Risk factors for radiological hip involvement in patients with ankylosing spondylitis

SUMMARY OBJECTIVE: Our study aimed to explore the potential risk factors for radiological hip joint involvement in patients with ankylosing spondylitis (AS). METHODS: This cross-sectional convey collected the clinical data, laboratory indicators, and radiographic data of patients with AS. Radiographic hip joint involvement was defined as a Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) score ≥2. Multivariate logistic regression analyses were conducted to explore the potential risk factors for radiological hip involvement in patients with AS. RESULTS: Based on BASRI-hip score, all enrolled 386 patients with AS were classified as patients involving with radiological hip joint involvement (BASRI-hip ≥2; n=203) and those without it (BASRI-hip ≤1; n=183). Mean age of enrolled patients with AS were 36.7±11.9 years, and 320 (82.9%) patients were male. Mean course of disease was 10.7±8.3 years, and 349 (90.4%) patients were with a positive HLAB27. Multivariate analyses indicated that Juvenile onset (onset age ≤16 years) (odds ratio [OR]=4.159, 95% confidence interval [CI], 1.779-9.721, p<0.001), body mass index (BMI) <18.5 kg/m2 (OR=1.986, 95%CI 1.187-3.323, p=0.009), continuous nonsteroidal anti-inflammatory drug (NSAID) use (OR=0.351, 95%CI 0.155-0.794, p=0.012), and bone mass below the expected range for age (Z score ≤-2) (OR=2.791, 95%CI 1.456-5.352, p=0.002) were independently associated with radiological hip joint involvement in patients with AS. CONCLUSIONS: The potential risk factors for radiological hip joint involvement were juvenile onset, lower BMI, and bone mass below the expected range for age. Furthermore, continuous NSAID use was the protective factor for radiological hip joint involvement in these population.

Lobular capillary hemangioma in a patient with ankylosing spondylitis using adalimumab: an exuberant presentation

Abstract Lobular capillary hemangioma or pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes. Most patients present a single lesion. It manifests clinically as an erythematous, friable, and fast-growing tumor. This report details a case with exuberant presentation in a patient with ankylosing spondylitis, using adalimumab. Factors triggering pyogenic granuloma are not well known. They may spontaneously regress, but most require treatment.

Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis

Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.

Cardiovascular disease in patients with ankylosing spondylitis from the rheumatology outpatient clinic of the UFMS-affiliated Hospital / Doença cardiovascular em pacientes com espondilite anquilosante do ambulatório de reumatologia do Hospital afiliado à UFMS

Background: Cardiovascular diseases are a major cause of morbidity and mortality today. Despite its wide distribution, it presents particularly prevalent in certain groups of individuals, particularly when exposed to a higher degree of inflammation, giving increased cardiovascular risk. Rheumatic diseases expose their holders to this increased cardiovascular risk condition; however only recently have been associated with spondyloarthritis, particularly ankylosing spondylitis (AS). For being a classically autoimmune disease related to HLA histocompatibility system, AS may present phenotypic variations in different ethnic groups with possible diverse cardiovascular consequences. Objectives: To estimate the prevalence of cardiovascular disease (CVD) and the cardiovascular risk profile, correlating the time since diagnosis and activity of ankylosing spondylitis (AS) in patients from the rheumatology outpatient clinic of the UFMS-affiliated hospital. Methods: Of 55 patients with AS, 42 were selected consecutively and compared to a control group (CG) in a cross-sectional study. Patients with diabetes, indigenous background and pregnant women were excluded. Quantitative variables were assessed by use of Student t test, while qualitative variables, by chi-square test. The patients underwent electrocardiography, echocardiography and carotid Doppler examination, measurement of serum lipid levels and inflammatory markers, and were stratified according to global cardiovascular risk. The AS activity and impairment were evaluated by use of the BASMI, BASDAI, BASFI and ASDAS. Results: Mean age, 42.87 ± 12.37 years; time since AS diagnosis, 10.76 ± 8.74 years. There was no difference in cardiovascular risk stratification between the groups, most of the patients being at high or moderate risk (AS: 64.3%, and CG: 52%, p = 0.134). The prevalence of manifest CVD (2%) showed no difference between the groups, except for right bundle-branch block (AS: 14%, and CG: 2%, p = 0.027). The prevalence of subclinical CVD showed no difference between the groups, except for higher carotid medial-intimal thickness (CIMT) in the AS group (AS: 1.82 ± 2.63, and CG: 0.67 ± 0.16, p = 0.018). There was no correlation between AS activity or inflammatory markers and CVD, but with time since AS diagnosis and CIMT (p = 0.039, r = 0.328). Conclusions: Prevalence of CVD and risk factors was similar in the groups. Subclinical atherosclerosis degree was higher in the AS group, related to the time since diagnosis, but was independent of the cardiovascular risk factors or inflammation. Most patients with AS are at high cardiovascular risk

Manejo de la vía aérea en una espondilitis anquilosante: Caso clínico / Case report: ankylosing spondylitis and difficult airway

Handling a difficult airway is one of the biggest challenges for an anesthesiologist due to morbidity and mortality that it involves. This is why available devices are permanently reviewed to validate them in the handling of a known difficult airway or previously unknown. Patients with severe ankylosing spondylitis, almost everyone of them, they have a difficult airway due to a stiff neck spine and/or limitation in the mouth opening. In this case report we present a patient with severe ankylosing spondylitis, admitted for a total hip replacement surgery. We followed recommendations for difficult airway management using the devices available in the Anesthesiology Unit of our Hospital. Previous patient consent, we performed an awake intubation using a video laryngoscope and gum elastic bougie, under sedation, succesfully and with no complications.

Manejar una vía aérea difícil es uno de los mayores desafíos para un anestesiólogo debido a la morbilidad y mortalidad que conlleva. Esta es la razón por la cual los dispositivos disponibles se revisan permanentemente para validarlos en el manejo de una vía aérea difícil conocida o desconocida previamente. Los pacientes con espondilitis anquilosante severa, casi todos ellos, tienen una vía aérea difícil debido a una rigidez en la columna cervical y/o limitación en la apertura de la boca. En este caso, presentamos a un paciente con EA grave, admitido para una cirugía de reemplazo total de cadera. Seguimos las recomendaciones para el manejo de la vía aérea difícil usando los dispositivos disponibles en la Unidad de Anestesiología de nuestro Hospital. Con el consentimiento previo del paciente, realizamos una intubación con un laringoscopio de video y goma elástica bougie, bajo sedación, con éxito y sin complicaciones.

The link between ankylosing spondylitis and oral health conditions: two nested case-control studies using data of the UK Biobank

Abstract Ankylosing Spondylitis (AS) is an inflammatory rheumatic disease that affects the axial skeleton and the sacroiliac joints. Recent studies investigated the link between AS and oral diseases, particularly periodontitis. Others suggested that periodontitis may have a role in the pathogenesis of rheumatic diseases. Objective: The aim of this study is to investigate the association between AS and oral conditions. Material and Methods: This research was conducted using the UK Biobank Resource under Application Number 26307. The UK Biobank recruited around 500000 participants throughout Great Britain. Clinical records were available for 2734 participants. Two case-control studies were conducted based on whether AS was self-reported or clinically diagnosed. Oral conditions were identified using self-reported reports of oral ulcers, painful gums, bleeding gums, loose teeth, toothache, and dentures. The association between AS and oral conditions was assessed using logistic regression adjusted for age, gender, educational level, smoking status, alcohol consumption, and body mass index. Results: A total of 1307 cases and 491503 control participants were eligible for the self-reported AS study. The mean age was 58 years for the cases [7.5 standard deviation (SD)] and 57 years for the control groups (8.1 SD). Also, 37.1% of the cases and 54.2% of the control participants were females. Among the oral conditions, only oral ulcers were strongly associated with AS [1.57 adjusted odds ratio (OR); 95% confidence interval (CI) 1.31 to 1.88]. For the study of clinically diagnosed AS, 153 cases and 490351 control participants were identified. The mean age for both cases and control groups was 57 years; 7.6 SD for the cases and 8.1 for the control group. Females corresponded to 26.1% of the cases, and 54.2% of the control participants. Clinically diagnosed AS was associated with self-reported oral ulcers (2.17 adjusted OR; 95% CI 1.33 to 3.53). Conclusion: Self-reported and clinically diagnosed AS populations have increased risk of reporting oral ulcers. Further investigations are required to assess the link between a specific type of oral condition and AS.

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.

Erectile dysfunction in ankylosing spondylitis patients

ABSTRACT Background Rheumatic diseases such as ankylosing spondylitis (AS) may be associated with sexual dysfunction. Aim To study erectile function of a group of Brazilian AS patients comparing them with controls. Materials and Methods This was a cross sectional study approved by the local Committee of Ethics in Research. The questionnaire IIEF (International Index of Erectile Function) was applied to 40 AS patients and 40 healthy controls. AS patients had determination of disease activity (through BASDAI or Bath Ankylosing Spondylitis Disease activity index), ASDAS (Ankylosing Spondylitis Disease Activity Score, MASES or Maastricht Ankylosing Spondylitis Score and SPARCC or Spondyloarthritis Research Consortium of Canada), function (through BASFI or Bath Ankylosing Spondylitis Functional Index and HAQ or Health Assessment Questionnaire) and BASMI (Bath Ankylosing Spondylitis Metrological Index). Results AS patients had a median score on IIEF of 22.0 (IQR=18-25) while controls had 29 (IQR=27-30) with p<0.0001 Only 17.5% of the AS patients had no erectile dysfunction, in opposite to 87.5% of controls (p<0.0001). IIEF scores had a negative association with BASDAI (p<0.0001), HAQ (p=0.05), body mass index (P=0.03), MASES (P=0.02) and SPARCC (P=0.02) in a univariate analysis. Multiple regression showed that BASDAI was the only variable independently associated with IIEF. Conclusion There is a high prevalence of erectile dysfunction among AS patients that is associated with disease activity measured by BASDAI.

Male fertility potential alteration in rheumatic diseases: a systematic review

ABSTRACT Background Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility. Materials and Methods A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases. Results A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies. Conclusions Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.

Espondiloartritis anquilosante: revisión de hallazgos imagenológicos en la columna / Ankylosing spondyloarthritis: review of spinal imaging findings

Abstract: Introduction. Ankylosing spondyloarthritis (AS) is the most common and representative of seronegative spondyloarthropathy. It is characterised by chronic inflammation of the axial skeleton, leading to chronic back pain and progressive stiffness. It typically occurs in young patients, with symptoms often appearing with peak onset between 20 and 30 years of age, and is strongly associated with human leukocyte antigen B-27 (HLA B-27). Current imaging techniques are central in the management of these patients. The recognition of its classic imaging findings and its complications is essential for radiologists. Objectives. To present a pictorial review of the spinal imaging findings in patients with AS. Methods and materials. An analysis will be made of the spinal imaging findings in conventional radiography, CT and MRI in multiple patients from our medical centre. The most representative findings, complications, differential diagnoses, and some radiological key points will be shown.

Resumen: Introducción. La espondilitis anquilosante (EA) es la artropatía seronegativa más común y representativa. Se caracteriza por inflamación crónica del esqueleto axial, dolor referido a la columna vertebral de tipo inflamatorio y rigidez progresiva. Típicamente se manifiesta en pacientes jóvenes que inician su sintomatología entre los 20-30 años de edad y está ligada al antígeno leucocitario humano B-27 (HLA B-27). Las imágenes son fundamentales en el manejo de estos pacientes. Es deber del radiólogo reconocer los hallazgos imagenológicos presentes. Objetivos. Realizar una revisión pictográfica de hallazgos imagenológicos presentes en la columna vertebral de pacientes portadores de EA. Material y método. Análisis de las manifestaciones imagenológicas de columna más representativas de la EA en pacientes de nuestro centro en radiografía convencional, TC y RM, junto con posibles complicaciones y diagnósticos diferenciales.

Características y manejo de la uveítis en el paciente con espondiloartropatías / Characteristics and management of uveitis associated to the spondiloarthropaties

La inflamación de los contenidos intraoculares o uveítis afectará a alrededor de un tercio de los pacientes con espondiloartropatías, especialmente a aquéllos con espondilitis anquilosante. La uveítis típica será unilateral, aguda y autolimitada, afectando los componentes de la úvea anterior: iris y cuerpo ciliar. Pese a ser muy sintomáticas se asocian a bajo riesgo de pérdida visual permanente. Su tratamiento es tópico, en base a corticoides y midriáticos. La terapia inmunosupresora y con menor frecuencia los biológicos, están reservados para los infrecuentes casos crónicos. Es posible reducir la frecuencia e intensidad de las recidivas con metotrexato o sulfasalazina, pero la evidencia que sostiene esta indicación es pobre.

The inflammatory disease affecting the intraocular contents we know as uveitis will affect around one every three patients with spondyloarthropaties, in particular those presenting ankylosing spondylitis. The typical uveitis attack will be unilateral, acute and self-limited, affecting the components of the anterior uvea; this is iris and ciliary body. Despite being very symptomatic, their associated risk of permanent vision loss is low. Treatment is based on topical therapy with corticosteroids and mydriatic eye drops. Systemic immunosuppressive therapy and rarely biologic agents are reserved for the infrequent chronic cases. The use of methotrexate and sulfadiazine could possibly reduce the frequency and intensity of uveitis recurrencies, but evidence supporting this practice is poor.

Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline - A longitudinal analysis after using TNFa blockers

Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)a blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNFa blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNFatherapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNFa blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.

Qualidade do sono em pacientes com espondilite anquilosante / Sleep quality in patients with ankylosing spondylitis

RESUMOIntroduçãoA espondilite anquilosante (EA) é uma doença reumática inflamatória crônica caracterizada pela inflamação da pelve e da coluna vertebral, que resulta em uma restrição na mobilidade da coluna vertebral. Em decorrência da postura alterada e da dor inflamatória noturna, os distúrbios do sono são passíveis de ocorrer em pacientes com EA.ObjetivoDeterminar as diferenças entre os pacientes com EA e controles saudáveis na qualidade do sono, bem como avaliar a relação entre a qualidade do sono e a atividade da doença.MétodoPara avaliar a qualidade do sono, 55 pacientes com EA (40 homens, 15 mulheres, idade média 43 ± 1 anos) que preencheram os critérios modificados de Nova York e 55 controles comparáveis (40 homens, 15 mulheres, idade média 42 ± 9 anos) preencheram o questionário Índice de Qualidade do Sono de Pittsburgh (PSQI). A atividade da doença foi avaliada pelo Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).ResultadosA espondilite anquilosante se correlacionou significativamente com a qualidade de sono prejudicada de acordo com os escores totais do PSQI (p = 0,001). Foram encontradas diferenças significativas entre os pacientes com EA e controles saudáveis nos domínios do PSQI, incluindo "qualidade subjetiva do sono" (p = 0,010), "duração do sono" (p = 0,011), "eficiência do sono habitual" (p = 0,034), "distúrbios do sono" (p = 0,003) e "disfunção diurna" (p = 0,009), mas não na "latência do sono" e no "uso de medicação para dormir". Houve uma correlação positiva entre as pontuações do BASDAI e do PSQI (r = 0,612, p = 0,001).ConclusãoVerificou-se que os distúrbios do sono foram significativamente maiores em pacientes com EA em comparação com os controles. Os pacientes com doença ativa apresentaram pior qualidade de sono. Além disso, a atividade da doença esteve correlacionada com a pontuação da maior parte das subescalas do PSQI. A investigação da qualidade do sono deve ser uma ferramenta usada na avaliação de pacientes com EA.

ABSTRACTIntroductionAnkylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease characterized by the inflammation of the pelvis and spine that results in a restriction in the mobility of the spine. Due to the altered posture and nocturnal inflammatory pain, sleep disturbances are likely to occur in patients with AS.ObjectiveThis cross-sectional study aimed at determining the differences between the patients with AS and healthy controls in sleep quality, as well as assessing the relationship between the sleep quality and disease activity.MethodIn order to assess sleep quality, fifty-five patients with AS (40 men, 15 women; mean age, 43 ± 1 yrs) who fulfilled the modified New York criteria and fifty-five comparable controls (40 men, 15 women; mean age, 42 ± 9 yrs) completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).ResultsAnkylosing spondylitis was associated with a significantly impaired sleep quality according to the total PSQI scores (p = 0.001). Significant differences were found between the patients with AS and healthy controls in PSQI domains, including "subjective sleep quality" (p = 0. 010), "sleep duration" (p = 0. 011), "habitual sleep efficiency" (p = 0. 034), "sleep disturbances" (p = 0. 003) and "daytime dysfunction" (p = 0. 009) but not in "sleep latency", "use of sleep medication". There was a significant positive correlation between the BASDAI and PSQI scores (r = 0.612, p = 0.001).ConclusionIn the current study, we found that the sleep disturbances were significantly higher in patients with AS in comparison to controls. Patients with active disease had worse sleep quality. In addition, disease activity was correlated with the scores of most of the PSQI subscales. Sleep quality assessment should be a tool for evaluating patients with AS.

Lipoma arborescens de joelho em paciente com espondilite anquilosante: relato de caso e revisão da literatura / Lipoma arborescens of the knee in a patient with ankylosing spondylitis: case report and literature review

RESUMOLipoma arborescens (LA) é definido como uma proliferação vilosa lipomatosa da membrana sinovial com substituição difusa do tecido sinovial por células gordurosas maduras. A lesão é muito rara, envolve a articulação do joelho (região suprapatelar) e se associa a doenças articulares degenerativas. Descrevemos o caso de um paciente de sexo masculino, portador de espondilite anquilosante com quadro de monoartrite de joelho direito e aumento de volume importante na região suprapatelar. O diagnóstico de lipoma arborescens foi confirmado a partir da ressonância magnética do joelho direito.

ABSTRACTLipoma arborescens (LA) is defined as a villous lipomatous proliferation of the synovial membrane with diffuse substitution of the synovial tissue by mature fat cells. The injury is very rare, involving the knee joint (suprapatellar region) and is associated with degenerative joint disease. We describe the case of a male patient, suffering from ankylosing spondylitis with monoarthritis of the right knee and swelling in suprapatellar region important. The diagnosis of lipoma arborescens was confirmed from the MRI of the right knee.

Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

BACKGROUND: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. METHODS: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. RESULTS: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9degrees +/- 11.7degrees with PSO, 14.3degrees +/- 8.4degrees with SPO, 38.3degrees +/- 12.7degrees with PVCR, and 19.3degrees +/- 7.1degrees with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%). CONCLUSIONS: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

Avaliação colonoscópica em pacientes com espondilite anquilosante / Colonoscopic evaluation in patients with ankylosing spondylitis

Introdução: Pacientes com espondilite anquilosante podem apresentar-se com lesões inflamatórias intestinais, e, por isso, deve ser definido o uso da colonoscopia para tais pacientes. Objetivos: Avaliar as alterações colonoscópicas intestinais macroscópicas e achados histopatológicos microscópicos de pacientes com espondilite anquilosante; correlacionar os achados colonoscópicos e histopatológicos; e estudar a relação dos achados histopatológicos com as manifestações extra-articulares da doença, HLA-B27, BASFI and BASDAI. Métodos: Este é um estudo transversal de 22 pacientes com espondilite anquilosante. Os pacientes passaram por uma avaliação clínica, BASDAI e BASFI, coleta de sangue para determinação de HLA-B27, e colonoscopia com biópsia de quarto segmentos intestinais (íleo terminal, cólon direito, cólon sigmoide e reto). Resultados: Resultados colonoscópicos anormais foram obtidos em 13 (59,1%) pacientes, e a principal anormalidade foi a presença de pólipos intestinais. Os grupos de resultados colonoscópicos normais e anormais (n = 9 e n = 13, respectivamente) foram homogêneos no que diz respeito à idade, BASFI, BASDAI, e variáveis categóricas, e o valor P não revelou diferença significativa entre grupos. Dos resultados histopatológicos, 81% tiveram uma biópsia anormal do íleo terminal, 90.9% tiveram uma biópsia anormal do cólon sigmoide, e a biópsia retal estava anormal em 86.4%. Os achados histopatológicos revelaram biópsias anormais em 81%, 90.9%, 90.9% e 86.4% para o íleo terminal, cólon direito, cólon sigmoide e reto, respectivamente. Os resultados histopatológicos não revelaram associação estatisticamente significativa com as manifestações ex...

Introduction: Patients with ankylosing spondylitis can have intestinal inflammatory lesions, thus the use of colonoscopy for such patients should be defined. Objectives: To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI. Methods: This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum). Results: Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n = 9 and n = 13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity. Conclusions: The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease. .

Fluoroscopy-guided intra-articular sacroiliac joint steroid injection for sacroiliitis in ankylosing spondylitis: a Case Report / Infiltración intraarticular de esteroides en la articulación sacro-ilíaca guiada por fluoroscopia para la sacroiliitis en la espondilitis anquilosante: Reporte de Caso

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

La sacroilitis, una condición comúnmente vista en la espondilitis anquilosante, es bien conocida por ser uno de los principales generadores de dolor lumbar, que puede ocasionar dificultad para caminar. Un paciente de 20 años de edad con una historia de espondilitis anquilosante, acompañada de dos años de dolor en la nalga derecha, la región lumbar, y en la ingle, acudió a la Clínica de Rehabilitación y Medicina Física del Hospital Universitario de West Indies. La evaluación radiográfica reveló esclerosis aumentada y cambios erosivos en la articulación sacroilíaca bilateral, mayor en el lado derecho que en el izquierdo. Con la ayuda de la fluoroscopia para guiar el procedimiento, se le administró al paciente una inyección intraarticular de esteroide en la articulación sacro-ilíaca, al lado derecho. La puntuación de la escala analógica visual del dolor (VAS) tras la inyección mejoró de 8 a 1, y el Índice de Discapacidad de Oswestry mejoró de una discapacidad moderada del 40% a una mínima discapacidad del 16%. La evaluación general del paciente fue de un 95% en cuanto a la percepción de la mejoría del dolor. Este reporte de caso ilustra la eficacia de la inyección intraarticular de esteroides de la articulación sacroilíaca para el tratamiento de la sacroiliitis en la espondilitis anquilosante.

Isolation of IgG Antibodies to Toxocara in Ankylosing Spondylitis Patients with Acute Anterior Uveitis

PURPOSE: Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. METHODS: Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. RESULTS: The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. CONCLUSIONS: These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.

Cervical spine fracture in advanced ankylosing spondylitis

No abstract available.

Avaliação da aterosclerose subclínica e de níveis plasmáticos de LDL minimamente modificada em pacientes com espondilite anquilosante e sua correlação com a atividade da doença / Evaluation of sub-clinical atherosclerosis and plasma levels of minimally modified LDL in patients with ankylosing spondylitis and its correlation with disease activity

INTRODUÇÃO: A aterosclerose acelerada foi demonstrada em algumas doenças autoimunes, principalmente lúpus eritematoso sistêmico e artrite reumatóide. Embora a alta prevalência do uso de corticosteróides possa ser um fator complicador, por causa de seus efeitos prejudiciais em diversos fatores de risco, acredita-se que, nesses pacientes, a inflamação sistêmica per se desempenhe papel importante na aterogênese. MÉTODOS: Avaliamos a aterosclerose subclínica e os níveis plasmáticos de LDL eletronegativa circulante em pacientes com espondilite anquilosante (EA). Catorze pacientes que atendiam aos critérios de Nova York modificados para EA foram comparados com 13 controles equiparados. Avaliamos a espessura da íntima-média (EIM) na carótida por ultrassonografia bilateral da artéria carótida comum, artéria carótida interna e na bifurcação. Os grupos foram homogêneos, no que tange a fatores de risco cardiovasculares. Apenas um paciente no grupo de EA estava sendo medicado com corticosteróide. RESULTADOS: A presença de inflamação ativa foi demonstrada por BASDAI elevado e níveis mais elevados de PCR em pacientes versus controles (12,36 vs. 3,45 mg/dl, P=0,002). Não observamos diferença na EIM da carótida entre os dois grupos, em qualquer local da artéria. A média de EIM (6 mensurações em 3 locais pré-especificados, bilateralmente) foi 0,72 ± 0,28 no grupo de EA e 0,70 ± 0,45 mm nos controles (P=0,91). Também não observamos diferença significativa na LDL minimamente modificada entre pacientes e controles (14,03 ± 17,40 vs. 13,21 ± 10,21; P=0,88). CONCLUSÕES: Pacientes com EA não demonstraram aumento na EIM da carótida, em comparação com controles. Do mesmo modo, os níveis plasmáticos circulantes de LDL(-) não diferiram significativamente nos dois grupos.

INTRODUCTION: Accelerated atherosclerosis has been shown in some autoimmune diseases, mainly in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Although high prevalence of corticosteroids use may be a confounding factor due to their detrimental effects on several risk factors, systemic inflammation per se is supposed to play an important role in atherogenesis in these patients. METHODS: We have evaluated sub-clinical atherosclerosis and plasma levels of circulating electronegative LDL, which represents the fraction of LDL that is minimally modified, in patients with ankylosing spondylitis (AS). Fourteen patients who fulfilled the modified New York criteria for AS were compared with 13 paired controls. Carotid intimal-media thickness (IMT) was assessed by ultrasonography bilaterally in common carotid artery, internal carotid artery and in the bifurcation. Groups were homogeneous regarding cardiovascular risk factors. Only a single patient in AS group was in use of corticosteroid. RESULTS: The presence of active inflammation was demonstrated by elevated BASDAI and higher CRP levels and in patients versus controls (12.36 vs. 3.45 mg/dl, P = 0.002). No difference was found in carotid IMT between both groups, in any site of artery. Averaged IMT (6 measurements, at 3 pre-specified sites bilaterally) was 0.72 ± 0.28 in AS group and 0.70 ± 0.45 mm in controls (P = 0.91). Minimally modified LDL did not differ significantly either between patients and controls (14.03 ± 17.40 vs. 13.21 ± 10.21; P = 0.88). CONCLUSIONS: Patients with AS did not show increased carotid IMT in comparison to controls. In the same way, circulating plasma levels of LDL (-), did not differ significantly in both groups.