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1.
Adv Rheumatol ; 61: 17, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152736

ABSTRACT

Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.(AU)


Subject(s)
Humans , Spondylitis, Ankylosing/etiology , Homocysteine/analysis , Case-Control Studies , Methotrexate/therapeutic use , Tumor Necrosis Factor-alpha/therapeutic use
2.
Adv Rheumatol ; 61: 4, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152735

ABSTRACT

Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.(AU)


Subject(s)
Humans , Spondylitis, Ankylosing/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Guidelines as Topic/standards , Decision Making
3.
Adv Rheumatol ; 61: 2, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152742

ABSTRACT

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)


Subject(s)
Humans , Spondylarthritis/epidemiology , Prognosis , Spondylitis, Ankylosing/epidemiology , Arthritis, Psoriatic/epidemiology , Demography , Prevalence , Risk Factors , Latin America/epidemiology
4.
Chinese Medical Journal ; (24): 1441-1449, 2021.
Article in English | WPRIM | ID: wpr-878189

ABSTRACT

BACKGROUND@#Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.@*METHODS@#A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.@*RESULTS@#Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001).@*CONCLUSIONS@#Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.


Subject(s)
Adult , Humans , Kyphosis/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Radiography , Retrospective Studies , Spine/diagnostic imaging , Spondylitis, Ankylosing/diagnostic imaging
5.
Rev. argent. radiol ; 84(2): 61-67, abr. 2020. tab, graf, il.
Article in Spanish | LILACS | ID: biblio-1125857

ABSTRACT

Resumen La inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad. El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.


Abstract Aortic inflammation (aortitis) is a rare pathology, with infectious (fungal pseudoaneurysm, syphilis) and noninfectious etiology (arteritis, idiopathic aortitis, ankylosing spondylitis, among others), it has a difficult clinical diagnosis and a variable prognosis. The use of various imaging methods such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and ultrasound (US) facilitate the identification, monitoring and treatment of this entity. The following paper aims to perform a literature review and update about aortitis and its various etiologies, exemplifying cases of our institution.


Subject(s)
Aortitis/etiology , Aortitis/diagnostic imaging , Spondylitis, Ankylosing/diagnostic imaging , Giant Cell Arteritis/diagnostic imaging , Angiography/methods , Takayasu Arteritis/etiology , Takayasu Arteritis/diagnostic imaging , Multidetector Computed Tomography/methods
6.
Coluna/Columna ; 19(1): 74-79, Jan.-Mar. 2020. tab
Article in English | LILACS | ID: biblio-1089640

ABSTRACT

ABSTRACT Objective We aim to identify retrospectively surgically treated patients with an ankylosed spine who sustained a vertebral fracture. Our goal is to evaluate the main outcomes and complications. Methods We selected patients through the database of surgical interventions in the setting of fractures of an ankylosed spine segment between January 1st 2008 and June 30th 2018. We collected data from digital medical records. The parameters analyzed include hospital length of stay, Intensive Care Unit (ICU) admission, perioperative and postoperative complications as well as neurological evolution. Results Fractures occurred in 14 patients with ankylosing spondylitis (82%) and 3 patients with diffuse idiopathic skeletal hyperostosis (18%). All patients were male and the mean age was 69 years. Fourteen fractures occurred after minor trauma (83%), of which 11 were due to falls from standing height or lower (65%). The cervical spine represents the majority of the levels involved (65%). Seven patients were admitted to the ICU (41%) and 11 suffered neurological damage. There was improvement of neurological status in less than 50% and there were high percentages of post-operative complications. Conclusion Patients with ankylosed spine diseases are at higher risk for vertebral fracture, even after minor trauma, and these are located predominantly in the cervical spine. The surgical treatment of these conditions is effective as it allows improvement of the patient's neurological status. However, they still present higher morbidity and mortality, as well as increased post-op complications. Prevention of falls may drastically change patients' outcome, neurological function and independence in activities of daily living. Level of evidence IV; A case series therapeutic study.


RESUMO Objetivo Identificar retrospetivamente casos de tratamento cirúrgico de fraturas vertebrais em pacientes com coluna anquilosada. O nosso propósito consiste em avaliar os principais desfechos e respectivas complicações. Métodos Selecionamos pacientes através do banco de dados de intervenções cirúrgicas no quadro de fraturas de um segmento da coluna anquilosada entre 1 de janeiro de 2008 a 30 de junho de 2018. Coletamos os dados a partir dos prontuários médicos digitais. Os parâmetros analisados incluem período de internação hospitalar, admissão na Unidade de Tratamento Intensivo (UTI), complicações pré- e pós-operatórias, assim como evolução neurológica. Resultados As fraturas ocorreram em 14 pacientes com espondilite snquilosante (82%) e em 3 pacientes com hiperostose esquelética difusa idiopática (18%). Todos os pacientes eram do sexo masculino e a idade média era de 69 anos. Quatorze fraturas ocorreram devido a trauma menor (83%), das quais 11 eram devido a quedas da própria altura ou inferiores (65%). A coluna cervical representa a maioria dos níveis envolvidos (65%). Sete pacientes foram admitidos na UTI (41%) e 11 sofreram lesão neurológica. Houve melhoria do estado neurológico em menos de metade dos pacientes e altas porcentagens de complicações pós-operatórias. Conclusão Os pacientes com doenças da coluna anquilosada têm maior risco de fraturas vertebrais, mesmo após trauma menor, localizando-se predominantemente na coluna cervical. O tratamento cirúrgico dessas condições é eficaz, uma vez que permite melhora do estado neurológico do paciente. Entretanto, ainda apresentam altos índices de morbilidade e mortalidade, assim como maior incidência de complicações pós-operatórias. A prevenção de quedas pode alterar drasticamente o desfecho, função neurológica e independência nas atividades diárias do paciente. Nível de evidência IV; Estudo terapêutico de série de casos.


RESUMEN Objetivo Identificar retrospectivamente casos de tratamiento quirúrgico de fracturas vertebrales en pacientes con columna anquilosada. Nuestro propósito consiste en evaluar sus principales resultados y respectivas complicaciones. Métodos Seleccionamos pacientes mediante banco de datos de intervenciones quirúrgicas en el cuadro de fracturas de un segmento de la columna anquilosada entre el 1 de enero de 2008 al 30 de junio de 2018. Recolectamos los datos a partir de los prontuarios médicos digitales. Los parámetros analizados incluyen período de internación hospitalaria, admisión en la Unidad de Tratamiento Intensivo (UTI), complicaciones pre y postoperatorias, así como evolución neurológica. Resultados Las fracturas ocurrieron en 14 pacientes con espondilitis anquilosante (82%) y en 3 pacientes con hiperostosis esquelética difusa idiopática (18%). Todos los pacientes eran del sexo masculino y la edad promedio era de 69 años. Catorce fracturas ocurrieron debido a trauma menor (83%), de las cuales 11 eran debido a caídas de la propia altura o inferiores (65%). La columna cervical representa la mayoría de los niveles implicados (65%). Siete pacientes fueron admitidos en la UTI (41%) y 11 sufrieron lesión neurológica. Hubo mejora del estado neurológico en menos de la mitad de los pacientes y altos porcentajes de complicaciones postoperatorias. Conclusión Los pacientes con enfermedades de la columna anquilosada tienen mayor riesgo de fracturas vertebrales, incluso después de trauma menor, localizándose predominantemente en la columna cervical. El tratamiento quirúrgico de esas condiciones es eficaz, ya que permite mejora del estado neurológico del paciente. Entretanto, aún presentan altos índices de morbilidad y mortalidad, así como mayor incidencia de complicaciones postoperatorias. La prevención de caídas puede alterar drásticamente los resultados, función neurológica e independencia en las actividades diarias del paciente. Nivel de evidencia IV; Estudio terapéutico de serie de casos.


Subject(s)
Humans , Spine , Spondylitis, Ankylosing , Spinal Fractures , Hyperostosis, Diffuse Idiopathic Skeletal
7.
Clin. biomed. res ; 40(1): 1-6, 2020.
Article in English | LILACS | ID: biblio-1104373

ABSTRACT

Introduction: Registries of spondyloarthritis (SpA) patients' follow-up provided evidence that tumor necrosis factor inhibitors (TNFi) increase the incidence of active tuberculosis infection (TB). However, most of these registries are from low burden TB areas. Few studies evaluated the safety of biologic agents in TB endemic areas. This study compares the TB incidence rate (TB IR) in anti-TNF-naïve and anti-TNF-experienced subjects with SpA in a high TB incidence setting.Methods: In this retrospective cohort study, medical records from patients attending a SpA clinic during 13 years (2004 to 2016) in a university hospital were reviewed. The TB IR was calculated and expressed as number of events per 105 patients/year; the incidence rate ratio (IRR) associated with the use of TNFi was calculated.Results: A total of 277 patients, 173 anti-TNF-naïve and 104 anti-TNF-experienced subjects, were evaluated; 35.7% (N = 35) of patients who were prescribed an anti-TNF drug were diagnosed with latent tuberculosis infection (LTBI). Total follow-up time (person-years) was 1667.8 for anti-TNF-naïve and 394.9 for anti-TNF-experienced patients. TB IR (95% CI) was 299.8 (37.4-562.2) for anti-TNF naïve and 1012.9 (25.3-2000.5) for anti-TNF experienced subjects. The IRR associated with the use of TNFi was 10.4 (2.3- 47.9).Conclusions: In this high TB incidence setting, SpA patients exposed to anti-TNF therapy had a higher incidence of TB compared to anti-TNF-naïve subjects, although the TB incidence in the control group was significant.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tuberculosis/chemically induced , Tuberculosis/epidemiology , Biological Products/adverse effects , Antirheumatic Agents/adverse effects , Spondylarthritis/drug therapy , Tumor Necrosis Factor Inhibitors/adverse effects , Spondylitis, Ankylosing/drug therapy , Biological Products/therapeutic use , Arthritis, Psoriatic/drug therapy , Incidence , Retrospective Studies , Follow-Up Studies , Antirheumatic Agents/therapeutic use , Endemic Diseases , Latent Tuberculosis/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic use
8.
Rev. colomb. reumatol ; 27(1): 46-49, 2020. tab, graf
Article in English | LILACS | ID: biblio-1144399

ABSTRACT

ABSTRACT Renal manifestations of spondyloarthritis are rare. The case is presented of a patient with ankylosing spondylitis of nine years of evolution. He had intense inflammation, as well as articular sequelae, with a significant deterioration in his quality of life. At the initial evaluation, the patient had a serum creatinine of 1.44mg/dL and a 24-h urine protein in the sub-nephrotic range (1.44 g). Renal biopsy showed the presence of Congophilic material, confirming the diagnosis of AA amyloidosis. Treatment with a TNF blocking agent was initiated with clinical improvement, especially regarding articular disease.


RESUMEN Las manifestaciones renales de la espondiloartritis son poco comunes. Se presenta el caso de un paciente con espondilitis anquilosante de 9 anos de evolución, con intensa inflamación y secuelas articulares y con un deterioro significativo en su calidad de vida. En la evaluación inicial, el paciente tenía una creatinina sérica de 1,44mg/dL y una proteína en orina de 24 horas en un rango subnefrótico (1,44 g). La biopsia renal mostró la presencia de material congofílico que confirmaba el diagnóstico de amiloidosis AA. Se inició tratamiento con un anti-TNF, con mejoría clínica, especialmente con respecto al componente articular.


Subject(s)
Humans , Male , Adult , Spondylitis, Ankylosing , Amyloidosis , Quality of Life , Inflammation
9.
Clinics ; 75: e1870, 2020. tab
Article in English | LILACS | ID: biblio-1133406

ABSTRACT

OBJECTIVES: To retrospectively evaluate the performance and distinctive pattern of latent tuberculosis (TB) infection (LTBI) screening and treatment in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under anti-tumor necrosis factor (TNF) therapy and determine the relevance of re-exposure and other risk factors for TB development. METHODS: A total of 135 and 83 patients with AS and PsA, respectively, were evaluated for LTBI treatment before receiving anti-TNF drugs via the tuberculin skin test (TST), chest radiography, and TB exposure history assessment. All subjects were evaluated for TB infection at 3-month intervals. RESULTS: The patients with AS were more often treated for LTBI than were those with PsA (42% versus 30%, p=0.043). The former also presented a higher frequency of TST positivity (93% versus 64%, p=0.002), although they had a lower frequency of exposure history (18% versus 52%, p=0.027) and previous TB (0.7% versus 6%, p=0.03). During follow-up [median, 5.8 years; interquartile range (1QR), 2.2-9.0 years], 11/218 (5%) patients developed active TB (AS, n=7; PsA, n=4). TB re-exposure was the main cause in seven patients (64%) after 12 months of therapy (median, 21.9 months; IQR, 14.2-42.8 months) and five LTBI-negative patients. TB was identified within the first year in four patients (36.3%) (median, 5.3 months; IQR, 1.2-8.8 months), two of whom were LTBI-positive. There was no difference in the TB-free survival according to the anti-TNF drug type/class; neither synthetic drug nor prednisone use was related to TB occurrence (p>0.05). CONCLUSION: Known re-exposure is the most critical factor for incident TB cases in spondyloarthritis. There are also some distinct features in AS and PsA LTBI screening, considering the higher frequency of LTBI and TST positivities in patients with AS. Annual risk reassessment taking into consideration these peculiar features and including the TST should be recommended for patients in endemic countries.


Subject(s)
Humans , Spondylitis, Ankylosing/drug therapy , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/epidemiology , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Spondylitis, Ankylosing/epidemiology , Retrospective Studies , Follow-Up Studies , Tumor Necrosis Factor Inhibitors/therapeutic use
11.
Article in English | WPRIM | ID: wpr-811118

ABSTRACT

BACKGROUND: In drug therapy for patients with arthritis, a naproxen/esomeprazole combination drug may be a tolerable choice because it can minimize gastrointestinal and cardiovascular adverse effects. The aim of this study was to investigate the changes in quality of life (QOL), medication adherence, and satisfaction after switch from the existing drug to the combination drug. In addition, we analyzed the correlation between the above-mentioned variables and the stratified demographic and medical data of the patients.METHODS: A prospective, noninterventional, observational study was conducted in 30 hospitals between May 2014 and July 2016. In total, 2,308 patients with osteoarthritis, 99 patients with rheumatoid arthritis, and 76 patients with ankylosing spondylitis were enrolled. Demographic information (age, sex, body mass index [BMI], alcohol consumption, and smoking) and medical information (type of arthritis, duration of disease, and comorbidities) were collected via a self-administered questionnaire. Patients were observed for more than three months after switching to the combination drug. Data on the QOL (EuroQoL 5-Dimension questionnaire [EQ-5D questionnaire]), medication adherence (Morisky Medication Adherence Scale [MMAS]), and satisfaction were collected at the first and last visits.RESULTS: A total of 2,483 patients enrolled at 30 hospitals completed the questionnaire. After the switch to the combination drug, the mean EQ-5D score improved from 0.72 ± 0.17 to 0.79 ± 0.14 (p < 0.001), and significant improvement was associated with female sex (p = 0.016), shorter disease duration (p < 0.001), and absence of comorbidities (p < 0.001). The mean MMAS score was 6.38 ± 1.77, indicating medium adherence. Satisfaction was significantly higher in female patients (p < 0.001), in patients with a shorter disease duration (p < 0.001), osteoarthritis (p = 0.003), and no comorbidities (p < 0.001). Serious drug-related adverse effects did not occur.CONCLUSIONS: The overall QOL was improved with medium adherence after the switch to the combination drug. On the basis of the analysis of stratified data, sex, age, drinking, smoking, disease duration, comorbidities, and BMI might be associated with QOL, satisfaction, and adherence.


Subject(s)
Alcohol Drinking , Arthritis , Arthritis, Rheumatoid , Body Mass Index , Comorbidity , Drinking , Drug Therapy , Female , Humans , Medication Adherence , Naproxen , Observational Study , Osteoarthritis , Prospective Studies , Quality of Life , Smoke , Smoking , Spondylitis, Ankylosing
12.
Article in Chinese | WPRIM | ID: wpr-826364

ABSTRACT

To investigate the relationship of both DNA methylation level and methylenetrahydrofolate reductase(MTHFR)gene polymorphism with ankylosing spondylitis(AS). Totally 200 Chinese AS patients with HLA-B27(+)and 120 healthy controls were included from Hunan Province.All the cases were diagnosed according to the 1984 modified New York criteria for AS.The DNA methylation was examined by cytosine extension method,while the MTHFR gene C677T polymorphism was analyzed by the polymerase chain reaction(PCR)and restriction fragment length polymorphism(RFLP).The plasma homocysteine(Hcy)level was examined by enzyme-linked immunosorbent assay(ELISA),while the red blood folate level was analyzed by the specific immunoassays. The ratio of the T/T genotype mutation in the AS group was significantly higher than in the control group(17.0% 5.0%;=9.874, =0.002).The plasma homocysteine concentration of AS group was(18.71 ± 2.42)μmol/L,which was significantly higher than that in normal control group [(10.97 ± 2.93)μmol/L](=24.402, <0.001).The plasma Hcy concentration of the T/T genotype [(21.70±1.80)μmol/L] was significantly higher than that of the C/C genotype[(18.31±1.94)μmol/L](=12.088, =0.01)and the C/T genotype [(17.80±2.18)μmol/L](=6.496, =0.01)in the AS group.The DNA methylation level of the T/T genotype in AS group was significantly lower than that in normal control group(=5.655, <0.001)and also significantly lower than those of the C/C genotype(=11.514, <0.001)and the C/T genotype in AS group(=10.287, <0.001). In the Han population in Hunan Province,the C677T polymorphism of the MTHFR gene is associated with the onset of AS.The T/T mutation at position 677 of the MTHFR gene is an important influencing factor for hyperhcyemia in the AS patients.The T/T mutation at position 677 of the MTHFR gene is associated with genomic DNA hypomethylation.Thus,hypomethylation of DNA may be one of the pathogenic mechanisms of AS.


Subject(s)
DNA , DNA Methylation , Genomics , Genotype , Humans , Methylenetetrahydrofolate Reductase (NADPH2) , Polymorphism, Genetic , Spondylitis, Ankylosing
13.
Article in Chinese | WPRIM | ID: wpr-828234

ABSTRACT

OBJECTIVE@#To evaluate accuracy and safety of individualized 3D printing guided template for thoracolumbar pedicle screw placement in patients with ankylosing spondylitis.@*METHODS@#From January 2016 to September 2019, thoracolumbar spine three-dimensional CT data of 8 patients with ankylosing spondylitis were included, Mimics 17.0 and ideaMaker computer software were applied to design thoracolumbar pedicle screw guided template of patients with AS, physical model of all patients (T-L)were printed by 3D printer, 2 parts in each patient, and divided into guide-plate-assisted screw group (experimental group) and free-hand nail group (control group). Thoracolumbar pedicle screws of both groups were placed by the same spinal surgeon. The accuracy of pedicle screw placement between two groups were evaluated according to results of postoperative CT, the accuracy of the fixation of thoracolumbar pedicle screw was divided into 4 grades, grade 0 and 1 screws were acceptable nails, grade 2 and 3 screws were unacceptable nails. The diameter and length of pedicle screws, the distance between entry point and posterior median line designed by preoperative 3D printing were compared with actual use in operation.@*RESULTS@#Twenty three blocks of thoracolumbar 3D printing screw of ankylosing spondylitis guided templates were designed and printed in guide-plate-assisted screw group, 46 screws were inserted and 44 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (4.20±1.15) min, the frequency of X-ray was (5.00±1.25) times and the average adjustment times of screw and Kirschner needle during screw placement was (1.76±1.32) times. In the control group, 46 nails were placed by traditional surgical method and 30 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (14.67±2.23) min, the frequency of X-ray fluoroscopy was (14.46±2.21) times and the average times of Kirschner needle adjustment was (4.76±3.39) times. The success rates between experimental group and control group were 95.65%(44 / 46) and 56.22%(30 / 46) respectively, and had statistical difference (χ=13.538, 0.05). The operation time of inserting a single screw, the times of X-ray fluoroscopy, and the average times of adjustment screw and Kirschner needle in experimental group were significant less than those in control group(<0.01).@*CONCLUSION@#The personalized guide template assisted the thoracolumbar fixation designed by 3D printing could significantly improve safety, accuracy and efficiency of surgery, especially suitable for thoracolumbar vertebral bodies requiring posterior pedicle screw fixation for fracture or dislocation with AS.


Subject(s)
Fluoroscopy , Humans , Pedicle Screws , Printing, Three-Dimensional , Spinal Fusion , Spondylitis, Ankylosing , Surgery, Computer-Assisted
14.
Article in Chinese | WPRIM | ID: wpr-828228

ABSTRACT

OBJECTIVE@#To choose the disease-causing gene in a Chinese pedigree with ankylosing spondylitis (AS) by whole-exome sequencing (WES), and provide theory basis for mechanism of disease.@*METHODS@#Clinical data of AS pedigree were collected, including 2 males, the age were 48 and 18 years old, the course of disease were 23 and 4 years. Whole blood genomic DNA of AS was extracted to perform whole exome sequencing, the results were compared with human databases, common variations which had been reported were wiped out, then non synonymous single nucleotide variants(SNVs) from the family members were combined, and candidate genes was selected initially.@*RESULTS@#Totally 80 G data was obtained from AS family with high quality.By comparing results between patient and normal subject, and filtering with number of biological database, the result showed heterozygous mutation of JAK2 gene 12 exon c.1709 A>G (p.Tyr570Cys) may be the potential disease-causing gene. The variant c.1151T>C of MUC3A gene may be one of the causes of intestinal symptoms in the family members.@*CONCLUSION@#It is feasible to find t candidate gene mutations of AS by Exon sequencing. The mutation c.1709 A>G in gene JAK2 identified by whole exome sequencing might be the pathogenic mutation in this AS pedigree.


Subject(s)
Exome , Humans , Male , Mucin-3 , Mutation , Pedigree , Spondylitis, Ankylosing , Whole Exome Sequencing
15.
Article in English | WPRIM | ID: wpr-786147

ABSTRACT

Biological disease-modifying antirheumatic drugs (bDMARDs) are highly effective agents for the treatment of inflammatory arthritis; however, they also possess a potential risk for serious infection. Recently, with the rapid expansion of the bDMARDs market in Korea, reports of serious adverse events related to the agents have also increased, necessitating guidance for the use of bDMARDs. Current work entitled, “Expert Consensus for the Use of bDMARDs Drugs for Inflammatory Arthritis in Korea,” is the first to describe the appropriate use of bDMARDs in the management of inflammatory arthritis in Korea, with an aim to provide guidance for the local medical community to improve the quality of clinical care. Twelve consensus statements regarding the use of bDMARDs for the management of rheumatoid arthritis and ankylosing spondylitis were generated. In this review, we provide detailed guidance on bDMARDs use based on expert consensus, including who should prescribe, the role of education, indications for use, and monitoring strategies for safety.


Subject(s)
Antirheumatic Agents , Arthritis , Arthritis, Rheumatoid , Consensus , Education , Korea , Spondylitis, Ankylosing
16.
Article in English | WPRIM | ID: wpr-786141

ABSTRACT

OBJECTIVE: The microRNA (miR)-10b is the T helper (Th) 17 cell specific in patients with ankylosing spondylitis (AS). The interleukin (IL)-22, which is closely related to Th17 cells, has been implicated in the regulation of new bone formation in experimental models. Therefore, the aim of this study was to evaluate whether miR-10b affects bone formation via the IL-22 pathway in AS.METHODS: Primary CD4+ T cells from AS were purified and transfected with miR-10b, anti-miR-10b, or scramble. Cell-surface markers and cytokine expression were analyzed by flow cytometry and enzyme-linked immunosorbent assay. Primary bone-derived cells (BdCs) from the facet joints of the spine were isolated, then osteogenic differentiation of primary BdCs was performed. We assessed alkaline phosphatase (ALP) activity and staining of BdCs at early time points. Alizarin red S staining of BdCs was performed at late time points.RESULTS: Overexpression of miR-10b reduced both IL-22 producing cell frequencies and cytokine production in T cells from the patients with AS. The IL-22 significantly increased ALP staining and bone mineralization. The ALP promotor activity of AS-BdCs was notably higher for the IL-22 concentration. The supernatants of the miR-10b overexpression group suppressed ALP activity on osteogenic progenitor cells from the facet joints of the spine in patients with AS.CONCLUSION: Our data suggest that miR-10b suppresses IL-22 production, which was involved in osteogenic proliferation in AS. Therefore, miR-10b might be a potential therapeutic candidate for regulation of new bone formation in patients with AS.


Subject(s)
Alkaline Phosphatase , Calcification, Physiologic , Enzyme-Linked Immunosorbent Assay , Flow Cytometry , Humans , Interleukins , MicroRNAs , Models, Theoretical , Osteogenesis , Spine , Spondylitis, Ankylosing , Stem Cells , T-Lymphocytes , Th17 Cells , Zygapophyseal Joint
17.
Chinese Medical Journal ; (24): 2521-2531, 2020.
Article in English | WPRIM | ID: wpr-877834

ABSTRACT

BACKGROUND@#Secukinumab demonstrated sustained efficacy in patients with ankylosing spondylitis (AS) through 5 years in pivotal Phase III studies. Here, we present efficacy and safety results (52-week) of secukinumab in patients with AS from the MEASURE 5 study.@*METHODS@#MEASURE 5 was a 52-week, Phase III, China-centric study. Eligible patients were randomly assigned (2:1) to receive subcutaneous secukinumab 150 mg or placebo weekly for the first five doses and then once every 4 weeks (q4w). All placebo patients switched to secukinumab 150 mg q4w starting at Week 16. Primary endpoint was Assessments of SpondyloArthritis international Society (ASAS) 20 at Week 16. Randomization was stratified by region (China vs. non-China).@*RESULTS@#Of 458 patients (secukinumab 150 mg, N = 305; placebo, N = 153) randomized, 327 (71.4%) were from China and 131 (28.6%) were not from China. Of these, 97.7% and 97.4% patients completed Week 16 and 91.1% and 95.3% (placebo-secukinumab) patients completed Week 52 of treatment. The primary endpoint was met; secukinumab significantly improved ASAS20 response at Week 16 vs. placebo (58.4% vs. 36.6%; P < 0.0001); corresponding rate in the Chinese population was 56.0% vs. 38.5% (P < 0.01). All secondary efficacy endpoints significantly improved with secukinumab 150 mg in the overall population at Week 16; responses were maintained with a trend toward increased efficacy from Week 16 to 52. No new or unexpected safety signals were reported up to Week 52.@*CONCLUSIONS@#Secukinumab 150 mg demonstrated rapid and significant improvement in signs and symptoms of AS. Secukinumab was well tolerated and the safety profile was consistent with previous reports. Efficacy and safety results were comparable between the overall and Chinese populations.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02896127; https://clinicaltrials.gov/ct2/show/NCT02896127?term=NCT02896127&draw=2&rank=1.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , China , Double-Blind Method , Humans , Spondylitis, Ankylosing/drug therapy , Treatment Outcome
18.
An. bras. dermatol ; 94(6): 751-753, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054883

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Skin Diseases/pathology , Spondylitis, Ankylosing/drug therapy , Granuloma, Pyogenic/pathology , Antirheumatic Agents/therapeutic use , Adalimumab/therapeutic use , Skin Diseases/etiology , Spondylitis, Ankylosing/complications , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Granuloma, Pyogenic/etiology
19.
J. bras. econ. saúde (Impr.) ; 11(2): 119-127, Agosto/2019.
Article in Portuguese | LILACS, ECOS | ID: biblio-1021058

ABSTRACT

Objetivo: O Planserv oferece cobertura à terapia biológica para as patologias de artrite reumatoide (AR), espondilite anquilosante (EA) e artrite psoriática (AP). Em agosto de 2016, 78 pacientes estavam em uso do medicamento Remicade® (infliximabe). Nessa data, o valor do Remicade® foi reduzido para o mesmo valor do Remsima™ (infliximabe biossimilar). Com isso, todos pacientes que estavam usando o Remicade® trocaram por Remsima™. Conduzimos um estudo para medir a descontinuidade da terapia e a economia. Métodos: Estudo de mundo real (coorte prospectiva), não controlado, em pacientes com AR, AP e EA que estavam utilizando Remicade® e trocaram para Remsima™, entre setembro de 2016 e setembro de 2017. O desfecho primário foi o índice de descontinuidade do tratamento (por qualquer causa). O desfecho secundário foi a taxa de "aumento da atividade da doença", medida por meio dos escores SDAI, BASDAI e CASPAR. Foi considerado como "aumento da atividade da doença" qualquer medida superior à medida inicial e que estivesse acima do limite de remissão da doença. Os valores de referência para "aumento da atividade da doença" foram as medidas históricas. O impacto econômico foi medido por uma análise de custo-minimização. Resultados: Em setembro de 2017, 5 (6%) pacientes que realizaram a troca do Remicade® para o Remsima™, descontinuaram a terapia (4 por falhas e 1 perda de acompanhamento). A taxa de descontinuação de referência (Remicade®) foi de 11% (9% de falha e 2% por perda de acompanhamento). As análises de subgrupo (descontinuidade da terapia por tipo de patologia) foram equivalentes. A taxa de "aumento da atividade da doença" ocorreu em 42% dos pacientes para o Remsima™ e em 46% para o Remicade®. As análises de subgrupo (por tipo de patologia) também demonstraram que as taxas de aumento da atividade da doença foram semelhantes entre os grupos. A análise econômica mostrou que a mudança do Remicade® para o Remsima™ trouxe economia de R$ 1,75 milhão de reais (0,5 milhão de dólares), com 1.689 ampolas de infliximabe dispensadas no período. Conclusão: A troca do medicamento Remicade® pelo Remsima™ nos pacientes com AR, EA e AP, no contexto do Planserv, demonstrou ter sido uma medida segura, eficaz e econômica.


Objective: Planserv offers coverage of biological therapy for rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PA). In August 2016, 78 patients were on Remicade® (infliximabe). At this date the value of Remicade® was reduced to the same value as Remsima™ (infliximabe biossimilar), with this all patients who were using Remicade® exchanged for Remsima™. We conducted a study to measure therapy discontinuity, and economics. Methods: An uncontrolled real-world study (prospective cohort) these patients who were using Remicade® and switched to Remsima™ between September 2016 and September 2017. The primary outcome was the discontinuation rate of treatment (for any cause). The secondary outcome was the "increased disease activity" rate as measured by the scores SDAI, BASDAI and CASPAR. It was as "increased disease activity", any measure higher than the initial, and that was above the remission limit of the disease. The reference values for "increased disease activity" were the historical measures. The economic impact measured by a cost minimization analysis. Results: In September 2017, 5 (6%) patients who switched from Remicade® to Remsima™, discontinued therapy (4 due to failure and 1 loss of follow-up). The reference discontinuation rate (Remicade®) was 11% (9% failure and 2% loss of follow-up). Subgroup analyzes (discontinuation of therapy by type of pathology) were equivalent. The rate of "increased disease activity" occurred in 42% of patients for Remsima™, and 46% for Remicade®. Subgroup analyzes (by type of pathology) also showed that rates of increase in disease activity were similar between groups. The economic analysis showed that the change from Remicade® to Remsima™ savings of R $ 1.75 million (US $ 0.5 million), with 1,689 ampoules of infliximabe dispensed in the period. Conclusion: The switching of Remicade® by Remsima™ in patients with RA, SA and PA in the context of Planserv, has been shown to be a safe, effective and economical measure.


Subject(s)
Humans , Arthritis, Rheumatoid , Spondylitis, Ankylosing , Arthritis, Psoriatic , Biosimilar Pharmaceuticals , Infliximab
20.
Autops. Case Rep ; 9(2): e2018070, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994653

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Esophagitis/pathology , Candidiasis, Invasive/pathology , Mycoses/pathology , Necrosis , Autopsy , Spondylitis, Ankylosing/complications , Fatal Outcome , Vasculitis, Leukocytoclastic, Cutaneous/complications , Sepsis/complications
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