Echocardiographic Evaluation of Axial Spondyloarthritis in Korea: Data From the Catholic Axial Spondyloarthritis Cohort

OBJECTIVE: Axial spondyloarthritis (axSpA) is often accompanied by cardiac manifestations, such as valvular heart disease. In this prospective cohort study, we evaluated the incidence of cardiac abnormalities in Korean axSpA patients by echocardiography.METHODS: AxSpA patients were prospectively recruited from a single tertiary hospital. Baseline demographic, clinical, radiographic, and echocardiographic data were collected at the time of enrollment. Echocardiography evaluations were performed with a focus on valvular heart disease and systolic and diastolic function. Logistic regression analyses were used to identify factors associated with diastolic dysfunction in axSpA.RESULTS: A total of 357 axSpA patients were included in the analyses, of whom 78 (21.8%) exhibited diastolic dysfunction, with no reports of systolic dysfunction. Thirteen patients (3.6%) had valvular heart disease, and aortic valve regurgitation (n=5) and mitral valve regurgitation (n=6) were most common. Multivariable logistic regression analyses indicated that older age and higher body mass index (BMI) were positively associated with diastolic dysfunction, whereas human leukocyte antigen (HLA)-B27 positivity was negatively associated with diastolic dysfunction.CONCLUSION: Valvular heart disease is infrequent in Korean axSpA patients. However, diastolic dysfunction is common in axSpA patients, and is significantly associated with older age, higher BMI, and HLA-B27.

Necesidades de capacitación para el diagnóstico genético de espondiloartropatías en médicos del Hospital "Hermanos Ameijeiras" / Training needs for the genetic diagnosis of spondyloarthropathies in doctors of the "Hermanos Ameijeiras" Hospital

RESUMEN Fundamento: la exploración de necesidades de capacitación es esencial para el diseño de estrategias educacionales que eleven la formación cualitativa de los profesionales, la calidad de los servicios y la utilización racional de los recursos. Objetivo: identificar las necesidades de capacitación para el diagnóstico genético de espondiloartropatías y uveítis en médicos del Hospital Docente Clínico Quirúrgico "Hermanos Ameijeiras". Métodos: se realizó una investigación de tipo descriptiva cuanticualitativa, en la que se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; empíricos: revisión documental de indicaciones médicas y un cuestionario para clasificar las necesidades de capacitación en manifiestas y ocultas o encubiertas, y sentidas y no sentidas acerca de la correcta indicación del estudio genético para el diagnóstico de espondiloartropatías y uveítis; y matemático-estadísticos para el procesamiento de los datos. Resultados: la minoría de las indicaciones médicas mostró resultados positivos; es decir, los pacientes presentaron el alelo HLA B-27U. Las mayores insuficiencias de conocimientos sobre el tema las mostraron los residentes a diferencia de los especialistas que presentaron menos respuestas erróneas, aunque estos últimos manifestaron mayor percepción de necesidades de capacitación que los residentes, con lo que asumieron una actitud más abierta y flexible ante la superación. Conclusiones: se identificaron las necesidades de capacitación sobre el tema lo cual permite generar estrategias para lograr el uso racional de las herramientas moleculares en el diagnóstico genético de espondiloartropatías y uveítis en el personal médico.

ABSTRACT Background: the exploration of training needs is essential for the design of educational strategies that increase the qualitative training of professionals, the quality of services and the rational use of resources. Objective: to identify training needs for the genetic diagnosis of spondyloarthropathies and uveitis in physicians of the "Hermanos Ameijeiras" Clinical Surgical Teaching Hospital. Methods: a descriptive quantitative-qualitative research was carried out, in which theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical; empirical ones: documentary review of medical indications and a questionnaire to classify the training needs in manifest and hidden or covert, and felt and not felt about the correct indication of the genetic study for the diagnosis of spondyloarthropathies and uveitis; and mathematical-statistics for data- processing. Results: the minority of the medical indications showed positive results; that is, the patients presented the HLA B-27U allele. The greatest knowledge shortcomings on the subject were shown by the residents, unlike the specialists who presented less wrong answers, although the latter expressed a greater perception of training needs than the residents, so they assumed a more open and flexible attitude towards overcoming. Conclusions: training needs on the subject were identified, which allows generating strategies to achieve the rational use of molecular tools in the genetic diagnosis of spondyloarthropathies and uveitis in medical personnel.

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients / Alterações eletrocardiográficas em espondiloartrites e uso de anti-TNF-α: estudo retrospectivo em 100 pacientes

ABSTRACT Objective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

RESUMO Objetivo Avaliar a prevalência de alterações eletrocardiográficas em pacientes com espondiloartrites, correlacionando-as com o uso de medicações antifator de necrose tumoral alfa (TNF-α) e presença do HLA-B27. Métodos Estudo retrospectivo com 100 pacientes com diagnóstico de espondiloartrites pelo critério Assessment of SpondyloArthritis International Society (ASAS) e 50 controles. Foram coletados nos prontuários dos pacientes, dados epidemiológicos, clínicos, exames de atividade inflamatória, presença do HLA-B27, e uso de medicamentos. A atividade de doença foi avaliada pelo Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Todos foram submetidos a eletrocardiograma realizado com aparelho de 12 derivações, sendo analisados ritmo, frequência cardíaca, distúrbios de condução e intervalo QT corrigido pela fórmula de Bazett. Resultados Dos 100 pacientes com espondiloartrites, 49 não usavam anti-TNF-α e 51 utilizavam este medicamento. O HLA-B27 estava presente em 53,1% da amostra. A frequência cardíaca foi mais baixa (p=0,06), o intervalo QT foi mais prolongado (p<0,0001) e existia mais perturbação de condução do ramo direito (p=0,014) nos pacientes com espondiloartrites do que nos controles. Uma modesta correlação de tempo de doença com frequência cardíaca foi encontrada (Rho=0,26; IC95%: 0,06-0,44; p=0,008). A presença do HLA-B27 aumentou a prevalência de perturbação de condução do ramo direito. Nenhum dos parâmetros eletrocardiográficos analisados alterou-se com uso de anti-TNF-α. Conclusão Pacientes com espondiloartrites tiveram frequência cardíaca menor, maior intervalo QT e prevalência maior de perturbação de condução do ramo direito do que controles. O HLA-B27 influi no aparecimento de perturbação de condução do ramo direito. O uso de anti-TNF-α não influiu nos achados eletrocardiográficos.

Abordagem Fisioterapêutica da Dor Crônica nas Espondiloartropatias Soronegativas / Treatment Physical Therapy of Cronic Pain in Spondyloarthropathies Seronegatives

Introdução: As espondiloartropatias formam um grupo de doenças distintas com características comuns, entre elas estão a espondilite anquilosante, artrite psoriática, artrite reativa e artrite enteropática. Caracterizam-se como doenças crônicas inflamatórias, e incluem uma variedade de características clínicas e genéticas, dentre essas está a associação com o antígeno HLA-B27. Objetivos: O estudo objetivou revisar na literatura informações sobre a abordagem fisioterapêutica na dor crônica nos indivíduos portadores de espondiloartropatias. Métodos: 26 artigos foram selecionados manualmente nas línguas portuguesa e inglesa indexados nas bases de dados eletrônicos SciELO, LILACS, e Pubmed partindo dos descritores Espondiloartropatias, Espondilite Anquilosante, Artrite Reativa, Artrite Psoriásica em cruzamento com a palavra chave Fisioterapia, de acordo com os Descritores em Ciências da Saúde (DeCS). Resultados: Foram analisados 178 artigos dos quais 147 artigos foram excluídos por não se enquadrarem nos critérios de seleção e 26 preencheram os critérios de inclusão, permitindo a fundamentação teórica e problemática do assunto pesquisado. Conclusão: O diagnóstico precoce juntamente com a cinesioterapia - com ênfase à hidrocinesioterapia - demonstra redução da dor, melhora na capacidade funcional, melhora da amplitude de movimento, diminuição do quadro inflamatório e melhora da qualidade de vida.

Introduction: Spondyloarthropathies form a group of different diseases with common characteristics, among them are ankylosing spondylitis, psoriatic arthritis, reactive arthritis and arthritis enteropathic. Are characterized as chronic inflammatory diseases, including a variety of clinical and genetic characteristics, among these is the association with the HLA-B27 antigen. Objectives: The aim of this study was to review the literature about the physical therapy approach to chronic pain in patients with spondyloarthritis. Méthods: We selected 26 articles, which were manually consulted in Portuguese and English indexed in electronic databases SciELO, LILACS and PubMed starting from descriptors Espondiloartropatias, Espondilite Anquilosante, Artrite Reativa, Artrite Psoriásica crossed with keyword Fisioterapia, all according to the Descriptors in Health Sciences (DeCS). Results: We analyzed 178 articles of which 147 articles were excluded because they do not fit the selection criteria and 26 met the inclusion criteria, allowing the theoretical foundation and problems of researched subject. Conclusion: Early diagnosis of seronegative spondyloarthropathies with kinesiotherapy - with emphasis on hydrokinesiotherapy - reduced pain, improved functional capacity, improved range of movement, decreased inflammatory process and improvement of quality of life of patients.

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

OBJECTIVE: We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA). METHODS: We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test. RESULTS: Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116). CONCLUSION: The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier.

A Case of Axial Spondyloarthropathy in a Patient with Human Immunodeficiency Virus Infection

Human immunodeficiency virus (HIV) infection is a global pandemic affecting more than 2.9 million people. Aside from opportunistic infections and malignancies, it involves multiple organs, resulting in many complications, and frequently shows various rheumatic manifestations. With improving survival of patients due to the development of highly active anti-retroviral therapy, the number of HIV-infected patients with rheumatic complications is certain to increase. However, reports on HIV induced rheumatic manifestations in Korean patients are limited. On the other hand, spondyloarthropathy is the most common form of inflammatory arthropathy in HIV associated rheumatic manifestations and is frequently accompanied by peripheral arthritis and enthesitis, while axial skeletal involvement is a rare presentation. Herein we report on a 46-year-old man with HIV infection presenting with an axial spondyloarthropathy who was treated successfully with nonsteroidal anti-inflammatory drug, sulfasalazine, and low dose steroid.

Caracterização clínica de pacientes com artrite psoriásica / Clinical characterization of patients with psoriatic arthritis

JUSTIFICATIVA E OBJETIVO: A artrite psoriásica é doença de apresentação clínica variável e heterogênea, seja do ponto de vista dermatológico ou reumatológico, podendo haver múltiplas combinações entre seus subtipos. Esse estudo teve por objetivo caracterizar clinicamente uma população portadora de artrite psoriásica para traçar um perfil dos pacientes e contribuir para o entendimento da doença. MÉTODOS: Estudo com delineamento transversal com 45 pacientes com diagnóstico de artrite psoriásica em tratamento no serviço de Reumatologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Os dados demográfico e clínicos-sociais, cutâneos e articulares obtidos foram analisados de modo descritivo. RESULTADOS: Pertencem ao sexo masculino 57,8% dos pacientes. A média de idade foi de 52,9 anos. A maior parte tem sobrepeso e dislipidemia. Utilizam metotrexato 64,4% dos pacientes e inibidores do TNF-α 31,1%. A psoríase em placas foi observada em 88,9% dos casos. As articulações mais comumente afetadas foram as mãos e os punhos acompanhadas de manifestações extra-articulares em 86,7% dos pacientes. CONCLUSÃO: A população estudada foi composta majoritariamente por pacientes do sexo masculino, portadores de fatores de risco cardiovascular, psoríase em placas, poliartrite periférica e com presença marcante de manifestações extra-articulares...

BACKGROUND AND OBJECTIVE: Psoriatic arthritis is a disease with variable and heterogeneous clinical presentation at the dermatological or rheumatological point of view. Multiple combinations within their subtypes are possible. This survey had the aim to characterize a group of patients with psoriatic arthritis and describe a pattern of them to contribute to better understanding the disease. METHODS: This study had cross- sectional design and had evaluated 45 patients with psoriatic arthritis under treatment at the Rheumatology Department of University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Demographic and clinical data obtained were treated descriptively. RESULTS: Male patients are 57.8% of the sample. They are 52.9 years-old at average. Most of them are overweight and dyslipidemic. Utilize methotrexate 64.4% of patients and TNF-α inhibitors 31.1%. Plaque type psoriasis was found in 88.9%. Joints most affected are hands and wrists accompanied by 86.7% of extra-articular manifestations. CONCLUSION: Sample studied is composed mostly by male gender, with cardiovascular risk factors, plaque type psoriasis, peripherical polyarthritis and with extra-articular manifestations...

The Reliability and Validity of a Korean Translation of the ASAS Health Index and Environmental Factors in Korean Patients with Axial Spondyloarthritis

The objective of this study was to develop a Korean version of the Assessment of Spondyloarthritis International Society-Health Index/Environmental Factor (ASAS HI/EF) and to evaluate its reliability and validity in Korean patients with axial spondyloarthritis (SpA). A total of 43 patients participated. Translation and cross-cultural adaptation of the ASAS HI/EF was performed according to international standardized guidelines. We also evaluated validity by calculating correlation coefficients between the ASAS-HI/EF score and the clinical parameters. Test-retest reliability was excellent. The correlations among the mean ASAS-HI score and all tools of assessment for SpA were significant. When it came to construct validity, the ASAS HI score was correlated with nocturnal back pain, spinal pain, patients's global assessment score, the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI) and EuroQoL visual analogue scale (EQ VAS) (r = 0.353, 0.585, 0.598, 0.637, 0.690, 0.430, and -0.534). The ASAS EF score was also correlated with the patient's global assessment's score, BASDAI, BASFI, BASMI, and EQ VAS score (r = 0.375, 0.490, 0.684, 0.485, and -0.554). The Korean version of the ASAS HI/EF can be used in the clinical field to assess and evaluate the state of health of Korean axial SpA patients.

Carotid intima-media thickness in spondyloarthritis patients / Espessamento da camada média-íntima da carótida em pacientes com espondiloartrite

CONTEXT AND OBJECTIVE Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT) in spondyloarthritis (SpA) patients and correlate this with clinical parameters and inflammatory markers. DESIGN AND SETTING Cross-sectional analytical study at Rheumatology Outpatient Clinic, Evangelical University Hospital, Curitiba. METHODS IMTs (measured using Doppler ultrasonography) of 36 SpA patients were compared with controls. The IMT in SpA patients was associated with inflammatory markers, like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); and with clinical parameters, like axial or peripheral involvement, dactylitis, HLA B27, uveitis occurrence, Bath Ankylosing Spondylitis Functional Index (BASFI) and lipid profile. RESULTS The mean IMT in SpA patients was 0.72 ± 0.21 mm; in controls, 0.57 ± 0.13 mm (P = 0.0007). There were no associations with ESR, CRP, BASDAI or clinical data. In univariate analysis, greater IMT was seen in patients with longer disease duration (P = 0.014; Pearson R = 0.40; 95% confidence interval, CI = 0.06 to 0.65); higher triglycerides (P = 0.02; Spearman R = 0.37; 95% CI = 0.03 to 0.64); and older age (P = 0.0014; Pearson R 0.51; 95% CI = 0.21 to 0.72). CONCLUSION SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients. .

CONTEXTO E OBJETIVO A aterogênese acelerada tem se tornado um grande problema nas doenças reumáticas inflamatórias. O objetivo foi analisar a espessura da camada íntima-média (ECIM) da carótida em pacientes com espondiloartrite (ES) e relacioná-la com parâmetros clínicos e marcadores inflamatórios. TIPO DE ESTUDO E LOCAL Estudo transversal analítico no Ambulatório de Reumatologia do Hospital Universitário Evangélico de Curitiba. MÉTODOS A ECIM (medida por Doppler) de 36 pacientes com ES foi comparada com controles. A ECIM de pacientes com ES foi associada com marcadores inflamatórios, como velocidade de hemossedimentação (VHS), proteína C-reativa (PCR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), e com parâmetros clínicos, como envolvimento axial e periférico, dactilite, HLA B27, ocorrência de uveíte, Bath Ankylosing Spondylitis Functional Index (BASFI) e perfil lipídico. RESULTADOS A ECIM média em pacientes com ES foi de 0,72 ± 0,21 mm, enquanto nos controles foi de 0,57 ± 0,13 mm (P = 0,0007). Não se encontrou associação com VHS, PCR, BASDAI e dados clínicos. Em análise univariada, maior ECIM foi encontrado nos indivíduos com maior duração de doença (P = 0,014; R Pearson = 0,40; 95% intervalo de confiança, IC = 0,06 to 0,65), aumento nos triglicerídeos (P = 0,02; R Spearman = 0,37; 95% IC = 0,03 to 0,64) e maior idade (P = 0,0014; R Pearson 0,51; 95% IC = 0,21 to 0,72). CONCLUSÃO Pacientes com ES têm maior grau de aterosclerose subclínica do que controles, dando suporte às evidências clínicas de aumento de risco cardiovascular em pacientes com doenças reumáticas. .

Tratamiento de síndrome de Sapho con ácido zoledrónico: reporte de caso / Treatment of SAPHO syndrome with zoledronic acid: a case report / Tratamento de síndrome de SAPHO com ácido zoledrónico: reporte de caso

El síndrome Sapho (sinovitis, acné, pustulosis, hiperostosis, osteítis) es una condición crónica e inflamatoria con manifestaciones cutáneas y osteoarticulares. Su etiología no es clara, aunque se ha considerado una posible asociación con las espondiloartritis. Diferentes tratamientos con esteroides y medicamentos antiinflamatorios son utilizados en esta patología, con respuesta variable. Los bisfosfonatos son nuevas modalidades en el tratamiento del síndrome de Sapho, gracias a sus propiedades antiosteoclásticas y antiinflamatorias. Se reporta el caso de un paciente con Sapho exitosamente tratado con ácido zoledrónico.

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) is a chronic and inflammatory condition, with cutaneous and osteoarticular manifestations. Its etiology is still unclear, although a possible association has been considered between this syndrome and spondylarthropathies. Several types of treatment with steroids and anti-inflammatory drugs are currently used for this condition, obtaining different results. Biphosphonates are a new treatment option for SAPHO syndrome due to their anti-osteoclastic and anti-inflammatory properties. We report the case of a male patient with SAPHO syndrome, who was successfully treated with zoledronic acid.

A síndrome SAPHO (sinovitis, acne, pustuloses, hiperosteoses, osteítes) é uma condição crônica e inflamatória com manifestações cutâneas e ósteo-articulares. Seu etiologia não é clara, ainda que se considerou uma possível associação com as espondiloartritis. Diferentes tratamentos com esteroides e medicamentos antiinflamatórios são utilizados nesta patologia, com resposta variável. Os bisfosfonatos são uma das novas modalidades no tratamento da síndrome de SAPHO, graças a suas propriedades anti-osteoclásticas e anti-inflamatórias. Reporta-se o caso de um paciente com SAPHO tratado com ácido zoledrónico com sucesso

HLA-B27 frequency in a group of patients with psoriatic arthritis / Freqüência de HLA-B27 em uma amostra de pacientes com artrite psoriática

BACKGROUND: HLA-B27 is associated with spondyloarthritis, a group of diseases that includes psoriatic arthritis. OBJECTIVES: To describe the HLA-B27 frequency in a group of Brazilian patients with psoriatic arthritis and correlate its presence or absence with their clinical manifestations. METHODS: Cross-sectional study with 44 psoriatic arthritis patients of a Rheumatology clinic. Demographic and social data were recorded, as were skin and joints clinical examination. HLA-B27 was tested. All data were processed descriptively and comparatively by appropriate software. Parametric and non parametric tests were used with 5% statistical significance. RESULTS: HLA-B27 was negative in 32 of the 44 patients (72,7%). Most of them were male, Caucasian, living in Rio de Janeiro, with plaque type psoriasis and average age of 52,9 years. There was statistical significant correlation between positive HLA-B27 and male gender (p=0,004). Negative HLA-B27 had a tendency to correlate with hands and wrists arthritis (p=0,07). There was an inverse significant correlation between HLA values and Schöber's test (p=0,02). CONCLUSION: Although HLA-B27 is negative in most of patients, it is significantly associated to male gender and inversely correlated with Schöber's test.

FUNDAMENTOS: O HLA-B27 está associado às espondiloartrites, grupo de doenças que engloba, entre outras, a artrite psoriásica. OBJETIVOS: Descrever a freqüência de HLA-B27 em uma amostra de pacientes brasileiros com artrite psoriásica e correlacionar sua presença ou ausência com as manifestações clínicas dos mesmos. MÉTODOS: Estudo transversal avaliando 44 pacientes com artrite psoriásica de um ambulatório de Reumatologia. A avaliação consistia em registro de informações demográficas e sociais, exame clínico da pele e das articulações e pesquisa de HLA-B27. Os dados gerados foram tratados por meio de estatística descritiva e comparativa em Software apropriado. Foram utilizados testes paramétricos e não-paramétricos com significância estatística de 5%. RESULTADOS: O HLA-B27 resultou negativo em 32 dos 44 pacientes estudados (72,7%). A maioria dos pacientes era do sexo masculino, da raça branca, procedente do Rio de Janeiro, portador de psoríase em placas e com idade média de 52,9 anos. Houve associação estatisticamente significativa entre o HLA-B27 positivo e o sexo masculino (p=0,004). O HLA-B27 negativo teve tendência à correlação com artrite de mãos e punhos (p=0,07). Houve correlação inversa significativa entre os valores do HLA e do teste de Schöber (p=0,02). CONCLUSÃO: Apesar do HLA-B27 ser negativo na maioria dos pacientes estudados, esteve significativamente associado ao sexo masculino e inversamente correlacionado ao teste de Schöber.

Demographic, clinical, laboratory and treatment characteristics of spondyloarthritis patients with and without acute anterior uveitis / Características demográficas, clínicas, laboratoriais e de tratamento entre pacientes com espondiloartrite com e sem uveíte anterior aguda

CONTEXT AND OBJECTIVE: Acute anterior uveitis is a common extra-articular manifestation in spondyloarthritis patients. The aim of this study was to compare demographic, clinical, laboratory and treatment data among spondyloarthritis patients with and without acute anterior uveitis. DESIGN AND SETTING: This was a cross-sectional analytical study at the Rheumatology Outpatient Clinic of the Evangelical University Hospital, Curitiba, Brazil. METHODS: Spondyloarthritis patients with without acute anterior uveitis were compared regarding demographic data, spondyloarthritis subtype, peripheral arthritis, enthesitis, disease activity, functional index, physical examination, radiological involvement, HLA-B27 and treatment. RESULTS: Presence of acute anterior uveitis was not found to have any relationship with functional index, degree of radiological involvement, peripheral arthritis or enthesitis. Acute anterior uveitis showed a negative association with skin manifestations (P = 0.04) and a trend towards higher disease activity (P = 0.06). CONCLUSION: In the study sample, it could not be shown that AAU had any association with the functional and radiological prognoses. The patients with spondyloarthritis with and without acute anterior uveitis did not differ clinically except for a higher proportion of ankylosing spondylitis and smaller presence of skin involvement in those with uveitis.

CONTEXTO E OBJETIVO: Uveíte anterior aguda é uma manifestação extra-articular comum em pacientes com espondiloartrite. O objetivo deste estudo foi comparar achados demográficos, clínicos, laboratoriais e de tratamento em pacientes com espondiloartrite com e sem uveíte anterior aguda. TIPO DE ESTUDO E LOCAL: Este é um estudo transversal analítico realizado no Ambulatório de Reumatologia do Hospital Universitário Evangélico de Curitiba, Brasil. MÉTODOS: Pacientes com espondiloartrite com e sem uveíte anterior aguda foram comparados quanto a dados demográficos, subtipo de espondiloartrite, artrite periférica, entesite, atividade da doença, índice funcional, exame físico, envolvimento radiológico, HLA-B27 e tratamento. RESULTADOS: Não se encontrou associação entre presença de uveíte anterior aguda e índice funcional, grau de envolvimento radiológico, artrite periférica e entesite. Encontrou-se uma associação negativa de uveíte anterior aguda com manifestações de pele (P = 0,04) e uma tendência para maior atividade de doença (P = 0,06). CONCLUSÃO: Na amostra estudada, não foi possível demonstrar associação entre uveíte anterior aguda no prognóstico funcional e radiológico. Pacientes com espondiloartrite com e sem uveíte anterior aguda não diferem clinicamente exceto por uma maior proporção de espondilite anquilosante e uma presença menor de envolvimento cutâneo naqueles com uveíte.

Unilateral pedicle screw fixation combined with lumbar interbody fusion for the treatment of lumbar degenerative diseases / 中华骨科杂志

Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion(TLIF)and posterolateral fusion(PLF)procedures in which unilateral pedicle screw fixation was used.Methods From December 2006 to August 2008,78 cases with the lumbar degenerative diseases who received lumbar posterolateral fusion were analyzed.There were 48 cases of which underwent TLIF and PLF procedures with unilateral pedicle screw fixation(unilateral group),including 25 males and 23 females with an average of 47.6 years;and 30 cases of which underwent TLIF and PLF procedures with bilateral pedicle screw fixation(bilateral group),including 21 males and 9 females with an average of 50.5 years.The clinical effects between the two groups were evaluated with Oswestry disability index and visual analogue score(VAS)index.The operation time,blood loss,fusion rates and intervertebral collapse rates were also compared.Results Oswestry disability index,low back pain VAS index and skelalgia VAS index in both groups showed statistical significance between preoperation and 3 months,or 3 months and 1 year postoperatively.There was no difference in score improvement between the two groups.There were difference in operation time,blood loss and cost of hospitalization between unilateral and bilateral group.The former was lower.There was no difference in postoperative length of stay between the two groups.The fusion rate of unilateral group and bilateral group were 91.7%(44/48)and 93.3%(28/30),respectively.Conclusion Auto graft combined with unilateral pedicle screw fixation provids better spinal instant stability.TLIF and PLF with unilateral pedicle screw fixation was a satisfactory method in treating degenerative disease of lumbar vertebrae.

Clinical Features and Prognosis of HLA-B27 Positive and Negative Anterior Uveitis in a Korean Population

Clinical features and prognosis of HLA-B27 positive anterior uveitis (AU) were assessed compared with HLA-B27 negative AU in a Korean population, based on the medical records of AU patients seen at a university hospital. Twenty-seven HLA-B27 negative, idiopathic AU patients (group I) and 55 HLA-B27 positive AU patients (group II) were studied. HLA-B27 positive group was further divided into 29 with associated systemic disease (seronegative spondyloarthropathy) (group IIA) and 26 without associated systemic disease (group IIB). Significantly more severe anterior chamber inflammation in terms of anterior chamber cells (P=0.006) and hypopyon formation (P=0.034) was observed with higher frequency of AU attacks (P=0.007) in the HLA-B27 positive group than in the HLA-B27 negative group. Systemic/periocular steroids were required in significantly more patients in the HLA-B27 positive group than in the HLA-B27 negative group (P=0.015). However, no significant differences were observed for final ocular and visual outcomes between these two groups. Associated systemic disease made no significant difference in the clinical features and prognosis in the HLA-B27 positive AU patients. In conclusion, despite more severe inflammation and a higher recurrence rate, HLA-B27 positive AU shows similar good final ocular and visual outcomes compared to HLA-B27 negative, idiopathic AU in a Korean population.

Uveíte das espondiloartropatias: prevalência e relação com doença articular / Uveitis and spondyloarthritis: prevalence and relationship with joint disease

OBJETIVOS: Estudar a prevalência de uveítes na população local de espondiloartropatias e sua relação temporal com achados articulares. MÉTODOS: Foram revisados prontuários de 77 pacientes com espondiloartropatias atendidos no ambulatório de reumatologia do Hospital Universitário Evangélico de Curitiba, para diagnóstico do tipo de espondiloartropatia, sexo, idade, presença e tipo de uveite, tempo decorrido entre as primeiras manifestações oculares e as articulares. RESULTADOS: Uveíte foi encontrada em 12 dos 77 pacientes (15,6 por cento), sendo anterior em 83,3 por cento dos casos. O aparecimento da uveíte foi semelhante em todas as formas de espondiloartropatia (p=0,27) e não sofreu influência do sexo do paciente (p=0,74). O tempo médio de aparecimento dos sintomas oculares em relação ao diagnóstico articular foi de 4,04 meses para artrite reativa e 73 meses para espondilite anquilosante (p=0,009). CONCLUSÕES: A uveíte encontrada em pacientes com espondiloartropatia é, na sua grande maioria, anterior. O aparecimento da uveíte em relação aos sintomas articulares é mais precoce em casos de artrite reativa do que em espondilite anquilosante.

PURPOSE: To study uveitis prevalence in the local population with spondyloarthritis and its temporal relationship with joint complaints. METHODS: We reviewed seventy-seven charts of spondyloarthropathy patients from the rheumatology clinic of the "Hospital Universitário Evangélico de Curitiba" for spondyloarthritis class, patients' sex and age, occurrence of uveitis and its location and relationship between the first episode of uveitis and initial joint complaints. RESULTS: Uveitis was found in 12 of 77 patients (15.6 percent) which was anterior in 83.3 percent of the cases, without preference for spondyloarthropathy class (p=0.72) and patients' sex (p=0.74). In patients with reactive arthritis, the mean time between uveitis appearance and joint complaints was 4.04 months and in ankylosing spondylitis 73 months (p=0.009). CONCLUSION: Spondyloarthropathy patients have uveitis that is anterior in most of the cases and that appears earlier in reactive arthritis than in ankylosing spondylitis.

Espódilo Artropatía indiferenciada, espondilitis anquilosante y artropatia psoriasica: descripcion clinica, diagnostica y radiologica / Espódilo undifferentiated arthropathy, ankylosing spondylitis and psoriatic arthropathy: clinical description, diagnostic and radiological

La espondilitis anquilosante, artritis reactiva, artritis psoriásica, artritis enteropática, espondilitis anquilosante juvenil y espondiloartropatía indife-renciada, conforman el grupo de Espóndilo artropatías seronegativas. Como síndrome clínico comparten signos y síntomas inflamatorios, compromiso articular y extra articular, HIA-B27 positivo, factor reumatoide negativo y curso crónico; debiendo ser incluidas como diagnósticos diferenciales del síndrome de dolor lumbar y cervical crónico, especialmente cuando es de tipo inflamatorio o maligno. Se realizó un estudio descriptivo, transversal y retrospectivo, elaborando una descripción clínica, diagnóstica y radiológica de pacientes incluidos en la base de datos de la unidad de reumatología de la Clínica Universitaria Bolivariana con diagnósticos de espondilitis anquilosante, espondiloanropatía indiferenciada y artritis psoriásica, atendidos entre septiembre de 2002 y julio de 2004, aplicando el formato de Espóndilo artropatías diseñado para esta investigación. Se evaluaron 27 pacientes: 55.6% hombres y 44.4% mujeres, entre 20 y 56 años. La Espóndilo artropatías serone-gativas más frecuente fue la espondilitis anquilosante (70.3%), seguida de artritis psoriásica (22.2%) y espon-diloartropatía indiferenciada (7.4%). Los síntomas más frecuentes se registraron en la región lumbar y en los talones (51.9%), rigidez artricular en la región lumbar (59.3%) y localización de la artritis en los hombros (11.1%). Los signos más frecuentes fueron Patrick y Sch6ber (62.9%).La sacroileitis bilateral y enteritis piramidal fueron los hallazgos radiológicos más frecuentes (48.1%). Para el presente estudio, la espondilítis anquilosante fue la entidad más frecuente y cursó con mayores signos y síntomas inflamatorios, predominó el compromiso del esqueleto axial, evolucionó de manera crónica y progresiva y cursó con mayor evidencia de compromiso radiológico, comparado con la anritis psoriásica y espondiloanropatía indiferenciada.

Ankylosing Spondyltis, Reactive Anhinis, Psoriasic Anhritis, Enteropatic Arthritis,youthful Ankylosing Spondylítis and Undifferentiated Spondyloanhropathies make up the group of sero-negative spondyloanhropaties. As a clinical syndrome, they share both inflammatory signs and symptoms, in-joint and out-joint involvement, positive HLA-B27, a negative rheumatoid factor and a chronic course. The physician ought to include them as differential diagnosis for chronic back pain and cervical pain, specially when the clínical picture is of inflammatory or maligntype. A descriptive, cross-sectional, retrospective study was performed, developing a description of the clinical, diagnostic and radiological issues of patients included in the Clínica...

Application of Multislice Spiral CT for Guidance of Insertion of Thoracic Spine Pedicle Screws: An in vitro study / 华中科技大学学报（医学）（英德文版）

To investigate the value of the guidance of three dimensional (3-D) reconstruction of multi-slice spiral CT (MSCT) for the placement of pedicle screws, the 3-D anatomical data of the thoracic pedicles were measured by MSCT in two embalmed human cadaveric thoracic pedicles spines (T1-T10) to guide the insertion of pedicle screws. After pulling the screws out, the pathways were filled with contrast media. The PW, PH, TSA and SSA of developed pathways were measured on the CT images and they were also measured on the real objects by caliper and goniometer. Analysis of variance demonstrated that the difference between the CT scans and real objects had no statistical significance (P＞0.05). Moreover, the difference between pedicle axis and developed pathway also had no statistical significance (P＞0.05). The data obtained from 3-D reconstruction of MSCT demonstrated that individualized standards, are not only accurate but also helpful for the successful placement ofpedicle screws.