Corneal biomechanical features in patients with ankylosing spondylitis / Características biomecânicas da córnea entre pacientes com espondilite anquilosante

ABSTRACT Purpose: To evaluate the corneal biomechanical features and central corneal thickness in ankylosing spondylitis patients and to evaluate correlations of these parameters with disease activity. Methods: The study included 51 patients diagnosed with ankylosing spondylitis (mean age, 40.80 ± 13.15 years; range, 18-72 years) and 34 age- and sex-matched healthy controls (mean age, 42.00 ± 12.32 years; range, 18-60 years). All underwent a complete ophthalmological and physical examination, including visual acuity testing and biomicroscopic anterior and posterior segment examinations. Corneal hysteresis, corneal resistance factor, Goldmann-correlated intraocular pressure, and corneal compensated intraocular pressure were evaluated with an ocular response analyzer, and the central corneal thickness was measured with Sirius® corneal tomography. The Bath Ankylosing Spondylitis Disease Activity Index, Functional Index, and Metrology Index scores were recorded. Results: In the ankylosing spondylitis patients, the mean disease duration was 7.73 ± 6.05 (range, 1-30) years. There was no statistically significant difference between the patients and controls in the corneal biomechanical features. The Goldmann-correlated intraocular pressure and corneal compensated intraocular pressure both showed positive correlations with age (p=0.003 and p=0.001, res­pectively). There was a negative correlation between corneal hysteresis and disease duration (p=0.002), and between central corneal thickness and the Bath Ankylosing Spondylitis Metrology Index score (p=0.003). Conclusion: This study demonstrated a significant negative correlation between corneal hysteresis and disease duration in ankylosing spondylitis patients. Furthermore, the central corneal thickness value decreased with an increase in Bath Ankylosing Spondylitis Metrology Index score, which may result in an underestimate of intraocular pressure readings and thus an inaccurate risk assessment of glaucoma.

RESUMO Objetivo: Avaliar as características biomecânicas da córnea e espessura central da córnea em pacientes com espondilite anquilosante e analisar a correlação destes parâmetros no grupo de estudo com a atividade da doença. Métodos: Foram incluídos no estudo 51 pacientes com diagnóstico de espondilite anquilosante e 34 controles saudáveis com idade e sexo. Todos os sujeitos foram submetidos a um exame oftalmológico e físico completo, incluindo exames de acuidade visual, exames de segmento anterior e posterior biomicroscópicos. Foram avaliados o coeficiente de resistência da córnea, a pressão intraocular correlacionada com Goldmann e a pressão intraocular compensada da córnea com o analisador de resposta ocular, a espessura corneana central com a tomografia corneana pelo Sirius®. Se o índice de atividade da doença de espondilite anquilosante de banho, o índice funcional de espondilite anquilosante de banho, o índice de metrologia de espondilite anquilosante de banho. Resultados: Foram incluídos no estudo 51 pacientes com idade média de 40,80 ± 13,15 (intervalo: 18-72) anos e 34 casos de controle com idade média de 42,00 ± 12,32 (intervalo: 18-60) anos. No grupo espondilite anquilosante a duração média da doença foi de 7,73 ± 6,05 (1,00-30,00) anos. Não houve diferença estatisticamente significante entre dois grupos quanto às características biomecânicas da córnea. Na análise de correlação, no grupo de estudo; pressão intraocular correlacionada com Goldmann e pressão intraocular compensada da córnea estavam positivamente correlacionados com a idade (p=0,003, p=0,001, respectivamente). Houve uma correlação negativa entre a duração da doença e CH (p=0,002), e entre índice de metrologia de espondilite anquilosante de banho e espessura corneana central (p=0,003). Conclusão: Este estudo demonstrou correlação negativa significativa entre a duração da doença e a histerese corneal em pacientes com espondilite anquilosante. Além disso, com um aumento na pontuação de índice de metrologia de espondilite anquilosante de banho, o valor de espessura corneana central também estava di­minuindo o que pode causar uma diminuição nas leituras de pressão intraocular artificialmente e resultar em avaliação de risco imprecisa de glaucoma.

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

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

Escalas de avaliação aplicadas à espondilite anquilosante pertinentes à fisioterapia / Ankylosing spondylitis evaluation scale related to physical therapy

A espondilite anquilosante (EA) é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial. A patologia evolui de forma insidiosa e é potencialmente debilitante, levando a redução da qualidade de vida dos indivíduos acometidos. Este estudo teve como objetivo realizar uma revisão literária das escalas de avaliação em EA (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, EVA – Escala Visual Analógica e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) pertinentes à fisioterapia, especificamente dos domínios: função, dor, mobilidade da coluna, rigidez e avaliação global do paciente, presentes na área SM-ARD/Fisioterapia. Foi abordada também uma escala de avaliação radiológica, SASSS (Stoke Ankylosing Spondylitis Spine Score). A revisão estendeu-se de outubro a dezembro de 2006, mediante pesquisas em livros de acervos particulares e públicos e em base de dados. Constatou-se neste estudo a necessidade da realização de pesquisas, metodologias ou complementos visando à validação de instrumentos no Brasil que sirvam de esclarecimento sobre o dinamismo e comportamento da EA diante da intervenção fisioterapêutica.

The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that affects the axial skeleton. The pathology develops in an insidious way and it is potentially debilitated, taking reduction of the life quality. The objective of this study was to make a literature review of the evaluation scales in AS (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, VAS – Visual Analog Scale e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) related with physical therapy, specifically of the domains: function, pain, mobility of the column, rigidity and the patient's global evaluation, present in SM-ARD/ physical therapy area. This review showed also a scale of radiologic evaluation, SASSS (Stoke Ankylosing Spondylitis Spine Score). The literature revision was performed from October to December 2006, using books of private and public collections and data basis. It was verified, in this study, the need of researches, methodologies or complements aiming at the validation of instruments in Brazil in order to explain the dynamism and behavior of AS with physical therapy intervention.

Defeito de mineralizaçäo e osteopenia em pacientes com espondilite anquilosante / Mineralization defect and osteopenia in patients with ankylosing spondylitis

Säo paucas as referências na literatura descrevendo aspectos histológicos e histomorfométricos no tecido ósseo de pacientes com espondilite anquilosante. O objetivo deste trabalho foi o estudo dos aspectos anatomopatológicos do tecido ósseo de pacientes com espindilite anquilosante, utilizando-se biópsia óssea de osso näo descalcificado. Dezesseis homens, brancos, com espondilite anquilosante, média de idade de 34 ñ 12 anos (15 a 55 anos) e tempo médio de doença de 11 ñ 8 anos (6 meses a 27 anos) submeteram-se à biópsia de crista iliaca. Quatorze pacientes apresentaram osteopenia em graus variáveis, dez com defeito de mineralizaçäo e três com osteomalacia. As correlaçöes, estatisticamente significantes, do tempo de evoluçäo da doença com o volume osteóide absoluto e relativo sugerem que a doença seja fator importante na determinaçäo da osteopenia e defeito de mineralizaçäo. Os autores concluíram que osteopenia e defeito de mineralizaçäo podem ser detectados precocemente em pacientes comn espondilite anquilosante e, conseqüentemente, podem e deveriam ser tratados

Ankylosing spondylitis in females. Similarities and differences with male spondylitics.

Ten female and seventy two male patients suffering from ankylosing spondylitis were studied to evaluate differences between the two sexes. Low lumbar backache and inactivity stiffness were the commonest presenting complaints in females (8/10) as compared to males (34/72). They also had a later age of onset (25.4 + 6.16 yrs) compared to males (20.56 + 6.57 yrs). Females were found to be symptomatically milder with a more benign course of the disease. There were no significant differences in the frequency of extra-articular features and HLA B27 between males and females. A positive family history was more often seen in female ankylosing spondylitis (50%) than male (31.94%) patients.