MICA is located near HLA-B on chromosome 6. Recent genomewide association studies indicate that genes most strongly linked to ankylosing spondylitis (AS) susceptibility come from the region containing HLA-B and MICA. While HLA-B27 is a well-known risk genetic marker for AS, the potential effect of linkage disequilibrium (LD) shields any associations of genes around HLA-B with AS. The aim of this study was to investigate a novel independent genetic association of MICA to AS. METHODS: We examined 1543 AS patients and 1539 controls from two ethnic populations by sequencing MICA and genotyping HLA-B alleles. Initially, 1070 AS patients and 1003 controls of European ancestry were used as a discovery cohort, followed by a confirmation cohort of 473 Han Chinese AS patients and 536 controls. We performed a stratified analysis based on HLA-B27 carrier status. We also conducted logistic regression with a formal interaction term. RESULTS: Sequencing of MICA identified that MICA*007:01 is a significant risk allele for AS in both Caucasian and Han Chinese populations, and that MICA*019 is a major risk allele in Chinese AS patients. Conditional analysis of MICA alleles on HLA-B27 that unshielded LD effect confirmed associations of the MICA alleles with AS. CONCLUSIONS: Parallel with HLA-B27, MICA confers strong susceptibility to AS in US white and Han Chinese populations. PMID:23727634

Zhou, Xiaodong; Wang, Jiucun; Zou, Hejian; Ward, Michael M; Weisman, Michael H; Espitia, Maribel G; Xiao, Xiangjun; Petersdorf, Effie; Mignot, Emmanuel; Martin, Javier; Gensler, Lianne S; Scheet, Paul; Reveille, John D

2013-06-01

147

Clinical sacroiliac tests in ankylosing spondylitis and other causes of low back pain--2 studies  

Microsoft Academic Search

Independent assessment by 2 observers of 4 tests for sacroiliac (SI) pain in patients with either mechanical\\/degenerative low back pain (M\\/D LBP) or ankylosing spondylitis (AS) showed all 4 to be reproducible, but only 2 of them, namely, pressure over the anterior superior iliac spines and pressure over the lower half of the sacrum, gave worthwhile discrimination. Positive results in

P W Blower; A J Griffin

1984-01-01

148

Ankylosing spondylitis or Crohn's disease? Case report and review of the literature.  

PubMed

A 27-year-old male with a 2 year history of ankylosing spondylitis (AS) was investigated for intermittent episodes of diarrhea and found to have granulomatous ileitis. Differential diagnosis, discussions regarding similarities in immune alterations in both AS and Crohn's disease and therapeutic options are presented in this paper. PMID:21528764

Zahiu, Denise Carmen Mihaela; Rimba?, M; Nicolau, Adriana; Zurac, Sabina; Voiosu, M R

2010-01-01

149

The cost-effectiveness of etanercept in patients with severe ankylosing spondylitis in the UK  

Microsoft Academic Search

Objectives. To examine the costs and benefits associated with long-term etanercept (ETN) treatment in patients with severe ankylosing spondylitis (AS) in the UK in accordance with the BSR guidelines. Methods. A mathematical model was constructed to estimate the costs and benefits associated with ETN plus non-steroidal anti- inflammatory drugs (NSAIDs) compared with NSAIDs alone. Individual patient data from Phase III

R. M. Ara; A. V. Reynolds; P. Conway

2007-01-01

150

Sequential studies in ankylosing spondylitis. Association of Klebsiella pneumoniae with active disease  

Microsoft Academic Search

A study of 163 patients with ankylosing spondylitis seen on 433 occasions showed that active inflammatory disease was strongly associated with the presence of Klebsiella pneumoniae in the faeces (P less than 0.001). Sequential studies showed that in patients with inactive disease the presence of a positive culture for Klebsiella was associated with the subsequent development of active inflammatory disease

R W Ebringer; D R Cawdell; P Cowling; A Ebringer

1978-01-01

151

Two year maintenance of efficacy and safety of infliximab in the treatment of ankylosing spondylitis  

Microsoft Academic Search

Objective: To obtain results of the second year extension of an original 3 month randomised, placebo controlled trial (and the 1 year extension study) assessing the use of infliximab, a monoclonal antibody to tumour necrosis factor ?, for the treatment of patients with ankylosing spondylitis (AS).Methods: Of the 54 patients with AS who completed the first year of the study,

J Braun; J Brandt; J Listing; A Zink; R Alten; G Burmester; E Gromnica-Ihle; H Kellner; M Schneider; H So?rensen; H Zeidler; J Sieper

2005-01-01

152

Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis  

Microsoft Academic Search

OBJECTIVE: A double blind, randomised, placebo controlled study to evaluate the safety and efficacy of etanercept to treat adult patients with ankylosing spondylitis (AS). METHODS: Adult patients with AS at 14 European sites were randomly assigned to 25 mg injections of etanercept or placebo twice weekly for 12 weeks. The primary efficacy end point was an improvement of at least

A. Calin; B. A. C. Dijkmans; P Emery; M Hakala; J Kalden; M Leirisalo-Repo; EM Mola; C Salvarani; R Sanmarti; J Sany; J Sibilia; J. Sieper; Linden de S. venr; E Veys; AM Appel; S Fatenejad

2004-01-01

153

Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis  

Microsoft Academic Search

The histopathological characteristic of ankylosing spondylitis (AS) is the presence of chronic enthesitis. Our aim was to develop a clinical measurement of the severity of tenderness over entheses. The scoring system was based on the patients' response to palpation over entheses easily accessible to examination. The enthesis index (EI) correlated with pain (r = 0.67, p less than 0.01) and

M Mander; J M Simpson; A McLellan; D Walker; J A Goodacre; W C Dick

1987-01-01

154

Effect of Spa therapy in Tiberias on patients with ankylosing spondylitis  

Microsoft Academic Search

Summary Fourteen patients with ankylosing spondylitis (AS) were treated in a pilot study for two weeks at a Tiberias spa with a combination of hot mineral water baths and mud packs. A significant improvement was noticed in morning stiffness, finger to floor distance and the overall well-being assessment both by the patient and the physician. A significant reduction in the

M. Tishler; Y. Brostovski; M. Yaron

1995-01-01

155

Successful Catheter-Directed Venous Thrombolysis in an Ankylosing Spondylitis Patient with Phlegmasia Cerulea Dolens  

PubMed Central

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis.

Rokni Yazdi, Hadi; Rostami, Nematollah; Hakimian, Homa; Mohammadifar, Mehdi; Ghajarzadeh, Mahsa

2013-01-01

156

Assessment of fatigue in the management of patients with ankylosing spondylitis  

Microsoft Academic Search

Background. Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis (AS). However, fatigue has been reported as the major complaint of AS patients. Objectives. To evaluate fatigue as a potential independent domain in comparison with the 'conventional' ones and to evaluate the sensitivity to change after non-

E. Dernis-Labous; M. Messow; M. Dougados

2003-01-01

157

Increased expression of carbonic anhydrase I in the synovium of patients with ankylosing spondylitis  

Microsoft Academic Search

BACKGROUND: One of the most distinctive features of ankylosing spondylitis (AS) is new bone formation and bone resorption at sites of chronic inflammation. Previous studies have indicated that the hyperplasia and inflammation of synovial tissues are significantly related to the pathogenic process of AS. The present study used a proteomic approach to identify novel AS-specific proteins by simultaneously comparing the

Xiaotian Chang; Jinxiang Han; Yan Zhao; Xinfeng Yan; Shui Sun; Yazhou Cui

2010-01-01

158

Cost effectiveness of adalimumab for the treatment of ankylosing spondylitis in the United Kingdom  

Microsoft Academic Search

Objectives. This study evaluated the cost effectiveness of adalimumab vs conventional therapy in patients with active ankylosing spondylitis (AS). Methods. The analysis was based on pooled data from two Phase III studies of adalimumab in active AS. Patients with an inadequate response to ? 1 NSAID received adalimumab 40 mg every other week (n ¼ 246) or placebo (n ¼

M. F. Botteman; J. W. Hay; M. P. Luo; A. S. Curry; R. L. Wong; B. A. van Hout

2007-01-01

159

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

ERIC Educational Resources Information Center

|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…

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

2007-01-01

160

Relation between chest expansion, pulmonary function, and exercise tolerance in patients with ankylosing spondylitis  

Microsoft Academic Search

Thirty three patients with definite ankylosing spondylitis (AS) were examined to establish the relation between restriction of chest expansion, limitation of lung function, and working capacity or exercise tolerance. As in previous studies there was a significant association between chest expansion and lung vital capacity. There was also a significant association between vital capacity and exercise tolerance as measured by

L R Fisher; M I Cawley; S T Holgate

1990-01-01

161

Ankylosing Spondylitis and Crohn's Disease: Biologic Treatment Advances and Guideline Interpretation  

Microsoft Academic Search

Ankylosing spondylitis (AS) and Crohn's disease (CD) are characterized by chronic inflammation in the joints and gastrointestinal tract (GI), respectively. There is con- siderable overlap between these 2 diseases, as a substantial proportion of patients with AS have asymptomatic gut inflammation on biopsy or clinically evidenced CD. In addition, AS and inflammatory peripheral arthropathies can be extraintestinal complications of CD.

Martin J. Bergman

162

The oxidative metabolism of circulating phagocytes in ankylosing spondylitis: determination by whole blood chemiluminescence  

Microsoft Academic Search

OBJECTIVESuperoxide anion radicals within the human body are regarded as a major cause of inflammation. However, their role in the pathogenesis of ankylosing spondylitis (AS) has not been well identified. This study aimed at investigating the relation between AS and the oxidative metabolism of phagocytes in whole blood.METHODS24 patients with classic AS were examined to determine their clinical status; complete

Kuo-Jang Ho; Po-Quang Chen; Chiung-Yu Chang; Fung-Jou Lu

2000-01-01

163

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

PubMed

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

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

2010-11-26

164

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis  

PubMed Central

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.

Kim, Sung-Min; Kim, Ki-Tack; Seo, Eun-Min

2010-01-01

165

Precise Bending Rod Technique a Novel Method for Precise Correction of Ankylosing Spondylitis Kyphosis.  

PubMed

STUDY DESIGN:: Report of a new technique. OBJECTIVE:: Introduce a new method of precise correction controlling for ankylosing spondylitis kyphosis. SUMMARY OF BACKGROUND DATA:: The exact angel method is excellent for calculating PSO angle, but difficult to perform during operation. In this study, Precise Rod Bending Technique as a new method of precise correction controlling for ankylosing spondylitis kyphosis was proposed via illustrative cases. METHODS:: A preoperative plan with exact osteotomy angle and level was done in the whole spine lateral X-film by exact angle method, then a precise contoured rod imitating the predicted spine correction was obtained in lateral spine X-film with actual size of trunk. At last, we disinfected this rod model and used it for controlling kyphosis correction precisely in ankylosing spondylitis patients with good cervical spine and hip joints. RESULTS:: Four Ankylosing spondylitis kyphosis patients were successfully corrected by precise bending rod technique, their mean age was 31 year-old, mean operative time was 247 mins (160?320 mins), mean bleeding was 1482 ml (727ml?2700ml), the average follow-up was 13.8 months (9?17 months), all patients reestablished sagittal balance (all C7-SSVL?2 cm), the predicted ostetomy degree was accurate to within 2° compared to the achieved degree at the osteotomy site, there were no any complications occurred during or after surgery. CONCLUSION:: Precise rod bending technique is a simple, effective method for exact correction of kyphosis caused by ankylosing spondylitis. The surgical result was corresponded with the preoperative planning. PMID:23429324

Yang, Junlin; Huang, Zifang; Grevitt, Michael; Li, Jun; Li, Fobao; Yang, Jingfan

2013-02-19

166

Assessment of subclinical atherosclerosis in ankylosing spondylitis: correlations with disease activity indices.  

PubMed

The aim of the study was to evaluate atherosclerosis in ankylosing spondylitis (AS) through the assessment of morphological and functional measures of subclinical atherosclerosis. Twenty patients [M/F=12/8, age (median/range) 43.5/28-69 years; disease duration (median/range) 9.7/1-36) years] with AS classified according to modified New York criteria and twenty age and sex related healthy controls with negative past medical history for cardiovascular events were enrolled in the study. In all patients and controls, the intima-media thickness (IMT) of common carotid artery, carotid bulb and internal carotid artery, and the flow-mediated dilatation (FMD) of non-dominant arm brachial artery were determined, using a sonographic probe Esaote GPX (Genoa, Italy). Furthermore, we assess the main disease activity and disability indices [bath ankylosing spondylitis disease activity index, ankylosing spondylitis disease activity score-eritrosedimentation rate (ASDAS-ESR), ASDAS-C-reactive protein (CRP), bath ankylosing spondylitis metrology index, bath ankylosing spondylitis functional index) and acute phase reactants. Plasmatic values of total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride and homocysteine were carried out in all twenty patients. IMT at carotid bulb was significant higher in patients than in controls (0.67 mm vs 0.54 mm; P=0.03). FMD did not statistically differ between patients and controls (12.5% vs 15%; P>0.05). We found a correlation between IMT at carotid bulb and ESR (rho 0.43; P=0.04). No correlation was found between FMD and disease activity and disability indices. This study showed that in AS patients, without risk factors for cardiovascular disease, carotid bulb IMT, morphological index of subclinical atherosclerosis, is higher than in controls. PMID:23884025

Perrotta, F M; Scarno, A; Carboni, A; Bernardo, V; Montepaone, M; Lubrano, E; Spadaro, A

2013-07-23

167

Psoriatic spondylitis in a patient with classical rheumatoid arthritis.  

PubMed Central

A patient exhibiting typical features of classical rheumatoid arthritis and psoriatic spondylitis is described. The patient, a woman, presented at the age of 29 with an inflammatory arthritis. Twenty years later, she developed psoriasis, and after a further 3 years, she was first noted to have rheumatoid nodules and to be strongly seropositive. Now at the age of 60, she has a rigid spine with radiographic changes of spondylitis. Neither rheumatoid arthritis, nor psoriatic spondylitis can account for all the features of her disease and there is evidence to suggest that both conditions combined to damage her peripheral joints. Images Fig. 1 Fig. 2 Fig. 3

Thurtle, O. A.; Dumbelton, I. B.; Preston, J. R.; Cook, P. L.; Cawley, M. I.

1983-01-01

168

Anti-tumour necrosis factor ? therapy for ankylosing spondylitis: international experience  

PubMed Central

The conventional approach to treatment of patients with spondyloarthritis (SpA), particularly ankylosing spondylitis (AS), has serious limitations, adding a sense of urgency to the evaluation of new treatments for these rheumatic disorders. Tumour necrosis factor ? (TNF?) is a cytokine that has been shown to mediate inflammatory and regulatory activities in SpA and other immune mediated diseases, including other arthritides and inflammatory bowel disease. Positive results have been reported in several international open label and randomised controlled trials of infliximab and etanercept, the two main biological agents targeting TNF?, which have included approximately 300 patients with SpA. Specifically, TNF?-directed therapy resulted in significant improvements in disease activity, function, and quality of life in these patients, most of whom had AS and received infliximab. Preliminary evidence from open label, long term extension trials suggests clinical benefit with continued use. Serious side effects were rare and consistent with experience from patient groups receiving infliximab or etanercept treatment for inflammatory bowel disease or rheumatoid arthritis. Together, these findings herald an age of more effective treatment of patients with AS with anti-TNF? and other emerging biological agents.

Braun, J; Sieper, J; Breban, M; Collantes-Estevez, E; Davis, J; Inman, R; Marzo-Ortega, H; Mielants, H

2002-01-01

169

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

SciTech Connect

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.

Resnick, D.; Williamson, S.; Alazraki, N.

1981-05-01

170

Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis  

Microsoft Academic Search

ObjectiveTo study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS).MethodsIn this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the

Pedro Machado; Robert Landewé; Jürgen Braun; Kay-Geert A Hermann; Daniel Baker; Désirée van der Heijde

2010-01-01

171

Finnish HLA studies confirm the increased risk conferred by HLA-B27 homozygosity in ankylosing spondylitis  

Microsoft Academic Search

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

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

2006-01-01

172

Prevalence, clinical relevance and characterization of circulating cytotoxic CD4+CD28- T cells in ankylosing spondylitis  

Microsoft Academic Search

Circulating CD3+CD4+CD28- cells exhibit reduced apoptosis and were found to be more enriched in patients with ankylosing spondylitis than in age-matched healthy control individuals (7.40 ± 6.6% versus 1.03 ± 1.0%; P +CD28- T cells correlate with disease status as measured using a modified metrology score, but they are independent of age and duration of ankylosing spondylitis. CD4+CD28- T cells

Christina Duftner; Christian Goldberger; Albrecht Falkenbach; Reinhard Würzner; Barbara Falkensammer; Karl P Pfeiffer; Elisabeth Maerker-Hermann; Michael Schirmer

2003-01-01

173

Arthritis Today.  

National Technical Information Service (NTIS)

Dr. Plotz discusses the symptoms, diagnosis and treatment of arthritis, including osteoarthritis, gout, ankylosing spondylitis and systemic lupus erythematosus. He describes the degenerative processes, immune abnormalities, genetic factors, and infectious...

1994-01-01

174

An international study on starting tumour necrosis factor-blocking agents in ankylosing spondylitis  

PubMed Central

Objectives To determine the type and proportion of patients with ankylosing spondylitis who rheumatologists consider to be candidates for treatment with tumour necrosis factor (TNF)?blocking agents, and to what extent this is in agreement with the ASsessment in Ankylosing Spondylitis (ASAS) international working group recommendations on initiation of treatment with anti?TNF agents. Methods Participants were rheumatologists from 10 different countries, who were considered to be experts in treating patients with ankylosing spondylitis and in the use of anti?TNF treatment, but were unaware of the ASAS recommendations (unpublished at the time of study in 2003). The first 10 consecutive patients with ankylosing spondylitis seen by the rheumatologist were evaluated as to whether the patient was a candidate for anti?TNF treatment. Thereafter, a metrologist assessed the patient for disease activity and severity, and collected data on demographics and treatment. Results Complete data were available for 1207 of the 1284 patients and were used for analysis. Overall, the rheumatologists indicated that they would initiate TNF?blocking agents in 49.3% of patients, ranging from 37.2% patients in Canada to 78.3% in Australia. These candidates had higher disease activity, higher levels of acute?phase reactants, worse spinal mobility, worse function, more often hip involvement and a higher prevalence of sick leave. Of all patients considered to be candidates, 40% did not fulfil ASAS recommendations with respect to previous use of non?steroidal anti?inflammatory drugs (NSAIDs; at least two NSAIDs) or Bath Ankylosing Spondylitis Disease Activity Index (?4). Conversely, 36% of patients who did not fulfil the NSAID or BASDAI recommendations were still considered to be candidates for TNF?blocking treatment. Objective variables, such as C reactive protein, erythrocyte sedimentation rate or magnetic resonance activity, were considered less important than disease activity in the decision on starting TNF?blocking drugs. The only important objective criterion was rapid radiographic progression. Conclusion Rheumatologists wanted to initiate TNF?blocking drugs in roughly half of the patients with ankylosing spondylitis. However, there was a wide variation across countries and doctors. Rheumatologists considered both disease activity and severity to be determinants of starting TNF blockers, but their decision was often in disagreement with ASAS recommendations.

Pham, T; Landewe, R; van der Linden, S; Dougados, M; Sieper, J; Braun, J; Davis, J; Rudwaleit, M; Collantes, E; Burgos-Vargas, R; Edmonds, J; Olivieri, I; van der Horst-Bruinsma, I; Mielants, H; Stone, M; Emery, P; van der Heijde, D

2006-01-01

175

OA01.04. Management of ankylosing spondylitis through ayurvedic medicine along with agnikarma- A case study  

PubMed Central

Purpose: To specify the role of Ayurvedic medicine along with Agni karma in treatment of Ankylosing spondylitis, a chronic inflammatory arthritis and auto immune disease with a strong genetic predisposition Method: In present case study of AS with +ve HLAB27 and LDH (lactate dehydrogenase) 624.1U/L(normal range 230460U/L)with radiological abnormalities at the sight of L.S. spine AP and Lt. are symptoms of mild lumbar spondylosis with right sacro-iliac arthritis. The patient was having Vata and Kapha dominant symptoms like Amavata so he was subjected to therapy which performs removal of Ama and detoxification of toxins from the body followed by ruksh virechan with swadista virechan churna 5 gm in every 4 days once in night and Nadi sweda with dashmool kwath for 7days there after agni karma in every 15 days periodically along with hypothetical herbomineral combination up to 6 months as patient follows. Result: After 4 months of regular treatment all other typical features related to disease like amajeerna, shoola etc were also improved. In lab reports, HLAB27 became negative and LDH returned to normal range up to 294U/L. In radiological reports the fusion of vertebral column was also reversed as showed in AP view of X-ray imaging. This particular case has proved the importance of Ayurvedic medicine and Agni karma in AS. Conclusion: Ayurvedic intervention was found to be efficacious in management of Ankylosing spondylitis. Further studies are needed to establish efficacy on the basis of rigorous parameters.

Tamrakar, Anupam; Sonkar, Ramsukh; Chandrakar, Vijaya Lakshmi; Tamrakar, Er. Anuraj

2012-01-01

176

Tubulointerstitial nephritis and uveitis with Fanconi syndrome in a patient with ankylosing spondylitis.  

PubMed

We report a 40-year-old man with ankylosing spondylitis who was referred to our hospital because of a 2-month history of general fatigue, anorexia, and weight loss. Laboratory findings showed anemia and renal dysfunction. Fanconi syndrome was suggested by multiple proximal tubular defects including renal glucosuria, hyperuricosuria, hyperphosphaturia, proximal renal tubular acidosis, and kaliuresis leading to hypokalemia. Renal biopsy showed acute tubulointerstitial nephritis. Furthermore, bilateral uveitis was diagnosed by an ophthalmologist. The patient was treated with systemic corticosteroids. The renal and proximal tubular function returned to normal and uveitis disappeared by 4 weeks after commencement of corticosteroid treatment. To our knowledge, tubulointerstitial nephritis and uveitis has rarely been associated with Fanconi syndrome and had not been reported in ankylosing spondylitis. PMID:19825339

Wen, Y K

2009-10-01

177

Interferon regulatory factor (IRF)-5: a potential therapeutic target for ankylosing spondylitis.  

PubMed

Ankylosing spondylitis is a common inflammatory rheumatic disease that affects the axial skeleton, causing characteristic inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. New imaging techniques and therapies have substantially changed the management of this disease in the past decade. Whether inhibition of radiographic progression and structural damage can be reached with available drugs is as yet unclear. Furthermore, treatment with non-steroidal anti-inflammatory agents and physiotherapy remains an important approach to long-term management of patients with ankylosing spondylitis. The new treatment options with IRF-5 seem to be a breakthrough for patients' refractory to conventional and feasible treatment. PMID:21928121

Xu, Wang-Dong; Ye, Dong-Qing

2011-09-18

178

The relationship between inflammation and new bone formation in patients with ankylosing spondylitis  

PubMed Central

Introduction Spinal inflammation as detected by magnetic resonance imaging and new bone formation as identified by conventional radiographs are characteristic of ankylosing spondylitis. Whether and how spondylitis and syndesmophyte formation are linked are unclear. Our objective was to investigate whether and how spinal inflammation are associated with new bone formation in ankylosing spondylitis. Methods Spinal magnetic resonance images and conventional radiographs from 39 ankylosing spondylitis patients treated with anti-tumour necrosis factor (anti-TNF) agents at baseline and after 2 years were analysed for syndesmophyte formation at vertebral edges with or without inflammatory lesions at baseline. Results Overall, 922 vertebral edges at the cervical and lumbar spine were analysed. At baseline, the proportion of vertebral edges with and without inflammation (magnetic resonance imaging) that showed structural changes (conventional radiographs) was similar (in total, 16.6% of all vertebral edges in 71.4% of patients). From the perspective of syndesmophyte formation (n = 26, 2.9%) after 2 years, there were more vertebral edges without (62%) than with (38%) inflammation at baseline (P = 0.03). From the perspective of spinal inflammation at baseline (n = 153 vertebral edges), more syndesmophytes developed at vertebral edges with (6.5%) than without (2.1%) inflammation (P = 0.002, odds ratio 3.3, 95% confidence interval 1.5 to 7.4). Inflammation persisted in 31% of the initially inflamed vertebral edges (n = 132), and new lesions developed in 8% of the vertebral edges without inflammation at baseline (n = 410). From the perspective of spinal inflammation after 2 years (n = 72 vertebral edges), 5.6% of the vertebral edges showed syndesmophyte development in contrast to 1.9% of the vertebral edges with new syndesmophytes without inflammation (P = 0.06). Conclusions These findings obtained in patients treated with anti-TNF agents suggest linkage and some dissociation of inflammation and new bone formation in ankylosing spondylitis. Although syndesmophytes were also found to develop at sites where no inflammation had been seen by magnetic resonance imaging at baseline, it was more likely that syndesmophytes developed in inflamed vertebral edges. More effective suppression of spinal inflammation may be required to inhibit structural damage in ankylosing spondylitis.

Baraliakos, Xenofon; Listing, Joachim; Rudwaleit, Martin; Sieper, Joachim; Braun, Juergen

2008-01-01

179

Biochemical markers of bone remodeling and bone sialoprotein in ankylosing spondylitis  

Microsoft Academic Search

The aim of this work was to determine bone mineral density (BMD) in a group of patients with ankylosing spondylitis (AS) and to study alterations in bone remodeling in these patients. Eighteen patients (16 males and two females) with AS, mean age 44.7, range 21–75, and 18 age- and sex-matched healthy controls were studied. BMD was evaluated by dual energy

Carlos Acebes; Concepción de la Piedra; Maria Luisa Traba; Markus J Seibel; Carlos Garc??a Mart??n; Jacome Armas; Gabriel Herrero-Beaumont

1999-01-01

180

HLA class I associations of ankylosing spondylitis in the white population in the United Kingdom  

Microsoft Academic Search

OBJECTIVE: To investigate the HLA class I associations of ankylosing spondylitis (AS) in the white population, with particular reference to HLA-B27 subtypes. METHODS: HLA-B27 and -B60 typing was performed in 284 white patients with AS. Allele frequencies of HLA-B27 and HLA-B60 from 5926 white bone marrow donors were used for comparison. HLA-B27 subtyping was performed by single strand conformation polymorphism

M A Brown; K D Pile; L G Kennedy; A Calin; C Darke; J Bell; B P Wordsworth; F Cornélis

1996-01-01

181

Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis  

Microsoft Academic Search

The mortality and causes of death in 398 patients (47 women, 351 men) with definite ankylosing spondylitis, admitted to hospital for the first time between 1961 and 1969, were investigated. The mean age at first admission was 36.5 years (SD 11.8). After a mean follow up time of 25.7 years, a total of 152 patients (12 women, 140 men) had

K Lehtinen

1993-01-01

182

Mortality among patients with ankylosing spondylitis after a single treatment course with x rays  

Microsoft Academic Search

Mortality was studied in 14 111 patients with ankylosing spondylitis given a single course of x-ray treatment during 1935-54. Mortality from all causes combined was 66% greater than that of members of the general population of England and Wales. There were substantial excesses of deaths from non-neoplastic conditions, but these appeared to be associated with the disease itself rather than

P G Smith; R Doll

1982-01-01

183

Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis  

Microsoft Academic Search

OBJECTIVE--To examine the relationship between disease severity and bone density as well as vertebral fracture risk in patients with ankylosing spondylitis (AS). METHODS--Measurements were taken for bone mineral density (BMD) and vertebral fracture rates in 87 patients with AS. BMD was measured at the hip (femoral neck -FN), lumbar spine (L1-L4-LS) and for the whole body using a hologic-QDR-1000\\/W absorptiometer.

S Donnelly; D V Doyle; A Denton; I Rolfe; E V McCloskey; T D Spector

1994-01-01

184

The use of the GlideScope(R) for tracheal intubation in patients with ankylosing spondylitis  

Microsoft Academic Search

Background. The GlideScopeVideo Laryngoscope is a new intubating device. The aim of the study was to investigate the use of the GlideScopefor tracheal intubation in patients with ankylosing spondylitis (AS) undergoing general anaesthesia. Methods. Twenty AS patients were chosen to undergo tracheal intubation by the GlideScope? . Preoperative airway assessments were carried out to predict the difficulty of tracheal intubation.

H. Y. Lai; I. H. Chen; A. Chen; F. Y. Hwang; Y. Lee

2006-01-01

185

Significance of non-pathogenic cross reactive bowel flora in patients with ankylosing spondylitis  

Microsoft Academic Search

We have previously shown that antisera raised in rabbits to certain enteric cross reactive strains of bacteria are capable of specifically lysing the peripheral blood lymphocytes of HLA-B27 positive patients with ankylosing spondylitis (B27+ AS+). We now report that bacteria with cross reactive antigenic determinants are found in the bowel flora of all of 52 B27+ AS+ patients but in

L E McGuigan; J K Prendergast; A F Geczy; J P Edmonds; H V Bashir

1986-01-01

186

Serum and secretory IgA immune response to Klebsiella pneumoniae in ankylosing spondylitis  

Microsoft Academic Search

Summary  Serum and salivary IgA antibodies toKlebsiella pneumoniae were estimated by enzyme-linked immunosorbent assay (ELISA) in 53 patients with ankylosing spondylitis (AS) and 30 healthy controls. The concentrations of total serum IgA, salivary secretory component (SC) and serum C-reactive protein (CRP) were also measured. In the serum of AS patients there was a positive correlation between Klebsiella IgA antibodies and the

A. K. Trull; G. S. Panayi

1983-01-01

187

Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis  

Microsoft Academic Search

Objectives. Treatment of ankylosing spondylitis (AS) with the tumour necrosis factor a (TNF-a) receptor fusion protein etanercept has shown efficacy in patients with active disease in randomized controlled trials (RCTs) for limited periods. The objective of the study was to assess the long-term efficacy and safety of etanercept over 1 yr, including discontinuation and readministration. Methods. In this 54-week open

J. Brandt; J. Listing; H. Haibel; H. Sorensen; A. Schwebig; M. Rudwaleit; J. Sieper; J. Braun

2005-01-01

188

The coexistence of ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis—a postmortem diagnosis  

Microsoft Academic Search

A 72-year-old male was diagnosed as having ankylosing spondylitis, mainly according to radiological findings, confirmed as\\u000a HLA-B27-negative. Postmortem examination of the skeleton raised doubts on the initial diagnosis, since spinal findings pointed\\u000a out also to diffuse idiopathic skeletal hyperostosis. The authors discuss the differential diagnosis and enhance the postmortem\\u000a findings which allowed the diagnosis of the two clinical entities in

Xavier Jordana; Ignasi Galtés; Ana Rita Couto; Luís Gales; Margarida Damas; Manuela Lima; Jácome Bruges-Armas

2009-01-01

189

Computed tomographic demonstration of calcification of the ligamenta flava of the lumbosacral spine in ankylosing spondylitis.  

PubMed Central

An axial computed tomographic (CT) scan of the lumbosacral regions was performed in 65 patients. The patient population was divided into two groups. The first (control) group included 40 elderly patients without calcification of the ligamenta flava. The second group included 25 patients with ankylosing spondylitis. More than 90% of those in the second group showed calcified lumbosacral ligamenta flava. In two patients these calcifications produced spinal stenosis. The diagnostic and practical importance of these findings are discussed. Images

Avrahami, E; Wigler, I; Stern, D; Caspi, D; Yaron, M

1988-01-01

190

Lack of association of matrix metalloproteinase 3 (MMP3) genotypes with ankylosing spondylitis susceptibility and severity  

Microsoft Academic Search

Objective. To study the linkage and association of ankylosing spondylitis (AS) with genotypes for matrix metalloproteinase 3 (MMP3), a gene located at chromosome 11q22.3 and lying within the 101-124 cM region observed in a recent genome-wide scan as a region associated with AS susceptibility. Methods. MMP3 genotypes were examined in 229 pedigrees with AS, 131 sporadic AS cases and 87

L. Jin; M. Weisman; G. Zhang; M. Ward; J. Luo; J. Bruckel; R. Inman; M. A. Khan; H. R. Schumacher; W. P. Maksymowych; M. Mahowald; T. Martin; J. T. Rosenbaum; D. T. Y. Yu; M. Stone; J. Watson; E. Dickman; J. Davis; J. D. Reveille

2005-01-01

191

Interleukin23 receptor genetic polymorphisms and ankylosing spondylitis susceptibility: a meta-analysis  

Microsoft Academic Search

Up to now, many publications have evaluated the correlation between IL-23R polymorphisms and ankylosing spondylitis with conflicting\\u000a results. We perform this meta-analysis to collect all the relevant studies up to date to further clarify the association of\\u000a IL-23R polymorphisms with AS. Relevant published data were retrieved through Medline, PubMed, Embase, Web of Science, CNKI,\\u000a Chinese BioMedical Literature Database on disc,

Zhenhua Duan; Faming Pan; Zhen Zeng; Tianchen Zhang; Sheng Wang; Guixing Li; Shengqian Xu; Jianhua Xu; Li Zhang

192

Association of an ERAP1 ERAP2 haplotype with familial ankylosing spondylitis  

Microsoft Academic Search

ObjectivesTo assess whether there is excess transmission of alleles from the ERAP1 ERAP2 locus in families with ankylosing spondylitis (AS).Methods199 multiplex families with AS with four non-synonymous single nucleotide polymorphisms (SNPs), three in the endoplasmic reticulum aminopeptidase 1 (ERAP1) gene (rs27044, rs10050860 and rs30187) and one in the endoplasmic reticulum aminopeptidase 2 (ERAP2) gene (rs2549782), were genotyped and family-based association

Florence W L Tsui; Nigil Haroon; John D Reveille; Proton Rahman; Basil Chiu; Hing Wo Tsui; Robert D Inman

2010-01-01

193

[Biologics in the early treatment of ankylosing spondylitis and related forms of spondyloarthritis].  

PubMed

New pathogenetic insights have identified the key role of TNF-alpha in inflammatory rheumatic diseases and have revolutionized the therapy of spondyloarthritides. TNF-alpha-antagonists specifically inhibit the pro-inflammatory effects of TNF-alpha. Clinical studies with infliximab (Remicade), Etanercept (Enbrel) or Adalimumab (Humira) in ankylosing spondylitis or related diseases demonstrate superior efficacy to conventional drugs like non-steroidal antirheumatic drugs or traditional disease modifying antirheumatic drugs. PMID:18500471

Langer, Hans-Eckhard

2008-01-01

194

Diet, disease activity, and gastrointestinal symptoms in patients with ankylosing spondylitis  

Microsoft Academic Search

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the\\u000a presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using\\u000a a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered\\u000a postal questionnaire regarding demographic data, diet, medication, and gastrointestinal

Björn Sundström; Solveig Wållberg-Jonsson; Gunnar Johansson

2011-01-01

195

Serum nitric oxide, catalase, superoxide dismutase, and malondialdehyde status in patients with ankylosing spondylitis  

Microsoft Academic Search

In this study, serum antioxidant and oxygen derived free radical status of patients with ankylosing spondylitis (AS) was investigated and compared with that of age- and sex-matched healthy controls. The relationship of these parameters to disease activity indices was also examined. Thirty patients with AS not currently under disease-modifying antirheumatic drug (DMARD) treatment (e.g., sulfasalazine or methotrexate) (15 active and

Salih Ozgocmen; Sad?k Sogut; Ozge Ardicoglu; Ersin Fadillioglu; Irfan Pekkutucu; Omer Akyol

2004-01-01

196

Pattern of ankylosing spondylitis in an Iranian population of 98 patients  

Microsoft Academic Search

The prevalence and pattern of ankylosing spondylitis (AS) can vary from country to country, according to genetic and environmental\\u000a factors. This study aims to analyze the patterns of disease in a population of Iranian patients with AS. We performed a prospective\\u000a study (2002–2007) analyzing 98 patients with diagnosis of AS according to the modified New York criteria. Selected patients\\u000a underwent

Mohammad Ali Nazarinia; Fariborz Ghaffarpasand; Hamid Reza Heiran; Zahra Habibagahi

2009-01-01

197

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

Microsoft Academic Search

We aimed to evaluate diagnosis delay and its impact on disease in terms of activity, functional disability, and radiographic\\u000a damage in Moroccan patients with ankylosing spondylitis (AS). We recruited 100 Moroccan patients who fulfilled New York Classification\\u000a criteria for AS. Diagnosis delay was defined as the interval between the first symptom of AS and the moment of a correct diagnosis.

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

198

Withdrawal from labour force due to work disability in patients with ankylosing spondylitis  

Microsoft Academic Search

OBJECTIVETo investigate withdrawal from the labour force because of inability to work owing to ankylosing spondylitis (AS) and to determine the characteristics of patients with no job because of work disability attributable to AS.METHODSA postal questionnaire was sent to 709 patients with AS aged 16–60 years followed up by a rheumatologist. Kaplan-Meier survival statistics were used to assess the time

A Boonen; A Chorus; H Miedema; D van der Heijde; R Landewé; H Schouten; H van der Tempel; S van der Linden

2001-01-01

199

Bone density, ultrasound measurements and body composition in early ankylosing spondylitis  

Microsoft Academic Search

Objectives. In this cross-sectional study, we evaluated bone density using both dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound (QUS) techniques and examined the changes in body composition in patients with ankylosing spondylitis (AS). Methods. Seventy-one patients were compared with seventy-one sex- and age-matched controls. Bone mineral density (BMD) was evaluated at the lumbar spine and femoral neck with a Lunar

E. Toussirot; F. Michel; D. Wendling

2001-01-01

200

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

PubMed

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

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

2012-11-29

201

Serum markers associated with clinical improvement in patients with ankylosing spondylitis treated with golimumab  

PubMed Central

Objective Identify serum biomarkers modulated by golimumab treatment and associated with clinical response in patients with ankylosing spondylitis (AS). Methods Sera were collected at weeks 0, 4 and 14 from 100 patients with active AS in the GO–RAISE study. Patients were randomly assigned subcutaneous injections of placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks. Samples were tested for select inflammatory, bone and cartilage markers, and protein profiling was also performed. Results Golimumab treatment resulted in significant decreases in several serum proteins at weeks 4 and 14 compared with placebo. Patients who achieved clinical response at week 14, as assessed by a ?20% improvement in the Assessment in SpondyloArthitis international Society response criteria (ASAS 20), demonstrated a distinct biomarker profile with lower levels of acute phase reactants and inflammatory biomarkers compared with patients who did not. Notably, combinations of two or three biomarkers assessed at baseline were predictive of various clinical outcomes (ASAS 20, Bath ankylosing spondylitis disease activity index 50 or Bath ankylosing spondylitis functional index) using a logistic regression analysis, and the overall predictive values for these combined biomarkers were greater than observed for C-reactive protein (CRP) alone. Conclusion Golimumab modulated acute phase reactants and inflammatory markers in patients with active AS. Specific combinations of biomarkers at baseline demonstrated a stronger prediction for clinical efficacy than CRP alone. These data provide insights into the mechanism of golimumab on inflammatory processes driving AS pathology, and may have utility in managing the treatment of patients with AS.

Wagner, Carrie; Visvanathan, Sudha; Braun, Jurgen; van der Heijde, Desiree; Deodhar, Atul; Hsu, Benjamin; Mack, Michael; Elashoff, Michael; Inman, Robert D

2012-01-01

202

Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks  

PubMed Central

Objective: To evaluate the continued safety and durability of clinical response in patients with ankylosing spondylitis receiving etanercept. Methods: 277 patients who had participated in a previous randomised, double blind, placebo controlled 24 week trial were eligible to continue in this open label extension study. All patients who enrolled in the open label extension (n = 257) received subcutaneous etanercept 25 mg twice weekly for up to 72 weeks, for a combined 96 weeks of cumulative trial and open label experience. For the patients who had received etanercept for 24 weeks in the double blind trial, this represented almost 2 years of continuous etanercept treatment. Results: Patients continuing etanercept treatment had a sustained response for almost 2 years, with 74% achieving an ASsessments in Ankylosing Spondylitis 20% (ASAS 20) response after 96 weeks of etanercept treatment. Patients who had received placebo in the preceding double blind trial had similar responses, with 70% of patients attaining an ASAS 20 response after 24 weeks of etanercept treatment and 78% achieving an ASAS 20 response after 72 weeks. Improved spinal mobility was seen in both groups. Etanercept was well tolerated in patients treated for up to 96 weeks. Conclusion: The subcutaneous administration of twice weekly doses of etanercept provided sustained durability of response in the improvement of signs and symptoms of ankylosing spondylitis for nearly 2 years.

Davis, J; van der Heijde, D M; Braun, J; Dougados, M; Cush, J; Clegg, D; Inman, R; Kivitz, A; Zhou, L; Solinger, A; Tsuji, W

2005-01-01

203

Biomarkers and cytokines of bone turnover: extensive evaluation in a cohort of patients with ankylosing spondylitis  

PubMed Central

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease of spine and sacroiliac joints; it is characterized by new bone formation, and the disease processes can be accompanied by osteoporosis. In the present study, we investigated changes in bone mineral density (BMD) and in the levels of various bone turnover-related biomarkers and cytokines in a cohort of AS patients, with regard to clinical parameters, disease activity, and treatment regimen. Methods 55 AS patients and 33 healthy controls included in the study. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI), and radiologic changes were scored by the Bath Ankylosing Spondylitis Radiologic Index (BASRI). Patients were also evaluated with the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Bone mineral density (BMD) assessed by dual energy X-ray absorptiometry. Various biomarkers and cytokines of bone turnover including osteoprotegerin (OPG), serum band 5 tartrate-resistant acid phosphatase (TRAP-5), soluble receptor activator of nuclear factor kappa-B ligand (sRANKL), secreted frizzled-related protein 1 (sFRP-1), Dickkopf-related protein 1 (DKK-1), and sclerostin were studied. Results The levels of TRAP-5, NTX, sRANKL, sclerostin, sFRP-1, DKK-1, and IFN?, were similar between the patients and controls (p?>?0.05), while BMD of femoral neck, and OPG levels were significantly lower in AS patients (p?

2012-01-01

204

Evaluation of paraoxonase and arylesterase activities in Egyptian patients with ankylosing spondylitis.  

PubMed

The role of paraoxonase (PON) and arylesterase (ARE) in the pathogenesis of inflammatory arthritis has been investigated, and their serum levels have been evaluated, but clinical study concerning PON1 and ARE and ankylosing spondylitis (AS) is little reported in literature. The aim of this study was to investigate PON1 and ARE activities in AS in comparison with healthy persons and their relation with the disease activity parameters. 35 AS patients and 35 healthy controls (matched for age and sex) participated. Disease activity of AS patients was assessed clinically according to the Bath AS disease activity index, and AS functional impairment was assessed using the Bath AS Functional Index. Serum samples were collected from all subjects to evaluate serum PON1, ARE activities, and lipid profile. The mean serum triglycerides, total cholesterol, and low density lipoprotein (LDL) were significantly higher in the AS patients than in controls, while the high-density lipoprotein (HDL) is significantly lower in the AS patients than controls. Serum PON1 and ARE activities were significantly lower in AS patients than in controls, while malondialdehyde (MDA) was significantly higher. AS patients with active disease had significantly higher serum triglycerides, total cholesterol, LDL and MDA while lower HDL, PON1 and ARE than those with no active AS. Decrease in the PON1/ARE activity leading to generation of oxidative stress may play an important role in the pathogenesis of AS. Moreover, it seems that activity of PON1/ARE in patients with AS is strictly correlated with the activity of the inflammatory process. PMID:23239038

Olama, Shereem Mohamed; Elarman, Mohammed Mohamed

2012-12-14

205

Association of ankylosing spondylitis with IgA-multiple myeloma: report of a case and pathogenetic considerations.  

PubMed

Multiple myeloma has rarely been reported in patients with ankylosing spondylitis. We observed a patient with a 20-year history of ankylosing spondylitis, who subsequently developed IgA myeloma. This association may not be simply coincidental. It has been proposed that the protracted stimulation of immunocytes by inflammatory lesions on the mucosal surfaces of the gastrointestinal, respiratory, and biliary tracts, where lymphocytes are already committed to IgA production, may be implicated in the pathogenesis of IgA myeloma in some patients. Ankylosing spondylitis is a chronic inflammatory disease, probably resulting from the interaction of a genetic predisposition involving HLA-B27 with an environmental event such as enteric bacterial infection. We propose that ankylosing spondylitis and IgA myeloma occurring concomitantly in our patient implies a possible pathogenetic relationship. In ankylosing spondylitis, persistent reticuloendothelial stimulation, due to chronic subclinical gastrointestinal infection, may lead to IgA-producing plasma cell activation and proliferation, and subsequent IgA myeloma development. PMID:2809565

Lam, S M; Ho, H H; Dunn, P; Luo, S F

1989-07-01

206

Effect of anti-TNF treatment on sleep problems in ankylosing spondylitis.  

PubMed

Sleep disturbances and problems are increased in ankylosing spondylitis (AS). But much is not known in a quantitative way about sleep problems and effect of treatments on AS. This study is aimed first, to investigate sleep disturbances in AS and secondly, to evaluate the effects of anti-TNF treatment on SD in AS. One hundred seventy-one (Female/male: 90/81) AS patients fulfilling modified New York criteria and 86 (F/M: 56/30) age- and gender-matched controls without inflammatory diseases were included into the study. Demographic data and disease activity and treatments were recorded using The Bath Ankylosing Spondylitis Functional Index (BASFI) and The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The Medical Outcomes Study (MOS) Sleep Questionnaire was used for evaluating sleep and problems of sleep. AS patients had higher sleep disturbance scale (SDS) and sleep problem index (SPI) II scores. Group A (patients using NSAID and/or DMARD, 53.2% of patients) had higher BASDAI and BASFI compared with Group B (Patients using anti-TNF treatments) (4.29 ± 2.38 vs. 2.46 ± 2.32, p < 0.001; 1.95 ± 2.15 vs. 0.93 ± 1.31, p < 0.001, respectively). Whereas Group A had higher scores of SDS, awaken short of breath or headache, somnolence, and SPI-II than controls, none of the sleep parameters were statistically different between patients on anti-TNF treatments and controls. BASDAI was positively correlated with SPI-I, SPI-II, SDS, and somnolence scale. AS patients had increased sleep problems and disturbances compared with controls. Anti-TNF agents improve significantly these problems. Sleep problems are significantly correlated with the disease activity. PMID:21448640

Karada?, Omer; Nakas, Dilek; Kalyoncu, Umut; Akdo?an, Ali; Kiraz, Sedat; Ertenli, Ihsan

2011-03-30

207

Effects of warming up on reliability of anthropometric techniques in ankylosing spondylitis.  

PubMed

To determine the effect of warm-up on anthropometric measures, 10 patients with ankylosing spondylitis and 10 normal control subjects were measured over a 1-hour period by one therapist. A series of 4 measures--a modified Schober's test, finger-to-floor with the subject standing on a 23-cm stool, chest expansion, and cervical rotation using an arthrodial protractor--were repeated completely 4 times. Subjects exercised between each series (except between the third and fourth series). Intra-rater reliability was determined by comparing measurement 3 with measurement 4, and the warm-up effect was determined by comparing measurement 1 with measurement 3. The Schober's test and chest expansion are stable measures and are not affected by warm-up. However, the finger-to-floor and cervical rotation exercises require warm-up to ensure stable values for clinical or research followup of spondylitis. PMID:3358812

Roberts, W N; Liang, M H; Pallozzi, L M; Daltroy, L H

1988-04-01

208

Axial spondyloarthritis: a new disease entity, not necessarily early ankylosing spondylitis.  

PubMed

New classification criteria for axial spondyloarthritis have been developed with the goal of increasing sensitivity of criteria for early inflammatory spondyloarthritis. However these criteria substantially increase heterogeneity of the resulting disease group, reducing their value in both research and clinical settings. Further research to establish criteria based on better knowledge of the natural history of non-radiographic axial spondyloarthritis, its aetiopathogenesis and response to treatment is required. In the meantime the modified New York criteria for ankylosing spondylitis remain a very useful classification criteria set, defining a relatively homogenous group of cases for clinical use and research studies. PMID:23100608

Robinson, Philip Cameron; Wordsworth, Bryan Paul; Reveille, John D; Brown, Matthew A

2012-10-25

209

Intestinal Behçet's disease appearing during treatment with adalimumab in a patient with ankylosing spondylitis.  

PubMed

Behçet's disease (BD) is a chronic inflammatory disease affecting multiple organ systems, such as the skin, joints, blood vessels, central nervous system, and gastrointestinal tract. Intestinal BD is characterized by intestinal ulcerations and gastrointestinal symptoms. The medical treatment of intestinal BD includes corticosteroids and immunosupressants. There have been several reports of tumor necrosis factor-? (TNF-?) blockers being successful in treatment of refractory intestinal BD. Here, we report on a patient who was diagnosed with intestinal BD despite treatment with the fully humanized TNF-? blocker (adalimumab) for underlying ankylosing spondylitis. This patient achieved clinical remission and complete mucosal healing through the addition of a steroid and azathioprine to the adalimumab regimen. PMID:23983446

Chung, Sook Hee; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho

2013-08-28

210

Intestinal Beh?et's disease appearing during treatment with adalimumab in a patient with ankylosing spondylitis  

PubMed Central

Behçet’s disease (BD) is a chronic inflammatory disease affecting multiple organ systems, such as the skin, joints, blood vessels, central nervous system, and gastrointestinal tract. Intestinal BD is characterized by intestinal ulcerations and gastrointestinal symptoms. The medical treatment of intestinal BD includes corticosteroids and immunosupressants. There have been several reports of tumor necrosis factor-? (TNF-?) blockers being successful in treatment of refractory intestinal BD. Here, we report on a patient who was diagnosed with intestinal BD despite treatment with the fully humanized TNF-? blocker (adalimumab) for underlying ankylosing spondylitis. This patient achieved clinical remission and complete mucosal healing through the addition of a steroid and azathioprine to the adalimumab regimen.

Chung, Sook Hee; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho

2013-01-01

211

Programmed cell death 1 gene polymorphisms is associated with ankylosing spondylitis in Chinese Han population  

Microsoft Academic Search

Programmed cell death 1 (PD-1) has been reported to have a genetic association in several autoimmune diseases. The aim of\\u000a this study was to investigate the association of PD-1 polymorphisms and haplotypes with ankylosing spondylitis (AS) in Chinese\\u000a Han population. In a case–control association study, three single-nucleotide polymorphisms (SNP), PD-1.3 G\\/A, PD-1.5 C\\/T and\\u000a PD-1.9 T\\/C, were genotyped in 216

Xiang Liu; Li-Hua Hu; Yi-Rong Li; Feng-Hua Chen; Yong Ning; Qun-Feng Yao

2011-01-01

212

Markers of intestinal inflammation in patients with ankylosing spondylitis: a pilot study  

PubMed Central

Introduction Inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) are similar chronic inflammatory diseases whose definitive etiology is unknown. Following recent clinical and genetic evidence supporting an intertwined pathogenic relationship, we conducted a pilot study to measure fecal calprotectin (fCAL) and IBD-related serologies in AS patients. Methods Consecutive AS patients were recruited from a long-term prospectively collected longitudinal AS cohort at Cedars-Sinai Medical Center. Controls were recruited from Cedars-Sinai Medical Center employees or spouses of patients with AS. Sera were tested by ELISA for IBD-associated serologies (antineutrophil cytoplasmic antibodies (ANCA), anti-Saccharomyces cerevisiae antibody IgG and IgA, anti-I2, anti-OmpC, and anti-CBir1). The Bath Ankylosing Spondylitis Disease Activity Index, the Bath Ankylosing Spondylitis Functional Index, and the Bath Ankylosing Spondylitis Radiology Index were completed for AS patients. Results A total of 81 subjects (39 AS patients and 42 controls) were included for analysis. The average age of AS patients was 47 years and the average disease duration was 22 years. AS patients were predominantly male; 76% were HLA-B27-positive. Median fCAL levels were 42 ?g/g and 17 ?g/g in the AS group and controls, respectively (P < 0.001). When using the manufacturer's recommended cutoff value for positivity of 50 ?g/g, stool samples of 41% of AS patients and 10% of controls were positive for fCAL (P = 0.0016). With the exception of ANCA, there were no significant differences in antibody levels between patients and controls. Median ANCA was 6.9 ELISA units in AS patients and 4.3 ELISA units in the controls. Among AS patients stratified by fCAL level, there were statistically significant differences between patients and controls for multiple IBD-associated antibodies. Conclusion Calprotectin levels were elevated in 41% of patients with AS with a cutoff value for positivity of 50 ?g/g. fCAL-positive AS patients displayed higher medians of most IBD-specific antibodies when compared with healthy controls or fCAL-negative AS patients. Further studies are needed to determine whether fCAL can be used to identify and characterize a subgroup of AS patients whose disease might be driven by subclinical bowel inflammation.

2012-01-01

213

Cauda equina syndrome associated with multiple lumbar arachnoid cysts in ankylosing spondylitis: improvement following surgical therapy.  

PubMed Central

A case of cauda equina syndrome with multiple lumbar arachnoid cysts complicating ankylosing spondylitis (AS) is described. The value of computerised tomography (CT) and magnetic resonance imaging (MRI) as a non-invasive means of establishing the diagnosis is emphasised. In contrast to previously reported cases the patient showed neurological improvement following surgical therapy. Surgery may be indicated in some patients, particularly when there is nerve root compression by the arachnoid cysts and when the patient is seen early before irreversible damage to the cauda equina has occurred. Images

Shaw, P J; Allcutt, D A; Bates, D; Crawford, P J

1990-01-01

214

Serum melatonin level in ankylosing spondylitis: is it increased in active disease?  

PubMed

In the recent years, the role of melatonin (MLT) in the pathogenesis of inflammatory arthritis has been investigated, and the serum levels of MLT have been evaluated, but clinical study concerning MLT and ankylosing spondylitis (AS) is little reported in literature. We aimed to investigate the serum levels of MLT and their relation with the disease activity parameters of patients with AS. Forty AS patients and 40 healthy controls (matched for age and sex with the patients) participated in this study. Demographic and clinical data were collected and assessed. Disease activity of AS patients was assessed clinically according to the Bath AS Disease Activity Index (BASDAI), while AS functional impairment was assessed using the Bath AS Functional Index (BASFI). Serum samples were collected from all subjects to evaluate serum MLT, ESR, and CRP. Serum MLT levels were significantly increased in AS patients as compared to healthy controls (95% CI: 4.63, 8.77, P < 0.001). ESR and CRP are significantly higher in the AS patients compared with the controls (P < 0.001). AS patients with active disease had significantly higher ESR (P = 0.0151), CRP (P = 0.0124), and BASFI (P = 0.0016). Also, the MLT serum level in AS patients with BASDAI ?40 was 39.7 ± 6.2 pg/ml compared with 35.2 ± 3.5 pg/ml in AS patients with BASDAI <40 (95% CI: 1.22, 7.78, P = 0.0106). Also, serum MLT level was significantly higher in the AS patients with enthesopathy than those without enthesopathy. Serum MLT levels were correlated with the duration of morning stiffness, BASDAI, BASFI, and CRP but not with ESR or duration of the disease. Serum levels of MLT were significantly increased in AS patients as compared to healthy controls. MLT levels correlated positively with BASDAI, BASFI, duration of morning stiffness, and CRP levels. Thus, it seems that MLT levels reflect the disease activity in AS patients. PMID:22057142

Senna, Mohammad Kamal; Olama, Shereen Mohamed; El-Arman, Mohammad

2011-11-06

215

Ankylosing spondylitis, late osteoarthritis, vascular calcification, chondrocalcinosis and pseudo gout: toward a possible drug therapy.  

PubMed

In this review we consider diseases associated with pathological mineralization/ossification, namely, ankylosing spondylitis (AS), osteoarthritis (OA), generalized artery calcification of infancy (GACI), vascular calcification as well as chondrocalcinosis (CC) and pseudo gout. Deciphering the key enzymes implicated in the calcification process is an objective of prime importance and the ultimate goal is to synthesize inhibitors of these enzymes in order to provide efficient alternate therapeutic strategies that will slow down the pathologic mineralization and complement the arsenal of anti-inflammatory drugs. One of the difficulties in the definition of diseases associated with pathologic mineralization/ossification lies in the controversial relationship between the type of calcification and the nature of the disease. Here, we propose to clarify this relationship by making a distinction between diseases associated with hydroxyapatite (HA) and calcium pyrophosphate dihydrate (CPPD) deposits. AS, OA, GACI and vascular calcification are usually characterized by mineralization/ossification associated with HA deposits, while CC and pseudo gout are mostly characterized by CPPD deposits. Although both HA and CPPD deposits may occur concomitantly, as in chronic pyrophosphate arthritis or in OA with CPPD, they are formed as a result of two antagonistic processes indicating that treatment of distinct diseases can be only achieved by disease-specific drug therapies. The hydrolysis of PPi, an inhibitor of HA formation, is mostly controlled by tissue non-specific alkaline phosphatase TNAP, while PPi production in the extracellular medium is controlled by ANK, a PPi transporter, and/or NPP1 which generates PPi from nucleotide triphosphates. Low PPi concentration may lead to a preferential deposition of HA while high PPi concentration will favor the formation of CPPD deposits. Thus, HA and CCPD deposition cannot occur concomitantly because they are determined by the Pi/PPi ratio which, in turn, depends on the relative activities of antagonistic enzymes, TNAP hydrolyzing PPi or ANK and NPP1 producing PPi. TNAP inhibitors could prevent HA formation in AS, in late OA, in GACI, as well as in vascular calcifications, while ANK or NPP1 inhibitors could slow down CCPD deposition in CC and pseudo gout. PMID:21517761

Mebarek, S; Hamade, E; Thouverey, C; Bandorowicz-Pikula, J; Pikula, S; Magne, D; Buchet, R

2011-01-01

216

HLA-B27 alone rather than B27-related class I haplotypes contributes to ankylosing spondylitis susceptibility  

Microsoft Academic Search

Characterization of non-B27 susceptibility genes will be required to know the pathogenesis of AS. The aim of this study was to examine whether ankylosing spondylitis (AS) susceptibility is controlled by B27 alone rather than B27 haplotypes and, whether other closely related class I loci , such as MICA and TNFA genes might play a role in AS. Three hundred eleven

J Martinez-Borra; Segundo Gonzalez; A López-Vazquez; M. A Gelaz; J. Bruges Armas; U Kanga; N. K Mehra; C López-Larrea

2000-01-01

217

Association of 1.25 vitamin D 3 deficiency, disease activity and low bone mass in ankylosing spondylitis  

Microsoft Academic Search

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication in established ankylosing spondylitis (AS). It is known that inflammatory activity in rheumatic diseases (i.e., proinflammatory cytokines) itself plays a possible role in the pathophysiology of bone loss. The aim of this study was to analyze whether inflammatory activity and an alteration of the vitamin D metabolism play

U. Lange; J. Teichmann; J. Strunk; U. Müller-Ladner; K. L. Schmidt

2005-01-01

218

Spondyloarthritis research consortium of canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis  

Microsoft Academic Search

Objective. To develop a feasible magnetic resonance imaging (MRI)- based scoring system for sacroiliac joint inflam- mation in patients with ankylosing spondylitis (AS) that requires minimal scan time, does not require contrast enhance- ment, evaluates lesions separately at each articular surface, and limits the number of sacroiliac images that are scored. Methods. A scoring method based on the assessment of

Walter P. Maksymowych; Robert D. Inman; David Salonen; Suhkvinder S. Dhillon; Ruben Krishnananthan; Millicent Stone; Barbara Conner-Spady; Janice Palsat; Robert G. W. Lambert

2005-01-01

219

There's more to life than everyday function: the challenge of measuring social role participation in ankylosing spondylitis  

Microsoft Academic Search

Symptoms and functional limitations are commonly reported primary outcome measures in ankylosing spondylitis (AS); however, participation has not been widely evaluated, as reflected by the scarcity of literature on the subject. People with AS suggest that participation in social roles (e.g. employment, leisure, and relationships with others) is a critical outcome that is often adversely affected by the sequelae of

Rosalind Wong; Elizabeth M Badley; Monique A Gignac; Aileen M Davis

2009-01-01

220

Association of Variants at 1q32 and STAT3 with Ankylosing Spondylitis Suggests Genetic Overlap with Crohn's Disease  

Microsoft Academic Search

Ankylosing spondylitis (AS) is a common inflammatory arthritic condition. Overt inflammatory bowel disease (IBD) occurs in about 10% of AS patients, and in addition 70% of AS cases may have subclinical terminal ileitis. Spondyloarthritis is also common in IBD patients. We therefore tested Crohn's disease susceptibility genes for association with AS, aiming to identify pleiotropic genetic associations with both diseases.

Patrick Danoy; Karena Pryce; Johanna Hadler; Linda A. Bradbury; Claire Farrar; Jennifer Pointon; Michael Ward; Michael Weisman; John D. Reveille; B. Paul Wordsworth; Millicent A. Stone; Walter P. Maksymowych; Proton Rahman; Dafna Gladman; Robert D. Inman; Matthew A. Brown

2010-01-01

221

Adalimumab in ankylosing spondylitis: an evidence-based review of its place in therapy  

PubMed Central

Introduction: Ankylosing spondylitis (AS) is an idiopathic chronic inflammatory disease that has prominent effects on the spine and peripheral joints. In addition, extraarticular manifestations such as enthesitis and acute anterior uveitis may be clinically important. In recent years, the therapy of AS has changed, largely due to the introduction of inhibitors of the proinflammatory cytokine tumor necrosis factor (TNF). Adalimumab, a human monoclonal antibody specifically for TNF, is the most recent of the TNF blocking agents that have been approved for the treatment of active, nonsteroidal antiinflammatory drug (NSAID)-refractory patients with AS. Aims: To evaluate the evidence for the therapeutic value of adalimumab in ankylosing spondylitis. Evidence review: There is clear evidence that adalimumab, administered 40 mg subcutaneously every 2 weeks, substantially improves the signs and symptoms of NSAID-refractory, active AS when compared with placebo treatment. There is ample evidence that adalimumab causes significant improvements in physical health status and overall AS-specific, health-related quality of life and physical functioning, which consequently leads to better work productivity. There is substantial evidence that adalimumab improves spinal and sacroiliac joint inflammation in AS patients. Initial results from clinical trials suggest that there is no increased risk of serious infections or malignancies in adalimumab-treated patients with AS. The most common adverse events were injection-site reactions. Limited economic evidence suggests that adalimumab 40 mg may be cost effective when used according to current valid treatment guidelines. Place in therapy: Adalimumab is an effective treatment for patients with active AS.

Hennigan, Stephanie; Ackermann, Christoph; Kavanaugh, Arthur

2007-01-01

222

A primary analysis of sexual problems in Chinese patients with ankylosing spondylitis.  

PubMed

While the physical impact of ankylosing spondylitis (AS) is central to clinical treatment, the sexual problems associated with AS are often overlooked. Sexual problems may be related to a variety of undocumented demographic parameters, physical impairments, and psychological problems. These associations were examined through a single-center cross-sectional study of 103 AS patients (78 males and 25 females) and 121 healthy individuals (73 males and 48 females). All participants provided information pertaining to sexual problems, sociodemographics, and clinical characteristics via written questionnaires including multiple-choice questions conducted independently in the clinical setting under physician supervision. Rates of both prevalence and severity of sexual dysfunctions in AS patients were much higher than those observed in healthy individuals. Bath Ankylosing Spondylitis (BAS) Disease Activity Index and two parameters of body image disturbance (distress and impairment in social functioning) correlated with impaired partner relationships (P < 0.05). BAS mobility index, impaired social functioning, and BAS functionality index were the most significant causes of impaired sexual function (P < 0.05) in AS patients. Both physical and psychological factors were shown to impact sexual relationships and function in Chinese AS patients. To more effectively manage AS in clinical settings, rheumatologists and nursing specialists should be aware of the condition's impact on sexual health, considering both physical outcomes, such as disease activity and physical function, as well as psychological well-being. PMID:23152087

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

2012-11-15

223

A study of the gram-negative bacterial flora in patients with ankylosing spondylitis.  

PubMed

1. Twenty-eight patients with active definite primary ankylosing spondylitis and fifty-four healthy control subjects were studied. 2. The HLA-B27 antigen was found in 75% of patients and 3.7% of controls. 3. Fecal samples from these subjects were cultured for gram-negative enteric bacteria on two occasions within one month. Positive cultures for Klebsiella sp were found in 32.1% of patients and in 22.2% of healthy controls, but this difference was not statistically significant. All other microorganisms detected were qualitatively and quantitatively similar in both groups. 4. Significantly increased mean values of serum IgA levels were found in the patient group when compared with the control group (P less than 0.01). The mean serum IgG and IgM levels did not differ statistically between the two groups. There was no correlation between any laboratory or clinical parameter and presence of Klebsiella sp carriage in ankylosing spondylitis patients. 5. These data are consistent with the view that a long time elapses between exposure to a trigger factor and clinical manifestations of the disease. PMID:2386846

Ferraz, M B; Atra, E; Trabulsi, L R; Goldenberg, J; Sato, E I

1990-01-01

224

Cardiac conduction system abnormalities in ankylosing spondylitis: a cross-sectional study  

PubMed Central

Background Cardiac conduction disturbances are common in spondyloarthropathies such as ankylosing spondylitis (AS). Whether their occurrence can be linked to signs and symptoms of rheumatic disease activity is an unsettled issue addressed in this study. Methods In this cross-sectional study patients with AS according to modified New York criteria but without psoriasis, inflammatory bowel disease, dementia, pregnancy, other severe diseases such as malignancy and difficulties in answering questionnaires were invited; and 210 participated (120 men), mean age 49 years (SD 13; range: 16–77). Questionnaires, physical examination, ECG, and laboratory tests were performed at the same visit. Results Cardiac conduction disturbances were common and diagnosed in 10-33%, depending on if conservative or less conservative predefined criteria were applied. They consisted mostly of 1st degree atrio-ventricular block and prolonged QRS duration, but one patient had a pacemaker and 7 more had complete bundle branch blocks. Conduction abnormalities were associated mainly with age, male gender and body weight, and not with laboratory measures of inflammation or with Bath Ankylosing Spondylitis Disease Activity Index. Neither were they associated with the presence of HLA B27, which was found in 87% of all patients; the subtype B270502 dominated in all patients. Conclusions Cardiac conduction abnormalities are common in AS, but not associated with markers of disease activity or specific B27 subtypes. Even relatively mild conduction system abnormalities might, however, indirectly affect morbidity and mortality.

2013-01-01

225

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

PubMed

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

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

2013-03-29

226

Building consensus on nomenclature and disease classification for ankylosing spondylitis: results and discussion of a questionnaire prepared for the International Workshop on New Treatment Strategies in Ankylosing Spondylitis, Berlin, Germany, 18-19 January 2002  

PubMed Central

Background: There is currently no universal consensus on nomenclature for spondyloarthropathy (SpA), or on activity and severity criteria for ankylosing spondylitis (AS). Method: Points of agreement and majority opinions among 28 international experts in the field were identified by questionnaire. Agreement was defined as >80% concurrence, clear majority as >60% concurrence, and a majority or trend as >50% concurrence. Results: Respondents agreed on the need for one term that reflects the inflammatory nature of the disease, but no agreement was reached on a specific term. Agreement included subdivision of patients with SpA into AS, psoriatic arthritis, inflammatory bowel disease associated arthritis, and undifferentiated spondyloarthritis/spondyloarthropathy. A majority of experts defined active disease as fulfilling classification criteria for AS and/or a SpA, and disease activity measured by a Bath AS Disease Activity Index (BASDAI) score >4 determined by two patient visits during a two month period, but no maximum radiographic score. The majority of participants considered failure of treatment response to non-steroidal anti-inflammatory drugs (NSAIDs) alone to be a prerequisite for active/severe AS, and 15/28 (54%) thought that NSAID treatment failure should be defined as lack of response to two or more NSAIDs. Conclusions: Respondents agreed that a two to five year study is the ethical method to demonstrate effects of anti-tumour necrosis factor ? (TNF?) therapy on radiographic progression of AS, and that inclusion criteria should include a certain level of disease activity (measured by BASDAI) and failure of certain treatments. After the efficacy of anti-TNF? therapy in AS and psoriatic arthritis is proved, respondents agreed that more studies will be needed to show efficacy for other SpA subsets.

Braun, J; Sieper, J

2002-01-01

227

[Critical study of radiculomedullary and neuromuscular complications of ankylosing spondylitis].  

PubMed

Medullo-radicular and neuro-muscular involvements of ankylosing spondylarthritis, often reported in an analytic fashion in the literature, deserve to be the subject of a critical study. Various neurological manifestations secondary to exceptional atlo-occipital and sometimes axis-atlas subluxations and medullary lesions as well as syndromes of the cauda equina. The medullary lesions have an epidural origin (3 cases in the literature, 2 cases from the authors) or are secondary to a spondylodiscitis (4 cases in the literature) or secondary to both (1 case reported by the authors). As for syndromes of the cauda equina the authors report 3 cases to be added to the 55 published previously. It concerns always old spondylarthritis. The lesions combine posterior diverticula and lesions of the lamina. The treatment is usually ineffective. A special case is represented by forms with trophic disorders. More debatable are the radicular lesions, which, except for intercostal pain, should be linked to local pain. Electromyographic abnormalities are of no significance. Alterations of the paravertebral muscles viewed on the scanner X have, for now, an uncertain significance. Finally, various associations, without significance such as multiple sclerosis, diffuse muscular lesions and the classic spondylotic pseudo-tabes, should be rejected. PMID:3035702

Serratrice, G; Acquaviva, P; Pouget, J; Guerra, L

1987-03-01

228

Erythrocyte Sedimentation Rate, C-Reactive Protein Level, and Serum Amyloid A Protein for Patient Selection and Monitoring of AntiTumor Necrosis Factor Treatment in Ankylosing Spondylitis  

Microsoft Academic Search

Objective. To study the usefulness of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum amyloid A (SAA) for response prediction and monitoring of anti-tumor necrosis factor (anti-TNF) treatment in ankylosing spondylitis (AS) patients. Methods. Patients were included consecutively before starting etanercept or infliximab treatment. ASsessment in Ankylosing Spondylitis (ASAS) response, defined as a 50% improvement or an absolute improvement

Vries de M. K; Eijk van I. C; I. E. Bruinsma; Mike J. L. Peters; Michael T. Nurmohamed; Ben A. C. Dijkmans; Bouke P. C. Hazenberg; Gerrit J. Wolbink

2009-01-01

229

Increased levels of serum IgA as IgA1 monomers in ankylosing spondylitis.  

PubMed Central

The various subsets of serum IgA were determined in 43 patients with ankylosing spondylitis to investigate the putative mucosal origin of increased IgA concentrations in this disease. Total IgA was shown to be increased and weakly correlated with the erythrocyte sedimentation rate (ESR). In contrast, although the mean concentration (but not the median) of secretory IgA (SIgA) was slightly increased, no correlation was found with total IgA nor the ESR. Moreover, molecular sieving of nine serum samples selected for their high concentrations of total IgA, and absorption with insoluble jacalin showed these immunoglobulins to be essentially monomers of the IgA1 subclass. These results are consistent with a non-secretory origin of the increase of serum IgA, which must be ascribed to the central immune system.

Hocini, H; Iscaki, S; Benlahrache, C; Vitalis, L; Chevalier, X; Larget-Piet, B; Bouvet, J P

1992-01-01

230

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

SciTech Connect

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.

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

1986-11-01

231

[Role of enteric Klebsiella pneumonia infection and HLA-B27 in ankylosing spondylitis].  

PubMed

Klebsiella pneumonia (KP) infection and HLA-B 27 have been shown to be strongly associated with ankylosing spondylitis (AS). In the present study, faecal cultures were performed and showed faecal carriage rate of KP was much higher in patients with AS (10/30) and hospital volunteers (2/10) than in the non-hospital volunteers (0/20). An octadecapeptide encompassing the shared hexamer between HLA-B 27 and KP nitrogenase residue was synthesized and autoantibodies against this short peptide were detected in sera of patients with AS and Reiter's syndrome (RS) and other related disease and normal controls. The results showed that such autoantibodies were detected in 42.2% of AS and 30% of RS patients yielding positive rate much higher than those found in other control groups. It is concluded that enteric KP infection were strongly implicated in the pathogenesis of AS probably by the mechanism of molecular mimicry with HLA-B 27. PMID:1298592

Huang, F; Cai, X H; Shi, G Y

1992-07-01

232

Significance of non-pathogenic cross reactive bowel flora in patients with ankylosing spondylitis.  

PubMed

We have previously shown that antisera raised in rabbits to certain enteric cross reactive strains of bacteria are capable of specifically lysing the peripheral blood lymphocytes of HLA-B27 positive patients with ankylosing spondylitis (B27+ AS+). We now report that bacteria with cross reactive antigenic determinants are found in the bowel flora of all of 52 B27+ AS+ patients but in only one of 50 HLA-B27 positive normal controls (B27+ AS-). These organisms are functionally similar to the cross reactive enteric bacteria originally reported. They are not confined to a particular genus or species and their cross reactive serological nature appears to be a property shared by all enteric organisms isolated from B27+ AS+ patients. Organisms with these properties have been shown to persist in the bowel flora of 14 B27+ AS+ patients followed up for more than one year. PMID:3527085

McGuigan, L E; Prendergast, J K; Geczy, A F; Edmonds, J P; Bashir, H V

1986-07-01

233

Cost-effectiveness of TNF-? inhibition in active ankylosing spondylitis: a systematic appraisal of the literature.  

PubMed

Ankylosing spondylitis (AS) is the most frequent prototype of spondyloarthritides. Substantial direct costs and productivity losses often arise in young patients. Currently, tumor necrosis factor (TNF) inhibitors are the only approved therapy escalation when usual care (physiotherapy and NSAIDs) proves to be insufficient. Owing to their high medication costs, TNF inhibitors are a target of cost-effectiveness analyses. There is consistent evidence regarding the use of TNF inhibitors according to recommendations in patients with active AS finding TNF inhibitors to be cost effective from a societal perspective. However, there are relevant uncertainties (discontinuation rate and progression rate) in the long-term estimates of the cost-effectiveness analyses analyzed. Whether TNF inhibitors are cost effective from an insurance perspective in the long run will have to be addressed by models based on observational data. PMID:22812555

Kirchhoff, Timm D; Mittendorf, Thomas; Schmidt, Reinhold E; Jablonka, Alexandra; Merkesdal, Sonja

2012-06-01

234

[Problem oriented learning (POL) in rehabilitation on the example of a patient with ankylosing spondylitis].  

PubMed

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported. PMID:17582557

Horn, K; Gülich, M; Lay, W; Morfeld, M; Schwarzkopf, S R; Mau, W

2007-06-01

235

Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire.  

PubMed

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific measure of needs-based quality of life developed in the UK and the Netherlands. This study describes translation, validation, and reliability of the scale into Turkish population. The ASQoL was translated into Turkish using the dual-panel process. Content validity was assessed via cognitive debriefing interviews with ankylosing spondylitis (AS) patients. Patients with AS according to modified New York criteria were recruited into the study from 12 hospitals of all part of Turkey. Psychometric and scaling properties were assessed via a two administration survey involving the ASQoL, the Nottingham Health Profile (NHP), Bath AS Functional Index (BASFI), and Bath AS Disease Activity Index (BASDAI). Classical psychometrics assessed reliability, convergent validity (correlation of ASQoL with NHP, BASFI, and BASDAI) and discriminative validity (correlation of ASQoL with perceived AS-severity and general health). Cognitive debriefing showed the new Turkish ASQoL to be clear, relevant, and comprehensive. Completed survey questionnaires were received from 277 AS patients (80 % Male, mean age 42.2/SD 11.6, mean AS duration 9.4 years/SD 9.4). Test-retest reliability was excellent (0.96), indicating low random measurement error for the scale. Correlations of ASQoL with NHP sections were low to moderate (NHP Sleep 0.34; NHP Emotional Reactions 0.83) suggesting the measures assess related but distinct constructs. The measure was able to discriminate between patients based on their perceived disease severity (p < 0.0001) and self-reported general health (p < 0.0001). The Turkish version of ASQoL has good reliability and validity properties. It is practical and useful scale to assess the quality of life in AS patients in Turkish population. PMID:23765201

Duruöz, M T; Doward, L; Turan, Y; Cerrahoglu, L; Yurtkuran, M; Calis, M; Tas, N; Ozgocmen, S; Yoleri, O; Durmaz, B; Oncel, S; Tuncer, T; Sendur, O; Birtane, M; Tuzun, F; Bingol, U; Kirnap, M; Celik Erturk, G; Ardicoglu, O; Memis, A; Atamaz, F; Kizil, R; Kacar, C; Gurer, G; Uzunca, K; Sari, H

2013-06-14

236

Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech Republic.  

PubMed

The aim of the study was to evaluate factors that influence health status and work disability in patients with ankylosing spondylitis (AS) in the Czech Republic. Data were collected in a retrospective fashion directly from patients with AS using mailed questionnaires containing questions regarding sociodemographic characteristics of patients, the course of their disease, therapy, rehabilitation, quality of life, and ability to work. HAQ-DI (Health Assessment Questionnaire-Disability Index) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) were also included in the questionnaires; 1,008 questionnaires were suitable for further statistical analysis. The average age +/- SD of patients was 50.2 +/- 10.7 years, the average symptom duration was 23.0 +/- 11.6 years. Mean time from first symptoms to diagnosis was 9.1 years. Full disability had been awarded to 303 patients (30%) at some point of their disease. Twenty seven percent of patients reported receiving full disability pension for 10 or more years. Four hundred fifty six subjects (45%) were currently or had been previously receiving partial disability pension. Receiving disability pension was more frequent among men (64%) compared to women (56%) (P = 0.012), despite the fact that women had higher BASDAI (P < 0.001) and HAQ-DI (P = 0.004) scores. Patients with a family history of AS had higher BASDAI and HAQ-DI scores (P = 0.001 and P = 0.008, respectively) compared to patients without a family history of AS. BASDAI and HAQ-DI scores correlated with age and duration of illness, younger patients and those with shorter disease duration had lower values. Fifty eight percent of patients reported a BASDAI score > or =4 (current cutoff value for initiation of biological therapy), but only 1% of patients were treated by anti TNF alpha agents within the last year. Seven hundred ninety one patients underwent spa treatment in the previous year; 96% of them experienced improvement of their health condition. PMID:18247079

Forejtová, S; Mann, H; Stolfa, J; Vedral, K; Fenclová, I; Némethová, D; Pavelka, K

2008-02-05

237

Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study  

PubMed Central

Background Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies. Methods This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis. Results Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73?years (mean age 53?years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course. Conclusions Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.

2013-01-01

238

Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance.  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the vertebral column and sacroiliac joints. Over time, the disease process promotes extensive remodeling of the spinal axis via ligamentous ossification, vertebral joint fusion, osteoporosis, and kyphosis. These pathological changes result in a weakened vertebral column with increased susceptibility to fractures and spinal cord injury (SCI). Spinal cord injury is often exacerbated by the highly unstable nature of vertebral column fractures in AS. A high incidence of missed fractures in the ankylosed spine as well as an increased incidence of spinal epidural hematoma also worsens the severity of SCI. Spinal cord injury in AS is a complex problem associated with high morbidity and mortality rates, which can be attributed to the severity of the injury, associated medical comorbidities, and the advanced age of most patients with AS who suffer an SCI. In this paper the authors outline the factors that increase the incidence of vertebral column fractures and SCI in AS and discuss the management of SCI in patients with AS. Primary prevention strategies for SCI in patients with AS are outlined as well. PMID:18290738

Jacobs, W Bradley; Fehlings, Michael G

2008-01-01

239

Lumbar Stiffness but not Thoracic Radiographic Changes Relate to Alteration of Lung Function Tests in Ankylosing Spondylitis  

Microsoft Academic Search

:   Involvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in\\u000a patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical\\u000a and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence\\u000a of involvement of the

L. Cerrahoglu; Z. Unlu; C. Goktan; P. Celik

2002-01-01

240

Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromsø, northern Norway  

Microsoft Academic Search

In an epidemiological survey in Tromsø, northern Norway a prevalence of definite ankylosing spondylitis (AS) of between 1.1% and 1.4% was found (males: 1.9-2.2% and females: 0.3-0.6%). The ratio of male to female was between 3.9 and 6.1 in favour of the male sex. It was calculated that 6.7% of the B27 positive individuals had AS, and that 22.5% of

J T Gran; G Husby; M Hordvik

1985-01-01

241

Evidence for a specific B27-associated cell surface marker on lymphocytes of patients with ankylosing spondylitis  

Microsoft Academic Search

THE strong association of HLA-B27 with ankylosing spondylitis (AS) as well as an increased frequency of B27 in other seronegative arthropathies is well documented1-4. Nevertheless, the significance and the molecular basis of this remarkable association is still unknown. Ebringer et al.5-7 reported that Klebsiella pneumoniae was present in the faeces of patients with AS more frequently than in those of

Kerri Seager; Helen V. Bashir; A. F. Geczy; J. EDMONDS; A. DE VERE-TYNDALL

1979-01-01

242

Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients  

Microsoft Academic Search

OBJECTIVETo evaluate employment status, work disability, and work days lost in patients with ankylosing spondylitis (AS).METHODSA questionnaire was sent to 709 patients with AS aged 16–60. The results of 658 of the patients could be analysed.RESULTSAfter adjustment for age, labour force participation was decreased by 15.4% in male patients and 5.2% in female patients compared with the general Dutch population.

A Boonen; A Chorus; H Miedema; D van der Heijde; H van der Tempel; Sj van der Linden

2001-01-01

243

Persistent clinical response to the anti-TNF-  antibody infliximab in patients with ankylosing spondylitis over 3 years  

Microsoft Academic Search

Objective. Infliximab, a monoclonal antibody against tumour necrosis factor a (TNF-a), is approved in Europe for the treatment of patients with active ankylosing spondylitis (AS) who have responded inadequately to conventional therapy. This report provides analyses from a 3-yr extension study, as a follow-up to both the 1- and 2-yr open label extensions of the original 3-month randomized controlled trial

J. Braun; X. Baraliakos; J. Brandt; J. Listing; A. Zink; R. Alten; G. Burmester; E. Gromnica-Ihle; H. Kellner; M. Schneider

2005-01-01

244

Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis  

Microsoft Academic Search

Objective. To investigate differences between HLA-B27- and HLA-B27+ patients with ankylosing spondylitis (AS). Methods. A total of 1080 patients with AS responded to a questionnaire containing 30 questions; 945 (87.5%) knew their HLA-B27 status, 10% of them being B27-. Results. The average age at disease onset was 27.7 years in B27- and 24.8 years in B27+ AS (P- (standard deviation

Ernst Feldtkeller; Muhammad Asim Khan; Désirée van der Heijde; Sjef van der Linden; Jürgen Braun

2003-01-01

245

Association of macroscopic gut inflammation with disease activity, functional status and quality of life in ankylosing spondylitis  

Microsoft Academic Search

The aim of this cross-sectional study was to evaluate the frequency of intestinal inflammation and its association with disease\\u000a activity, functional status and quality of life in patients with ankylosing spondylitis (AS). A total of 25 patients with\\u000a AS had undergone ileocolonoscopy and concomitant histological study. Clinical and demographical parameters, BASDAI, BASFI,\\u000a and SF-36 scores were compared between patients with

Gulen Hascelik; Bengi Oz; Nese Olmez; Asuman Memis; Gazi Yoruk; Belk?s Unsal; Nese Ekinci

2009-01-01

246

HLA-B27 associated cross-reactive marker on the cells of New Zealand patients with ankylosing spondylitis  

Microsoft Academic Search

We have previously shown that antibodies raised in rabbits to certain enteric bacteria will specifically lyse, in a 51Cr release assay, the peripheral blood lymphocytes (PBL) of 80% of HLA-B27 positive patients with ankylosing spondylitis (B27+ AS+) but not the PBL of HLA-B27 positive normal controls (B27+ AS-). Other laboratories have been unable to reproduce these findings. This study was

L E McGuigan; A F Geczy; J K Prendergast; J P Edmonds; H H Hart; H V Bashir

1986-01-01

247

Population pharmacokinetics of rhTNFR-Fc in healthy Chinese volunteers and in Chinese patients with Ankylosing spondylitis  

Microsoft Academic Search

Aim:To investigate the population pharmacokinetics of recombinant human tumor necrosis factor receptor-Fc fusion protein (rhTNFR-Fc) administered via subcutaneous (SC) injection in healthy Chinese volunteers and in Chinese patients with ankylosing spondylitis (AS).Methods:Thirty-two healthy volunteers were randomly assigned to receive a single SC injection of 12.5, 25, 37.5, or 50 mg of rhTNFR-Fc. Twenty male patients with moderate AS were randomly

Yi Fang; Lu-jin Li; Rui Wang; Feng Huang; Hai-feng Song; Zhong-ming Tang; Yu-zhen Li; Hua-shi Guan; Qing-shan Zheng

2010-01-01

248

Ossification of the posterior longitudinal ligament in three geographically and genetically different populations of ankylosing spondylitis and other spondyloarthropathies  

Microsoft Academic Search

STUDY DESIGNCross sectional.RESEARCH QUESTIONS(a) Is any clinical variable of ankylosing spondylitis (AS) associated with the presence of ossification of the posterior longitudinal ligament (OPLL)? and (b) Is OPLL present in patients with AS from different geographical or genetic backgrounds?METHODSThree groups were assembled: (1) a prospective group of 103 consecutive AS patients from two community based rheumatology clinics from Guadalajara, who

Cesar Ramos-Remus; Anthony S Russell; Amparo Gomez-Vargas; Abel Hernandez-Chavez; Walter P Maksymowych; Jorge I Gamez-Nava; Laura Gonzalez-Lopez; Alicia García-Hernández; Esther Meoño-Morales; Ruben Burgos-Vargas; Maria E Suarez-Almazor

1998-01-01

249

Relationship Between Disease Activity and Serum Levels of Vitamin D Metabolites and Parathyroid Hormone in Ankylosing Spondylitis  

Microsoft Academic Search

:   Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication of ankylosing spondylitis (AS)\\u000a and various factors may contribute to the development of osteoporosis in AS. It is known that inflammatory activity in rheumatic\\u000a disease (i.e., proinflammatory cytokines) itself plays a possible role in the pathophysiology of bone loss. 1,25-Dihydroxyvitamin\\u000a D3 (1,25(OH)2D3) seems to be another possible

U. Lange; O. Jung; J. Teichmann; G. Neeck

2001-01-01

250

Parallel analysis of cancer mortality among atomic bomb survivors and patients with ankylosing spondylitis given X-ray therapy  

Microsoft Academic Search

Radiation-induced cancer mortality rates among atomic bomb survivors with doses of at least 100 rad and patients with ankylosing spondylitis given X-ray therapy have been compared for the first time. The estimated average mean bone marrow dose for the spondylitics is more than twice that for atomic bomb survivors, and yet spondylitics experienced only half the risk of radiation-induced leukemia

S. C. Darby; E. Nakashima; H. Kato

1985-01-01

251

Fracture in ankylosing spondylitis after minor trauma: radiological pitfalls and treatment by percutaneous instrumentation. A case report.  

PubMed

Patients with ankylosing spondylitis may experience spinal fractures even after minor injuries. The diagnosis of non-dislocated spinal fracture is based on clinical symptoms and radiological findings. Difficulties in interpreting the imaging studies can result in considerable diagnostic delays. We describe the steps of the radiological diagnosis in a patient with a fracture of L2 that was not visible on standard lumbar spine radiographs. Magnetic resonance imaging (MRI) T2 STIR sequences allowed determining the location and showed signs of a recent fracture. Then, MRI T1 images and computed tomography provided a detailed evaluation of the fracture line. In patients with ankylosing spondylitis, fracture instability is common, making surgical treatment mandatory. Open surgery is associated with substantial rates of infection and implant loosening. Percutaneous instrumentation has not yet been evaluated for the treatment of spinal fractures in patients with ankylosing spondylitis. This minimally invasive surgical technique enables multilevel internal fixation and may constitute an interesting alternative to open surgery. PMID:23270725

Charles, Y P; Buy, X; Gangi, A; Steib, J-P

2012-12-25

252

Ankylosing Spondylitis  

MedlinePLUS

... front of your shoulder, the center of your hip, behind your kneecap, and in front of your anklebone. If you are not standing ... already, practice holding your body that way in front of a mirror until you ... have only mild episodes of back pain that come and go, while others will have ...

253

International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis  

PubMed Central

Objective: To obtain an international consensus about the use of anti-tumour necrosis factor ? (anti-TNF?) for treating patients with ankylosing spondylitis (AS). Methods: These recommendations were developed by a review of published reports in combination with expert opinion, including a Delphi exercise, and a consensus meeting of the ASsessments in AS (ASAS) Working Group. Results: The final consensus comprises the following requirements: (1) For the initiation of anti-TNF? therapy: (a) a diagnosis of definitive AS; (b) presence of active disease for at least four weeks as defined by both a sustained Bath AS Disease Activity Index (BASDAI) of at least 4 and an expert opinion based on clinical features, acute phase reactants, and imaging modalities; (c) presence of refractory disease defined by failure of at least two non-steroidal anti-inflammatory drugs during a single three month period, failure of intra-articular steroids if indicated, and failure of sulfasalazine in patients with peripheral arthritis; (d) application and implementation of the usual precautions and contraindications for biological therapy. (2) For the monitoring of anti-TNF? therapy: both the BASDAI and the ASAS core set for clinical practice should be followed regularly. (3) For the discontinuation of anti-TNF? therapy: in non-responders, consideration should be made after 6–12 weeks' treatment. Response is defined as improvement of (a) at least 50% or 2 units (on a 0–10 scale) of the BASDAI, (b) expert opinion that treatment should be continued. Conclusion: This consensus statement on anti-TNF? treatment in AS may be used for guidance in clinical decision making and as the basis for the development of guidelines. Evaluation of the healthcare consequences of this consensus is subject to further research by the ASAS group.

Braun, J; Pham, T; Sieper, J; Davis, J; van der Linden, S.; Dougados, M; van der Heijde, D

2003-01-01

254

Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes  

PubMed Central

Background Structural changes such as erosions, syndesmophytes and ankylosis are characteristic of ankylosing spondylitis (AS). These can be quantified by the modified Stokes Anklylosing Spondylitis Spinal Score (mSASSS). It is unknown which radiographic feature is most relevant for the assessment of change and the prediction of future damage in AS. Objectives To analyse radiographic progression in AS by using different assessments to define the most important changes. Methods Spinal radiographs of 116 patients with AS were scored by the mSASSS at baseline (BL) and after 2?years. Radiographic progression was assessed by differentiating (1) any change; (2) progression to syndesmophytes/ankylosis (definite change); and (3) changes exceeding the smallest detectable change (SDC) as predefined. A growth angle of 45° was used to differentiate syndesmophytes from spondylophytes. Results Some radiographic progression after 2?years was detected in 42% of patients, novel syndesmophytes in 31% of patients, and, using the SDC (calculated at 2 mSASSS units) as cut?off, progression was seen in 28% of patients. Thus, in 74% of the patients changes were because of syndesmophytes and/or ankylosis. Using the predefined cut?off, only 12% of all syndesmophytes were spondylophytes. Patients with such changes were of older age. Definite radiographic progression was found in 44% of the patients with syndesmophytes/ankylosis at BL (n?=?57) versus 19% (p?=?0.03) of the patients without such changes (n?=?59). Conclusions Syndesmophytes and ankylosis are the most relevant structural changes in AS, and also in the mSASSS. Development of just one syndesmophyte within 2?years indicates progression of structural changes in AS; this is relevant for clinical practice. Syndesmophytes are the best predictors of radiographic progression.

Baraliakos, X; Listing, J; Rudwaleit, M; Haibel, H; Brandt, J; Sieper, J; Braun, J

2007-01-01

255

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

PubMed Central

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.

Rashid, Taha; Wilson, Clyde; Ebringer, Alan

2013-01-01

256

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

PubMed

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

Bussey, Melanie D; Milosavljevic, Stephan

2012-09-07

257

Possible role of enteric organisms in the pathogenesis of ankylosing spondylitis and other seronegative arthropathies.  

PubMed

One-hundred eighty-five clinical isolates of Salmonella sp., Shigella sp., Escherichia coli, and Campylobacter sp. were tested for their ability to absorb the lymphocytotoxic activity of an antiserum (anti-Klebsiella sp. K43) directed against a specific HLA-B27-associated cell surface determinant on the lymphocytes of patients with ankylosing spondylitis (AS). Seven of these isolates (three Salmonella sp., two Shigella sp., one E. coli, and one Campylobacter sp.) were found to cross-react with the B27-positive cells of AS patients (B27+ AS+); an E. coli organism isolated from the rectal swab of an HLA-B27-negative clinically normal individual also cross-reacted with B27+ AS+ cells. These cross-reactive enteric organisms elaborate a factor (modifying factor) which specifically modifies the B27-positive lymphocytes of normal individuals; this factor is structurally and antigenically related to a functionally similar factor secreted by certain isolates of Klebsiella sp. These data suggest that certain enteric organisms share a common determinant which cross-reacts with B27+ AS+ cells. It is suggested that this cross-reactivity is somehow related to an early event in the pathogenesis of AS and possibly of other seronegative arthropathies. PMID:6350189

Prendergast, J K; Sullivan, J S; Geczy, A; Upfold, L I; Edmonds, J P; Bashir, H V; Reiss-Levy, E

1983-09-01

258

Adalimumab for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis - a five-year update.  

PubMed

Introduction: Following its marketing authorization for the treatment of ankylosing spondylitis (AS) in 2006 in the United States und in the European Union, adalimumab became one of the most frequently prescribed tumor necrosis factor (TNF) ? blockers available for this indication. Recently, the label for adalimumab was extended to nonradiographic axial spondyloarthritis (nr-axSpA), which might be considered as an early stage of AS. The increasing number of patients with AS being treated with adalimumab raises issues concerning long-term safety, efficacy in the prevention of structural damage in the spine and high treatment costs. Areas covered: Herein, we summarize data on efficacy and safety of adalimumab treatment in AS and nr-axSpA obtained over the past 5 years. Expert opinion: Adalimumab is clinically effective and reasonably safe in the short-term and long-term treatment of patients with AS who do not respond to standard therapy. Recent data indicate good efficacy of adalimumab also in patients with nr-axSpA but only in the presence of objective signs of active inflammation. Yet unresolved questions relate to the ability of adalimumab to stop or retard structural damage development in the spine in patients with AS and nr-axSpA. The introduction of biosimilar drugs in the near future may potentially reduce the currently very high treatment costs associated with adalimumab treatment. PMID:24074224

Poddubnyy, Denis; Rudwaleit, Martin

2013-09-27

259

Profiling of HLA-B Alleles for Association Studies with Ankylosing Spondylitis in the Chinese Population  

PubMed Central

Human leucocyte antigen (HLA) B*27 is a susceptibility allele to ankylosing spondylitis (AS). However, major AS-associated subtypes of HLA-B*27 and other HLA-B alleles vary in different ethnic populations. Herein, we examined HLA-B alleles in a total of 360 AS patients and 350 controls of Chinese Han ancestry. The HLA-B genotyping was performed with sequence-based typing (SBT) method. Six HLA-B*27 subtypes B*27:04, B*27:05, B*27:07, B*27:08, B*27:10 and B*27:15 were observed in the cohorts. HLA-B*27:04:01 and -B*27:05:02 appeared significantly increased in AS patients, which indicated as two major susceptibility alleles to AS. Homozygous B*27 was observed only in AS patients. There are 30 HLA-B alleles identified in the studies. HLA-B*15, especially B*15:01:01:01, appeared as the major allele type in the Chinese controls. Some common HLA-B alleles such as HLA-B*15, B*13, B*46 and B*51 were significantly reduced in Chinese AS patients. In conclusion, the studies profiled the HLA-B alleles, and identified major susceptibility subtypes of B27 to AS in Han Chinese population

Yi, Lin; Wang, Jiucun; Guo, Xinjian; Espitia, Maribel G.; Chen, Enuo; Assassi, Shervin; Jin, Li; Zou, Hejian; Reveille, John D.; Zhou, Xiaodong

2013-01-01

260

Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries  

PubMed Central

Objective: To assess direct costs associated with ankylosing spondylitis (AS). To determine which variables, including country, predict costs. Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study and filled in bimonthly economic questionnaires. Disease related healthcare resource use was measured and direct costs were calculated from a societal perspective (true cost estimates) and from a financial perspective (country-specific tariffs). Predictors of costs were assessed using Cox's regression analysis. Results: 209 patients provided sufficient data for cost analysis. Mean annual societal direct costs for each patient were €2640, of which 82% were direct healthcare costs. In univariate analysis costs were higher in the Netherlands than in Belgium, but this difference disappeared after adjusting for baseline differences in patients' characteristics among countries. Longer disease duration, lower education, worse physical function, and higher disease activity were predictors of costs. Mean annual direct costs from a financial perspective were €2122, €1402, and €941 per patient in the Netherlands, France, and Belgium, respectively. For each country, costs from a financial perspective were significantly lower than costs from a societal perspective. Conclusion: Direct costs for AS are substantial in three European countries but not significantly different after adjusting for baseline characteristics among countries. Worse physical function and higher disease activity are important determinants of costs, suggesting better disease control might reduce the costs of AS. The difference in costs from a societal and financial perspective emphasises the importance of an economic analysis.

Boonen, A; van der Heijde, D; Landewe, R; Guillemin, F; Rutten-van, M; Dougados, M; Mielants, H; de Vlam, K; van der Tempel, H; Boesen, S; Spoorenberg, A; Schouten, H; van der Linden, S.

2003-01-01

261

Prevalence of Chlamydia trachomatis in urine of male patients with ankylosing spondylitis is not increased  

PubMed Central

OBJECTIVE—To compare the prevalence of Chlamydia trachomatis infections in ankylosing spondylitis (AS) patients with controls, using DNA amplification assays in urine specimens.?METHODS—The prevalence of C trachomatis infections was assessed in 32 male AS patients and 120 age and sex matched controls. Urine specimens were tested by ligase chain reaction and polymerase chain reaction. In addition, blood samples of AS patients were tested on serum antibodies to C trachomatis (IgA and IgG) by a specific peptide based solid phase enzyme immunoassay. A questionnaire was used to assess the differences in sexual behaviour and ethnic origin between the two groups. AS patients were also asked about disease characteristics.?RESULTS—No significant differences were found between cases and controls in the prevalence of C trachomatis infections. No associations were found between C trachomatis antibodies and disease characteristics, except for acute anterior uveitis (AAU). Four of eight (50%) AS men positive for IgG had a history of AAU in comparison with three of 24 (12.5%) IgG negative men (OR = 7.0; 95% confidence intervals: 1.1, 44.1).?CONCLUSION—The prevalence of Chlamydia trachomatis infections, as detected by commercially available DNA amplification assays in urine specimens, in AS patients is not higher compared with male controls of the same age. However, there seems to be an association between specific antibodies to C trachomatis and AAU.??

van der Paardt, M; van Denderen, J C; van den Brule, A J C; Morre, S; van der Horst-Bru..., I E; Bezemer, P; Dijkmans, B

2000-01-01

262

Level set based vertebra segmentation for the evaluation of Ankylosing Spondylitis  

NASA Astrophysics Data System (ADS)

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.

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

2006-03-01

263

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

PubMed

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

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

264

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

PubMed Central

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.

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; Ozgocmen, S; van Drogen, C; van Royen, BJ; van der Heijde, D

2011-01-01

265

The association between varicocele and ankylosing spondylitis via color duplex sonography.  

PubMed

OBJECTIVE: To evaluate the relationship between varicocele and ankylosing spondylitis (AS) via color duplex sonography (CDS). METHODS: Thirty male patients (age range 18-40 years, mean age 30.27 years) with AS and 30 male healthy controls (age range 20-36 years, mean age 27.23 years) were evaluated for varicocele using CDS. RESULTS: Vein diameter in right and left pampiniform plexus (PP) in the AS group was significantly higher than in the control group (p < 0.001 and p = 0.003, respectively). The incidence of varicocele was observed as 33.3 % in the AS group and 10 % in the control group. However, the difference was statistically significant (p = 0.028). The rate of right, left, and bilateral varicocele was 3.3 % (1 patient), 23.3 % (7 patients), and 6.6 % (2 patients), respectively, in the AS group, versus 0, 10, and 0 % in the control group (p = 1.000, p = 0.166, and p = 0.492, respectively). CONCLUSIONS: The incidence of varicocele in AS patients is higher than in control subjects, and the difference is statistically significant. Therefore, varicocele must be taken into consideration and investigated in patients with AS. PMID:23436011

Hamidi, Cihad; Batmaz, Ibrahim; Gümü?, Hatice; Penbegül, Necmettin; Cetinçakmak, Mehmet Guli; Tahtas?z, Mehmet; Bilici, Aslan; Nas, Kemal

2013-02-23

266

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

PubMed

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

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

2013-07-31

267

Early-onset ankylosing spondylitis is associated with a functional MICA polymorphism.  

PubMed

Major histocompatibility complex (MHC) class I chain-related A (MICA) molecules deliver activating signals through the NKG2D receptor expressed on the surface of natural killer (NK), CD8alphabeta and gammadelta T cells, and the MICA gene is polymorphic. The recently described MICA amino acid substitution at position 129 (MICA-129) seems to affect its binding to NKG2D. We investigated whether this dimorphism (MICA-129met [methionine] and MICA-129val [valine]) is associated with susceptibility to ankylosing spondylitis (AS) in a cohort of Algerian patients stratified according to their HLAB27 status and the age of onset of the disease. DNA from 129 patients and 76 healthy individuals were analyzed to determine the HLA-B generic type as well as MICA-129 polymorphism. Statistical analysis revealed: (1) a weaker association between AS and HLA-B27 in Algerians than in that reported for European patients (63% versus 80-90%), suggesting a possible influence of other genetic/environmental determinants in the studied population and (2) an association between MICA-129 met/met genotype and juvenile AS (p = 0.02) independent of HLA-B27 status. These data suggest a potential role for a functionally relevant MICA gene polymorphism in autoimmune/inflammatory disease susceptibility. PMID:16386647

Amroun, Habiba; Djoudi, Hachemi; Busson, Marc; Allat, Rachida; El Sherbini, Shérif Mohsen; Sloma, Ivan; Ramasawmy, Rajendranath; Brun, Manuel; Dulphy, Nicolas; Krishnamoorthy, Rajagopal; Toubert, Antoine; Charron, Dominique; Abbadi, Mohamed Chérif; Tamouza, Ryad

2005-11-02

268

Validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme.  

PubMed

OBJECTIVES: To evaluate the validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in early spondyloarthritis (SpA) in comparison with conventional clinical measures of disease activity. METHODS: Six hundred and seventy-six incident cases of early SpA from the Esperanza programme were included. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and on the physician's decision to start treatment with a disease-modifying antirheumatic drug or tumour necrosis factor blocker. The discriminant ability of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) was tested using standardised mean differences between patients with high and low disease activity. Convergent validity was tested by Pearson correlation between ASDAS versions and other measures of disease activity. RESULTS: ASDAS-ESR and ASDAS-CRP showed good correlation with BASDAI (r=0.79 and 0.74, respectively). Both indices correlated well with the patient global assessment (r=0.70 in both indices) and moderately with the physician global score (r=0.46 and 0.47, respectively). CRP and ESR showed poor correlation with patient- and physician-derived measures. ASDAS performed similarly across the global SpA sample, ankylosing spondylitis (AS), non-radiographic axial SpA and peripheral SpA. CONCLUSIONS: ASDAS performed as a valid activity score even being slightly better than the Bath Ankylosing Spondylitis Disease Activity Index in its ability to discriminate between high and low disease activity in early SpA. ASDAS performed similarly in AS, early forms of SpA, non-radiographic axial SpA and peripheral SpA. PMID:23709245

Fernández-Espartero, C; de Miguel, E; Loza, E; Tomero, E; Gobbo, M; Descalzo, M A; Collantes-Estévez, E; Mulero, J; Muñoz-Fernández, S; Zarco, P; Carmona, L

2013-05-24

269

Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study  

PubMed Central

Introduction Literature data suggest that sleep disturbances are prevalent among patients with ankylosing spondylitis (AS) and have a close correlation with pain. Other studies indicate that sleep disturbances are constantly accompanied by depression and anxiety in AS, but their interrelations are poorly understood. This study was designed to evaluate sleep disturbances and their association with demographic variables, pain, disease-specific variables, functional status, covering depression and anxiety in AS patients. Methods The 314 patients with AS and age- and sex-matched controls took part in the study, completed a battery of questionnaires, and participated in long-term follow-up. Blood samples were taken to measure C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR). The association among sleep, pain, disease activity, functional status, depression, and anxiety were assessed by using Pearson/Spearman correlations and multiple regression analysis. Results The Pittsburgh Sleep Quality Index (PSQI) score of the Chinese version was significantly higher in the AS group than in the control group (P = 0.020). Of the 314 patients with AS, 184 (58.6%) had a high risk for sleep disturbances. The PSQI score was associated with age, years of education, ESR, CRP, overall assessment of health, pain, morning stiffness, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), depression, and anxiety (all P < 0.001), but were not associated with disease duration, fingertip-to-floor distance, and Bath Ankylosing Spondylitis Metrology Index (BASMI) (P > 0.05). In hierarchic multiple regression analysis, the medical and psychological variables contributed significantly to the variance in sleep-disturbances scores, adding an additional 23.9% to the overall R2 beyond that accounted for by demographic variables (R-square, 8.5%), resulting in a final R2of 42.6%. Multiple stepwise regression analysis revealed that anxiety was the maximal statistical contribution in predicting sleep disturbances (standardized coefficients, 0.287). Conclusions The prevalence of sleep disturbances in AS patients is higher than it is generally thought to be. Depression, anxiety, nocturnal pain, and total back pain are the major contributors of sleep disturbances in AS.

2012-01-01

270

Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Troms?, northern Norway.  

PubMed Central

In an epidemiological survey in Tromsø, northern Norway a prevalence of definite ankylosing spondylitis (AS) of between 1.1% and 1.4% was found (males: 1.9-2.2% and females: 0.3-0.6%). The ratio of male to female was between 3.9 and 6.1 in favour of the male sex. It was calculated that 6.7% of the B27 positive individuals had AS, and that 22.5% of the B27 positive subjects with back pain or stiffness suffered from AS.

Gran, J T; Husby, G; Hordvik, M

1985-01-01

271

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

PubMed Central

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.

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

272

Assessment of sexual functions in female patients with ankylosing spondylitis compared with healthy controls.  

PubMed

Healthy human sexuality is integral to a well-lived life. Recent studies reported that sexual problems were common in patients with ankylosing spondylitis (AS) in relation to the consequences of the illness such as pain, stiffness of the spine and depression. Twenty-three female patients with AS and 27 healthy female controls were applied the Female Sexual Function Index (FSFI) to determine the influence of the disease on sexual functions. The rate of low sexual function was 60.9% in female patients with AS and 66.7% in healthy controls (P > 0.05). Ten patients were depressed in our study group according to the Beck Depression Inventory (BDI), while 15 healthy controls were depressed (P > 0.05). No statistically significant differences were found between the female patients and controls in FSFI and BDI scores. There was a significant correlation between BDI and total FSFI, desire and orgasm domains in female patients with AS. Pain, disease activity and functional status of the patients with AS were correlated with FSFI. However, there was no correlation between spinal mobility, laboratory parameters and sexual functions. General health, vitality, emotional role and mental health subscales of Short Form-36 were correlated with total FSFI scores. We did not find any relationship between AS quality of life scale and sexual functions. Sexual dysfunctions are common, but not different in female patients with AS when compared with healthy controls. Sexual problems in female patients with AS seem to be associated with higher depression level, increased disease activity, decreased functionality, higher pain scores and decreased quality of life. PMID:22218640

Demir, Saliha Eroglu; Rezvani, Aylin; Ok, Seniz

2012-01-05

273

The economic burden of the ankylosing spondylitis in the Czech Republic: comparison between 2005 and 2008.  

PubMed

To investigate the burden of ankylosing spondylitis in the Czech Republic as a baseline for future health economic evaluations. Data were obtained from two cross-sectional studies Beda I (2005) and Beda II (2008), performed in 1,008 and 509 patients, respectively. Methodology used was Cost-of-Illness prevalence-based analysis bottom-up approach. Analysis was performed from payer (health insurance companies) and societal perspective (including productivity costs using friction cost approach). Mean age of sample in Beda I and Beda II was 50.2 and 52.5 years, male were present by 61.0 and 62.7 %; average disease duration was 23.0 and 26.4 years, respectively. Mean total annual costs per patient in the sample were €4,782 in Beda I and €5806 in Beda II. Average direct costs per patient in the sample per year are estimated at €1,812 (Beda I) and €2,588 (Beda II) with the average productivity costs €2,970 (Beda I) and €3,218 (Beda II). We observed a small decrement in percentage (6.7 %) of productivity costs for Beda II as an influence of higher consumption of biologic drugs, hence higher direct costs and possible productivity preservation. The largest direct cost burdens were spa procedures (45.3 %, Beda I) and biological drugs (52.8 %, Beda II). Unique analysis of the burden of the AS in the Central-Eastern Europe presents health care resource and cost consumption by comparing two cross-sectional prevalence-based studies. Further analysis should be carried to obtain data connecting health status with costs consumption in order to analyse the AS from this perspective. PMID:23314983

Pet?íková, Alena; Doležal, Tomáš; Klimeš, Ji?í; Vocelka, Milan; Sedová, Liliana; Kolá?, Jozef

2013-01-13

274

Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor ? blockers in ankylosing spondylitis  

PubMed Central

Background: TNF? blockers have been shown to be highly efficacious in patients with active ankylosing spondylitis (AS). Objective: To identify parameters predicting the clinical response to TNF blockers in AS. Methods: Patients with active AS participated in two placebo controlled, randomised trials conducted in Germany with infliximab (n = 69) and etanercept (n = 30), respectively. For inclusion in either trial patients had to have high disease activity (BASDAI ?4) and a spinal pain score (numerical rating scale 0–10) ?4 despite treatment with NSAIDs. A major clinical response was defined as a 50% improvement of the initial BASDAI (BASDAI 50) after 12 weeks' treatment with active drug. Logistic regression likelihood ratio tests (univariate and multivariate), Student's t test, and ?2 tests were performed. Results: Univariate analysis showed the following to be predictors of a major response (BASDAI 50) to treatment: shorter disease duration (p = 0.003); lower BASFI (p = 0.007); younger age (p = 0.009); raised ESR (p = 0.033); raised CRP (p = 0.035). After adjustment for disease duration, BASFI, ESR, and CRP, but not age, remained significantly associated. After adjustment for disease duration and for BASFI, ESR, CRP, and in addition, a higher BASDAI were significantly associated with response. The best multivariate model built by stepwise regression contained the covariables disease duration, BASFI, BASDAI, and CRP. Conclusion: A shorter disease duration, younger age, and a lower BASFI are predictors of a major clinical response to TNF blockers in active AS. Raised CRP and a higher BASDAI may also be valuable predictors. These data need to be confirmed in further studies.

Rudwaleit, M; Listing, J; Brandt, J; Braun, J; Sieper, J

2004-01-01

275

Two year maintenance of efficacy and safety of infliximab in the treatment of ankylosing spondylitis  

PubMed Central

Objective: To obtain results of the second year extension of an original 3 month randomised, placebo controlled trial (and the 1 year extension study) assessing the use of infliximab, a monoclonal antibody to tumour necrosis factor ?, for the treatment of patients with ankylosing spondylitis (AS). Methods: Of the 54 patients with AS who completed the first year of the study, 52 continued to receive infliximab 5 mg/kg every 6 weeks up to week 102. The primary end point was the proportion of patients achieving at least 50% improvement from baseline in the Bath AS Disease Activity Index (BASDAI) at week 102. Other assessments included patient and physician global assessments, quality of life as assessed by Short Form-36, Bath AS Functional Index, Bath AS Metrology Index, and C reactive protein (CRP). Results: Improvement in signs and symptoms of AS seen during the first year of the study was sustained during the second year. Forty nine patients (71% of 69 enrolled patients and 49/52 (94%) patients who started year 2) completed the study up to week 102. Thirty (58%) patients achieved at least 50% improvement from baseline in the BASDAI score at week 102. Scores for other efficacy assessments were similar at weeks 54 and 102. Median CRP levels remained low at weeks 54 and 102 (3.9 and 4.3 mg/l, respectively). Side effects during the second year of the study were similar to those of the first year of treatment with infliximab. Conclusions: Patients with AS treated for 2 years with infliximab 5 mg/kg exhibited a good and durable clinical response.

Braun, J; Brandt, J; Listing, J; Zink, A; Alten, R; Burmester, G; Gromnica-Ihle, E; Kellner, H; Schneider, M; Sorensen, H; Zeidler, H; Sieper, J

2005-01-01

276

Is avoidant coping independent of disease status and stable over time in patients with ankylosing spondylitis?  

PubMed Central

Objective: To determine whether avoidant coping in ankylosing spondylitis (AS) is independent of disease status and whether it is stable over time. Methods: 658 patients with AS completed a postal questionnaire on health status, including pain and stiffness (BASDAI), physical function (BASFI), and coping (CORS). In CORS, "decreasing activities to cope with pain" and "pacing to cope with limitations" reflect avoidant behavioural coping. Ninety patients continued in a longitudinal study and 70 completed the CORS after four years. The adjusted contribution of age, sex, disease duration, educational level, pain (BASDAI), and physical function (BASFI) to the two avoidant coping strategies at first assessment was determined by multiple linear regression. Agreement between coping at first assessment and four years later was determined by intraclass correlation, and the correlation between change in coping and change in disease status over time by Pearson's correlation. Results: At first assessment, worse physical function (BASFI) and more pain (BASDAI) were associated with "decreasing activities to cope with pain". Worse physical function, but not pain, was associated with "pacing to cope with limitations". The contribution of physical function or pain to the total explained variance in each of the coping strategies was small. Disease duration was not a determinant of avoidant coping, but greater age was associated with "pacing to cope with limitations". Change in avoidant coping strategies over time could not be explained by change in function or pain. Conclusions: In AS, avoidant coping at a particular time is largely independent of disease duration or status. Variability in avoidant coping over a limited period of four years cannot be explained by change in disease status.

Boonen, A; van der Heijde, D; Landewe, R; Chorus, A; van Lankveld, W; Miedema, H; van der Tempel, H; van der Linden, S

2004-01-01

277

Gene Expression Analysis of Macrophages Derived from Ankylosing Spondylitis Patients Reveals Interferon-? Dysregulation  

PubMed Central

Objective To determine whether macrophages, a cell type implicated in the pathogenesis of ankylosing spondylitis (AS), exhibit a characteristic gene expression pattern. Methods Macrophages were derived from the peripheral blood of 8 AS patients (median disease duration 13 yrs, range 1-43 yrs) and 9 healthy controls over 7 days with GM-CSF. Cells were stimulated with IFN-? (100 U/ml) for 24 hours, or left untreated, or treated with LPS (10 ng/ml) for 3 hours. RNA was isolated and analyzed by microarray and real time PCR. Results Microarray analysis revealed 198 probe sets detecting differential expression of 141 unique genes in untreated macrophages from AS subjects compared to healthy controls. Clustering and Principle Components Analysis clearly distinguished AS patients and controls. Seventy-eight (55%) of the differentially expressed genes are IFN-regulated, and their relative expression indicates a ‘reverse’ IFN signature in AS patient macrophages, where IFN-?-upregulated genes are underexpressed and downregulated genes are overexpressed. Treatment of macrophages with exogenous IFN-? normalized expression of these genes between patients and controls. In addition, the mRNA encoded by the IFN-? gene was ?2-fold lower in AS patient macrophages at baseline (p=0.004), and was poorly responsive to LPS (p=0.018) compared to healthy controls. Conclusions This study reveals consistent gene expression differences in macrophages from AS subjects, with evidence for a striking ‘reverse’ IFN signature. Together with poor expression and responsiveness of the IFN-? gene, these results suggest there may be a relative defect in IFN-? gene regulation with autocrine consequences, and implications for disease pathogenesis.

Smith, Judith A.; Barnes, Michael D.; Hong, Dihua; DeLay, Monica L.; Inman, Robert D.; Colbert, Robert A.

2010-01-01

278

Persistent clinical efficacy and safety of anti-tumour necrosis factor   therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response  

Microsoft Academic Search

Background: There is insufficient evidence for the long- term efficacy and safety of anti-tumour necrosis factor therapy in patients with ankylosing spondylitis (AS). This is the first report on the treatment with infliximab over 5 years. Methods: As part of a multicentre randomised trial, 69 patients with active AS at baseline (BL) have been continuously treated with infliximab (5 mg\\/kg

J Braun; X Baraliakos; J Listing; C Fritz; R Alten; G Burmester; A Krause; S Schewe; M Schneider; H Sorensen; H Zeidler; J Sieper

2007-01-01

279

Comparison of radiological indices (SASSS, M-SASSS, BASRI-s, BASRI-t) in patients with ankylosing spondylitis.  

PubMed

This study was performed to compare radiologic methods of Bath Ankylosing Spondilitis Radiology Index-spine (BASRI-s), Bath Ankylosing Spondilitis Radiology Index-total (BASRI-t), Stoke Ankylosing Spondilitis Spine Score (SASSS) and Modified Stoke Ankylosing Spondilitis Spine Score (M-SASSS) and to test their superiority over each other. Eighty-one patients (60 males, 21 females) with ankylosing spondylitis (AS) were included in the study. Patients were evaluated for their functional status, disease activity, quality of life, and spinal mobility using Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), AS Quality of Life Index (ASQoL) scale, and Bath AS Metrology Index (BASMI), respectively. Radiographs of the patients were evaluated using BASRI-s, BASRI-t, SASSS, and M-SASSS methods. Spearman's correlation test was used for the correlation analysis. Significant correlations were found between the duration of disease with radiological indices (P < 0.05), BASMI with SASSS (P < 0.01), M-SASSS (P < 0.01), BASRI-s (P < 0.01), and BASRI-t (P < 0.01). Furthermore, there were correlations between BASFI with SASSS (P < 0.05), M-SASSS (P < 0.05), BASRI-s (P < 0.05). and BASRI-t (P < 0.05). According to the results of our study, among these four radiological measuring methods, SASSS appears to be the one that is the least reflective of patient status. The reason to that is the fact that while in SASSS method only lumbosacral radiography is evaluated, in other methods one more area is evaluated. However, the disadvantages of BASRI methods relative to others, in BASRI methods, patients are exposed to more radiation. PMID:21484307

Gurer, Gulcan; Butun, Bulent; Tuncer, Tiraje; Unubol, Ayse Iyiyapici

2011-04-12

280

Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway  

PubMed Central

Objectives. To evaluate the cost-effectiveness of etoricoxib (90?mg) relative to celecoxib (200/400?mg), and the nonselective NSAIDs naproxen (1000?mg) and diclofenac (150?mg) in the initial treatment of ankylosing spondylitis in Norway. Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach. Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered. Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

Jansen, Jeroen P.; Taylor, Stephanie D.

2011-01-01

281

Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis?  

Microsoft Academic Search

ObjectiveTo assess the discriminative ability and correlation of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) with disease activity in axial psoriatic arthritis (AxPsA).MethodsPatients with AxPsA were selected from a large prospective cohort study of psoriatic arthritis. Patient and physician global scores were used as constructs of disease activity. Patients were categorised

Lihi Eder; Vinod Chandran; Hua Shen; Richard J Cook; Dafna D Gladman

2010-01-01

282

Low sclerostin levels: a predictive marker of persistent inflammation in ankylosing spondylitis during anti-tumor necrosis factor therapy?  

PubMed

ABSTRACT: INTRODUCTION: Sclerostin levels have been reported to be low in ankylosing spondylitis (AS), but there is no data regarding the possible role of this Wnt inhibitor during anti-tumor necrosis factor (TNF) therapy. The present study longitudinally evaluated sclerostin levels, inflammatory markers and bone mineral density (BMD) in AS patients under anti-TNF therapy. METHODS: Thirty active AS patients were assessed at baseline, 6 and 12 months after anti-TNF therapy regarding clinical parameters, inflammatory markers, BMD and baseline radiographic damage (mSASSS). Thirty age- and sex-matched healthy individuals comprised the control group. Patients' sclerostin levels, sclerostin binding low-density lipoprotein receptor-related protein 6 (LRP6) and BMD were evaluated at the same time points and compared to controls. RESULTS: At baseline, AS patients had lower sclerostin levels (60.5 ± 32.7 vs. 96.7 ± 52.9 pmol/L, P = 0.002) and comparable sclerostin binding to LRP6 (P = 0.387) than controls. Improvement of 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) was observed at baseline vs. 6 vs. 12 months (P < 0.01). Concomitantly, a gradual increase in spine BMD (P < 0.001) and a positive correlation between baseline mSASSS and spine BMD was found (r = 0.468, P < 0.01). Inflammatory parameters reduction was observed comparing baseline vs. 6 vs. 12 months (P <0.01). Sclerostin levels progressively increased [baseline (60.5 ± 32.7) vs. 6 months (67.1 ± 31.9) vs. 12 months (72.7 ± 32.3) pmol/L, P <0.001]. At 12 months, the sclerostin levels remained significantly lower in patients compared to controls (72.7 ± 32.3 vs. 96.70 ± 52.85 pmol/L, P = 0.038). Moreover, sclerostin serum levels at 12 months were lower in the 10 patients with high C reactive protein (CRP) (? 5 mg/l) compared to the other 20 patients with normal CRP (P = 0.004). Of note, these 10 patients with persistent inflammation also had lower sclerostin serum levels at baseline compared to the other patients (P = 0.023). Univariate logistic regression analysis demonstrated that AS patients with lower sclerostin serum levels had an increased risk to have high CRP at 12 months (odds ratio = 7.43, 95% CI 1.23 to 45.01, P = 0.020) than those with higher sclerostin values. CONCLUSIONS: Persistent low sclerostin levels may underlie continuous inflammation in AS patients under anti-TNF therapy. PMID:23062122

Saad, Carla Gs; Ribeiro, Ana Cm; Moraes, Julio Cb; Takayama, Liliam; Goncalves, Celio R; Rodrigues, Marcelo B; de Oliveira, Ricardo M; Silva, Clovis A; Bonfa, Eloisa; Pereira, Rosa Mr

2012-10-12

283

Low sclerostin levels: a predictive marker of persistent inflammation in ankylosing spondylitis during anti-tumor necrosis factor therapy?  

PubMed Central

Introduction Sclerostin levels have been reported to be low in ankylosing spondylitis (AS), but there is no data regarding the possible role of this Wnt inhibitor during anti-tumor necrosis factor (TNF) therapy. The present study longitudinally evaluated sclerostin levels, inflammatory markers and bone mineral density (BMD) in AS patients under anti-TNF therapy. Methods Thirty active AS patients were assessed at baseline, 6 and 12 months after anti-TNF therapy regarding clinical parameters, inflammatory markers, BMD and baseline radiographic damage (mSASSS). Thirty age- and sex-matched healthy individuals comprised the control group. Patients' sclerostin levels, sclerostin binding low-density lipoprotein receptor-related protein 6 (LRP6) and BMD were evaluated at the same time points and compared to controls. Results At baseline, AS patients had lower sclerostin levels (60.5 ± 32.7 vs. 96.7 ± 52.9 pmol/L, P = 0.002) and comparable sclerostin binding to LRP6 (P = 0.387) than controls. Improvement of 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) was observed at baseline vs. 6 vs. 12 months (P < 0.01). Concomitantly, a gradual increase in spine BMD (P < 0.001) and a positive correlation between baseline mSASSS and spine BMD was found (r = 0.468, P < 0.01). Inflammatory parameters reduction was observed comparing baseline vs. 6 vs. 12 months (P <0.01). Sclerostin levels progressively increased [baseline (60.5 ± 32.7) vs. 6 months (67.1 ± 31.9) vs. 12 months (72.7 ± 32.3) pmol/L, P <0.001]. At 12 months, the sclerostin levels remained significantly lower in patients compared to controls (72.7 ± 32.3 vs. 96.70 ± 52.85 pmol/L, P = 0.038). Moreover, sclerostin serum levels at 12 months were lower in the 10 patients with high C reactive protein (CRP) (? 5 mg/l) compared to the other 20 patients with normal CRP (P = 0.004). Of note, these 10 patients with persistent inflammation also had lower sclerostin serum levels at baseline compared to the other patients (P = 0.023). Univariate logistic regression analysis demonstrated that AS patients with lower sclerostin serum levels had an increased risk to have high CRP at 12 months (odds ratio = 7.43, 95% CI 1.23 to 45.01, P = 0.020) than those with higher sclerostin values. Conclusions Persistent low sclerostin levels may underlie continuous inflammation in AS patients under anti-TNF therapy.

2012-01-01

284

Monoclonal anti-TNF antibodies can elevate hemoglobin level in patients with ankylosing spondylitis.  

PubMed

Anemia is one of the extra-articular findings of ankylosing spondylitis (AS), and anti-TNF therapy has been shown benefit in patients with anemia associated AS. In this study, we aimed to evaluate and compare the effects of biological and non-biological agents on hemoglobin levels in AS patients. One hundred consecutive patients who fulfilled ASAS criteria for AS were included in the study. Fifty-four of the patients treated with anti-TNF agents (20 patients treated with infliximab, 20 patients with adalimumab, and 14 patients with etanercept), and 46 patients treated with non-steroidal anti-inflammatory drugs and/or other disease modifying anti-rheumatic drugs. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (HGB), hematocrit (HCT) counts, and BASDAI scores were compared before starting therapy and at 52 weeks. There was no statistically significant difference between patients about demographical data (age, sex) and disease age (p > 0.05 for all). Significant difference was determined between HGB, HCT, CRP, ESR, and BASDAI values before and after therapy (for infliximab p: 0.001; 0.000; 0.000; 0.000; 0.000, respectively, and for adalimumab p: 0.017; 0.03; 0.001; 0.002; 0.000, respectively). In etanercept group, there was no significant difference in HGB values, when compared with before starting therapy and at 52 weeks (p > 0.05). In the group of treated with non-biological agents, ESR values and BASDA? scores showed distinctive improvement after 52 weeks of therapy, but was not a significant difference in hemoglobin and hematocrit values. Conclusion: Anti-TNF-alpha therapy with monoclonal antibodies (adalimumab and infliximab) did not only suppress disease activity but also provided a significant improvement in HGB levels. In the groups of treated with a TNF-alpha receptor antagonist (ETA) and non-biological agents, disease activity was suppressed, but there was not founded significant improvement in HGB levels after 52 weeks. Different outcomes of anti-TNF agents may be associated with their different effect mechanisms. PMID:23143665

Bes, Cemal; Yazici, Ayten; Soy, Mehmet

2012-11-13

285

Inflammatory bowel disease serologies in ankylosing spondylitis patients: a pilot study  

PubMed Central

Introduction Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) share similarities and are classified as spondyloarthropathies. In IBD, anti-Saccharomyces cerevisiae antibody (ASCA), anti-I2 (associated with anti-Pseudomonas activity), anti-Escherichia coli outer membrane porin C (anti-OmpC), anti-flagellin (anti-CBir1), and antineutrophil cytoplasmic antibodies (ANCA) possess clinical significance. Because of the overlap between the two conditions, a pilot study was designed to compare the frequency of these antibodies in AS patients compared to normal controls. Methods Serum stored from 80 AS patients and 80 control subjects was available for analysis. ASCA, anti-I2, anti-OmpC, anti-CBir1, and ANCA studies were completed on all serum samples using Enzyme-Linked Immunosorbent Assay (ELISA) methodology. The following analyses were performed: comparison of positivity based on the established values in IBD, median values, the number of subjects in each serology in the 4th quartile of a normal distribution, and the mean quartile sum of all the antibodies. Results There was no difference in positivity rates between AS and control groups with the established IBD values. The median anti-I2 response was significantly higher in AS than in controls (11.78 vs 7.86, p = 0.017). Significantly more AS patients had quartile scores of 4 for the following antibody responses: ASCA IgG (26% vs 13%, p = 0.016, OR = 2.49, CI 1.168 - 5.313), ASCA IgG and IgA (27% vs 12%, p = 0.006, OR = 2.9, CI: 1.342 - 6.264), and anti - I2 (25% vs 14%, p = 0.0424, OR = 2.15, CI: 1.018 - 4.538). The mean quartile sum of the antibody responses was elevated in AS patients when ANCA was excluded (10.526 vs 9.519, p = 0.03). When ANCA was included, this difference lost significance. Conclusions The data from this pilot study points towards mucosal dysregulation as an important pathway in AS. We were able to demonstrate that anti-I2 could play a pathologic role in AS. The elevated mean total antibody response being significant only with ANCA exclusion is consistent with the histopathological evidence that intestinal inflammation in AS is similar to Crohn's disease. To better define the roles of these antibodies in AS, larger studies with more precisely defined patient characteristics are required.

2009-01-01

286

The information needs of people living with ankylosing spondylitis: a questionnaire survey  

PubMed Central

Background Today, health care is patient-centred with patients more involved in medical decision making and taking an active role in managing their disease. It is important that patients are appropriately informed about their condition and that their health care needs are met. We examine the information utilisation, sources and needs of people with Ankylosing Spondylitis (AS). Methods Participants in an existing AS cohort study were asked to complete a postal or online questionnaire containing closed and open-ended questions, regarding their information access and needs. Participants were stratified by age and descriptive statistics were performed using STATA 11, while thematic analysis was performed on open-ended question narratives. Qualitative data was handled in Microsoft Access and explored for emerging themes and patterns of experiences. Results Despite 73% of respondents having internet access, only 49% used the internet to access information regarding AS. Even then, this was only infrequently. Only 50% of respondents reported accessing written information about AS, which was obtained mainly in specialist clinics. Women were more likely than men to access information (63% (women) 46% (men)) regardless of the source, while younger patients were more likely to use online sources. The main source of non-written information was the rheumatologist. Overall, the respondents felt there was sufficient information available, but there was a perception that the tone was often too negative. The majority (95%) of people would like to receive a regular newsletter about AS, containing positive practical and local information. Suggestions were also made for more information about AS to be made available to non-specialist medical professionals and the general public. Conclusions There appears to be sufficient information available for people with AS in the UK and this is mostly accessed by younger AS patients. Many patients, particularly men, choose not to access AS information and concerns were raised about its negative tone. Patients still rely on written and verbal information from their specialists. Future initiatives should focus on the delivery of more positive information, targeting younger participants in particular and increasing the awareness in the general population and wider non-specialist medical community.

2012-01-01

287

[German patient version of the ASAS/EULAR recommendations for the management of ankylosing spondylitis].  

PubMed

The evidence-based recommendations on the management of ankylosing spondylitis (AS) have enjoyed a high level of acceptance and circulation in Germany, as well as in other European countries. To make patient participation in the decision-making process regarding their disease easier, as well as to strengthen the physician-patient relationship, the ASAS and EULAR have set up an initiative to formulate a patient-friendly version of the recommendations, initially in English. In order that this lay version can also be used in German-speaking countries, a group predominantly comprising patients was formed to ensure that the German translation of this version has the broadest possible basis. In cooperation with the German (DVMB), Austrian (OVMB) and Swiss Morbus Bechterew Associations (SVMB), as well as the German Rheumatology League, patients from Germany, Austria and Switzerland with appropriate English skills were invited to a meeting in 2008. The aim of the translation was to leave the content unchanged while finding a level of speech easily understandable to the lay person. The translated text was considered as accepted when a minimum of 12 patients (>80%) gave their approval on the wording of the translation of individual recommendations in an open vote. The rheumatologist given the function of moderator was not entitled to vote. The level of approval for each recommendation was determined (0: no approval to 10: full approval). The 14 patients were able to translate the English patient version into German. Choice of words and style of speech were discussed intensively. Acceptance of the translation of the 10 recommendations was generally high. The content was clearly accepted with an approval rate of 8.4+/-1.6. This was the first time that patients, in cooperation with rheumatologists, have translated an international patient version on AS management into German under controlled conditions. The translation text was approved by the majority in terms of both form and content. Acceptance and circulation of the German patient version should be evaluated in the near future. PMID:19214540

Kiltz, U; Feldtkeller, E; Braun, J

2010-03-01

288

UGT2B17 copy number gain in a large ankylosing spondylitis multiplex family  

PubMed Central

Background The primary objective of this study is to identify novel copy number variations (CNVs) associated with familial ankylosing spondylitis (AS). A customized genome-wide microarray was designed to detect CNVs and applied to a multiplex AS family with six (6) affected family members. CNVs were detected using the built-in DNA analytics aberration detection method-2 (ADM-2) algorithm. Gene enrichment analysis was performed to observe the segregation. Subsequent validation was performed using real time quantitative fluorescence polymerase reaction (QF-PCR). The frequency of copy number variation for the UGT2B17 gene was then performed on two well-defined AS cohorts. Fisher exact test was performed to quantify the association. Results Our family-based analysis revealed ten gene-enriched CNVs that segregate with all six family members affected with AS. Based on the proposed function and the polymorphic nature of the UGT2B17 gene, the UGT2B17 gene CNV was selected for validation using real time QF-PCR with full concordance. The frequency of two copies of the UGT2B17 gene CNV was 0.41 in the Newfoundland AS cases and 0.35 in the Newfoundland controls (OR = 1.26(0.99-1.59); p < 0.05)), whereas the frequency of two (2) copies of the UGT2B17 gene CNV was 0.40 in the Alberta AS cases and 0.39 in the Alberta controls (OR = 1.05(95% CI: 0.83-1.33); p < 0.71)). Conclusions A genome-wide microarray interrogation of a large multiplex AS family revealed segregation of the UGT2B17 gene CNV among all affected family members. The association of the UGT2B17 CNV with AS is particularly interesting given the recent association of this CNV with osteoporosis and the proposed function as it encodes a key enzyme that inhibits androgens. However, two copies of the UGT2B17 gene CNV were only marginally significant in a uniplex AS cohort from Newfoundland but not in a uniplex AS cohort from Alberta.

2013-01-01

289

Body mass index influences the response to infliximab in ankylosing spondylitis  

PubMed Central

Introduction The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetic consequences. The aim of this study was to determine whether body mass index (BMI) affects response to infliximab (IFX) in ankylosing spondylitis (AS) patients. Methods In 155 patients retrospectively included with active AS, the BMI was calculated before initiation of IFX treatment (5 mg/kg intravenously). After 6 months of treatment, changes from baseline in BASDAI, Visual Analogue Scale (VAS) pain, C-reactive protein (CRP) level, and total dose of nonsteroidal antiinflammatory drug (NSAID) were dichotomized with a threshold corresponding to a decrease of 50% of initial level of the measure, into binary variables assessing response to IFX (BASDAI50, VAS50, CRP50, NSAID50). Whether the BMI was predictive of the response to IFX therapy according to these definitions was assessed with logistic regression. Results Multivariate analysis found that a higher BMI was associated with a lower response for BASDAI50 (P = 0.0003; OR, 0.87; 95% CI (0.81 to 0.94)), VAS50 (P < 0.0001; OR, 0.87; 95% CI (0.80 to 0.93)); CRP50 (P = 0.0279; OR, 0.93; 95% CI (0.88 to 0.99)), and NSAID50 (P = 0.0077; OR, 0.91; 95% CI (0.85 to 0.97)), criteria. According to the three WHO BMI categories, similar results were found for BASDAI50 (77.6%, 48.9%, and 26.5%; P < 0.0001), VAS50 (72.6%, 40.4%, and 16.7%; P < 0.0001); CRP50 (87.5%, 65.7%, and 38.5%; P = 0.0001), and NSAID50 (63.2%, 51.5%, and 34.6%; P = 0.06). Conclusions This study provides the first evidence that a high BMI negatively influences the response to IFX in AS. Further prospective studies, including assessment of the fat mass, pharmacokinetics, and adipokines dosages are mandatory to elucidate the role of obesity in AS IFX response.

2012-01-01

290

Association of Variants at 1q32 and STAT3 with Ankylosing Spondylitis Suggests Genetic Overlap with Crohn's Disease  

PubMed Central

Ankylosing spondylitis (AS) is a common inflammatory arthritic condition. Overt inflammatory bowel disease (IBD) occurs in about 10% of AS patients, and in addition 70% of AS cases may have subclinical terminal ileitis. Spondyloarthritis is also common in IBD patients. We therefore tested Crohn's disease susceptibility genes for association with AS, aiming to identify pleiotropic genetic associations with both diseases. Genotyping was carried out using Sequenom and Applied Biosystems TaqMan and OpenArray technologies on 53 markers selected from 30 Crohn's disease associated genomic regions. We tested genotypes in a population of unrelated individual cases (n?=?2,773) and controls (n?=?2,215) of white European ancestry for association with AS. Statistical analysis was carried out using a Cochran-Armitage test for trend in PLINK. Strong association was detected at chr1q32 near KIF21B (rs11584383, P?=?1.6×10?10, odds ratio (OR)?=?0.74, 95% CI:0.68–0.82). Association with disease was also detected for 2 variants within STAT3 (rs6503695, P?=?4.6×10?4. OR?=?0.86 (95% CI:0.79–0.93); rs744166, P?=?2.6×10?5, OR?=?0.84 (95% CI:0.77–0.91)). Association was confirmed for IL23R (rs11465804, P?=?1.2×10?5, OR?=?0.65 (95% CI:0.54–0.79)), and further associations were detected for IL12B (rs10045431, P?=?5.2×10?5, OR?=?0.83 (95% CI:0.76–0.91)), CDKAL1 (rs6908425, P?=?1.1×10?4, OR?=?0.82 (95% CI:0.74–0.91)), LRRK2/MUC19 (rs11175593, P?=?9.9×10?5, OR?=?1.92 (95% CI: 1.38–2.67)), and chr13q14 (rs3764147, P?=?5.9×10?4, OR?=?1.19 (95% CI: 1.08–1.31)). Excluding cases with clinical IBD did not significantly affect these findings. This study identifies chr1q32 and STAT3 as ankylosing spondylitis susceptibility loci. It also further confirms association for IL23R and detects suggestive association with another 4 loci. STAT3 is a key signaling molecule within the Th17 lymphocyte differentiation pathway and further enhances the case for a major role of this T-lymphocyte subset in ankylosing spondylitis. Finally these findings suggest common aetiopathogenic pathways for AS and Crohn's disease and further highlight the involvement of common risk variants across multiple diseases.

Danoy, Patrick; Pryce, Karena; Hadler, Johanna; Bradbury, Linda A.; Farrar, Claire; Pointon, Jennifer; Ward, Michael; Weisman, Michael; Reveille, John D.; Wordsworth, B. Paul; Stone, Millicent A.; Maksymowych, Walter P.; Rahman, Proton; Gladman, Dafna; Inman, Robert D.; Brown, Matthew A.

2010-01-01

291

Association of variants at 1q32 and STAT3 with ankylosing spondylitis suggests genetic overlap with Crohn's disease.  

PubMed

Ankylosing spondylitis (AS) is a common inflammatory arthritic condition. Overt inflammatory bowel disease (IBD) occurs in about 10% of AS patients, and in addition 70% of AS cases may have subclinical terminal ileitis. Spondyloarthritis is also common in IBD patients. We therefore tested Crohn's disease susceptibility genes for association with AS, aiming to identify pleiotropic genetic associations with both diseases. Genotyping was carried out using Sequenom and Applied Biosystems TaqMan and OpenArray technologies on 53 markers selected from 30 Crohn's disease associated genomic regions. We tested genotypes in a population of unrelated individual cases (n = 2,773) and controls (n = 2,215) of white European ancestry for association with AS. Statistical analysis was carried out using a Cochran-Armitage test for trend in PLINK. Strong association was detected at chr1q32 near KIF21B (rs11584383, P = 1.6 × 10(-10), odds ratio (OR)?= 0.74, 95% CI:0.68-0.82). Association with disease was also detected for 2 variants within STAT3 (rs6503695, P = 4.6 × 10(-4). OR = 0.86 (95% CI:0.79-0.93); rs744166, P = 2.6 × 10(-5), OR = 0.84 (95% CI:0.77-0.91)). Association was confirmed for IL23R (rs11465804, P = 1.2 × 10(-5), OR = 0.65 (95% CI:0.54-0.79)), and further associations were detected for IL12B (rs10045431, P = 5.2 × 10(-5), OR = 0.83 (95% CI:0.76-0.91)), CDKAL1 (rs6908425, P = 1.1 × 10(-4), OR = 0.82 (95% CI:0.74-0.91)), LRRK2/MUC19 (rs11175593, P = 9.9 × 10(-5), OR = 1.92 (95% CI: 1.38-2.67)), and chr13q14 (rs3764147, P =?5.9 × 10(-4), OR = 1.19 (95% CI: 1.08-1.31)). Excluding cases with clinical IBD did not significantly affect these findings. This study identifies chr1q32 and STAT3 as ankylosing spondylitis susceptibility loci. It also further confirms association for IL23R and detects suggestive association with another 4 loci. STAT3 is a key signaling molecule within the Th17 lymphocyte differentiation pathway and further enhances the case for a major role of this T-lymphocyte subset in ankylosing spondylitis. Finally these findings suggest common aetiopathogenic pathways for AS and Crohn's disease and further highlight the involvement of common risk variants across multiple diseases. PMID:21152001

Danoy, Patrick; Pryce, Karena; Hadler, Johanna; Bradbury, Linda A; Farrar, Claire; Pointon, Jennifer; Ward, Michael; Weisman, Michael; Reveille, John D; Wordsworth, B Paul; Stone, Millicent A; Maksymowych, Walter P; Rahman, Proton; Gladman, Dafna; Inman, Robert D; Brown, Matthew A

2010-12-02

292

A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease. PMID:24009460

Albayrak, Ilknur; Ba?cac?, Sinan; Sall?, Ali; Kucuksen, Sami; U?urlu, Hatice

2013-08-14

293

Sulfasalazine in the treatment of ankylosing spondylitis. A twenty-six-week, placebo-controlled clinical trial.  

PubMed

Eighty-five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine (less than or equal to 3 gm/day, mean 2.5) or placebo for 26 weeks. There was a statistically significant improvement, compared with baseline, in most of the clinical variables in patients receiving the active drug. Laboratory parameters (erythrocyte sedimentation rate, C-reactive protein, IgG, IgM, and IgA) also improved during the active treatment, suggesting a beneficial effect of sulfasalazine on AS. At the end of the treatment, significant differences between the sulfasalazine and placebo groups were observed in morning stiffness, chest expansion, erythrocyte sedimentation rate, and in all immunoglobulin classes. Two patients in each treatment group discontinued the trial because of side effects. Enteric-coated sulfasalazine seemed to be effective and well tolerated in patients with active AS. PMID:2901839

Nissilä, M; Lehtinen, K; Leirisalo-Repo, M; Luukkainen, R; Mutru, O; Yli-Kerttula, U

1988-09-01

294

Morning stiffness and nightime pain in ankylosing spondylitis. A comparison between enteric-coated and plain naproxen tablets.  

PubMed

Thirty-nine patients with ankylosing spondylitis participated in a randomized, double-blind, double-dummy, multi-cross-over study with enteric-coated (ECT) and plain (PT) naproxen tablets. The duration of the study was 24 days with 6 treatment periods of 4 days. The majority of the patients were taking 750 mg naproxen daily. The mean plasma concentration of naproxen in the morning was 36% higher with ECT (p < 0.001). No significant differences regarding duration of morning stiffness and night time pain were found in this patient category. The mean duration of morning stiffness was 116 minutes (ECT) and 125 minutes (PT). We were not able to show correlation between plasma concentration of naproxen and duration of morning stiffness. PMID:1364937

Johnsen, V; Brun, J G; Fjeld, E; Hansen, K; Sydnes, O A; Ugstad, M B

1992-01-01

295

Successful etanercept therapy for refractory sacroiliitis in a patient with ankylosing spondylitis and mixed connective tissue disease.  

PubMed

The concurrence of ankylosing spondylitis (AS) in a patient with mixed connective tissue disease (MCTD) is rarely described in the literature. Significant and sustained efficacy with tumor necrosis factor (TNF)-alpha blockers has been demonstrated in AS patients. However, evidence to date has revealed associated side effects, including antinuclear antibody induction and development of a lupus-like syndrome. Several authors have reported lupus-like manifestations in MCTD patients treated with TNF-alpha blockers used to control peripheral polyarthritis. In our case report, we demonstrate a good response to etanercept therapy for refractory sacroiliitis in a patient with coexisting AS and MCTD, without development of a lupus-like syndrome. This demonstrates that etanercept therapy may be an appropriate therapeutic agent for sacroiliitis in MCTD patients, as it is in AS alone. PMID:18306484

Lee, Jee Young; Chang, Hyun Kyu; Kim, Seong-Kyu

2008-02-29

296

A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis  

PubMed Central

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

Bagcac?, Sinan; Sall?, Ali; Kucuksen, Sami; Ugurlu, Hatice

2013-01-01

297

Both Baseline Clinical Factors and Genetic Polymorphisms Influence the Development of Severe Functional Status in Ankylosing Spondylitis  

PubMed Central

Functional severity in ankylosing spondylitis (AS) patients is variable and difficult to predict early. The aim of our study was to assess whether a combination of baseline clinical factors and genetic markers may predict the development of severe functional status in AS. We performed a cross-sectional association study on AS patients included in the Spanish National Registry of Spondyloarthropathies—REGISPONSER. Bath Ankylosing Spondylitis Functional Index (BASFI) was standardized by adjusting for disease duration since the first symptoms (BASFI/t). We considered as severe functional status the values of BASFI/t in the top of the 60th (p60), 65th (p65), 70th (p70), and 75th (p75) percentile. We selected 384 single nucleotide polymorphisms (SNPs) distributed in 190 genes to be analyzed. The study cohort included 456 patients with mean age 50.8(±10.5) years and with mean disease duration since first symptoms 24.7 (±10.1) years. Older age at disease onset and neck pain at baseline showed statistical significant association with severe BASFI/t. Polymorphisms associated in the allele frequencies test with severe BASFI/t in all classifications were: rs2542151 (p60 [P?=?.04], p65 [P?=?.04], p70 [P?=?.001] and p75 [P?=?.001]) and rs2254441 (p60 [P?=?.004], p65 [P?=?.02], p70 [P?=?.01] and p75 [P<.001]).. Genotype association, after adjustment for covariates, found an association in three of the four patients' classifications for rs2542151 and in two of the classifications for rs2254441.Forward logistic regression did not identify any model with a good predictive power for severe functional development. In our study we identified clinical factors and 24 polymorphisms associated with development of severe functional status in AS patients. Validation of these results in other cohorts is required.

Schiotis, Ruxandra; Bartolome, Nerea; Sanchez, Alejandra; Szczypiorska, Magdalena; Sanz, Jesus; Cuende, Eduardo; Collantes Estevez, Eduardo; Martinez, Antonio; Tejedor, Diego; Artieda, Marta; Buzoianu, Anca; Mulero, Juan

2012-01-01

298

Scoring of radiographic progression in randomised clinical trials in ankylosing spondylitis: a preference for paired reading order  

PubMed Central

Objectives: To describe the influence of the reading order (chronological v paired) on radiographic scoring results in ankylosing spondylitis. To investigate whether this method is sufficiently sensitive to change because paired reading is requested for establishing drug efficacy in clinical trials. Methods: Films obtained from 166 patients (at baseline, 1 year, and 2 years) were scored by one observer, using the modified Stoke Ankylosing Spondylitis Spinal Score. Films were first scored chronologically, and were scored paired 6 months later. Results: Chronological reading showed significantly more progression than paired reading both at 1 year (mean (SD) progression 1.3 (2.6) v 0.5 (2.4) units) and at 2 years (2.1 (3.9) v 1.0 (2.9) units); between-method difference: p<0.001 at 1 year, and p<0.001 at 2 years. After 1 year, progression (>0 units) was found in 35/166 (21%) patients after paired reading and in 55/166 (33%) after chronological reading. After 2 years, these figures were 50/166 (30%) and 68/166 (41%), respectively. Sample size calculations showed that 94 patients in each treatment arm are required in a randomised clinical trial (RCT) to provide sufficient statistical power to detect a difference in 2 year progression if films are scored paired. Conclusion: Reading with chronological time order is more sensitive to change than reading with paired time order, but paired reading is sufficiently sensitive to pick up change with a follow up of 2 years, resulting in an acceptable sample size for RCTs.

Wanders, A; Landewe, R; Spoorenberg, A; de Vlam, K; Mielants, H; Dougados, M; van der Linden, S; van der Heijde, D

2004-01-01

299

Golimumab for the treatment of ankylosing spondylitis: a NICE single technology appraisal.  

PubMed

As part of the National Institute for Health and Clinical Excellence (NICE) single technology appraisal (STA) process, the Evidence Review Group (ERG) produced a report to comment on the clinical and cost effectiveness of golimumab (Simponi(®), Merck Sharp & Dohme) for the treatment of ankylosing spondylitis (AS) relative to other comparators as presented in the manufacturer's submission (MS) to NICE. The population was those with active disease who had not responded to conventional therapy. The specified comparators were conventional care and two other tumour necrosis factor alpha (TNF-?) inhibitors (adalimumab and etanercept). Outcomes to be considered were disease activity, functional capacity, disease progression, adverse effects of treatment and health-related quality of life (HR-QOL). There were no head-to-head trials comparing TNF-? inhibitors. The submission included one trial of golimumab versus placebo (the GO-RAISE trial) and additionally seven placebo-controlled randomized controlled trials (RCTs) of other TNF-? inhibitor agents (five with etanercept, and two with adalimumab). The results of these trials were generally a statistically significant improvement from each of the TNF-? inhibitors. A Bayesian mixed treatment comparison (MTC) showed there was generally overlap in the 95 % credible intervals (CrIs) between the TNF-? inhibitors. Exceptions included a greater risk of discontinuation of treatment for golimumab than for etanercept (relative risk [RR] 4.30; 95 % CrI 1.01-18.50). The cost-effectiveness analysis (CEA) compared all of these TNF-? inhibitors. Relative effectiveness was informed only by RR of response (proportion achieving at least a 50 % improvement in Bath AS Disease Activity Index [BASDAI] score; BASDAI50) from the MTC. In the base-case analysis, the incremental cost-effectiveness ratio (ICER) of golimumab versus conventional care was £26,597 and adalimumab and etanercept were extendedly dominated by golimumab. The manufacturer concluded that golimumab is a cost-effective treatment option. Generally, the ERG agreed with the MTC analyses. The main problem was that the MS used data from one trial, which included a period of cross-over. The ERG found some problems with the CEA model, mainly that it did not allow for comparison of TNF-? inhibitor sequences and did not use MTC estimates for treatment discontinuation or adverse events (AEs). The ERG could not correct the sequencing problem, but re-ran the CEA with discontinuations and AEs estimated from the MTC and using the correct trial data. The results of the ERG analysis were that golimumab was extendedly dominated by etanercept, and the preferred treatment was either conventional treatment or etanercept, depending on the ICER threshold. Uncertainty was also substantial. NICE issued guidance (technology appraisal [TA] 233), which recommended golimumab according to the indications described in TA143 for etanercept and adalimumab, i.e. as first-line therapy among the TNF-? inhibitors unless patients are intolerant to one or both alternatives. Given the factors cited by NICE for their decision, the ERG recommends that there should be greater clarity in the NICE methods guidance on handling uncertainty in CEAs as well as the incorporation of benefit from process of care. PMID:23580355

Armstrong, Nigel; Joore, Manuela; van Asselt, Thea; Misso, Kate; Manning, Nathan; Tomini, Florian; Kleijnen, Jos; Riemsma, Rob

2013-05-01

300

Excessive bone formation in a mouse model of ankylosing spondylitis is associated with decreases in Wnt pathway inhibitors  

PubMed Central

Introduction Ankylosing spondylitis (AS) is unique in its pathology where inflammation commences at the entheses before progressing to an osteoproliferative phenotype generating excessive bone formation that can result in joint fusion. The underlying mechanisms of this progression are poorly understood. Recent work has suggested that changes in Wnt signalling, a key bone regulatory pathway, may contribute to joint ankylosis in AS. Using the proteoglycan-induced spondylitis (PGISp) mouse model which displays spondylitis and eventual joint fusion following an initial inflammatory stimulus, we have characterised the structural and molecular changes that underlie disease progression. Methods PGISp mice were characterised 12 weeks after initiation of inflammation using histology, immunohistochemistry (IHC) and expression profiling. Results Inflammation initiated at the periphery of the intervertebral discs progressing to disc destruction followed by massively excessive cartilage and bone matrix formation, as demonstrated by toluidine blue staining and IHC for collagen type I and osteocalcin, leading to syndesmophyte formation. Expression levels of DKK1 and SOST, Wnt signalling inhibitors highly expressed in joints, were reduced by 49% and 63% respectively in the spine PGISp compared with control mice (P < 0.05) with SOST inhibition confirmed by IHC. Microarray profiling showed genes involved in inflammation and immune-regulation were altered. Further, a number of genes specifically involved in bone regulation including other members of the Wnt pathway were also dysregulated. Conclusions This study implicates the Wnt pathway as a likely mediator of the mechanism by which inflammation induces bony ankylosis in spondyloarthritis, raising the potential that therapies targeting this pathway may be effective in preventing this process.

2012-01-01

301

Contribution of KIR3DL1\\/3DS1 to ankylosing spondylitis in human leukocyte antigen-B27 Caucasian populations  

Microsoft Academic Search

Killer cell immunoglobulin-like receptors (KIRs) and human leukocyte antigen (HLA) loci are both highly polymorphic, and some HLA class I molecules bind and trigger cell-surface receptors specified by KIR genes. We examined whether the combination of KIR3DS1\\/3DL1 genes in concert with HLA-B27 genotypes is associated with susceptibility to ankylosing spondylitis (AS). Two HLA-B27-positive Caucasian populations were selected, one from Spain

Carlos Lopez-Larrea; Miguel Angel Blanco-Gelaz; Juan Carlos Torre-Alonso; Jacome Bruges Armas; Beatriz Suarez-Alvarez; Laura Pruneda; Ana Rita Couto; Segundo Gonzalez; Antonio Lopez-Vázquez; Jesus Martinez-Borra

2006-01-01

302

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

PubMed

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 ?mol/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

Geçene, Muharrem; Tuncay, Figen; Borman, P?nar; Yücel, Dogan; Senes, Mehmet; Y?lmaz, Behice Kaniye

2012-12-18

303

Association of chromosome 2q36.1–36.3 and autosomal dominant transmission in ankylosing spondylitis: results of genetic studies across generations of Han Chinese families  

Microsoft Academic Search

Background:Ankylosing spondylitis (AS) is a chronic, potentially crippling, spondyloarthropathy with strong genetic components affecting approximately 0.3% of the population. Its exact genetic mechanism and mode of transmission, however, remains obscure.Methods and results:The authors conducted a genome wide scan on 75 individuals across multiple generations of three Han Chinese families affected with AS. Segregation analysis and pedigree investigation suggested an autosomal

J. Gu; J. Huang; C. Li; L. Zhao; F. Huang; Z. Liao; T. Li; Q. Wei; Z. Lin; Y. Pan; X. Wang; Q. Lin; C. Lu; Y. Wu; S. Cao; J. Wu; H. Xu; B. Yu; Y. Shen

2009-01-01

304

Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions  

Microsoft Academic Search

The home-based exercise therapy recommended to the patients with ankylosing spondylitis (AS) is a simply applicable and cheap\\u000a method. The aim of this study was to investigate the effects of home-based exercise therapy on pain, mobility, function, disease\\u000a activity, quality of life, and respiratory functions in patients with AS. Eighty patients diagnosed with AS according to the\\u000a modified New York

Ebru Aytekin; Nil Say?ner Caglar; Levent Ozgonenel; Sule Tutun; Dilay Y?lmaz Demiryontar; Saliha Eroglu Demir

305

MRI and clinical findings in patients with ankylosing spondylitis eligible for anti-tumour necrosis factor therapy after a short course of etoricoxib  

Microsoft Academic Search

Objective:To describe and assess the response to short-term etoricoxib as shown by MRI and clinical variables in patients with ankylosing spondylitis (AS) selected for eligibility for anti-tumour necrosis factor therapy.Methods:In a 6-week open-label study, 22 patients with AS and eligible for biological therapy were treated with 90 mg of etoricoxib daily. Clinical and laboratory parameters were obtained and MRI of

S J Jarrett; F Sivera; L S Cawkwell; H Marzo-Ortega; D McGonagle; E Hensor; L Coates; P J O’Connor; A Fraser; P G Conaghan; P Emery

2009-01-01

306

Physical function, disease activity, and health-related quality-of-life outcomes after 3 years of adalimumab treatment in patients with ankylosing spondylitis  

Microsoft Academic Search

INTRODUCTION: We evaluated the three-year impact of adalimumab on patient-reported physical function and health-related quality-of-life (HRQOL) outcomes in patients with active ankylosing spondylitis (AS). METHODS: The Adalimumab Trial Evaluating Long-Term Efficacy and Safety in AS (ATLAS) is an ongoing five-year study that included an initial 24-week, randomized, placebo-controlled, double-blind period, followed by open-label extension treatment with adalimumab. Clinical and HRQOL

Désirée M van der Heijde; Dennis A Revicki; Katherine L Gooch; Robert L Wong; Hartmut Kupper; Neesha Harnam; Chris Thompson; Joachim Sieper

2009-01-01

307

Aberrant expression of microRNAs in T cells from patients with ankylosing spondylitis contributes to the immunopathogenesis.  

PubMed

Ankylosing spondylitis (AS) is a chronic inflammatory disorder characterized by dysregulated T cells. We hypothesized that the aberrant expression of microRNAs (miRNAs) in AS T cells involved in the pathogenesis of AS. The expression profile of 270 miRNAs in T cells from five AS patients and five healthy controls were analysed by real-time polymerase chain reaction (PCR). Thirteen miRNAs were found potentially differential expression. After validation, we confirmed that miR-16, miR-221 and let-7i were over-expressed in AS T cells and the expression of miR-221 and let-7i were correlated positively with the Bath Ankylosing Spondylitis Radiology Index (BASRI) of lumbar spine in AS patients. The protein molecules regulated by miR-16, miR-221 and let-7i were measured by Western blotting. We found that the protein levels of Toll-like receptor-4 (TLR-4), a target of let-7i, in T cells from AS patients were decreased. In addition, the mRNA expression of interferon (IFN)-? was elevated in AS T cells. Lipopolysaccharide (LPS), a TLR-4 agonist, inhibited IFN-? secretion by anti-CD3(+) anti-CD28 antibodies-stimulated normal T cells but not AS T cells. In the transfection studies, we found the increased expression of let-7i enhanced IFN-? production by anti-CD3(+) anti-CD28(+) lipopolysaccharide (LPS)-stimulated normal T cells. In contrast, the decreased expression of let-7i suppressed IFN-? production by anti-CD3(+) anti-CD28(+) LPS-stimulated AS T cells. In conclusion, we found that miR-16, miR-221 and let-7i were over-expressed in AS T cells, but only miR-221 and let-7i were associated with BASRI of lumbar spine. In the functional studies, the increased let-7i expression facilitated the T helper type 1 (IFN-?) immune response in T cells. PMID:23607629

Lai, N-S; Yu, H-C; Chen, H-C; Yu, C-L; Huang, H-B; Lu, M-C

2013-07-01

308

Comparison of statistically derived ASAS improvement criteria for ankylosing spondylitis with clinically relevant improvement according to an expert panel  

PubMed Central

Objective: To investigate whether the recently developed (statistically derived) "ASsessment in Ankylosing Spondylitis Working Group" improvement criteria (ASAS-IC) for ankylosing spondylitis (AS) reflect clinically relevant improvement according to the opinion of an expert panel. Methods: The ASAS-IC consist of four domains: physical function, spinal pain, patient global assessment, and inflammation. Scores on these four domains of 55 patients with AS, who had participated in a non-steroidal anti-inflammatory drug efficacy trial, were presented to an international expert panel (consisting of patients with AS and members of the ASAS Working Group) in a three round Delphi exercise. The number of (non-)responders according to the ASAS-IC was compared with the final consensus of the experts. The most important domains in the opinion of the experts were identified, and also selected with discriminant analysis. A number of provisional criteria sets that best represented the consensus of the experts were defined. Using other datasets, these clinically derived criteria sets as well as the statistically derived ASAS-IC were then tested for discriminative properties and for agreement with the end of trial efficacy by patient and doctor. Results: Forty experts completed the three Delphi rounds. The experts considered twice as many patients to be responders than the ASAS-IC (42 v 21). Overall agreement between experts and ASAS-IC was 62%. Spinal pain was considered the most important domain by most experts and was also selected as such by discriminant analysis. Provisional criteria sets with an agreement of ?80% compared with the consensus of the experts showed high placebo response rates (27–42%), in contrast with the ASAS-IC with a predefined placebo response rate of 25%. All criteria sets and the ASAS-IC discriminated well between active and placebo treatment (?2=36–45; p<0.001). Compared with the end of trial efficacy assessment, the provisional criteria sets showed an agreement of 71–82%, sensitivity of 67–83%, and specificity of 81–88%. The ASAS-IC showed an agreement of 70%, sensitivity of 62%, and specificity of 89%. Conclusion: The ASAS-IC are strict in defining response, are highly specific, and consequently show lower sensitivity than the clinically derived criteria sets. However, those patients who are considered as responders by applying the ASAS-IC are acknowledged as such by the expert panel as well as by patients' and doctors' judgments, and are therefore likely to be true responders.

van Tubergen, A; van der Heijde, D; Anderson, J; Landewe, R; Dougados, M; Braun, J; Bellamy, N; Udrea, G; van der Linden, S.

2003-01-01

309

Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis  

Microsoft Academic Search

Background: Although disease-specific health status measures are available for ankylosing spondyli- tis (AS), no instrument exists for assessing quality of life (QoL) in the condition. Objective: To produce an AS-specific QoL measure that would be relevant and acceptable to respond- ents, valid, and reliable. Methods: The ASQoL employs the needs-based model of QoL and was developed in parallel in the

L C Doward; A Spoorenberg; S A Cook; D Whalley; P S Helliwell; L J Kay; S P McKenna; A Tennant; D van der Heijde; M A Chamberlain

2006-01-01

310

Health-related quality of life in Turkish patients with Ankylosing spondylitis: impact of peripheral involvement on quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning.  

PubMed

Ankylosing spondylitis (AS) affects sacroiliac joints at early stages and may involve the axial skeleton at later stages of disease. Peripheral involvement usually occurs in lower extremities. When it develops early in the disease course, it is a predictor of more aggressive disease. The aim of this study is to evaluate health-related quality of life (HRQoL) in AS and to assess the impact of peripheral involvement on HRQoL domains in terms of disease activity, functional status, pain, and social and emotional functioning. Seventy-four AS patients were included. Peripheral involvement was present in 51.35 % of the patients. In 65.79 % of these cases the hips, in 31.58 % the knees, in 18.42 % the shoulders and in 13.16 % the ankles were affected. Patients were evaluated by Ankylosing Spondylitis Quality of Life (ASQoL), Short Form-36 (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). ASQoL was strongly correlated with ASDAS, BASDAI, BASFI, and Bath Ankylosing Spondylitis Metrology Index (BASMI), severity of total pain, night pain, fatigue, morning stiffness and ESR. ASDAS and BASDAI showed the strongest correlation with ASQoL. Severity of total pain, functional status and severity of night pain followed it, respectively. Patients with peripheral involvement scored significantly lower in all subgroups of SF36 and significantly higher in ASDAS, BASDAI, BASFI, BASMI and ASQoL scores and levels of pain, night pain, fatigue and morning stiffness. Peripheral involvement is associated with more active disease and functional disability and has a negative influence on HRQoL including physical, social and emotional functioning. PMID:22955799

Y?lmaz, Ozlem; Tuto?lu, Ahmet; Garip, Ye?im; Ozcan, Esra; Bodur, Hatice

2012-09-06

311

Clinical symptoms and signs useful in the early diagnosis of ankylosing spondylitis  

Microsoft Academic Search

Summary  Seventy patients between the ages of 18 to 30 with early spondylitis (eAS), with bilateral grade II–III sacroiliitis without syndesmophytes were examined. The control group comprised 32 patients of the same age range with lumbar disc disease (LDD) confirmed by radiculography, without changes in the sacroiliac joints. In both groups the same clinical parameters were evaluated, calculating for each the

M. Sadowska-Wróblewska; A. Filipowicz; H. Garwolinska; J. Michalski; B. Rusiniak; T. Wróblewska

1983-01-01

312

Ankylosing Spondylitis Patients Commencing Biologic Therapy Have High Baseline Levels of Comorbidity: A Report from the Australian Rheumatology Association Database  

PubMed Central

Aims. To compare the baseline characteristics of a population-based cohort of patients with ankylosing spondylitis (AS) commencing biological therapy to the reported characteristics of bDMARD randomised controlled trials (RCTs) participants. Methods. Descriptive analysis of AS participants in the Australian Rheumatology Association Database (ARAD) who were commencing bDMARD therapy. Results. Up to December 2008, 389 patients with AS were enrolled in ARAD. 354 (91.0%) had taken bDMARDs at some time, and 198 (55.9%) completed their entry questionnaire prior to or within 6 months of commencing bDMARDs. 131 (66.1%) had at least one comorbid condition, and 24 (6.8%) had a previous malignancy (15 nonmelanoma skin, 4 melanoma, 2 prostate, 1 breast, cervix, and bowel). Compared with RCT participants, ARAD participants were older, had longer disease duration and higher baseline disease activity. Conclusions. AS patients commencing bDMARDs in routine care are significantly different to RCT participants and have significant baseline comorbidities.

Oldroyd, John; Schachna, Lionel; Buchbinder, Rachelle; Staples, Margaret; Murphy, Bridie; Bond, Molly; Briggs, Andrew; Lassere, Marissa; March, Lyn

2009-01-01

313

Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life.  

PubMed

The aim of this study is to investigate sleep quality in patients with ankylosing spondylitis (AS) and to evaluate the relationship of the disease parameters with sleep disturbance. Eighty AS patients (60 males and 20 females) fulfilling the modified New York criteria, and 52 age- and gender-matched controls (33 males and 19 females) were enrolled in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Pain was measured by visual analogue scale. The disease activity and functional status were assessed by the Bath AS disease Activity Index and the Bath AS Functional Index. The Bath AS Metrology Index was used to evaluate mobility restrictions, and the Bath AS Radiology Index was employed to evaluate the radiological damage. The psychological status and quality of life were assessed with the hospital anxiety-depression scale and AS quality of life scale. The patients with AS had significantly more unfavourable scores in the subjective sleep quality, habitual sleep efficiency domains (p < 0.001) and the total PSQI score (p < 0.05). Poor sleep quality (total PSQI score) was positively correlated with increased pain, poor quality of life, higher depressed mood, higher disease activity and mobility restrictions. Pain was also an independent contributor to poorer sleep quality (p = 0.002). The sleep quality is disturbed in patients with AS. The lower quality of sleep is greatly associated with the pain, disease activity, depression, quality of life and increased limitation of mobility. PMID:22940709

Batmaz, ?brahim; Sar?y?ld?z, Mustafa Akif; Dilek, Banu; Bez, Yasin; Karakoç, Mehmet; Çevik, Remzi

2012-09-02

314

Targeted delivery of an antigenic Peptide to the endoplasmic reticulum: application for development of a Peptide therapy for ankylosing spondylitis.  

PubMed

The development of suitable methods to deliver peptides specifically to the endoplasmic reticulum (ER) can provide some potential therapeutic applications of such peptides. Ankylosing spondylitis (AS) is strongly associated with the expression of human leukocytic antigen-B27 (HLA-B27). HLA-B27 heavy chain (HC) has a propensity to fold slowly resulting in the accumulation of misfolded HLA-B27 HC in the ER, triggering the unfolded protein response, and forming a homodimer, (B27-HC)2. Natural killer cells and T-helper 17 cells are then activated, contributing to the major pathogenic potentials of AS. The HLA-B27 HC is thus an important target, and delivery of an HLA-B27-binding peptide to the ER capable of promoting HLA-B27 HC folding is a potential mechanism for AS therapy. Here, we demonstrate that a His6-ubiquitin-tagged Tat-derived peptide (THU) can deliver an HLA-B27-binding peptide to the ER promoting HLA-B27 HC folding. The THU-HLA-B27-binding peptide fusion protein crossed the cell membrane to the cytosol through the Tat-derived peptide. The HLA-B27-binding peptide was specifically cleaved from THU by cytosolic ubiquitin C-terminal hydrolases and subsequently transported into the ER by the transporter associated with antigen processing. This approach has potential application in the development of peptide therapy for AS. PMID:24155957

Yu, Hui-Chun; Lu, Ming-Chi; Li, Chin; Huang, Hsien-Lu; Huang, Kuang-Yung; Liu, Su-Qin; Lai, Ning-Sheng; Huang, Hsien-Bin

2013-10-14

315

Improved precision of syndesmophyte measurement for the evaluation of ankylosing spondylitis using CT: a phantom and patient study  

NASA Astrophysics Data System (ADS)

Ankylosing spondylitis is a disease characterized by abnormal bone formation (syndesmophyte) at the margins of inter-vertebral disc spaces. Syndesmophyte growth is currently typically monitored by the visual inspection of radiographs. The limitations inherent to the modality (2D projection of a 3D object) and rater (qualitative human judgment) may compromise sensitivity. With newly available treatments, more precise measures of syndesmophytes are needed to determine whether treatment can slow rates of syndesmophyte growth. We previously presented a computer algorithm measuring syndesmophyte volumes and heights in the 3D space of CT scans. In this study, we present improvements to the original algorithm and evaluate the gain in precision as applied to an anthropomorphic vertebral phantom and patients. Each patient was scanned twice in one day, thus providing two syndesmophyte volume and height measures. The difference between those two measures (ideally zero) determines our algorithm's precision. The technical improvements to the algorithm decreased the mean volume difference (standard deviation) between scans from 3.01% (2.83%) to 1.31% (0.95%) and the mean height difference between scans from 3.16% (2.99%) to 1.56% (1.13%). The high precision of the improved algorithm holds promise for application to longitudinal clinical studies.

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

2012-07-01

316

Is a Klebsiella plasmid involved in the aetiology of Ankylosing Spondylitis in HLA-B27-positive individuals?  

PubMed

The possibility that plasmid genes, carried by enteric organisms previously indirectly implicated as disease agents, play a role in the pathogenesis of Ankylosing Spondylitis (AS) was explored. A particular Klebsiella isolate (K21) previously found to cross-react with cells from HLA-B27 positive (B27+) patients with AS, but not with cells from normal individuals, was found to contain a plasmid(s). This coded for the organism's ability to produce a factor which could modify B27+ normal cells (AS-) rendering them lysable by the anti-Klebsiella serum. Curing of this isolate resulted in the loss of the plasmid concerned and a loss of ability of its culture filtrate to modify B27+ lymphocytes of clinically healthy subjects. When plasmids from K21 were transferred to a plasmid free laboratory strain, E. coli JP995, the recipient strain acquired the ability to elaborate modifying factor. These data suggest that plasmids, harboured by some enteric bacteria, and their products, may be implicated in modifying cells bearing certain Major Histocompatibility Complex genes, and that such modification may be an important factor in the pathogenesis of a number of diseases including the seronegative arthropathies. PMID:6348514

Cameron, F H; Russell, P J; Sullivan, J; Geczy, A F

1983-05-01

317

Persistence of HLA-B27 cross-reactive bacteria in bowel flora of patients with ankylosing spondylitis.  

PubMed

Previous studies have shown that antisera raised in rabbits to certain enteric bacteria (cross-reactive bacteria) are capable of specifically lysing in a 51chromium-release lymphocytotoxicity test the lymphocytes of HLA-B27-positive (B27+) patients with ankylosing spondylitis (AS). This study investigated the clinical relevance of this finding by ascertaining whether Escherichia coli isolated from the rectal swabs of 20 B27+ AS patients (B27+ AS+) and 46 controls (35 B27- AS- and 11 B27+ AS-) were able to absorb the lymphocytotoxic activity of these antisera. All isolates from B27+ AS+ patients and one from a B27- AS- individual were capable of removing this activity. These organisms persisted in the bowel flora of five selected patients for at least 9 months. Cross-reactive bacteria were also found in a range of gram-positive organisms, including streptococcal, staphylococcal, and clostridial species. The relevance of these findings is discussed in terms of a pathogenetic concept relating the persistence of cross-reactive bacteria in the bowel flora of B27+ individuals to an early event in the development of AS. PMID:6334031

Prendergast, J K; McGuigan, L E; Geczy, A F; Kwong, T S; Edmonds, J P

1984-12-01

318

Overexpression and unique rearrangement of VH2 transcripts in immunoglobulin variable heavy chain genes in ankylosing spondylitis patients  

PubMed Central

To identify immunoglobulin variable heavy chain (VH) gene usages in Korean ankylosing spondylitis (AS) patients, expression level of VH2 genes from peripheral blood mononuclear cells (PBMCs) of 8 AS patients and 9 healthy donors was analysed by quantitative real-time PCR (Q-PCR). Q-PCR results demonstrated VH2 genes were overexpressed in AS patients (Relative amount of mRNA of VH2 genes to a house-keeping gene, 7.13 ± 7.77 vs, 0.68 ± 0.55; P < 0.0001). The sequence analysis revealed the majority of them contained CDC42 binding protein kinase beta (CDC42 BPB) genes. The insertion of CDC42 BPB gene was confirmed by PCR with primers corresponding CDC42 BPB and CH genes. Our study revealed VH2 overexpression and unique rearrangement in Ig VH genes from peripheral blood of AS patients. This may imply aberrant immunoglobulin gene rearrangement in B cell occurs in Korean AS patients, which requires further investigation.

Kim, Yeon Joo; Kim, Nayoung; Lee, Min-Kyung; Choi, Hyo-Jin

2010-01-01

319

HLA-B27 associated cross-reactive marker on the cells of New Zealand patients with ankylosing spondylitis.  

PubMed

We have previously shown that antibodies raised in rabbits to certain enteric bacteria will specifically lyse, in a 51Cr release assay, the peripheral blood lymphocytes (PBL) of 80% of HLA-B27 positive patients with ankylosing spondylitis (B27+ AS+) but not the PBL of HLA-B27 positive normal controls (B27+ AS-). Other laboratories have been unable to reproduce these findings. This study was designed to ascertain whether this lack of reproducibility was due to a peculiarity of our B27+ AS+ patients or to technical difficulties in the complement mediated 51Cr release assay. We have shown in this blind study that the PBL of 16 out of 18 B27+ AS+ patients from a New Zealand population were lysed by our antisera but none of the PBL of 20 B27+ AS- normal controls were lysed. The phenomenon of 'cross reactivity' between certain enteric bacteria and B27+ AS+ PBL is not confined to the Sydney AS population. PMID:3484937

McGuigan, L E; Geczy, A F; Prendergast, J K; Edmonds, J P; Hart, H H; Bashir, H V

1986-02-01

320

The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors.  

PubMed

Despite advances in pharmacological therapy, physical treatment continues to be important in the management of ankylosing spondylitis (AS). The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors. Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were randomized and assessed by an investigator independent from the spa staff: 15 were prescribed 10 sessions of spa therapy (mud packs and thermal baths) and rehabilitation (exercises in a thermal pool) and the other 15 were considered controls. The patients in both groups had been receiving anti-TNF agents for at least three months. The outcome measures utilized were BASFI, BASDAI, BASMI, VAS for back pain and HAQ. The evaluations were performed in all patients at the entry to the study, at the end of the spa treatment, and after 3 and 6 months. Most of the evaluation indices were significantly improved at the end of the spa treatment, as well as at the 3 and 6 months follow-up assessments. No significant alterations in the evaluation indices were found in the control group. Combined spa therapy and rehabilitation caused a clear, long-term clinical improvement in AS patients being treated with TNF inhibitors. Thermal treatment was found to be well tolerated and none of the patients had disease relapse. PMID:21947374

Ciprian, Luca; Lo Nigro, Alessandro; Rizzo, Michela; Gava, Alessandra; Ramonda, Roberta; Punzi, Leonardo; Cozzi, Franco

2011-09-27

321

Targeted Delivery of an Antigenic Peptide to the Endoplasmic Reticulum: Application for Development of a Peptide Therapy for Ankylosing Spondylitis  

PubMed Central

The development of suitable methods to deliver peptides specifically to the endoplasmic reticulum (ER) can provide some potential therapeutic applications of such peptides. Ankylosing spondylitis (AS) is strongly associated with the expression of human leukocytic antigen-B27 (HLA-B27). HLA-B27 heavy chain (HC) has a propensity to fold slowly resulting in the accumulation of misfolded HLA-B27 HC in the ER, triggering the unfolded protein response, and forming a homodimer, (B27-HC)2. Natural killer cells and T-helper 17 cells are then activated, contributing to the major pathogenic potentials of AS. The HLA-B27 HC is thus an important target, and delivery of an HLA-B27-binding peptide to the ER capable of promoting HLA-B27 HC folding is a potential mechanism for AS therapy. Here, we demonstrate that a His6-ubiquitin-tagged Tat-derived peptide (THU) can deliver an HLA-B27-binding peptide to the ER promoting HLA-B27 HC folding. The THU-HLA-B27-binding peptide fusion protein crossed the cell membrane to the cytosol through the Tat-derived peptide. The HLA-B27-binding peptide was specifically cleaved from THU by cytosolic ubiquitin C-terminal hydrolases and subsequently transported into the ER by the transporter associated with antigen processing. This approach has potential application in the development of peptide therapy for AS.

Yu, Hui-Chun; Lu, Ming-Chi; Li, Chin; Huang, Hsien-Lu; Huang, Kuang-Yung; Liu, Su-Qin; Lai, Ning-Sheng; Huang, Hsien-Bin

2013-01-01

322

The natural course of radiographic progression in ankylosing spondylitis: differences between genders and appearance of characteristic radiographic features.  

PubMed

Our study set out to analyze the radiographic progression of ankylosing spondylitis (AS) patients based on gender differences. A total of 146 AS patients were retrospectively blindly analyzed in at least 2 time points within 6 years using the modified Stokes AS Spine Score. The mean follow-up time was 3.8?±?1.7 years, and 114 patients (78%) were male. The overall progression was similar between genders. Females showed higher progression in the cervical spine, and males in the lumbar spine. More females showed new cervical syndesmophytes, and more males showed new lumbar syndesmophytes. More females showed slow radiographic progression, and more males showed fast radiographic progression, while moderate progression was similar for both genders. Dorsal syndesmophytes showed no impact in the prediction of future progression. Female AS patients showed more cervical structural lesions, but male patients overall showed more rapid progress, leading us to conclude that dorsal vertebral edges do not add in depiction of radiographic deterioration in AS patients. PMID:21706179

Baraliakos, Xenofon; Listing, Joachim; von der Recke, Anna; Braun, Juergen

2011-10-01

323

Overexpression and unique rearrangement of VH2 transcripts in immunoglobulin variable heavy chain genes in ankylosing spondylitis patients.  

PubMed

To identify immunoglobulin variable heavy chain (VH) gene usages in Korean ankylosing spondylitis (AS) patients, expression level of VH2 genes from peripheral blood mononuclear cells (PBMCs) of 8 AS patients and 9 healthy donors was analysed by quantitative real-time PCR (Q-PCR). Q-PCR results demonstrated VH2 genes were overexpressed in AS patients (Relative amount of mRNA of VH2 genes to a house-keeping gene, 7.13+/-7.77 vs, 0.68+/-0.55; P<0.0001). The sequence analysis revealed the majority of them contained CDC42 binding protein kinase Beta (CDC42 BPB) genes. The insertion of CDC42 BPB gene was confirmed by PCR with primers corresponding CDC42 BPB and CH genes. Our study revealed VH2 overexpression and unique rearrangement in Ig VH genes from peripheral blood of AS patients. This may imply aberrant immunoglobulin gene rearrangement in B cell occurs in Korean AS patients, which requires further investigation. PMID:20177145

Kim, Yeon Joo; Kim, Na Young; Lee, Min Kyung; Choi, Hyo Jin; Baek, Han Joo; Nam, Chang Hoon

2010-05-31

324

Circulating Levels of Soluble Receptor Activator of NF-?B Ligand and Matrix Metalloproteinase 3 (and Their Antagonists) in Asian Indian Patients with Ankylosing Spondylitis  

PubMed Central

Background. Bone loss in ankylosing spondylitis may be related to inflammation. Data from previous studies on circulating levels of sRANKL, OPG, MMP3, and TIMP is inconsistent; thus this study is planned to look at this aspect in Asian Indian patients. Methods. Cross-sectional study included patients with ankylosing spondylitis and age- and gender-similar controls. Serum levels of sRANKL, OPG, MMP-3, and TIMP-1 were measured by ELISA. Results. Included 85 patients (M?:?F = 82?:?3) having mean age (±SD) 33.0 ± 10.0 years and disease duration 11.3 ± 7.3 years. BASDAI, BASFI, BASMI, and ESR were 4.0 ± 2.2, 3.9 ± 2.8, 3.0 ± 2.8, and 59.2 ± 31.2, respectively. Patients had higher mean (±SD) OPG level (649.7 ± 286.8, 389.3 ± 244.8?pg/mL, P < 0.001). However, there was no difference in sRANKL (349.2 ± 872.0, 554.7 ± 1850.1, P = ns). Serum MMP-3 (91.4 ± 84.7, 55.9 ± 37.1?ng/mL, P < 0.01) and TIMP-1 (520.6 ± 450.7, 296.5 ± 114.2?ng/mL, P < 0.001) levels were higher in patients; however, there was no difference in MMP-3/TIMP-1 ratio. Conclusion. Circulating levels of OPG were higher; however, there was no difference in sRANKL in Asian Indian ankylosing spondylitis patients. Although both MMP-3 and TIMP-1 were raised, their ratio was not different from that of controls.

Srivastava, Rajni; Aggarwal, Amita

2013-01-01

325

Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab  

PubMed Central

We analyzed the clinical response and the time to relapse after discontinuation of continuous long-term infliximab therapy in patients with ankylosing spondylitis (AS). After 3 years of infliximab therapy, all AS patients (n = 42) discontinued treatment (time point (TP)1) and were visited regularly for 1 year in order to assess the time to relapse (TP2). Relapse was defined as an increase to a value ? 4 on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and a physician's global assessment ? 4 according to the recommendations of the Assessments in Ankylosing Spondylitis (ASAS) working group. After 52 weeks, 41 of the 42 patients (97.6%) had to be reinfused because of relapse. The mean change in the BASDAI between TP1 and TP2 was 3.6 ± 1.7 and that in the physician's global assessment was 4.4 ± 1.8 (both P < 0.001). The mean time to relapse was 17.5 weeks (± 7.9 weeks, range 7 to 45). Ten patients (24%) showed a relapse within 12 weeks and 38 patients (90.5%), within 36 weeks. After 52 weeks, only one patient had remained in ongoing remission without further treatment with anti-tumor-necrosis factor. Patients who were in partial remission according to the ASAS criteria and those with normal C-reactive protein levels at the time point of withdrawal had longer times to relapse after discontinuation of the treatment. Retreatment with infliximab was safe and resulted in clinical improvement in all patients to a state similar to that before the treatment was stopped. Discontinuation of long-term therapy with infliximab eventually led to relapse of disease activity in all patients but one.

Baraliakos, Xenofon; Listing, Joachim; Brandt, Jan; Rudwaleit, Martin; Sieper, Joachim; Braun, Juergen

2005-01-01

326

Markov model into the cost-utility over five years of etanercept and infliximab compared with usual care in patients with active ankylosing spondylitis  

PubMed Central

Objective To estimate the incremental cost?utility of etanercept and infliximab compared with usual care in active ankylosing spondylitis. Methods A Markov model over five years with cycle times of three months was computed. Patients included all had active disease, defined as Bath ankylosing spondylitis disease activity index (BASDAI) ?4 and could reach low disease activity, defined as BASDAI <4. Non?response to tumour necrosis factor?? (TNF?) inhibitors was always followed by cessation of treatment. Response to TNF? inhibitors could be followed at any time by either relapse to BASDAI ?4, leading to cessation of treatment, or toxicity, leading to cessation of treatment if major. Probabilities for efficacy, relapse, and toxicity were derived from two European randomised controlled trials. Utilities and costs assigned to the BASDAI disease states were derived from a two year observational Dutch cohort. In sensitivity analyses probabilities of effectiveness, toxicity, costs, and utilities were varied. Results Over five years the total quality adjusted life years varied from 2.57 to 2.89 for usual care, compared with 3.13 to 3.42 and 3.07 to 3.35 for etanercept or infliximab. Cumulative costs were between €49?555 to 69?982 for usual care compared with €59?574 to 91?183 or €28?3330 to 106?775 for etanercept and infliximab. This resulted in incremental cost?utility ratios varying between €42?914 and 123?761 per QALY for etanercept compared with usual care and €67?207 to 237?010 for infliximab. The model was sensitive to drug prices. Conclusion Etanercept and infliximab have large clinical effects in ankylosing spondylitis. The present model suggests the high drug costs restricts efficient use in all patients who have a BASDAI >4. The validity of the model is limited by insufficient insight in the natural course of the disease and long term effectiveness and toxicity of TNF? inhibitors.

Boonen, A; van der Heijde, D; Severens, J L; Boendermaker, A; Landewe, R; Braun, J; Brandt, J; Sieper, J; van der Linden, Sj

2006-01-01

327

Posterior Fixation of a Cervical Fracture Using the RRS Loop Spine System and Polyethylene Tape in an Elderly Ankylosing Spondylitis Patient: A Case Report  

PubMed Central

An 80-year-old woman presented with neck pain and paraparesis of Frankel C in her upper and lower extremities after falling. Imaging revealed an ankylosing cervical spine and a fracture line running obliquely from the anterior C3-4 to the posterior C4-5 level. Posterior fixation from the occi pit to T3 was performed using the RRS Loop Spine System and concomitant polyethylene tape fixation. This system is characterized by the uniqueness of how it screws to the occi pit and its use of a fixation rod with a larger diameter than in other instrumentation devices for use in the cervical region. Sublaminar banding using polyethylene tape was used to secure fixation. Her postoperative course was unremarkable, and her neck pain was relieved, although neurological improvement was minor. To our knowledge, this is the first report of an application of the RRS Loop Spine System to an ankylosing spondylitis patient with a cervical fracture.

Iida, Jin; Shigematsu, Hideki; Satoh, Nobuhisa; Tanaka, Masato; Kura, Tomohiko; Tsukamoto, Shinji; Kato, Yoshinobu; Tanaka, Yasuhito

2012-01-01

328

[ASAS/EULAR recommendations for the management of ankylosing spondylitis : evaluation of the 2010 update in the German-speaking area].  

PubMed

The ASAS/EULAR recommendations for the management of ankylosing spondylitis have been updated in 2010. The recommendations have been extended from 10 to 11 recommendations and 4 superior principles have been introduced based on the level of evidence and expert knowledge. The recommendations have been translated into German and have been evaluated by 25 experts from Germany, Austria and Switzerland. The experts scored the strength of the recommendations (SOR) on an 11 point numerical rating scale (from 0?=?no agreement to 10?=?total agreement). With a mean score of 9.6?±?1.05 the SOR was generally very good. PMID:23223873

Kiltz, U; Sieper, J; Braun, J

2013-02-01

329

Heat shock proteins and reactive arthritis  

Microsoft Academic Search

\\u000a Reactive arthritis (ReA) is unusual amongst inflammatory joint diseases because the cause of arthritis has been identified,\\u000a namely preceding infection with certain bacteria, whereas the aetiology of rheumatoid arthritis or ankylosing spondylitis,\\u000a or at least the triggering event, remains unknown. Most subjects infected by Chlamydia,Salmonella, Campylobacter,Yersinia or Shigella develop symptoms due to the effects of the infection in the genito-urinary

J. S. Hill Gaston; Richard C. Duggleby; Jane C. Goodall; Roberto Raggiaschi; Mark S. Lillicrap

330

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey  

PubMed Central

Objectives The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS. Methods A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease-specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire. Results This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI. Conclusion Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

Azzouz, Dhouha; Ghannouchi, Mohamed Mehdi; Haouel, Manel; Kochbati, Samir; Saadellaoui, Kaouthar; Ben Hmida, Abdelmajid; Zouari, Bechir; Kchir, Mohamed Montacer

2012-01-01

331

Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis.  

PubMed

The objective of this study is to evaluate the role of MMP-3 and MRI in assessing disease activity in sacroiliac joints of AS patients in comparison to the conventional measures Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Serum MMP-3 was measured in 30 patients who fulfilled the modified New York criteria for AS and in ten healthy volunteers. AS patients were categorized into those having high or low MMP-3 according to a cut-off value = 7.1 ng/ml. MRI of the sacroiliac joints (SIJs) was performed on all patients. SIJs were evaluated for enhancement and subchondral bone marrow edema. Results of MMP-3 and findings on MRI were correlated with multiple clinical parameters including BASDAI, ESR and CRP. Serum MMP-3 was significantly elevated in AS patients with active disease. Elevated MMP-3 levels were significantly associated with high BASDAI (P = 0.046), but not with ESR or CRP. MRI showed bone marrow edema and enhancement of SIJs in 19/30 patients with one patient showing enhancement only. These MRI findings were not correlated with MMP-3, BASDAI, CRP or ESR. In conclusion, serum MMP-3 is an objective measure reflecting clinical disease activity in AS. Bone marrow edema and enhancement detected by MRI of SIJs is another objective measure of disease activity, but are not correlated with MMP-3 or the conventional parameters as BASDAI, ESR, or CRP. Although both MMP-3 and MRI can reflect disease activity in AS they seem to be unrelated, perhaps each is reflecting a different aspect of disease activity. MMP-3 and MRI should be considered together with BASDAI in assessing disease activity and in guiding the available recommendations for initiation of biologics in AS. PMID:21431945

Soliman, Eiman; Labib, W; el-Tantawi, G; Hamimy, A; Alhadidy, A; Aldawoudy, A

2011-03-24

332

IL23R Gene Confers Susceptibility to Ankylosing Spondylitis Concomitant with Uveitis in a Han Chinese Population  

PubMed Central

Purpose The interleukin-23 receptor (IL-23R) has been shown to be associated with ankylosing spondylitis (AS) in many different populations. This study examined whether IL-23R polymorphisms were associated with susceptibility to this disease in a Chinese Han population. Methods Three single-nucleotide polymorphisms (SNP), rs7517847, rs11209032, and rs17375018, were genotyped in 291 AS patients and 312 age-, sex-, and ethnically matched healthy controls using a polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) assay. Results The genotype and allele frequencies of rs17375018, rs7517847, and rs11209032 were not different between the patients with AS and the healthy controls. On the one hand, stratification analysis indicated that the rs17375018 GG genotype and the G allele were increased in AS patients who were HLA-B27 positive (corrected p?=?0.024, odds ratio [OR] 2.35, 95% CI 1.30–4.24; pc?=?0.006, OR 1.98, 95% CI 1.28–3.07, respectively). On the other hand, the analysis according to clinical characteristics showed a significantly increased prevalence of the homozygous rs17375018 GG genotype and the G allele in patients with AS and uveitis compared with the controls (pc?=?0.024 and pc?=?0.024, respectively). In addition, haplotype analysis performed with the SHEsis platform revealed no significant difference concerning the haplotypes between AS patients and healthy controls. Conclusions In this study, the results suggested that the rs17375018 of IL23R was positively associated with HLA-B27-positive AS and that the rs17375018 GG of IL-23R was associated with AS concomitant with uveitis. We found no evidence for an association between the other two SNPs of IL-23R and AS.

Dong, Hongtao; Li, Qiuming; Zhang, Ying; Tan, Wei; Jiang, Zhengxuan

2013-01-01

333

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with ankylosing spondylitis.  

PubMed

OBJECTIVES: Ankylosing spondylitis (AS) is a chronic multi-systemic inflammatory rheumatic disorder. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with AS, and to assess the relation with inflammation. METHODS: Sixty-two patients with AS and 50 controls were included. Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. The plasma level of high sensitive C-reactive protein (hsCRP) was measured. These parameters were compared between groups. RESULTS: In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in AS patients compared to the controls (31.7 ± 9.6 vs 28.2 ± 7.4 and 35.8 ± 11.5 vs 30.6 ± 7.9 ms, P = 0.03 and P = 0.007, respectively). cTp-e interval and Tp-e/QT ratio were also significantly higher in AS patients (92.1 ± 10.2 vs 75.8 ± 8.4 and 0.22 ± 0.02 vs 0.19 ± 0.02 ms, all P values <0.001). cTp-e interval and Tp-e/QT ratio were significantly correlated with hsCRP (r = 0.63, P < 0.001 and r = 0.49, P < 0.001, respectively). CONCLUSIONS: Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in AS patients. These electrocardiographic ventricular repolarization indexes were significantly correlated with the plasma level of hsCRP. PMID:23579501

Acar, Gurkan; Yorgun, Hikmet; Inci, Mehmet Fatih; Akkoyun, Murat; Bakan, Betul; Nacar, Alper Bugra; Dirnak, Imran; Cetin, Gozde Yildirim; Bozoglan, Orhan

2013-04-12

334

Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor ? antibody infliximab  

PubMed Central

Background: Anti-tumour necrosis factor (TNF) treatment is clinically efficacious in patients with active ankylosing spondylitis (AS) and leads to improvement of spinal inflammation, as assessed by magnetic resonance imaging. It is unclear whether anti-TNF treatment affects chronic spinal changes in AS. Objectives: To analyse the effect of infliximab on the radiographic course of AS over 2 years. Methods: Complete sets of lateral radiographs of the cervical spine and lumbar spine were available from 82 patients from two sources: 41 patients (group 1) had been treated with infliximab (5 mg/kg/6 weeks) as part of a recent randomised controlled trial and 41 patients (group 2) were part of the early German AS cohort (GESPIC), without controlled interventions. Radiographs were obtained at baseline and after 2 years and scored by the modified Stokes AS Spinal Score (mSASSS). Results: Patients in the infliximab group were older, had a longer disease duration, and more radiographic damage at baseline. The mean (SD) mSASSS change was 0.4 (2.7) and 0.7 (2.8) for groups 1 and 2, respectively (p = NS). Radiographic damage at baseline was a predictor for more radiographic progression. Patients with baseline damage who were treated with infliximab showed a trend for less radiographic progression. No correlations between clinical parameters and radiographic progression were found. Conclusions: Patients with AS treated with infliximab had less radiographic progression after 2 years. Patients with prevalent radiographic damage are prone to develop more damage over time. Infliximab may decelerate radiographic progression in such patients. Larger studies are needed to prove that anti-TNF treatment inhibits structural damage.

Baraliakos, X; Listing, J; Rudwaleit, M; Brandt, J; Sieper, J; Braun, J

2005-01-01

335

Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging  

PubMed Central

Background: Magnetic resonance imaging (MRI) is increasingly used to detect inflammation in the spine of patients with ankylosing spondylitis (AS). Objectives: To detect differentially the presence and extent of inflammation in the three spinal segments of patients with AS by MRI. Methods: In 38 patients with active AS, acute spinal lesions were assessed by T1 weighted, gadolinium enhanced, spin echo MRI (T1/Gd-DTPA) and short ? inversion recovery (STIR) sequences. MRI was quantified by the validated scoring system ASspiMRI-a. Acute spinal lesions were detected in the whole spine and in each spinal segment. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebral body. Results: A greater number of inflammatory spinal lesions were found by the STIR sequence than by Gd-DTPA: inflammation was present in 30.6% of the VUs as assessed by STIR, compared with 26.8% of the same VUs assessed by T1/Gd-DTPA. Inflammation was found more commonly in the thoracic spine (TS) than in the cervical (CS) or the lumbar spine (LS) with both techniques. When STIR was used, spinal inflammation in the CS, the TS, and LS was detected in 10/38 (26%), 28/38 (74%), and 9/38 (24%) patients, respectively. The VU T7/8 was found to be the VU most often affected by both techniques (27.8% by T1/Gd-DTPA and 34.5% by STIR). Conclusions: Spinal inflammation is a common manifestation in patients with AS, and appears more frequently in the TS. The scoring system ASspiMRI-a can be used for evaluation of acute spinal changes in AS.

Baraliakos, X; Landewe, R; Hermann, K; Listing, J; Golder, W; Brandt, J; Rudwaleit, M; Bollow, M; Sieper, J; van der Heijde, D; Braun, J

2005-01-01

336

Development and preselection of criteria for short term improvement after anti-TNF? treatment in ankylosing spondylitis  

PubMed Central

Objective: To develop and compare candidate improvement criteria for anti-TNF? treatment in ankylosing spondylitis with optimal discriminating capacity between treatment and placebo. Methods: Data from two randomised controlled trials which included 99 patients treated with infliximab or etanercept were used to evaluate 50 candidate improvement criteria. These were developed on the basis of pain, patient's global assessment, function, morning stiffness, spinal mobility, and C reactive protein. Different levels of improvement in each domain (20–60%) were used to define Boolean type criteria. These criteria were compared with different percentages of improvement on the BASDAI and with modified ASAS improvement criteria. Bootstrap methods were applied to calculate 95% confidence intervals (CI) of the ?2 test values to select the best candidate improvement criteria. Results: The best performing improvement criteria were "20% improvement in five of six domains" (?2 = 31.9 (95% CI, 18.0 to 46.9)) with a low placebo response of 2.9% and a high response to infliximab of 67.7%; and "ASAS 40% improvement" (?2 = 26.5 (13.3 to 41.1)), with response to placebo of 5.7% and response to infliximab of 64.7%. The good discriminating capacity of the two improvement criteria was confirmed by the combined dataset of the infliximab and etanercept trial. Conclusions: The "five of six" improvement criterion has the advantage of including the objective domains spinal mobility and acute phase reactants, but requires only 20% improvement. The ASAS 40% improvement criterion has the advantage of setting a high threshold, but only in patient reported outcomes. The choice between these improvement criteria needs to be based on further validation from upcoming trials.

Brandt, J; Listing, J; Sieper, J; Rudwaleit, M; van der Heijde, D; Braun, J

2004-01-01

337

Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept  

PubMed Central

Objective: To assess the changes in inflammatory lesions of the spine and the sacroiliac (SI) joints as detected by magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) with predominant axial symptoms during treatment with etanercept. Methods: MRI of the spine and/or the SI joints of patients with active AS or axial uSpA was performed at baseline (TP0, n = 25), after 6 weeks (TP1, n = 20), and after 24 weeks of continuous treatment with etanercept (TP2, n = 12). T1 weighted spin echo pre -(T1), post-gadolinium (T1/Gd-DTPA) and short tau inversion recovery (STIR) MRI sequences were used to assess chronic and active spinal lesions using the scoring system ASspiMRI. Active and chronic SI lesions were assessed using a simple scoring system. Results: By use of the definite STIR sequence, significant regression of spinal inflammation was already seen already after 6 weeks in the patients treated with etanercept (mean (SD) 11.2 (13.8) at TP0 v 6.8 (7.9) at TP1; p = 0.023) but not in patients treated with placebo. Continuous treatment with etanercept for 24 weeks reduced active spinal changes by 69% (p = 0.012). T1/Gd-DTPA sequences gave similar results. There was only a trend for a decrease of active inflammatory lesions of the SI joints. Conclusions: Etanercept treatment in patients with active AS and uSpA leads to regression of active inflammatory lesions of the spine as depicted by MRI. The potential role of etanercept on deceleration of chronic spinal changes needs further study.

Rudwaleit, M; Baraliakos, X; Listing, J; Brandt, J; Sieper, J; Braun, J

2005-01-01

338

Golimumab reduces spinal inflammation in ankylosing spondylitis: MRI results of the randomised, placebo- controlled GO-RAISE study  

PubMed Central

Objective To evaluate golimumab's effect on MRI-detected spinal inflammation in ankylosing spondylitis (AS). Methods Patients were randomly assigned to subcutaneous injections of placebo (n=78), golimumab 50 mg (n=138), or golimumab 100 mg (n=140) every 4 weeks. An MRI substudy comprising 98 patients (placebo n=23, 50 mg n=37, 100 mg n=38) at eligible MRI substudy sites had serial spine MRI scans (sagittal plane, 1.5T scanners, T1 and short tau inversion recovery sequences) at baseline and weeks 14 and 104. Two blinded (treatment, image order) readers independently evaluated MRI spinal inflammation using AS spine MRI-activity (ASspiMRI-a) scores; reader scores were averaged. Changes from baseline to weeks 14 and 104 were compared among treatment groups using analysis of variance on van der Waerden normal scores both with (post-hoc) and without (prespecified) adjustment for baseline ASspiMRI-a scores. Results Median baseline ASspiMRI-a scores were lower in the 100 mg (3.5) than placebo (6.8) and 50 mg (7.8) groups. Median decreases in activity scores from baseline to week 14 were ?0.5 for placebo, ?3.5 for 50 mg (p=0.047 vs placebo), and ?1.5 for 100 mg (p=0.14 vs placebo). After adjusting for baseline ASspiMRI-a score imbalance, significant improvements were observed with both 50 mg (p=0.011) and 100 mg (p=0.002) versus placebo. ASspiMRI-a scores improvement achieved with golimumab was maintained at week 104. Improvement in ASspiMRI-a scores correlated with improvement in the recently developed AS disease activity score (ASDAS) and C-reactive protein (CRP) levels but not with other key AS clinical outcomes. Conclusion Golimumab significantly reduced MRI-detected spinal inflammation of AS; improvements were sustained to week 104 and correlated with improvement in ASDAS and CRP.

Braun, Jurgen; Baraliakos, Xenofon; Hermann, Kay-Geert A; van der Heijde, Desiree; Inman, Robert D; Deodhar, Atul A; Baratelle, Anna; Xu, Stephen; Xu, Weichun; Hsu, Benjamin

2012-01-01

339

Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment  

PubMed Central

OBJECTIVES—Three operative techniques have been described to correct thoracolumbar kyphotic deformity (TLKD) resulting from ankylosing spondylitis (AS) at the level of the lumbar spine: opening wedge osteotomy, polysegmental wedge osteotomies, and closing wedge osteotomy. Little knowledge exists on the indication for, and outcome of these corrective lumbar osteotomies.?METHODS—A structured review of the medical literature was performed.?RESULTS—A search of the literature revealed 856 patients reported in 41 articles published between 1945 and 1998. The mean age at time of operation was 41 years, male-female ratio 7.5 to 1. In 451 patients an open wedge osteotomy was performed. Polysegmental wedge osteotomies were performed in 249 patients and a closing wedge osteotomy in 156 patients. Most of the studies primarily focus on the surgical technique. Technical outcome data were poorly reported. Sixteen reports, including 523 patients, met the inclusion criteria of this study, and could be analysed for technical outcome data. The average correction achieved with each surgical techniques ranged from 37 to 40 degrees. Loss of correction was mainly reported in patients treated by open wedge osteotomy and polysegmental wedge osteotomies. Neurological complications were reported in all three techniques. The perioperative mortality was 4%. Pulmonary, cardiac and intestinal problems were found to be the major cause of fatal complications.?CONCLUSION—Lumbar osteotomy for correction of TLKD resulting from AS is a major surgery. The indication for these lumbar osteotomies as well as the degree of correction in the lumbar spine has not yet been established. Furthermore, there is a need for a generally accepted clinical score that encompasses accurate preoperative and postoperative assessment of the spinal deformity. The results of this review suggest that the data from the literature are not suitable for decision making with regard to surgical treatment of TLKD resulting from AS.??

Van Royen, B J; De Gast, A

1999-01-01

340

Posterior Instrumentation and Simultaneous Intertransverse Approach Using Transforaminal Cage Fusion for Thoracic Pseudoarthrosis in Ankylosing Spondylitis: A Case Report.  

PubMed

Background Unrecognized or untreated injury in patients with ankylosing spondylitis (AS) may develop anterior column spinal pseudoarthrosis with an open wedge bone defect. The methods of surgical treatment are controversial. Combined anterior and posterior stabilizations or posterior instrumentation with osteoclasis are beneficial as shown in an existing literature review.Case Report A 36-year-old Asian man with AS sustained a motor vehicle accident 2 years before presentation. At that time, his immediate magnetic resonance imaging scan demonstrated T10-T11bone edema and granulation tissue formation with fluid accumulation in T10-T11 disc space. He opted for conservative treatment. His back pain was then exacerbated 2 years after the accident, and he underwent three-dimensional (3D) computed tomography (CT) scan revealing a severe pseudoarthrosis with sclerotic margins across the T10 caudal end vertebra to the T11 upper end plate, with a maximal fracture gap of 15 mm. Spinal cord compression was not present. After selecting for an appropriate cage size with the aid of the preoperative 3D CT images, we used a single posterior approach to apply pedicle screws, removed pseudoarthrotic granulation tissue through an intertransverse posterior lateral approach without entering the spinal canal, and inserted a transforaminal lumbar interbody fusion (TLIF) cage with bone graft. There was radiographic evidence of spinal fusion at the 9-month follow-up, and the patient had resumed all normal daily activities.Conclusion The authors found that a less invasive single posterior surgical approach using a TLIF cage and pedicle screws could be applied to AS patients with combined thoracic pseudoarthrosis and an anterior column defect. Using a TLIF cage may provide circumferential stability immediately, bone graft fusion, and sagittal plane correction simultaneously. An appropriate cage size and placement selected with preoperative 3D CT images are the keys to success. PMID:23765917

Lo, Hung-Kai; Chiang, Tsay-I; Chang, Olivia Hui-Chiun; Chang, I-Chang

2013-06-13

341

Parallel analysis of cancer mortality among atomic bomb survivors and patients with ankylosing spondylitis given X-ray therapy  

SciTech Connect

Radiation-induced cancer mortality rates among atomic bomb survivors with doses of at least 100 rad and patients with ankylosing spondylitis given X-ray therapy have been compared for the first time. The estimated average mean bone marrow dose for the spondylitics is more than twice that for atomic bomb survivors, and yet spondylitics experienced only half the risk of radiation-induced leukemia of atomic bomb survivors. For sites that were heavily irradiated in the spondylitics, provisional estimates indicate comparable doses in the two studies, and similar levels of cancer risk were observed. For these sites, when information from the studies was combined, there were statistically significant excesses for cancers of the esophagus, stomach, lung, and ovaries, multiple myeloma, other lymphomas, and tumors of the spinal cord and nerves. Very high relative risks (RR's) for tumors of the spinal cord and nerves were observed in both studies. For sites that were lightly irradiated in the spondylitics, in addition to previously documented sites, there was a statistically significant excess of cancers of the liver and gallbladder among atomic bomb survivors. A previous subdivision of cancer sites into radiosensitive and other tissues was not supported by the atomic bomb survivor data. Changes in the rates of radiation-induced cancers with age at exposure and time since exposure were studied and compared with the use of generalized linear modeling of the RR's and also by examination of the excess mortality rates. The level of agreement between the two studies was high; provided it is accepted that the reduced level of leukemia risk in the spondylitics is due to cell sterilization, no inconsistencies were found.

Darby, S.C.; Nakashima, E.; Kato, H.

1985-07-01

342

JARID1A, JMY, and PTGER4 Polymorphisms Are Related to Ankylosing Spondylitis in Chinese Han Patients: A Case-Control Study.  

PubMed

Susceptibility to ankylosing spondylitis (AS) is largely genetically determined. JARID1A, JMY and PTGER4 have recently been found to be associated with AS in patients of western European descent. We aim to examine the influence of JARID1A, JMY, and PTGER4 polymorphisms on the susceptibility to and the severity of ankylosing spondylitis in Chinese ethnic majority Han population. This work can lead the clinical doctors to intervene earlier. Blood samples were drawn from 396 AS patients and 404 unrelated healthy controls. Both the AS patients and the controls are Han Chinese. The AS patients are classified based on the severity of the disease. Thirteen tag single nucleotide polymorphisms (tagSNPs) in JARID1A, JMY and PTGER4 are selected and genotyped. Frequencies of different genotypes and alleles are analyzed among the different severity AS patients and the controls. The rs2284336 SNP in JARID1A, the rs16876619 and rs16876657 SNPs in JMY are associated with susceptibility of AS. The rs11062357 SNP in JARID1A, the rs2607142 SNP in JMY and rs10440635 in PTGER4 are related to severity of AS. Haplotype analyses indicate PTGER4 is related to susceptibility to AS; JARID1A and JMY are related to severity of AS. PMID:24069348

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

2013-09-19

343

Biochemical studies on a factor isolated from Klebsiella K43-BTS1 that cross-reacts with cells from HLA-B27 positive patients with ankylosing spondylitis.  

PubMed

A component of the cell walls of certain enteric bacteria has been identified that cross-reacts with an HLA-B27-associated cell-surface structure on lymphocytes and other cell types from patients with ankylosing spondylitis. This component, or "modifying factor," from one particular organism, Klebsiella K43-BTS1, has been studied in detail. A purification scheme has been developed using preparative electrofocusing and gel-permeation high performance liquid chromatography techniques and the purified material used in various characterization studies. A previous study demonstrated that the modifying factor has an approximate molecular weight of 30,000 and an isoelectric point of 5.4-5.5. In this study two-dimensional gel electrophoresis experiments demonstrated that the modifying factor is associated with a single protein component of the cell wall of this organism. Pronase and papain destroyed the modifying factor activity whereas trypsin and alpha-chymotrypsin degraded the factor into smaller fragments without destroying its ability to modify B27+ AS- lymphocytes. Neuraminidase did not affect the modifying factor itself but did affect B27+ AS- lymphocytes such that they became unresponsive to modification. Sugar inhibition studies suggested that sugar groups are probably not involved in the function of the modifying factor. The availability of purified modifying factor should permit more detailed chemical analyses as well as functional studies to determine the significance of this molecule to the pathogenesis of ankylosing spondylitis. PMID:3539895

Upfold, L I; Sullivan, J S; Geczy, A F

1986-11-01

344

JARID1A, JMY, and PTGER4 Polymorphisms Are Related to Ankylosing Spondylitis in Chinese Han Patients: A Case-Control Study  

PubMed Central

Susceptibility to ankylosing spondylitis (AS) is largely genetically determined. JARID1A, JMY and PTGER4 have recently been found to be associated with AS in patients of western European descent. We aim to examine the influence of JARID1A, JMY, and PTGER4 polymorphisms on the susceptibility to and the severity of ankylosing spondylitis in Chinese ethnic majority Han population. This work can lead the clinical doctors to intervene earlier. Blood samples were drawn from 396 AS patients and 404 unrelated healthy controls. Both the AS patients and the controls are Han Chinese. The AS patients are classified based on the severity of the disease. Thirteen tag single nucleotide polymorphisms (tagSNPs) in JARID1A, JMY and PTGER4 are selected and genotyped. Frequencies of different genotypes and alleles are analyzed among the different severity AS patients and the controls. The rs2284336 SNP in JARID1A, the rs16876619 and rs16876657 SNPs in JMY are associated with susceptibility of AS. The rs11062357 SNP in JARID1A, the rs2607142 SNP in JMY and rs10440635 in PTGER4 are related to severity of AS. Haplotype analyses indicate PTGER4 is related to susceptibility to AS; JARID1A and JMY are related to severity of AS.

Chen, Chao; Liu, Jingyi; Shi, Lewis L.; Wang, Yan

2013-01-01

345

Six months open label trial of leflunomide in active ankylosing spondylitis  

PubMed Central

Patients and methods: Twenty patients with AS fulfilling the 1984 modified New York criteria with a Bath AS Disease Activity Index (BASDAI) >3 were given leflunomide for 6 months. Clinical outcome assessments included disease activity (BASDAI), function (BASFI), metrology (BASMI), patient's and physician's global assessment, peripheral joint assessment, quality of life (SF-36), global pain, and CRP. Primary end point was a reduction of disease activity as measured by the BASDAI of >25% at 6 months. Results: A BASDAI 25% improvement was noted in 5/20 (25%) patients and a BASDAI 50% improvement in 4/20 (20%) patients. The absolute BASDAI did not change significantly over the 6 month study (4.9 at baseline v 4.3 at week 24, p>0.05). Similarly, no significant change was found for the BASFI, BASMI, patient's and physician's global assessment, SF-36 mental component, and CRP. For the 10 patients with peripheral arthritis, the mean number of inflamed joints was significantly reduced from 1.7 at baseline to 0.9 at week 12 (p = 0.034) and 0.2 at week 24 (p = 0.039). Conclusion: In this open study of patients with active AS only those with peripheral arthritis improved significantly with leflunomide treatment. Axial symptoms did not improve.

Haibel, H; Rudwaleit, M; Braun, J; Sieper, J

2005-01-01

346

Position of the aorta relative to the spine in patients with thoracolumbar/lumbar kyphosis secondary to ankylosing spondylitis.  

PubMed

Study Design. A computed tomography (CT) study.Objective. To explore the anatomic relationship between the aorta and spine in patients with thoracolumbar/lumbar kyphosis secondary to ankylosing spondylitis (AS).Summary of Background Data. The lumbar spinal osteotomy has been widely adopted for the correction of thoracolumbar/lumbar kyphosis caused by AS. During this procedure, the aorta may be stretched at the osteotomized level and in proximity to the tip of the pedicle screw, both of which imply a potential risk of the aortic injury. To date, no reports have been specifically published for describing the position of the aorta relative to the spine in AS patients with fixed thoracolumbar/lumbar kyphosis.Methods. Thirty-three AS patients with thoracolumbar/lumbar kyphosis and thirty-eight age and gender matched patients with a normal spine were included in this study. For each subject, the left pedicle-aorta angle and distance were measured from T9 to L3 on the CT images. Radiographs were analyzed to measure the global kyphosis, lumbar lordosis and to record the apex of the kyphotic curve.Results. At T9-L3 levels, AS patients with thoracolumbar/lumbar kyphosis exhibited significantly smaller Left Pedicle-Aorta angles (from 10.23° to -11.56°) and larger distances (from 39.0 mm to 55.5 mm) than those with a normal spine. With increased global kyphosis, the aorta shifted more laterally to the right at periapical levels (L1 and L2, P <0.05). Notably, the aorta was located at the middle front of the vertebrae at T12-L1 levels, and far away from the vertebrae at L2 and L3 levels.Conclusion. In AS patients with thoracolumbar/lumbar kyphosis, the aorta is positioned more anteromedially relative to the vertebral body compared with that in the normal subjects. The aorta is far away from the vertebral body at L2 and L3 levels, thus it could be much safer to perform osteotomy below L1. PMID:24042726

Feng, Fan; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang; Jiang, Jun

2013-09-15

347

Assessment of disability with the World Health Organisation Disability Assessment Schedule II in patients with ankylosing spondylitis  

PubMed Central

Objective: To investigate in ankylosing spondylitis (AS) whether the newly developed World Health Organisation Disability Assessment Schedule II (WHODAS II) is a useful instrument for measuring disability, to assess its responsiveness in relation to other traditional disease specific instruments, and to identify factors that are associated with both short term and long term scores on the WHODAS II. Methods: Patients with AS from a randomised controlled trial assessing the efficacy of spa treatment (n=117) and from a five year longitudinal observational study (n=97) participated. The patients completed several questionnaires, including the WHODAS II. After a three week course of spa treatment, 31 patients again completed all questionnaires to assess responsiveness. To determine to what degree the WHODAS II reflects some AS oriented measures on disease activity, functioning, and quality of life, correlation coefficients between the WHODAS II and these other questionnaires were calculated. Responsiveness was calculated by the effect size (ES) and standardised response mean (SRM). Linear regression analysis was performed to explore which factors might be associated with short term changes on the WHODAS II and to investigate (in the observational study) which factors of WHODAS II might predict disability five years later. Results: Mean score on the WHODAS II was 23.9 (SD 15.5 (range 0.0-76.1)). Scores on the WHODAS II were significantly correlated with all disease specific questionnaires measured (all p<0.001). The WHODAS II showed a comparable short term responsiveness score (SRM 0.41; ES 0.39). In regression analysis these short term changes on the WHODAS II were significantly associated with changes in functioning (ß coefficient 4.25, 95% confidence interval (95% CI) 1.24 to 7.26, p=0.007). In the observational study, disease activity (ß coefficient 0.35, 95% CI 0.17 to 0.53, p<0.000) as well as functioning (ß coefficient 0.23, 95% CI 0.09 to 0.38, p=0.002) seemed to significantly predict disability (WHODAS II) after five years. Conclusion: The WHODAS II is a useful instrument for measuring disability in AS in that it accurately reflects disease specific instruments and that it shows similar responsiveness scores. In AS, a short term change on the WHODAS II is associated with a change in physical function. At the group level, disease activity and physical functioning may predict disability after five years.

van Tubergen, A; Landewe, R; Heuft-Dorenbosch, L; Spoorenberg, A; van der Heijde, D; van der Tempel, H; van der Linden, S

2003-01-01

348

Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study  

PubMed Central

Introduction Pulmonary involvement is a known manifestation in patients with ankylosing spondylitis (AS). However, previous studies have been based on small samples and the reported prevalence and associations with typical clinical features vary. The purpose of this study was to compare pulmonary function (PF) in patients with AS and population controls, and to study associations between PF and disease related variables, cardio-respiratory fitness and demographic variables in patients with AS. Methods In a cross-sectional controlled study, 147 AS patients and 121 controls underwent examinations, including demographic variables, laboratory (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and clinical measures (disease activity (AS disease activity score, ASDAS), physical function (Bath ankylosing spondylitis functional index, BASFI), spinal mobility (Bath ankylosing spondylitis metrology index, BASMI), chest expansion, cardio-respiratory fitness (peak oxygen uptake, VO2peak) and pulmonary function test (PFT) (spirometry)). Cumulative probability plots were used to visualize associations between the ASDAS and BASMI scores and the corresponding forced vital capacity (FVC%, percentage of predicted value controlled for the influence of confounding factors) score for each patient. Univariate ANCOVAs were performed to explore group differences in PF adjusting for relevant variables, and a multiple regression model was used to estimate the explanatory power of independent variables (demographic, disease related, VO2peak) on restrictive ventilatory impairment (FVC%). Results AS patients showed significantly lower PF values compared with controls, and significantly more patients were categorized with restrictive pattern (18% vs. 0%, P < 0.001). Cumulative probability plots showed significant associations between spinal mobility measures (BASMI) and FVC% for individual patients. BASMI, chest expansion and male gender contributed significantly and independently in a multiple regression model predicting the variation of FVC% in AS patients, whereas disease activity, physical function and VO2peak did not contribute significantly. The final model explained 45% of the variance in FVC% (P < 0.001). Conclusions This study showed significantly impaired pulmonary function in the AS patients compared to controls and reference data, and demonstrated a clear relationship between reduced spinal mobility and restrictive PF in AS patients. The results support the assumption of an association between musculoskeletal limitations and restrictive respiratory impairment in AS, emphasizing the importance of maintaining spinal flexibility in the management of the disease. Further, patients with severely reduced spinal mobility should be referred for pulmonary function examination and relevant follow-up treatment.

2012-01-01

349

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

PubMed

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

Huwart, Laurent; Amoretti, Nicolas

2013-07-11

350

The balance of tissue repair and remodeling in chronic arthritis  

Microsoft Academic Search

The introduction of targeted therapies has dramatically changed the prognosis of patients with chronic joint diseases such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). As control of inflammation, and hence of symptoms of disease, is increasingly achieved, more attention is given towards the long-term consequences of these disorders, to the structural damage in the skeletal tissues and to the

Rik Lories

2011-01-01

351

Effects and Safety of Allogenic Mesenchymal Stem Cells Intravenous Infusion in Active Ankylosing Spondylitis Patients Who Failed NSAIDs: A 20 Week Clinical Trial.  

PubMed

Objective: To evaluate the feasibility, safety, and efficacy of intravenous infusion of allogenic mesenchymal stem cells (MSCs) in ankylosing spondylitis (AS) patients who are refractory to or could not tolerate the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). Method: AS patients enrolled in this study received 4 intravenous infusions (IVI) of MSCs on days 0,7,14, and 21. The percentage of ASAS20 responders (the primary endpoint) at the 4th week and the mean ASAS20 response duration (the secondary endpoint) were used to assess treatment response to MSC infusion and duration of the therapeutic effects. Ankylosing Spondylitis Disease Activity Score Containing C-reactive Protein (ASDAS-CRP) and other pre-established evaluation indices were also adopted to evaluate the clinical effects. Magnetic resonance imaging (MRI) was performed to detect changes of bone marrow edema in the spine. The safety of this treatment was also evaluated. Results: Thirty-one patients were included, and the percentage of ASAS20 responders reached 77.4% at the 4th week and the mean ASAS20 response duration was 7.1 weeks. The mean ASDAS-CRP score decreased from 3.6±0.6 to 2.4±0.5 at the 4th week, and then increased to 3.2±0.8 at the 20th week. The average total inflammation extent (TIE) detected by MRI decreased from 533,482.5 at baseline to 480,692.3 at the 4th week (p>0.05) and 400,547.2 at the 20th week (p<0.05). No adverse effects were noted. Conclusion: Intravenous infusion of MSCs is a feasible, safe, and promising treatment for patients with AS. PMID:23711393

Wang, Peng; Li, Yuxi; Huang, Lin; Yang, Jiewen; Yang, Rui; Deng, Wen; Liang, Biling; Dai, Lie; Meng, Qingqi; Gao, Liangbin; Chen, Xiaodong; Shen, Jun; Tang, Yong; Zhang, Xin; Hou, Jingyi; Ye, Jichao; Chen, Keng; Cai, Zhaopeng; Wu, Yanfeng; Shen, Huiyong

2013-05-22

352

Analysis of PPARGC1B, RUNX3 and TBKBP1 Polymorphisms in Chinese Han Patients with Ankylosing Spondylitis: A Case-Control Study  

PubMed Central

Background Susceptibility to and severity of ankylosing spondylitis (AS) are largely genetically determined. PPARGC1B, RUNX3 and TBKBP1 have recently been found to be associated with AS in patients of western European descent. Our purpose is to examine the influence of PPARGC1B, RUNX3 and TBKBP1 polymorphisms on the susceptibility to and the severity of ankylosing spondylitis in Chinese ethnic majority Han population. Methods Blood samples are drawn from 396 AS patients and 404 unrelated healthy controls. All the patients and the controls are Han Chinese and the patients are HLA-B27 positive. The AS patients are classified based on the severity of the disease. Twelve tag single nucleotide polymorphisms (tagSNPs) in PPARGC1B, RUNX3 and TBKBP1 are selected and genotyped. Frequencies of different genotypes and alleles are analyzed among the different severity AS patients and the controls. Results After Bonferroni correction, the rs7379457 SNP in PPARGC1B shows significant difference when comparing all AS patients to controls (p?=?0.005). This SNP also shows significant difference when comparing normal AS patients to controls (p?=?0.002). The rs1395621 SNP in RUNX3 shows significant difference when comparing severe AS patients to controls (p?=?0.007). The rs9438876 SNP in RUNX3 shows significant difference when comparing normal AS patients to controls (p?=?0.007). The rs8070463 SNP in TBKBP1 shows significant difference in genotype distribution when comparing severe AS patients to controls (p?=?0.003). Conclusions The rs7379457 SNP in PPARGC1B is related to susceptibility to AS in Chinese Han population. The rs7379457 SNP in PPARGC1B, the rs1395621 and rs9438876 SNPs in RUNX3, and the rs8070463 SNP in TBKBP1 are related to the severity of AS in Chinese Han population.

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

2013-01-01

353

EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis  

Microsoft Academic Search

Objectives:To develop evidence-based EULAR recommendations for cardiovascular (CV) risk management in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA).Methods:A multidisciplinary expert committee was convened as a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), comprising 18 members including rheumatologists, cardiologists, internists and epidemiologists, representing nine European countries. Problem areas and related keywords for

M. J. L. Peters; D. P. M. Symmons; D. McCarey; B. A. C. Dijkmans; P. Nicola; T. K. Kvien; I. B. McInnes; H. Haentzschel; M. A. Gonzalez-Gay; S. Provan; A. Semb; P. Sidiropoulos; G. Kitas; Y. M. Smulders; M. Soubrier; Z. Szekanecz; N. Sattar; M. T. Nurmohamed

2010-01-01

354

Increased Prevalence of Anti-Third Generation Cyclic Citrullinated Peptide Antibodies in Patients With Rheumatoid Arthritis and CREST Syndrome  

Microsoft Academic Search

To investigate the prevalence of anti-third generation cyclic citrullinated peptide antibodies (anti-CCP3) in patients with\\u000a systemic connective tissue diseases, we assembled a training set consisting of 115 patients with rheumatoid arthritis (RA),\\u000a 52 with Calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia (CREST) syndrome, 21 with\\u000a scleroderma, 20 with ankylosing spondylitis, 18 with reactive arthritis, 25 with juvenile rheumatoid arthritis (RA),

R. Wu; O. Shovman; Y. Zhang; B. Gilburd; G. Zandman-Goodard; Yehuda Shoenfeld

2007-01-01

355

IgA1 and IgA2 subclass antibodies against Klebsiella pneumoniae in the sera of patients with peripheral and axial types of ankylosing spondylitis.  

PubMed Central

OBJECTIVE--To study further the Klebsiella specific serum antibody response in patients with axial and peripheral types of ankylosing spondylitis (AS). METHODS--IgA1 and IgA2 subclass antibodies to Klebsiella pneumoniae were measured by enzyme linked immunosorbent assay in the sera of 171 patients with axial or peripheral type AS, and in sera of 100 healthy controls. The effect of 26 weeks of sulphasalazine treatment on the antibody levels in the two types of AS was also analysed. RESULTS--K pneumoniae specific antibody levels of both IgA1 and IgA2 subclasses were increased in the sera of patients with AS compared with healthy controls. The increased levels were present in patients with axial and with peripheral AS, and there were no statistically significant differences in the antibody levels between these two groups. Sulphasalazine treatment decreased the Klebsiella specific antibody level of IgA1 subclass in patients with axial AS, but there were no statistically significant changes in the IgA2 subclass, or in the patients with peripheral type AS. CONCLUSIONS--These results agree with earlier published findings suggesting that IgA (especially Klebsiella specific IgA) may have a role in the pathogenetic mechanisms of both peripheral and axial types of AS. In addition, it seems that both IgA1 and IgA2 subclasses are involved in the disease process.

Maki-Ikola, O; Nissila, M; Lehtinen, K; Leirisalo-Repo, M; Granfors, K

1995-01-01

356

Association of chromosome 2q36.1-36.3 and autosomal dominant transmission in ankylosing spondylitis: results of genetic studies across generations of Han Chinese families  

PubMed Central

Background: Ankylosing spondylitis (AS) is a chronic, potentially crippling, spondyloarthropathy with strong genetic components affecting approximately 0.3% of the population. Its exact genetic mechanism and mode of transmission, however, remains obscure. Methods and results: The authors conducted a genome wide scan on 75 individuals across multiple generations of three Han Chinese families affected with AS. Segregation analysis and pedigree investigation suggested an autosomal dominant inheritance. Pairwise logarithm of odds (LOD) scores were calculated using LINKAGE package for the obtained genotypes. High resolution mapping was then performed based on markers with significant LOD scores. To minimise the number of crossovers in each family, haplotype were constructed and assigned. Two of the pedigrees shared one candidate region for AS on 2q36.1–2q36.3 spanning 6-cM (maximum heterogeneity LOD score of 12.41 at marker D2S2228), while the other showed strong linkage to the HLA-B region. Conclusions: This is the first report which proposes one of the new genetic models of autosomal dominant transmission in AS. The breakthrough in the identification of linkage to chromosome 2q36.1–2q36.3 and the HLA-B region highlights the future potential of more comprehensive genetic studies of determinants of disease risk.

Gu, J; Huang, J; Li, C; Zhao, L; Huang, F; Liao, Z; Li, T; Wei, Q; Lin, Z; Pan, Y; Huang, J; Wang, X; Lin, Q; Lu, C; Wu, Y; Cao, S; Wu, J; Xu, H; Yu, B; Shen, Y

2009-01-01

357

Infliximab Dose Reduction Sustains the Clinical Treatment Effect in Active HLAB27 Positive Ankylosing Spondylitis: A Two-Year Pilot Study  

PubMed Central

The rationale of the study was to evaluate the efficacy of infliximab (IFX) treatment in patients with ankylosing spondylitis (AS) and to determine whether IFX dose reduction and interval extension sustains the treatment effect. Nineteen patients were included and treated with IFX 5?mg/kg every 6 weeks for 56 weeks. All patients concomitantly received MTX with median dose 7.5?mg/weekly. During the second year, the IFX dose was reduced to 3?mg/kg every 8 weeks. Eighteen patients completed the 1-year and 15 patients the 2-year trial. The ?50% improvement at week 16 from baseline of BASDAI was achieved in 16/19 (84%) patients. Significant reductions in BASDAI, BASFI, and BASMI scores, decrease in ESR and CRP, and improvement in SF-36 were observed at weeks 16 and 56. The MRI-defined inflammatory changes in the sacroiliac joints disappeared in 10/15 patients (67%) already at 16 weeks. IFX treatment effect was sustained throughout the second year after IFX dose reduction and interval extension. We conclude that IFX treatment is effective in well-established active AS and a dose reduction sustains the treatment effect. These observations are of clinical importance and open the opportunity to reduce the drug costs. This trial is registered with ClinicalTrials.gov NCT01850121.

Morck, Boel; Bremell, Tomas; Forsblad-d'Elia, Helena

2013-01-01

358

Familial Mediterranean Fever and Seronegative Arthritis  

Microsoft Academic Search

Familial Mediterranean fever (FMF) is characterized by recurrent, self-limited episodes of polyserositis, with articular involvement\\u000a also being a common manifestation. The pattern and joint predilection of arthritis show many similarities to those of spondyloarthritis.\\u000a Moreover, case series suggest an increased prevalence of ankylosing spondylitis or spondyloarthritis among FMF patients. FMF\\u000a is caused by mutations in the MEFV gene encoding pyrin,

Nurullah Akkoc; Ahmet Gul

359

Ultrasound Measurements at the Proximal Phalanges in Male Patients with Psoriatic Arthritis  

Microsoft Academic Search

:   Bone ultrasound parameters at the proximal phalanges of the hands were measured in 55 male patients with psoriatic arthritis\\u000a (PA) (39 with peripheral radiologic involvement and 16 with axial involvement), comparing the findings with those in 16 rheumatoid\\u000a arthritis (RA) patients, 20 ankylosing spondylitis (AS) patients and 55 age- and sex-matched normal controls. Mean values\\u000a of amplitude-dependent speed of

E. Taccari; F. Sensi; A. Spadaro; V. Riccieri; T. Rinaldi

2001-01-01

360

Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life.  

PubMed

Sleep disturbance is often reported by the patients with ankylosing spondylitis (AS), with awakenings produced by inflammatory pain. There are limited studies about sleep disturbance on these patients, and especially its association with psychological state and quality of life to examine the prevalence of sleep disturbance and to assess its association with disease-specific variables, psychological status and quality of life. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. Sleep disturbance was assessed by the fourth item of Hamilton Anxiety Scale. Psychological status was assessed by The Hospital Anxiety and Depression Scale including depression subscale and anxiety subscale. The quality of life was evaluated by the short form-36 (SF-36). Sleep disturbance was found in 64.5 %, depression in 55.5 % and anxiety in 60.9 % amongst our patients. Significantly, worse pain, higher disease activity and functional disability were present in patients with sleep disturbance. Likewise, sleep problems were significantly higher in patients with depression, anxiety and in patients with low scores of the SF36. Multivariate logistic regression analysis revealed that the pain (OR = 1.019) and depression (OR = 1.304) were independent risk factors that influenced sleep disturbance. Sleep problems are prevalent amongst Moroccan patients with AS. Our findings suggest that pain and depression were the independent risk factors that influenced the sleep disturbance and hence, the need for evaluation and optimal management of pain and depression to improve sleep quality in AS patients. PMID:22441961

Hakkou, Jinane; Rostom, Samira; Mengat, Mariam; Aissaoui, Nawal; Bahiri, Rachid; Hajjaj-Hassouni, Najia

2012-03-24

361

The time-averaged inflammatory disease activity estimates the progression of erosions in MRI of the sacroiliac joints in ankylosing spondylitis.  

PubMed

A method to estimate the individual ankylosing spondylitis (AS) patient radiological progression of semi-quantitative magnetic resonance imaging (MRI) changes in the sacroiliac joints has not been described yet, which this study examines. Inflammatory disease activity and MRIs of the sacroiliac joints of 38 patients with recent onset established AS were analyzed at baseline and during follow-up. Sacroiliac MRIs were semi-quantitatively assessed using a modification of the "Spondylarthritis Research Consortium of Canada" (SPARCC) method. In each patient, the annual inflammatory disease activity was estimated by the time-averaged C-reactive protein (CRP; mg/l), calculated as the area under the curve. The mean (SD) CRP decreased from 1.3 (1.8) at baseline to 0.5 (0.6) at follow-up MRI (p < 0.04), which has been performed after a mean (SD) disease course of 2.8 (1.5) years. The mean (SD) annual increase (?) of SPARCC score from baseline to follow-up MRI was 0.4 (0.4). Baseline individual SPARCC sub-score for bone marrow edema did not statistically significantly correlate with individual ?SPARCC sub-score for erosions (p = N.S.). The individual AS patient correlation between annual time-averaged inflammatory disease activity and each annual ?SPARCC sub-scores was only statistically significant for erosions (p < 0.01; r = 0.71). Our results show that bone marrow edema and contrast-medium enhancement at baseline do not relate to the progression of erosions but the calculation of the individual patient annual time-averaged inflammatory disease activity allows to estimate the annual progression of erosions in sacroiliac MRIs of patients with AS. PMID:22422197

Wick, Marius C; Grundtman, Cecilia; Weiss, Rüdiger J; Gruber, Johann; Kastlunger, Martin; Jaschke, Werner; Klauser, Andrea S

2012-03-16

362

Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors.  

PubMed

The importance of exercise and regular physiotherapy in patients with ankylosing spondylitis (AS) under treatment with tumor necrosis factor alpha inhibitors (TNF? inhibitors) was reported in some studies, but the literature on this topic is still scarce. The aim of this study was to assess the effects of home-based exercise therapy on functional capacity, disease activity, spinal mobility, quality of life, emotional state and fatigue in patients with AS receiving TNF? inhibitors. Forty-two AS patients were trained on the disease, and home-based exercise program was demonstrated to all the patients. At baseline and at the end of 10 week, we evaluated Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Multidimensional Assessment of Fatigue Scale, Beck Depression Inventory and Short-Form 36. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) were compared with those exercising less than five times a week (control group). At baseline, exercise and control group had similar demographic features. After 10 weeks, all outcome parameters showed statistically significant improvements in exercise group. There were significant differences in all the parameters except social functioning subscale of Short-Form 36 between groups in favor of exercise group at 10th week (P < 0.05). Home-based exercise program is an effective therapy in increasing functional capacity and joint mobility, decreasing disease activity, improving emotional state, fatigue and quality of life for AS patient receiving TNF? inhibitors. We need to find out new ways to provide continuity of AS patients with it. PMID:22218641

Yigit, Semra; Sahin, Zerrin; Demir, Saliha Eroglu; Aytac, Deniz Hatun

2012-01-05

363

How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis?  

PubMed Central

Purpose To compare aspects of validity of EuroQol—5 Dimensions (EQ?5D) and Short?Form—6 Dimensions (SF?6D), two indirect utility instruments, and the well?being rating scale (RS) in ankylosing spondylitis (AS). Methods EQ?5D, SF?6D and RS were available for 254 patients fulfilling modified New York criteria. 134 patients were part of an observational cohort and 120 were part of a randomised controlled trial (RCT). Aspects of validity assessed were truth (agreement and correlation with external health measures) and discrimination (differentiation between health states, repeatability and detection of treatment effect). Results Median (range) values were 0.69 (?0.08–1.00) for the EQ?5D, 0.65 (0.35–0.95) for the SF?6D and 0.65 (0.14–1.00) for the RS. Agreement (intraclass correlation coefficient) was moderate (0.46–0.55). Instruments correlated equally with disease activity, functioning and quality of life. The SF?6D showed smaller average differences in utility between patients with better and worse disease compared with the EQ?5D and the RS. The smallest detectable difference (SDD) (in the control group of RCT) was 0.36, 0.17 and 0.33 for EQ?5D, SF?6D and RS, respectively. The ability to detect treatment effect (in the intervention trial) showed standardised effect sizes that were moderate for EQ?5D and SF?6D (0.63 and 0.64) and low for the RS (0.23). Conclusion In patients with AS, EQ?5D, SF?6D and the RS correlate equally well with external measures of health, but have different psychometric properties. The SDD is most favourable for the SF?6D, but it discriminates less well between patients with different disease severities. The RS has a poorer ability to detect treatment effects. It is difficult to recommend one of the instruments.

Boonen, Annelies; van der Heijde, Desiree; Landewe, Robert; van Tubergen, Astrid; Mielants, Herman; Dougados, Maxime; van der Linden, Sjef

2007-01-01

364

Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study  

PubMed Central

Objective: To evaluate the effect of adalimumab on the frequency of anterior uveitis (AU) flares in patients with active ankylosing spondylitis (AS). Methods: We determined the history of ophthalmologist-diagnosed AU in 1250 patients with active AS who were enrolled in a multinational, open-label, uncontrolled clinical study of treatment with adalimumab, 40 mg every other week for up to 20 weeks. All AU flares were documented throughout the adalimumab treatment period plus 70 days. We compared the rates of AU flares per 100 patient years (PYs) reported during the year before adalimumab treatment with rates during adalimumab treatment, in total and by patient subgroups. Results: The AU flare rates before adalimumab treatment were 15/100 PYs in all patients (n?=?1250), 68.4/100 PYs in 274 patients with a history of AU flares, 176.9/100 PYs in 106 patients with a recent history of AU flares, 192.9/100 PYs in 28 patients with symptomatic AU at baseline and 129.1/100 PYs in 43 patients with a history of chronic uveitis. During adalimumab treatment, the rate of AU flares was reduced by 51% in all patients, by 58% in 274 patients with a history of AU, by 68% in 106 patients with a recent history of AU, by 50% in 28 patients with symptomatic AU at baseline and by 45% in 43 patients with chronic uveitis. AU flares during adalimumab treatment were predominantly mild. Two patients with periods of high AS disease activity had new-onset AU during the treatment period. Conclusions: Results of this prospective open-label study suggest that adalimumab had a substantial preventive effect on AU flares in patients with active AS, including patients with a recent history of AU flares. Clinical trials: ClinicalTrials.gov Identifier: NCT00478660.

Rudwaleit, M; R?devand, E; Holck, P; Vanhoof, J; Kron, M; Kary, S; Kupper, H

2009-01-01

365

Evidence that autophagy, but not the unfolded protein response, regulates the expression of IL-23 in the gut of patients with ankylosing spondylitis and subclinical gut inflammation.  

PubMed

OBJECTIVES: Interleukin (IL)-23 has been implicated in the pathogenesis of ankylosing spondylitis (AS). The aim of the study was to clarify the mechanisms underlying the increased IL-23 expression in the gut of AS patients. METHODS: Consecutive gut biopsies from 30 HLA-B27(+) AS patients, 15 Crohn's disease (CD) patients and 10 normal subjects were obtained. Evidence for HLA-B27 misfolding was studied. Unfolded protein response (UPR) and autophagy were assessed by RT-PCR and immunohistochemistry. The contribution of UPR and autophagy in the regulation of IL-23 expression was evaluated in in vitro experiments on isolated lamina propria mononuclear cells (LPMCs). RESULTS: Intracellular colocalisation of SYVN1 and FHCs but not a significant overexpression of UPR genes was observed in the gut of AS patients. Conversely, upregulation of the genes involved in the autophagy pathway was observed in the gut of AS and CD patients. Immunohistochemistry showed an increased expression of LC3II, ATG5 and ATG12 but not of SQSTM1 in the ileum of AS and CD patients. LC3II was expressed among infiltrating mononuclear cells and epithelial cells resembling Paneth cells (PC) and colocalised with ATG5 in AS and CD. Autophagy but not UPR was required to modulate the expression of IL-23 in isolated LPMCs of AS patients with chronic gut inflammation, CD patients and controls. CONCLUSIONS: Our data suggest that HLA-B27 misfolding occurs in the gut of AS patients and is accompanied by activation of autophagy rather than a UPR. Autophagy appears to be associated with intestinal modulation of IL-23 in AS. PMID:23740229

Ciccia, Francesco; Accardo-Palumbo, Antonina; Rizzo, Aroldo; Guggino, Giuliana; Raimondo, Stefania; Giardina, Annarita; Cannizzaro, Alessandra; Colbert, Robert A; Alessandro, Riccardo; Triolo, Giovanni

2013-06-01

366

High prevalence of spondyloarthritis and ankylosing spondylitis among familial Mediterranean fever patients and their first-degree relatives: further evidence for the connection  

PubMed Central

Introduction Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by recurrent attacks of fever and serositis. Limited data suggest that the prevalence of sacroiliitis is increased in patients with FMF. In our present study, we assessed the prevalence of spondyloarthritis (SpA), including ankylosing spondylitis (AS), among a cohort of FMF patients and their unaffected first-degree relatives (FDRs). Methods The current study cohort comprised a consecutive group of 201 unrelated patients with FMF and 319 FDRs (? 16 years old). These subjects were examined according to a standard protocol. Results A total of 157 FMF patients (78.1%) and 233 (73%) unaffected FDRs reported back pain. Fifteen FMF patients (7.5%) and nine unaffected FDRs fulfilled the modified New York (mNY) criteria for AS. One additional FDR with AS was identified after review of the medical records. None of the FMF patients with AS was HLA-B27 positive. The allele frequency of M694V among the FMF patients with radiographic sacroiliitis was significantly higher in comparison with those without sacroiliitis (OR 4.3). When compared with the general population, the risk ratios for SpA and AS among the FDRs of our FMF patients were 3.3 (95% CI; 2.0 to 5.5) and for AS 2.9 (95% CI; 1.3 to 6.4), respectively. Conclusions Our study suggests that a) factors other than HLA-B27 play a role in the association of FMF and SpA/AS; b) MEFV gene variations may be one of the geographic/region-specific potential pathogenetic links between these two disorders in the Turkish population.

2013-01-01

367

High prevalence of spondyloarthritis and ankylosing spondylitis among familial Mediterranean fever patients and their first-degree relatives: further evidence for the connection.  

PubMed

ABSTRACT: INTRODUCTION: Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by recurrent attacks of fever and serositis. Limited data suggest that the prevalence of sacroiliitis is increased in patients with FMF. In our present study, we assessed the prevalence of spondyloarthritis (SpA), including ankylosing spondylitis (AS), among a cohort of FMF patients and their unaffected first-degree relatives (FDRs). METHODS: The current study cohort comprised a consecutive group of 201 unrelated patients with FMF and 319 FDRs (? 16 years old). These subjects were examined according to a standard protocol. RESULTS: A total of 157 FMF patients (78.1%) and 233 (73%) unaffected FDRs reported back pain. Fifteen FMF patients (7.5%) and nine unaffected FDRs fulfilled the modified New York (mNY) criteria for AS. One additional FDR with AS was identified after review of the medical records. None of the FMF patients with AS was HLA-B27 positive. The allele frequency of M694V among the FMF patients with radiographic sacroiliitis was significantly higher in comparison with those without sacroiliitis (OR 4.3). When compared with the general population, the risk ratios for SpA and AS among the FDRs of our FMF patients were 3.3 (95% CI; 2.0 to 5.5) and for AS 2.9 (95% CI; 1.3 to 6.4), respectively. CONCLUSIONS: Our study suggests that a) factors other than HLA-B27 play a role in the association of FMF and SpA/AS; b) MEFV gene variations may be one of the geographic/region-specific potential pathogenetic links between these two disorders in the Turkish population. PMID:23356447

Akar, Servet; Soysal, Ozgul; Balci, Ali; Solmaz, Dilek; Gerdan, Vedat; Onen, Fatos; Tunca, Mehmet; Akkoc, Nurullah

2013-01-28

368

Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis  

PubMed Central

Objectives: To evaluate the relationship between bone mineral density (BMD) and biomarkers of bone turnover and inflammation in patients with ankylosing spondylitis (AS) treated with infliximab. Methods: Patients (n?=?279) were randomly assigned (3:8) to receive placebo or 5 mg/kg infliximab every 6 weeks through week 96. At week 24, placebo-treated patients crossed over to infliximab 5 mg/kg. Starting at week 36, patients treated with infliximab received dose escalations to 7.5 mg/kg. Hip and spine BMD were measured (baseline, week 24, week 102) using dual-energy x-ray absorptiometry. Sera were analysed (baseline, week 24, week 102) for levels of bone alkaline phosphatase (BAP), osteocalcin, C-terminal cross-linking telopeptide of type I collagen (CTX), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) and transforming growth factor-?. Results: Patients treated with infliximab showed significantly greater median increases in BMD of the spine (2.5%, p<0.001) and hip (0.5%, p?=?0.033) at week 24 than those who received placebo (0.5% and 0.2% respectively). Baseline levels of IL-6, VEGF, osteocalcin, BAP and CTX were significantly correlated with increases in spinal BMD at weeks 24 and 102 in the infliximab group. In a multiple regression analysis, high baseline osteocalcin levels and early increases in BAP at week 2 were significantly associated with increases in BMD scores of the spine (week 102) and hip (weeks 24 and 102) in the infliximab group. Conclusions: Patients with AS who received infliximab showed significant increases in BMD scores over 2 years. While many significant correlations were observed between BMD scores of the hip and spine and biomarker levels, high baseline osteocalcin levels and early increases in BAP were consistently associated with increases in BMD scores.

Visvanathan, S; van der Heijde, D; Deodhar, A; Wagner, C; Baker, D G; Han, J; Braun, J

2009-01-01

369

Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional x rays with magnetic resonance imaging using established and new scoring systems  

PubMed Central

Objectives: To compare conventional radiography and magnetic resonance imaging (MRI) for detection of chronic changes in the spine of patients with ankylosing spondylitis (AS). Methods: Assessment of chronic lesions in conventional x rays and T1 weighted MRI turbo spin echo sequences was performed with the established x ray scores BASRI and SASSS, the new Berlin score, and the MRI scoring system ASspiMRI-c All images were read twice and "blindly" by two readers. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebra. Definite involvement was defined as a score ?2 in a spinal segment. Results: Thirty nine patients with AS were examined (25 (64%) male, mean age 40.9 years, 33/36 (92%) HLA-B27 positive). The Berlin score correlated with the BASRI (r = 0.73, p = 0.01). The ASspiMRI-c correlated well with the BASRI and the Berlin score (r = 0.66 and r = 0.51, respectively, p = 0.01). The Berlin x ray score showed that 12/35 (34.3%), 13/35 (37.1%), and 12/28 (31.6%) patients had definite involvement of the cervical spine (CS), thoracic spine (TS), and lumbar spine (LS), respectively. The ASspiMRI-c showed that 10/36 (27.8%), 21/36 (58.3%), and 9/35 (25.7%) patients had definite involvement of the CS, TS, and LS, respectively. Syndesmophytes were found in 14.4% of all VUs with 90% agreement between the SASSS and Berlin score. Conclusions: T1 weighted MRI can detect chronic lesions in AS. The two new scoring systems proved valid in comparison with established scoring systems and based on aspects of the OMERACT filter. The thoracic spine is most commonly affected in AS. This part of the spine is best assessed by MRI.

Braun, J; Baraliakos, X; Golder, W; Hermann, K; Listing, J; Brandt, J; Rudwaleit, M; Zuehlsdorf, S; Bollow, M; Sieper, J; van der Heijde, D

2004-01-01

370

Dissemination and evaluation of the ASAS/EULAR recommendations for the management of ankylosing spondylitis: results of a study among 1507 rheumatologists  

PubMed Central

Background: Ten ASAS/EULAR recommendations for the management of ankylosing spondylitis (AS) were published in 2006. Objectives: (a) To disseminate and (b) to evaluate conceptual agreement with, and (c) application of, these recommendations as well as (d) potential barriers to the application. Methods: A questionnaire was sent to rheumatologists in 10 countries. It included (a) the text of the recommendations; (b) rheumatologists’ demographic variables; (c) two numerical rating scales from 1 to 10 for each recommendation: conceptual agreement with, and application of, the recommendation (10 indicates maximal agreement and maximal application); and (d) a list of potential barriers to the application of the recommendation. Statistical analysis included descriptive and multivariate analyses. Results: 7206 questionnaires were sent out; 1507 (21%) were returned. Of the 1507 answering rheumatologists, 62% were men, mean (SD) age 49 (9) years, and 34% had an academic position. Conceptual agreement with the recommendations was high (mean (SD) for all recommendations 8.9 (0.9)). Self-reported application was also high (8.2 (1.0)). The difference between agreement and application varied across recommendations and countries. The most pronounced discrepancies were reported for use of anti-tumour necrosis factor drugs in a few countries, with funding as the most commonly reported barrier for application of this recommendation. Conclusion: This large project has helped the dissemination of the ASAS/EULAR recommendations for the management of AS and shows that conceptual agreement with the recommendations is very high. The project also highlights inequalities in access to healthcare for European citizens with AS.

Gossec, L; Dougados, M; Phillips, C; Hammoudeh, M; de Vlam, K; Pavelka, K; Pham, T; Braun, J; Sieper, J; Olivieri, I; van der Heijde, D; Collantes, E; Stone, M; Kvien, T K

2008-01-01

371

Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences  

PubMed Central

Objectives: To compare the performance of two different MRI sequences—T1 weighted, fat saturated, spin echo after application of contrast medium, and short ? inversion recovery (STIR) sequences—to detect spinal inflammation in patients with ankylosing spondylitis (AS). Methods: Both MRI sequences were performed in 38 patients with active AS and compared using the MRI activity scoring system, ASspiMRI-a. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebral body. Results: Intraclass correlation coefficients were excellent—0.91 and 0.86 for the Gd-DTPA and STIR sequences, respectively. The overall correlation of the single MRI scores for both sequences was also good (r = 0.84, p = 0.01). The intrarater variance was 6.71 and 9.41 and the interrater variance was 13.16 and 19.04 for the Gd-DTPA and STIR sequences, respectively. The smallest detectable distance was 4.7 and 5.6 for the Gd-DTPA and STIR sequences, respectively. The concordance rate for both sequences was 83.5% (range 80.5–87.7% in the three spinal segments). Inflammatory spinal lesions were found in 10.1% of the VUs in the STIR sequence but not in the T1/Gd-DTPA sequence, while the T1/Gd-DTPA sequence showed inflammatory lesions in 6.4% of the VUs that were found normal by STIR. Conclusions: Both MRI techniques can evaluate active spinal lesions in patients with AS. More spinal lesions are detected by the STIR sequence, but the reliability between readings and readers is better for the Gd-DTPA sequence. The ASspiMRI-a is a reliable instrument for evaluating acute spinal changes in AS.

Baraliakos, X; Hermann, K; Landewe, R; Listing, J; Golder, W; Brandt, J; Rudwaleit, M; Bollow, M; Sieper, J; van der Heijde, D; Braun, J

2005-01-01

372

ERAP1 genetic variations associated with HLA-B27 interaction and disease severity of syndesmophytes formation in Taiwanese ankylosing spondylitis  

PubMed Central

Introduction Ankylosing spondylitis (AS) is a familial, heritable disease specified by syndesmophyte formation leading to an ankylosed spine. Endoplasmic reticulum aminopeptidase 1 (ERAP1) genetic variations have been widely proved to be associated with AS in several ethnic populations. The aim of this study was to investigate whether ERAP1 single nucleotide polymorphisms (SNPs) are associated with AS susceptibility and disease severity in Taiwanese. Methods Four ERAP1 SNPs (rs27037, rs27980, rs27044 and rs30187) were genotyped in 797 Taiwanese AS patients and 1,150 healthy controls. Distributions of genotype and alleles were compared between AS patients and healthy controls, and among AS patients stratified by clinical parameters. Results The SNP rs27037T allele appeared to be a risk factor for AS susceptibility (P = 5.5 × 10-5, OR 1.30, 95% CI: 1.15 to 1.48; GT+TT vs. GG P = 9.3 × 10-5, OR 1.49, 95% CI: 1.22 to 1.82). In addition, the coding SNP (cSNP) rs27044G allele (P = 1.5 × 10-4, OR 1.28, 95% CI: 1.13 to 1.46; CG+GG vs. CC, P = 1.7 × 10-3, OR 1.44, 95% CI: 1.15 to 1.81) and the cSNP rs30187T allele (P = 1.7 × 10-3, OR 1.23, 95% CI: 1.08 to 1.40; CT+TT vs. CC P = 6.1 × 10-3, OR 1.38, 95% CI: 1.10 to 1.74) were predisposing factors for AS. Notably, the rs27044G allele carriers (CG+GG vs. CC, P = 0.015, OR 1.59, 95% CI: 1.33 to 2.30) and rs30187T allele carriers (CT+TT vs. CC, P = 0.011, OR 1.63, 95% CI: 1.12 to 2.38) were susceptible to syndesmophyte formation in AS patients. Furthermore, two cSNPs (rs27044 and rs30187) strongly associated with HLA-B27 positivity in AS patients. Finally, the ERAP1 SNP haplotype TCG (rs27037T/rs27980C/rs27044G) is a major risk factor for AS (adjusted P <0.00001, OR 1.38, 95% CI: 1.12 to 1.58) in Taiwanese. Conclusions This study provides the first evidence of ERAP1 SNPs involving syndesmophyte formation. The interactions between ERAP1 SNPs and HLA-B27 play critical roles in pMHC I pathway processing contributing to the pathogenesis of AS in multiple populations.

2012-01-01

373

Implications of structural and thermodynamic studies of HLA-B27 subtypes exhibiting differential association with ankylosing spondylitis.  

PubMed

Structural and thermodynamic properties of HLA-B27 molecules provide the basis for their function within the immune system and are probably also central for the understanding of the pathology of HLA-B27-associated diseases such as ankolysing spondylitis (AS). Several HLA-B27 alleles are AS-associated, whereas some are not, although the protein encoded by the former may differ in only a single amino acid exchange from those specified by the latter. This indicates that subtype-specific polymorphic residues play a key role in determining whether an HLA-B27 subtype is AS-associated or not and open the possibility to correlate structural, thermodynamic and functional characteristics ofa given subtype with the disease association. Our studies involved X-ray crystallography and various other biophysical techniques to examine how several different peptides are accommodated within the binding groove of the molecules. The HLA-B*2705 and HLA-B*2709 subtypes, whose products differ in only a single amino acid residue of their heavy chains from each other, were primarily chosen for these analyses, but our studies have recently also been extended to the closely related subtypes HLA-B*2703, HLA-B*2704 and HLA-B*2706. The analyses reveal that structural and thermodynamic differences between HLA-B27 complexes may exist, depending on the peptide that is displayed. Furthermore, aviralpeptide and two self-peptides were found that exhibit HLA-B27 subtype-dependent molecular mimicry, thereby providing a molecular basis to account for the subtype-dependent presence of autoreactive T-cells. Although these results do not exclude other theories for the pathogenesis of AS, they support the arthritogenic peptide hypothesis which envisages molecular mimicry between HLA-B27-presented foreign and self-peptides to explain the cross-reactivity of autoreactive T-cells that are found in HLA-B*2705-positive individuals, in particular when they suffer from AS. PMID:19731629

Ziegler, Andreas; Loll, Bernhard; Misselwitz, Rolf; Uchanska-Ziegler, Barbara

2009-01-01

374

Contribution of KIR3DL1/3DS1 to ankylosing spondylitis in human leukocyte antigen-B27 Caucasian populations  

PubMed Central

Killer cell immunoglobulin-like receptors (KIRs) and human leukocyte antigen (HLA) loci are both highly polymorphic, and some HLA class I molecules bind and trigger cell-surface receptors specified by KIR genes. We examined whether the combination of KIR3DS1/3DL1 genes in concert with HLA-B27 genotypes is associated with susceptibility to ankylosing spondylitis (AS). Two HLA-B27-positive Caucasian populations were selected, one from Spain (71 patients and 105 controls) and another from the Azores (Portugal) (55 patients and 75 controls). All were typed for HLA-B and KIR (3DS1 and 3DL1) genes. Our results show that in addition to B27, the allele 3DS1 is associated with AS compared with B27 controls (p < 0.0001 and p < 0.003 in the Spanish population and Azoreans, respectively). We also observed that the association of KIR3DS1 to AS was found in combination with HLA-B alleles carrying Bw4-I80 in trans position in the Spanish population (30.9% in AS versus 15.2% in B27 controls, p = 0.02, odds ratio (OR) = 2.49) and in Azoreans (27.2% in AS versus 8.7% in B27 controls, p = 0.01, OR = 4.4 in Azoreans). On the other hand, 3DL1 was decreased in patients compared with B27 controls (p < 0.0001 in the Spanish population and p < 0.003 in Azoreans). The presence of this allele in combination with Bw4-I80 had a protective effect against the development of AS in the Spanish population (19.7% in AS, 35.2% in B27 controls; p = 0.03, OR = 0.45). The presence of KIR3DS1 or KIR3DL1 in combination with HLA-B*27s/HLA-B Bw4-I80 genotypes may modulate the development of AS. The susceptibility to AS could be determined by the overall balance of activating and inhibitory composite KIR-HLA genotypes.

Lopez-Larrea, Carlos; Blanco-Gelaz, Miguel Angel; Torre-Alonso, Juan Carlos; Armas, Jacome Bruges; Suarez-Alvarez, Beatriz; Pruneda, Laura; Couto, Ana Rita; Gonzalez, Segundo; Lopez-Vazquez, Antonio; Martinez-Borra, Jesus

2006-01-01

375

Efficacy of etanercept on rheumatic signs and pulmonary function tests in advanced ankylosing spondylitis: results of a randomised double-blind placebo-controlled study (SPINE)  

PubMed Central

Objectives Patients with advanced ankylosing spondylitis (AS) experience disability because of reduced spinal mobility and pulmonary function impairment. This placebo-controlled study evaluated the effect of etanercept (ETN) in patients with advanced AS. Methods A multicentre randomised double-blind placebo-controlled trial of 12 weeks' duration was performed. Patients had definite (modified New York criteria), active (Bath AS Disease Activity Index (BASDAI) ?40), severe (radiological intervertebral bridges) AS refractory to non-steroidal anti-inflammatory drugs and were antitumour necrosis factor naive. They were treated with ETN 50 mg once weekly or identical placebo (PBO). Results Of the 95 patients screened, 82 were randomised to receive ETN (n=39) or PBO (n=43). At baseline the disease was active (mean BASDAI 61.0±13.4, C reactive protein (CRP) 20.7±25.5 mg/l) and severe (mean Bath AS Metrology Index (BASMI) 5.7±1.3, mSASSS 36.5±20.5); forced pulmonary vital capacity (FVC) was 3.3±0.7 l. Improvement in BASDAI (normalised net incremental area under the curve between baseline and week 12, primary end point) was significantly greater in the ETN group than in the PBO group (?19.8±16.5 vs ?11.0±16.4, p=0.019). Moreover, at week 12, ETN gave better results than PBO for the BASDAI (?26.4±19.7 vs ?14.4±19.7; p=0.008), total back pain (?29.2±24.0 vs ?14.9±24.0; p=0.010), BASFI (?21.7±17.6 vs ?10.1±17.6; p=0.004), BASMI (?0.6±0.6 vs ?0.2±0.6; p=0.011), CRP level (?15.7±14.2 vs ?1.3±14.2; p<0.001) and FVC (+160±280 ml vs ?20±280 ml; p=0.006). Conclusions ETN has short-term efficacy for patients with advanced AS, as was previously reported for less advanced disease. The efficacy is observed for the main symptoms (pain) and on markers of inflammation (CRP), as well as disease severity in terms of spinal mobility and pulmonary function.

Dougados, M; Braun, J; Szanto, S; Combe, B; Elbaz, M; Geher, P; Thabut, G; Leblanc, V; Logeart, I

2011-01-01

376

A 17 year old with isolated proximal tibiofibular joint arthritis  

PubMed Central

The proximal tibiofibular joint (TFJ) is rarely affected in rheumatic diseases, and we frequently interpret pain of the lateral knee as the result of overuse or trauma. Nonetheless, the TFJ is a synovial joint that communicates with the tibiofemoral joint in a proportion of patients. While proximal TFJ arthritis has been rarely associated with existing spondyloarthritis, isolated TFJ arthritis as the presenting manifestation of spondyloarthritis has not yet been described. Here, we report the clinical and radiographic presentation of an adolescent with chronic proximal TFJ arthritis heralding spondyloarthritis highly suggestive of ankylosing spondylitis.

2013-01-01

377

Yersinia enterocolitica arthritis in southern Sweden: a four-year follow-up study.  

PubMed Central

Thirty-eight cases of suspected yersinia arthritis occurring in southern Sweden in 1975-6 were reviewed four to five years later. In 31 cases the diagnosis was confirmed. At follow-up three of the patients had definite ankylosing spondylitis, three radiologically confirmed sacroiliitis, three extensor tenosynovitis, five isolated articular joint disease, and 10 localised arthralgias; one patient had developed seropositive rheumatoid arthritis. Only six of the 31 patients were free of joint symptoms. These results suggest that although the acute symptoms of yersinia arthritis disappear within 12 months, the long-term prognosis may be less favourable than previously thought.

Marsal, L; Winblad, S; Wollheim, F A

1981-01-01

378

Reactive arthritis due to Salmonella schwarzengrund in a patient with asymptomatic spondylitis.  

PubMed

Reactive arthritis following enteric infection with Salmonella schwarzengrund, a species not previously described in association with this condition, occurred in a 51-year-old man with bilateral sacro-iliitis. PMID:3873266

Golding, D N; Robertson, M H

1985-05-01

379

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

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??gh/ml for CT-P13 and 31?359.3??gh/ml for INX. Geometric mean Cmax,ss was 147.0 ??g/ml for CT-P13 and 144.8??g/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.

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

2013-01-01

380

Specific cell-mediated responses to bacterial antigens and clinical correlations in reactive arthritis, Reiter's syndrome and ankylosing spondylitis.  

PubMed

In 2 cases of ReA seen during the acute phase and shown serologically to be due to Y. enterocolitica 0:3, the LT test showed a marked response using as antigen a freeze dried preparation of the causative organism. The test result correlated with the activity of the disease when repeated during a flare in the 1st case, and during remission in both. Patients with ReA/RS in general showed a significantly higher response to the yersinia and klebsiella antigens tested when compared to AS, suggesting an overall difference in cell-mediated immunity to these enteric bacteria. AS cases reacted significantly less than controls to K. pneumoniae under suboptimal conditions. K. pneumoniae was shown to enhance the LT response to yersinia, possibly through an adjuvant effect. This was found with AS, ReA and in controls, though whether it is of relevance in the etiopathogenesis of AS or ReA/RS remains far from clear. Acute non-traumatic synovitis of the knee, occurring de novo, or in association with psoriasis, inflammatory bowel disease, or as part of RS, may be accompanied by evidence of heightened reactivity to streptococci both by blood and synovial fluid mononuclear cells. In 1 case with serological evidence of streptococcal infection and erythema nodosum, these changes were found to parallel disease activity. ReA can, it appears, follow recent streptococcal infection, and be associated with B27. PMID:3899916

Sheldon, P

1985-08-01

381

A factor shed by lymphoblastoid cell lines of HLA-B27 positive patients with ankylosing spondylitis, specifically modifies the cells of HLA-B27 positive normal individuals.  

PubMed

Epstein-Barr virus transformed lymphoblastoid cell lines from HLA-B27 positive individuals with ankylosing spondylitis (B27+AS+) release, into the culture medium, a factor capable of specifically modifying the HLA-B27 positive lymphocytes of normal individuals (B27+AS-); this modification results in a phenotypic change similar to that seen on B27+AS+ lymphocytes. This lymphoblastoid cell line derived factor appears to be physically and functionally similar to a factor present in the culture filtrate of certain Klebsiella isolates. Biogel P-100 chromatography of the material released from the cell line indicated a mol.wt of 25,000-30,000, similar to that of the Klebsiella derived factor. Chromatofocusing on a PBE 94 column revealed that cell line derived factor had an isoelectric point of 5.5 (cf. pI 5.4 for the Klebsiella derived factor). Immunoadsorption experiments suggest that the factor from the B27+AS+ cell line shares antigenic determinants with a cell surface component present on certain Klebsiella isolates. These results will form the basis for future studies on the nature of the interaction between HLA-B27 and certain enteric organisms and their products. A better understanding of this association should elucidate some of the early events in the pathogenesis of the seronegative arthropathies. PMID:6191893

Orban, P; Sullivan, J S; Geczy, A F; Upfold, L I; Coulits, N; Bashir, H V

1983-07-01

382

Two-dimensional electrophoretic analysis of human leukocyte proteins from patients with rheumatoid arthritis  

SciTech Connect

Human leukocyte proteins from more than 150 patients with rheumatoid arthritis, together with age- and sex-matched controls, were analyzed by use of the ISO-DALT technique of two-dimensional polyacrylamide gel electrophoresis. Patients with ankylosing spondylitis, polymyalgia rheumatica, psoriatic arthritis, calcium tendinitis, post-infectious arthritis, and asymmetrical seronegative arthritis were also included as positive controls. Synthesis of several proteins, referred to by number as members of the Rheuma set, is shown to increase in the leukocyte preparations from patients with classical rheumatoid arthritis. Several of these proteins are specific to monocytes or granulocytes; others are of unknown cellular origin, but appear to be unique to rheumatoid arthritis. The Rheuma proteins appear to be indicators of disease activity, because their increased synthesis can be correlated with sedimentation rate and other clinical indices of rheumatoid disease activity.

Willard, K.E. (Argonne National Lab., IL); Thorsrud, A.K.; Munthe, E.; Jellum, E.

1982-04-01

383

Incidental findings of massive heel spurs in a veteran with a variant of psoriatic arthritis.  

PubMed

A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter's, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct. PMID:23001738

Lowell, Danae L; Osher, Lawrence S; Grady, Angela F

384

The effect of three years of TNF alpha blocking therapy on markers of bone turnover and their predictive value for treatment discontinuation in patients with ankylosing spondylitis: a prospective longitudinal observational cohort study  

PubMed Central

Introduction The aim of this study was to investigate the effect of three years of tumor necrosis factor-alpha (TNF-?) blocking therapy on bone turnover as well as to analyze the predictive value of early changes in bone turnover markers (BTM) for treatment discontinuation in patients with ankylosing spondylitis (AS). Methods This is a prospective cohort study of 111 consecutive AS outpatients who started TNF-? blocking therapy. Clinical assessments and BTM were assessed at baseline, three and six months, as well as at one, two, and three years. Z-scores of BTM were calculated to correct for age and gender. Bone mineral density (BMD) was assessed yearly. Results After three years, 72 patients (65%) were still using their first TNF-? blocking agent. In these patients, TNF-? blocking therapy resulted in significantly increased bone-specific alkaline phosphatase, a marker of bone formation; decreased serum collagen-telopeptide (sCTX), a marker of bone resorption; and increased lumbar spine and hip BMD compared to baseline. Baseline to three months decrease in sCTX Z-score (HR: 0.394, 95% CI: 0.263 to 0.591), AS disease activity score (ASDAS; HR: 0.488, 95% CI: 0.317 to 0.752), and physician's global disease activity (HR: 0.739, 95% CI: 0.600 to 0.909) were independent inversely related predictors of time to treatment discontinuation because of inefficacy or intolerance. Early decrease in sCTX Z-score correlated significantly with good long-term response regarding disease activity, physical function and quality of life. Conclusions Three years of TNF-? blocking therapy results in a bone turnover balance that favors bone formation, especially mineralization, in combination with continuous improvement of lumbar spine BMD. Early change in sCTX can serve as an objective measure in the evaluation of TNF-? blocking therapy in AS, in addition to the currently used more subjective measures.

2012-01-01

385

OMERACT magnetic resonance imaging initiative on structural and inflammatory lesions in ankylosing spondylitis--report of a special interest group at OMERACT 10 on sacroiliac joint and spine lesions.  

PubMed

The ASAS/OMERACT MRI group recently described and defined magnetic resonance imaging (MRI) findings in sacroiliac joints (SIJ) that are essential for the diagnosis of sacroiliitis in patients with axial spondyloarthritis, including ankylosing spondylitis (AS). At the Outcome Measures in Rheumatology Clinical Trials (OMERACT) 2010 meeting, a special interest group (SIG) was formed to design a research agenda for the definition and description of structural lesions in the SIJ and the spine in patients with established AS. During the SIG, a summary of the previous work of the group was presented to all participants, containing: (1) a description of the current definitions of structural SIJ changes; (2) available scoring methods for SIJ changes; (3) data from a previous pilot MRI exercise on chronic SIJ changes performed by members of the group; and (4) a proposal for a research agenda for OMERACT 11. The group agreed on the project's scientific merits and the need to evaluate all available scoring methods and to have clear definitions for all possible abnormalities that can be seen on MRI, prior to the start of the exercise. It was also agreed that the exercise should include scoring of both structural and inflammatory lesions, due to lack of agreement about the best scoring method for assessing both types of lesions in AS. Participants agreed that longitudinal MRI over a certain period are needed to learn about the time sequence of pathologic changes and to understand the course of the disease. Finally, participants asked the group to add the development of a scoring method for structural changes in the spine in a subsequent exercise. Further to these objectives, all experts who agreed to contribute in the exercise will collaborate to achieve consensus on definitions and to organize training in the different scoring systems prior to the start of the project, with the aim to finalize the multiple reader exercise by the end of 2011, in time for OMERACT 11. PMID:21885516

Baraliakos, Xenofon; van der Heijde, Desirée; Braun, Jurgen; Landewé, Robert B M

2011-09-01

386

Immunohistological examination of open sacroiliac biopsies of patients with ankylosing spondylitis: detection of tumour necrosis factor ? in two patients with early disease and transforming growth factor ? in three more advanced cases  

PubMed Central

Objective To characterise the immunohistological features of sacroiliitis in ankylosing spondylitis (AS) at different disease stages. Methods Biopsy samples from sacroiliac joints (SIJs) of five patients with AS, two with early, three with advanced changes and samples from age matched controls from one necropsy SIJ and two iliac bone marrow (BM) biopsies were studied. Paraffin sections were immunostained in triplicate for T cells (CD3, CD8), macrophages (CD68), and the cytokines tumour necrosis factor ? (TNF?), interferon ?, interleukin (IL) 1?, IL6, IL10, and transforming growth factor ?1 (TGF?1). Stained cells were counted over one entire high power field (×400) per section in BM, cartilage, and other connective tissue (CT). Results are the mean of three sections. Results CD3+ T cells were numerous in the BM of early AS, and in the CT of one patient with early and one with late AS, with variable proportions of CD8+ T cells. All patients with AS had more CD68+ macrophages than controls in BM and CT; in cartilage, one patient with early and one with late AS had increased CD68+ cells, some being osteoclasts. The patient with very early AS had large numbers of TNF? cells in the three tissular areas; for the other patient with early disease they were found only in CT and cartilage. IL6 was seen in 4/4 patients with AS in most areas. Patients with early disease had more T cells, TNF?, and IL6, and patients with advanced AS more TGF?1. Conclusion The immunohistological findings of a limited sample suggest a role for BM in sacroiliitis, for TNF? and IL6 in early, active lesions, and for TGF?1 at the time of secondary cartilage and bone proliferation.

Francois, R J; Neure, L; Sieper, J; Braun, J

2006-01-01

387

Undifferentiated Spondyloarthropathy (uSpA)  

MedlinePLUS

... a well-defined form of spondylitis such as ankylosing spondylitis. Some doctors consider USpA a "cousin" to ankylosing spondylitis, psoriatic arthritis, spondylitis associated with inflammatory bowel/Crohn's ...

388

Keratan sulphate in rheumatoid arthritis, osteoarthritis, and inflammatory diseases.  

PubMed Central

Serum concentrations of antigenic keratan sulphate determined by an enzyme linked immunosorbent assay (ELISA) with a monoclonal antibody were studied in patients with rheumatoid arthritis (RA), osteoarthritis, ankylosing spondylitis, other inflammatory diseases, and a large control group of women without arthritis. Mean keratan sulphate concentrations were low in 117 women with RA compared with 227 female control subjects matched for age drawn from a community survey. There were significant correlations between serum keratan sulphate concentrations in patients with RA and serum C reactive protein and the erythrocyte sedimentation rate. Serum keratan sulphate concentrations were also low in 29 men and women with ankylosing spondylitis and 29 patients with arthritis and high concentrations of C reactive protein. In 98 women undergoing an operation for benign breast disease there were decreases in serum keratan sulphate concentrations after the operation which correlated with doses in serum C reactive protein. No differences were found in keratan sulphate concentrations in 137 women with osteoarthritis compared with controls. Within the group with osteoarthritis there were no differences for the various joint groups and there was no obvious correlation with radiographic severity or progression. These findings suggest serum keratan sulphate is unlikely to be useful as a diagnostic marker in osteoarthritis or RA but indicate a role for inflammation in the regulation of cartilage loss.

Spector, T D; Woodward, L; Hall, G M; Hammond, A; Williams, A; Butler, M G; James, I T; Hart, D J; Thompson, P W; Scott, D L

1992-01-01

389

The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people  

Microsoft Academic Search

BACKGROUND: The health-related quality of life (HRQL) is an important indicator of the burden of musculoskeletal disease. The Medical Outcome Study Short-Term 36 (SF-36) is the most used tool that evaluates HRQL as a subjective perception about psychological and physical limitations due to an underlying illness. The purpose of this study was to compare the HRQL scores among patients with

Fausto Salaffi; Marina Carotti; Stefania Gasparini; Michele Intorcia; Walter Grassi

2009-01-01

390

Incidence of serum antibodies to native type I and type II collagens in patients with inflammatory arthritis.  

PubMed Central

Using a new solid-phase double-antibody radioimmunoassay we have determined the incidence of serum IgG antibodies to native bovine type I and type II collagens in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis. Raised serum IgG antibody levels to native type I collagen were present in 49% of patients with RA, 30% with AS, and none of the patients with psoriatic arthritis. Raised serum IgG antibody levels to native type II collagen were present in 42% of patients with RA, 30% with AS, and none of the patients with psoriatic arthritis. In rheumatoid arthritis there was a lack of correlation between IgG antibody levels to collagen and the erythrocyte sedimentation rate, IgG rheumatoid factor, and circulating immune complexes measured by the Clq-binding activity. In ankylosing spondylitis IgG antibody levels to native type II collagen were raised only in patients with peripheral joint involvement. The significance of IgG anticollagen antibodies is not certain, but parallels with rheumatoid factor are discussed.

Clague, R B; Shaw, M J; Holt, P J

1980-01-01

391

Continuous long-term anti-TNF therapy does not lead to an increase in the rate of new bone formation over 8 years in patients with ankylosing spondylitis.  

PubMed

OBJECTIVE: Compare the radiographic progression of ankylosing spondylitis (AS) patients treated with infliximab (INF) versus historical controls (Herne cohort, HC) never treated with tumour necrosis factor (TNF)-blockers over 8 years. METHODS: Patients were selected based on the availability of lateral cervical and lumbar radiographs at baseline (BL) and after 8 years. Radiographs were scored by two blinded readers using modified Stokes AS spinal score (mSASSS). Mixed linear models were applied to compare radiographic progression between cohorts after adjustment for baseline status. RESULTS: Patients in INF (n=22) and HC (n=34) did not differ in the mSASSS status: 13.2±17.6 in INF versus 14.2±13.8 in HC (p=0.254). Both showed progression at 8 years: mean mSASSS 20.2±21.4 in INF and 25.9±17.8 in HC. After adjustment for baseline damage the mean mSASSS (SEM) at 8 years was 21.0 (1.4) in INF and 25.5 (1.1) HC (p=0.047). The mean mSASSS difference was similar in the groups between baseline and 4 years but was more pronounced in HC between 4 and 8 years (p=0.03 between groups). The mean number of syndesmophytes, although similar at baseline, differed significantly at 8 years: 1.0±0.6 new syndesmophytes/patient in INF versus 2.7±0.8 in HC (p=0.007). Adjustment for age, symptom duration, HLA-B27, Bath AS disease activity index and Bath AS function index at baseline had no influence. CONCLUSIONS: Despite limitations of patient numbers and retrospective study design, these data show increase in new bone formation in both patients treated with anti-TNF and those who did not. However, since there was even less bone formation in the INF treated group after 8 years, these data argue against a major role for the TNF-brake hypothesis. PMID:23505240

Baraliakos, Xenofon; Haibel, Hildrun; Listing, Joachim; Sieper, Joachim; Braun, Jürgen

2013-03-27

392

Classification and diagnostic criteria for psoriatic arthritis  

PubMed Central

Background: The study of psoriatic arthritis is difficult and has lagged behind the study of other arthropathies in that there are no universally agreed or properly validated case definitions. Method: This paper examined the validity and practicality of the original Moll and Wright criteria and subsequent criteria sets. Key features discriminating between psoriatic and other arthropathies were reviewed. A comparative study involving patients with psoriatic arthritis and rheumatoid arthritis was used to contrast the different classification methods. Results: Although the Moll and Wright criteria continue to be widely used, they have been shown to discriminate poorly between psoriatic and rheumatoid arthritis. In comparison, the most sensitive criteria were those of Vasey and Espinoza, McGonagle et al, and Gladman et al (99%), whereas the others were significantly less sensitive (between 56% and 94%). The specificity of all methods was high and statistically similar (between 93% and 99%). Models that had reasonably good accuracy even without such key variables as psoriasis or rheumatoid factor were developed. Spinal involvement continues to be a key feature of psoriatic arthritis, but dissimilarities with classic ankylosing spondylitis have been highlighted. Conclusions: Further work is required to produce classification criteria for psoriatic arthritis. A prospective study collecting clinical, radiological, human leucocyte antigen (HLA) and immunological data from both psoriatic and non-psoriatic cases should provide agreed criteria for use in psoriatic arthritis studies in the future.

Helliwell, P; Taylor, W

2005-01-01

393

Spondylitis Association of America  

MedlinePLUS

... Membership Browse Our Books, Brochures & Materials eSUN: electronic Spondylitis Update Newsletter Read The Featured Article From Spondylitis Plus Learn About Us Learn About Spondylitis >>> Overview, ...

394

[Therapy of psoriatic arthritis].  

PubMed

In psoriatic arthritis (PsA) the heterogeneous spectrum of the disease with arthritis/synovitis, axial manifestation, enthesitis, dactylitis, psoriatic skin disease and nail psoriasis has to be considered. Moreover, PsA activity and severity as well as comorbidities are of importance for making therapeutic decisions. Measurement instruments developed for therapeutic studies of rheumatoid arthritis or ankylosing spondylitis are often not appropriate for application in PsA investigations. In this paper established therapies with nonsteroidal antirheumatic drugs, disease modifying antirheumatic drugs (DMARDs) and TNF-alpha inhibitors and the current EULAR guidelines from 2012 are reviewed. However, there is a need for new therapeutic agents for those patients who do not respond to or do not tolerate the current therapies. Other biologic agents have also been tested for PsA with moderate effects only. New therapeutic options could result from the anti-IL12 and anti-IL23 receptor monoclonal antibody ustekinumab and from small molecules such as the oral PDE-4 inhibitor apremilast. PMID:24043297

Märker-Hermann, E

2013-10-01

395

The skin tissue is adversely affected by TNF-alpha blockers in patients with chronic inflammatory arthritis: a 5-year prospective analysis  

PubMed Central

OBJECTIVE: We evaluated the incidence of and the main risk factors associated with cutaneous adverse events in patients with chronic inflammatory arthritis following anti-TNF-? therapy. METHODS: A total of 257 patients with active arthritis who were taking TNF-? blockers, including 158 patients with rheumatoid arthritis, 87 with ankylosing spondylitis and 12 with psoriatic arthritis, were enrolled in a 5-year prospective analysis. Patients with overlapping or other rheumatic diseases were excluded. Anthropometric, socioeconomic, demographic and clinical data were evaluated, including the Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index and Psoriasis Area Severity Index. Skin conditions were evaluated by two dermatology experts, and in doubtful cases, skin lesion biopsies were performed. Associations between adverse cutaneous events and clinical, demographic and epidemiological variables were determined using the chi-square test, and logistic regression analyses were performed to identify risk factors. The significance level was set at p<0.05. RESULTS: After 60 months of follow-up, 71 adverse events (73.85/1000 patient-years) were observed, of which allergic and immune-mediated phenomena were the most frequent events, followed by infectious conditions involving bacterial (47.1%), parasitic (23.5%), fungal (20.6%) and viral (8.8%) agents. CONCLUSION: The skin is significantly affected by adverse reactions resulting from the use of TNF-? blockers, and the main risk factors for cutaneous events were advanced age, female sex, a diagnosis of rheumatoid arthritis, disease activity and the use of infliximab.