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RESUMEN Introducción: El uso de TNFi es cada vez más frecuente en los pacientes con espondiloartritis. Identificar tempranamente aquellos que los requerirán o poder predecir su uso puede ayudar a hacer un tratamiento más efectivo y oportuno racionalizando su uso. Objetivo: Determinar los factores qué mejor explican la indicación de TNFi en la población en estudio. Material y métodos: La asociación entre el uso de medicamentos anti-TNFα y las variables categóricas demográficas, clínicas, de laboratorio, radiológicas y de tratamiento se exploró por prueba exacta de Fisher. La asociación con las variables cuantitativas fue evaluada con t de Student o U de Mann Withney, de acuerdo con su distribución. Aquellas variables con p < 0,25 fueron ingresadas a modelos univariante de regresión logística explicativa para construir los OR crudos; aquellas con p < 0,25 se incluyeron en el modelo multivariante para construir OR ajustados. Resultados y discusión: La población está constituida por 181 pacientes. Modelo univariante: la artritis reactiva, uretritis y compromiso periférico fueron factores protectores para el uso de TNFi. Espondiloartritis axial, lumbalgia inflamatoria, dolor glúteo alternante, rigidez matinal sacroilitis demostrada por cualquier método, tratamiento con inhibidores COX-2, tiempo de evolución de tres arios o más y los puntajes de BASDAI y BASFI se asociaron con el uso de TNFi. Modelo multivariante: artritis reactiva (OR 0,1, IC 95% 0,012-0,86, p = 0,036), lumbalgia inflamatoria (OR 13,63, IC 95% 1,36-136, p = 0,026), sacroilitis (OR 7,71, IC 95% 1,04-57, p = 0,045, uso de coxib (OR 10,1, IC 95% 2,71-37,62, p = 0,001) y el puntaje máximo de BASDAI (4-6: OR 6,1, IC 95% 1,3-28,7, p = 0,022, mayor de 6: OR 15,8, IC 95% 2,2-113, p = 0,006) se asociaron independientemente con el uso de TNFi. El uso de coxib se asoció con la indicación de usar TNFi tanto en los pacientes con espondiloartritis axial (OR 4,2, IC 95% 1,74-10,11, p = 0,001) como periférica (OR 4, IC 95% 1,85-8,62, p < 0,001). Conclusiones: El inicio de la enfermedad en la forma de artritis reactiva se comportó como un factor protector para la necesidad posterior de usar TNFi, mientras que presentar lumbalgia inflamatoria, sacroilitis demostrada por cualquier método, el tratamiento con coxib y el puntaje máximo de BASDAI mayor de 4 se asociaron con el uso de estos medicamentos.
ABSTRACT Introduction: The use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. Objective: To determine factors that better explain the indication of TNFi in the study population. Material and methods: The association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < 0.25 were entered into univariate models of explanatory logistic regression to cons truct crude ORs, and those with P < 0.25 were included in the multivariate model to construct adjusted ORs. Results and discussion: The study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX-2 inhibitors, evolu tion time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = 0.036), inflammatory back pain (P = 0.026), sacroiliitis (P = 0.045), use of coxibs (P = 0.001) and the maximum score of BASDAI (P = 0.022, P = 0.006) were independently associated with the use of TNFi. The use of coxibs was associa ted with the indication of using TNFi in both patients with axial spondyloarthritis (P = 0.001) and peripheral (P < 0.001). Conclusions: The onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.
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Humans , Adult , Bone Diseases , Musculoskeletal Diseases , SpondylarthritisABSTRACT
Objective: To observe the effects of Biqi Capsules on clinical efficacy and cytokines of patients with ankylosing spondylitis. Methods: Patients (120 cases) with ankylosing spondylitis were randomly divided into control group and treatment group for 60 cases in each group. Patients in the control group were po administered with Sulfasalazine Tablets, four tablets twice a day. Patients in the treatment group were po administered with Biqi Capsules, 1.2 g for each time, three times daily. Four weeks were a course. Patients in two groups were treated for three courses. After treatment, the clinical efficacy was evaluated, and visual analog scales (VAS), Bath ankylosing spondylitis disease active index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) in two groups before and after treatment were compared. Enzyme linked immunosorbent assay (ELISA) were employed to measure the expression levels of cytokines IL-1β, TNF-α, IL-4, and IL-10. Erythrocyte sedimentation rate (ESR) was detected by instrument method and hs-CRP was detected by automatic biochemical analyzer. Results: After treatment, the compliance rate of ASAS20 (20%) and BASDAI50 (50%) in the treatment group was higher than that in the control group, but the difference was not statistically significant. After treatment, VAS, BASDAI, BASFI, BASMI, ESR, and hs-CRP in two groups were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And BASDAI and hs-CRP were significantly lower than those in the control group (P < 0.05). After treatment, IL-4 and IL-10 were significantly increased, but TNF-α and IL-1β were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And IL-10 was significantly higher than that in the control group (P < 0.05). Conclusion: Biqi Capsules has certain therapeutic effect on ankylosing spondylitis, and it may be associated with increasing anti-inflammatory factors, decreasing inflammatory factors and regulating inflammatory immunity.
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Objective: To observe the effect of Yaotongning Capsules combined with Imrecoxib Tablets in the treatment of ankylosing spondylitis with cold-dampness and blood-stasis syndrome. Methods: A total of 120 cases with ankylosing spondylitis were randomly divided into two groups: treatment group and control group, with 60 patients in each group. The control group was given Imrecoxib Tablets, and the treatment group was given Imrecoxib Tablets and Yaotongning Capsules. The levels of ESR, CRP, and the scores of BASDAI, BASFI, TCM syndrome were compared before and after treatment, the treatment effect of two groups were evaluated. Results: There was no significant difference in the levels of ESR, CRP and the scores of BASDAI, BASFI, TCM syndrome between two groups before treatment. After treatment, the levels of ESR, CRP and the scores of BASDAI, BASFI, TCM syndrome of the two groups were decreased (P < 0.05), and all the indexes in treatment group were lower than those in control group (P < 0.05), the total effective rate in treatment group (86.67%) was better than that in control group (65.00%) (P < 0.01). Conclusion: Yaotongning Capsules can effectively improve TCM syndrome and functional activity indexes, reduce inflammatory indexes and disease activity, has definite clinical effect on ankylosing spondylitis.
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Objective: To assess the clinical features of SpA including BATH indices and to compare clinical data of male and femalespondyloarthropathy patients.Methods: The study included male and female patients (60 each) fulfilling the European Spondyloarthropathy StudyGroup (ESSG) or assessment of ankylosing spondylitis (ASAS) criteria for SpA and the CASPER criteria for PsA or themodified New York criteria for AS. The subjects completed initial clinical evaluation and radiological and laboratoryassessment.Results: The mean age of presentation was found to be higher in females (34.6± 9.6 years). Backache was the mostcommon features identified in both the groups. Peripheral arthritis was present in 51.7% of total patients (56.7% malesand 46.7% females). Asymmetrical lower limb arthritis was found to be more predominant; however, 10% of the patientsreported involvement of wrist. Psoriasis and inflammatory bowel disease, and uveitis were noted in 13 (7 males and 6females), three (1 male and 2 females) and 14 patients (9 males and 5 females) respectively. Dorsal and neck pain werefrequently prevalent among the patients.Conclusion: Though the severity of symptoms and disability are comparable across both the genders, females haveincreasingly been diagnosed with SpA. Most common symptom of presentation is low back pain followed by gluteal pain.Peripheral arthritis, predominantly lower limb oligoarthritis is common in Indian population when compared to theirwestern counterparts.
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Introduction: Spondyloarthritis (or spondyloarthropathy) is the overall name for a family of inflammatory rheumatic diseases that can affect the spine and joints, ligaments and tendons These diseases can cause fatigue and pain or stiffness in the back, neck, hands, knees, and ankles as well as inflammation of the eyes, skin, lungs, and heart valves While there is no course of prevention at this time treatment can reduce discomfort and delay the development of spinal deformities Aim of the study: The aim of the study was to differentiate gender difference at presentation of spondyloarthritis and to identify markers in determining the severity of disease Materials and methods: This was a prospective observational study conducted for a period of 6 months at Institute of Rheumatology, Government KAPV Medical College and MGM Government Hospital Totally 62 patients were included in the study 31 males and 31 consecutive females with features of spondyloarthritis per ASAS (Assessment of Spondyloarthritis international Society) at first presentation to our clinic were enrolled and their clinical characteristics were analyzed Results: On comparing disease activity and functional indices between males and females, mean BASDAI was 466±18 versus 498±194 (p=05), mean BASFI was 46±23 versus 48±23 (p=07), TN Tamil Selvam, VA Sowndhariya, NK Senthil Nathan A study on comparison of gender-based prevalence and severity at presentation in spondyloarthritis in a tertiary care rheumatic center IAIM, 2018; 5(12): 35-39 Page 36 mean BASMI was391±194 versus 418±206 (p=04) Out of 31 males, 17 were positive for HLA B27 and 6 out of 31 females were positive for HLA B27 (p=004) Conclusion: The pathogenesis of SpA is multifactorial and not yet fully understood Genetic factors (HLA-B27 and non– HLA-B27 related genes), inflammatory cytokines (eg TNF-alpha, IL-1, IL-6, IL-7, IL-17, and IL-23) and environmental triggers (infections, mechanical stress, abnormal intestinal microbiota) play an important role These different factors and their complex interaction can lead to activation of autoinflammation and autoimmunity and to the new bone formation Men are more prone to spondyloarthritis when compared with women
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Objective To investigate the clinical efficacy of superficial needling therapy for early ankylosing spondylitis and its effect on tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6).Methods Eighty patients with early ankylosing spondylitis meeting the inclusion criteria were randomly allocated to treatment and control groups using random number card method with the ratio of 1:1, 40 cases each. The treatment group received superficial needling therapy alone and the control group, conventional treatment with celecoxib capsules, methotrexate tablets and sulfasalazine enteric-coated tablets. Treatment was given for a total of 24 weeks. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 were observed in the two groups before and after treatment.Results The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 improved in the two groups after treatment compared with those before the treatment (P<0.05). The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 in the treatment group superior to those in the control group after the treatment (P<0.05).Conclusions Superficial needling therapy can relieve the clinical symptoms in patients with early ankylosing spondylitis and improve spinal joint function with good safety. Its mechanism may be related to reducing inflammatory cytokines TNF-α, IL-1 and IL-6.
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Objective To investigate the clinical efficacy of superficial needling therapy for early ankylosing spondylitis and its effect on tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6).Methods Eighty patients with early ankylosing spondylitis meeting the inclusion criteria were randomly allocated to treatment and control groups using random number card method with the ratio of 1:1, 40 cases each. The treatment group received superficial needling therapy alone and the control group, conventional treatment with celecoxib capsules, methotrexate tablets and sulfasalazine enteric-coated tablets. Treatment was given for a total of 24 weeks. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 were observed in the two groups before and after treatment.Results The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 improved in the two groups after treatment compared with those before the treatment (P<0.05). The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 in the treatment group superior to those in the control group after the treatment (P<0.05).Conclusions Superficial needling therapy can relieve the clinical symptoms in patients with early ankylosing spondylitis and improve spinal joint function with good safety. Its mechanism may be related to reducing inflammatory cytokines TNF-α, IL-1 and IL-6.
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ObjectiveTo investigate the efficacy of acupoint application with direct current in treating ankylosing spondylitis. MethodA clinical controlled trial was carried out. Sixty patients were randomly allocated to two groups. The treatment group was given acupoint application with direct current plus sulfasalazine and the control group, sulfasalazine alone. The course of treatment was two months. Inflammation indices, and the SF-36 health survey, BASDI, BASFI, night pain VAS and spinal pain VAS scores, and liver and kidney functions were observed in the patients before and after treatment.ResultInflammation indices, and the SF-36 health survey, BASDI, BASFI, night pain VAS and spinal pain VAS scores took a turn for the better in both groups after treatment. The therapeutic effect was better and the TCM symptom score was lowerin the treatment group than in the control group (P<0.05). ConclusionAcupoint application with direct current for treating winter diseases in summer has a therapeutic effect on ankylosing spondylitis.
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OBJETIVO: Conduzir uma adaptação cultural cruzada do Índice Funcional de Espondilite Anquilosante de Bath (BASFI, Bath Ankylosing Spondylitis Functional Index) para o português do Brasil e avaliar suas propriedades de medição. MéTODOS: O BASFI foi traduzido por quatro reumatologistas e três professores de língua inglesa. O questionário traduzido foi aplicado a pacientes com espondilite anquilosante por observadores treinados e autoaplicado em três momentos, dias 1, 2 e 14. A validade foi estimada analisando-se a associação do BASFI e as medidas de capacidade funcional (rotação cervical, distância intermaleolar, teste de Schober e distância occipito-parede). A consistência interna foi testada pelo coeficiente α de Cronbach, e a confiabilidade pelo teste-reteste (coeficiente de correlação intraclasse [CCI]). RESULTADOS: Foram incluídos 60 pacientes com espondilite anquilosante: 85% do gênero masculino, com idade média de 47 ± 12 anos e duração média da doença de 20 ± 11 anos. A confiabilidade intraobservador no teste-reteste (intervalo de duas semanas) revelou alto ICC (0,999; 95% IC: 0,997-0,999), além de alta consistência interna (coeficiente α de Cronbach: 0,86; 95% IC: 0,80-0,90). Considerando-se a validade, os índices do BASFI foram correlacionados com a rotação cervical (0,53; P < 0,001) e a distância intermaleolar (0,50; P < 0,001). CONCLUSÃO: A versão do BASFI para o português do Brasil é confiável e válida para avaliação de pacientes com espondilite anquilosante.
OBJECTIVE: To conduct a cross-cultural adaptation of the Bath Ankylosing Spondylitis Functional Index (BASFI) into Brazilian-Portuguese language and to assess its measurement properties. METHODS: The BASFI was translated by four rheumatologists and three English teachers. The translated questionnaire was applied to ankylosing spondylitis patients by trained observers, and self-administered in three moments: days 1, 2, and 14. The validity was assessed analyzing the association of BASFI and functional capacity measures (cervical rotation, intermalleolar distance, Schober's test and occiput-to-wall distance). The internal consistence was tested by Cronbach's αcoefficient and the reliability by testretest (intraclass correlation coefficient - ICC). RESULTS: A total of 60 patients with ankylosing spondylitis was included: 85% male, mean age 47 ± 12 years, and mean disease duration 20 ± 11 years. The intra-observer test-retest (two-week interval) reliability showed a high ICC (0.999, 95% CI: 0.997-0.999) and a high internal consistency (Cronbach's α coefficient: 0.86, CI 95%: 0.80-0.90). Considering the validity, the BASFI indices were correlated with cervical rotation (0.53, P < 0.001) and with intermalleolar distance (0.50, P < 0.001). CONCLUSION: The BASFI Brazilian-Portuguese version is reliable and valid for assessment of patients with ankylosing spondylitis.
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Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Spondylitis, Ankylosing/diagnosis , Brazil , Cultural Characteristics , Language , TranslatingABSTRACT
OBJECTIVE: To assess the health-related quality of life (HRQOL), the correlation among each measurement, and to identify the predictors for HRQOL in Korean patients with ankylosing spondylitis (AS). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, occiput to wall test, ESR, and CRP from 90 patients with AS. RESULTS: 78 patients (86.7%) were men with a mean (+/-SD) age of 28.4 (+/-7.9) years. The mean years of disease onset was 10.44 (+/-6.95). The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 53.4 (+/-21.2), 61.8 (+/-26.3), and 51.7 (+/-24.4), respectively. The mean EQ-5D utility and visual analog scale (VAS) score were 0.63 (+/-0.2) and 57.1 (+/-18.6). The mean scores of the TTO and SG were 0.46 (+/-0.6) and 0.46 (+/-0.6). The scores of the SF-36 and EQ-5D in AS patients were lower than those in healthy control. The mean scores of CES-D, self-efficacy scale, social support and social network were 10.5 (+/-6.8), 65.3 (+/-14.6), 2.46 (+/-0.22), and 2.33 (+/-0.47), respectively. The mean score of BASFI was 2.48 (+/-2.13). The BASFI total score was negatively correlated with the scores of SF-36, MCS, PCS, EQ-5D utility and VAS score, social network, and self-efficacy scale, and positively correlated with CES-D. In multivariate models, the predicting variables of SF-36 global and PCS were BASFI and self-efficacy scale and the predicting variables of SF-36 MCS were BASFI, social support, and self-efficacy scale. CONCLUSION: In this study, we observed that HRQOL in Korean patients with ankylosing spondylitis is decreased compare to healthy control. And the efforts to improve HRQOL should be designed to improve the self-efficacy and social support in addition to active treatment to prevent functional disability.