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Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.
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Ankylosing spondylitis is an autoimmune disease with a high incidence rate in clinic. It is characterized by abnormal ossification and ankylosis of the spine and sacroiliac joints. With the further development of the disease, the quality of life of patients will eventually decline sharply. At present, there are many treatment methods that can be chosen, and early intervention and comprehensive treatment are key, including drug therapy, rehabilitation training, surgical treatment, etc. Although there are many treatment methods to choose from, its pathogenesis is not fully understood, and it is still a difficult point in clinical treatment. This article systematically reviews the literature on the treatment of ankylosing spondylitis in recent years, providing reference for further optimizing comprehensive treatment strategies.
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ABSTRACT BACKGROUND AND OBJECTIVES: The feet may be involved in patients with ankylosing spondylitis (AS), causing pain and walking difficulties. This research aimed to study the involvement of the foot in a sample of Brazilian patients with AS. METHODS: The Brazilian version of the Foot Function Index (FFI-BR) was applied to 103 individuals (57 AS patients and 46 controls). Clinical profiles were obtained in AS patients as well as the measurement of disease activity by the ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR (erythrocyte sedimentation rate), ASDAS-CRP (C reactive protein) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and function by BASFI (Bath Ankylosing spondylitis functional score). RESULTS: Only 19.2% of AS patients did not have any foot complaints and the FFI-BR score presented worse results than the control group (p = 0.02). The "pain" domain of FFI-BR scored highest in AS patients, followed by "disability". There was no association between the results of the FFI-BR and the clinical profile of patients with AS, but there was an association between the score and the disease activity indexes (r = 0.50, p = 0.003 with ASDAS-ESR; r = 0.44, p = 0.005 with ASDAS-CRP; and r = 0.60, p < 0.0001 with BASDAI). The BASFI also showed a positive correlation (r = 0.72; p < 0.0001). CONCLUSION: Pain and disability are common in AS patients and these symptoms are associated with disease activity.
RESUMO JUSTIFICATIVA E OBJETIVOS: Os pés podem ser acometidos em pacientes com espondilite anquilosante (EA), causando dor e dificuldade de locomoção. O objetivo deste trabalho foi estudar o envolvimento do pé em uma amostra de pacientes brasileiros com EA. MÉTODOS: A versão brasileira do Foot Function Index (FFI-BR) foi aplicada a 103 indivíduos (57 pacientes com EA e 46 controles). O perfil clínico foi obtido para pacientes com EA, bem como a medição da atividade da doença por meio do ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR. (velocidade de hemossedimentação), ASDAS-CRP (proteína C reativa) e BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) e função pelo BASFI (Bath Ankylosing Spondylitis Functional Score). RESULTADOS: Apenas 19,2% dos pacientes com EA não apresentaram queixas nos pés e o escore FFI-BR apresentou resultados piores do que os do grupo controle (p = 0,02). O domínio "dor" do FFI-BR apresentou a maior pontuação nos pacientes com EA seguido pelo domínio "disfunção". Não se observou associação dos resultados do FFI-BR com o perfil clínico dos pacientes com EA, mas houve associação do escore com os índices de atividade da doença (r = 0,50, p = 0,003 com ASDAS-ESR; r = 0,44, p = 0,005 com ASDAS-CRP; e r = 0,60, p < 0,0001 com BASDAI). O BASFI também apresentou correlação positiva (r = 0,72; p< 0,0001). CONCLUSÃO: Dor e disfunção são comuns em pacientes com EA e estes sintomas se associam com atividade de doença.
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The spinal fracture in patients with ankylosing spondylitis (AS) is predominantly unstable, involving all three columns of the spine. If AS combined with spinal fracture is not effectively treated in the early stage, continuous stress on the lesion site may result in pseudarthrosis, progressive kyphotic deformity, neurologic deficits and other complications during later stages. Currently, the diagnosis of AS combined with spinal fracture mainly relies on symptoms, signs and imaging examination. However, there is a certain rate of missed diagnoses. Although surgical intervention is preferred, there is no unified standard for selecting the surgical approaches. Anterior cervical surgery, due to potential risks of unstable fixation and vascular nerve damage, is limited to a selected group of AS patients combined with concurrent cervical spine fracture. The combined anterior and posterior approach provides good stability, but patients may not tolerate the surgical trauma. The traditional posterior open surgery is widely employed and can achieve good results, but it also causes significant surgical trauma and intraoperative bleeding. Minimally invasive posterior percutaneous procedures are becoming more and more popular due to its advantages of less trauma, less bleeding and faster recovery. Additionally, the use of robot-assisted and navigation techniques increases both safety and accuracy during operations. In this study, the authors reviewed the progress in the diagnosis and treatment of AS combined with spinal fracture, providing references for optimizing diagnostic and therapeutic strategies.
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Objective:To compare the application effect of whole-process seamless nursing and conventional nursing in the perioperative period of ankylosing spondylitis (AS) with kyphosis complicated by cervical spine fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with AS with kyphosis complicated by cervical spine fracture admitted to Henan Provincial People′s Hospital from April 2017 to December 2022, including 37 males and 27 females, aged 27-73 years [(49.8±14.6)years]. There were 43 patients with vertebral fractures and 21 with intervertebral space fractures. All patients underwent reduction and fixation or correction and fixation. Thirty-two patients admitted from April 2017 to August 2019 received conventional care (conventional nursing group), and 32 patients admitted from September 2019 to December 2022 received whole-process seamless care (seamless nursing group). The two groups were compared concerning the visual analog scale (VAS) before, at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up, the American Spinal Injury Association (ASIA) score before surgery, at 1 and 3 months after surgery and at the last follow-up, the health survey questionnaire (SF-36) score and patient satisfaction score before surgery and at the last follow-up, as well as the incidence of postoperative complications.Results:All patients were followed up for 6-12 months [(9.8±3.2)months]. There was no statistical difference in preoperative VAS between the two groups ( P>0.05). The values of VAS in the seamless nursing group were (3.9±1.9)points, (4.2±0.7)points, (2.7±0.9)points, (2.6±0.6)points, and (1.7±0.8)points at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up, respectively, lower than those of the conventional nursing group [(5.7±1.2)points, (5.8±1.1)points, (3.6±1.2)points, (3.2±1.1)points, and (2.4±1.0)points] ( P<0.05 or 0.01). The VAS of the seamless nursing group at 12 hours, 24 hours, 1 month, 3 months after surgery and at the last follow-up was lower than that before surgery (all P<0.05). The VAS at 1 and 3 months after surgery and at the last follow-up was lower than those before and at 12, 24 hours after surgery and the VAS at the last follow-up was lower than those at 1, 3 months after surgery (all P<0.05). The differences among VAS of the conventional nursing group before and at 12, 24 hours after surgery were statistically insignificant (all P>0.05). The VAS of the conventional nursing group at 1 and 3 months after surgery and at the last follow-up was lower than those before surgery and at 12, 24 hours after surgery and the VAS at the last follow-up was lower than those at 1, 3 months after surgery (all P<0.05). There was no statistically significant difference in VAS of the two groups between 12 hours and 24 hours after surgery, and between 1 month and 3 months after surgery (all P>0.05). There was no significant difference in the ASIA scores before surgery between the two groups ( P>0.05). There were significant improvements in ASIA scores in the seamless nursing group at 1, 3 months after surgery and at the last follow-up compared with those of the conventional nursing group ( P<0.05). There were no statistically significant differences in preoperative SF-36 score and patient satisfaction score between the two groups (all P>0.05). At the last follow-up, the SF-36 score and patient satisfaction score of the seamless nursing group were (47.4±6.2)points and (99.5±1.2)points, respectively, which were higher than those of the conventional nursing group [(42.2±7.3)points and (98.1±1.6)points] (all P<0.05). At the last follow-up, the SF-36 score and patient satisfaction score of the seamless nursing group were higher than those before surgery (all P<0.01). The SF-36 score of the conventional nursing group was higher than that before surgery ( P<0.01), but there was no significant difference in patient satisfaction score ( P>0.05). The incidence of postoperative complications in the seamless nursing group was 6.3% (2/32), lower than that of the conventional nursing group [25.0% (8/32)] ( P<0.05). Conclusion:For AS with kyphosis complicated by cervical spine fracture, whole-process seamless nursing is associated with alleviated postoperative pain, improved spinal nervous function, quality of life and degree of satisfaction, and reduced incidence of complications compared with the conventional nursing.
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Objective:In order to understand the difference of clinical efficacy between original TNF-α inhibitors (TNFi) and their biosimilars, Bayesian mesh Meta-analysis was compare Etanercept, Infliximab, Adalimumab with their biosimilars in the treatment of ankylosing spondylitis (AS).Methods:A systematic literature search was performed, using Ovid Biomedical, Embase, Cochrane Library, CNKI, Wanfang Database and Weipu Database (up to March 8, 2023 for all resources above), to search publications of randomized controlled trial (RCT) about all original and biosimilar TNFi for the treatment of AS in all language. Two reviewers independently identified the eligible trails, evaluated bias risk and extracted relevant data. Based on Bayesian network, data analysis of included studies was conducted using statistical software R3.6.1 and R Studio.Results:The results of the network meta-analysis showed that, no significant differences was observed among. Etanercept, Infliximab,Adalimumab, and their biosimilars for ASAS20 when Infliximab was compared with Etanercept [ OR (95% CI)=1.4 (0.54, 3.5)], placebo was compared with Etanercept [ OR (95% CI)=0.35 (0.17,0.67)], No significant differences were observed among Etanercept, Infliximab, Adalimumab, and their biosimilars for BASDAI, when Infliximab was compared with Ctanercept [ OR (95% CI)=-0.89 (-1.8, 0.081)], placebo was compared with Etanercept [ OR(95% CI)=1.7(0.86, 2.5)], No significant differences were observed among Etanercept, Infliximab, Adalimumab, and their biosimilars for BASFI, when Infliximab was compared with Etanercept [ OR(95% CI)=-0.46(-1.3, 0.47)], placebo was compared with Etanercept [ OR(95% CI)=1.6(0.8, 2.3)]. Conclusion:Etanercept, Infliximab, Adalimumab with their biosimilars are significantly superior to placebo and sulfasalazine in terms of ASAS20, BASDAI, BASFI, CRP, ESR. Limited evidence have shown that the efficacy of biological biosimilars are similar to that of their corresponding original drugs.
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Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
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Objective:To investigate the expression and clinical significance of decoy receptor 3 (DcR3) and its signal pathway-related molecules in PBMCs of patients with ankylosing spondylitis (AS).Methods:Peripheral blood samples, clinical data and laboratory test results were collected from 100 patients with ankylosing spondylitis [50 patients with AS activity (ASA), 50 patients with AS stability (ASS)], 30 patients with osteoarthritis and 30 patients with gouty arthritis (as disease control group), and 60 healthy controls (HC). The mRNA expression levels of DcR3 and its signal pathway related genes (DR3, TL1A, Fas, FasL, LIGHT, LIGHTR, LTβR) were measured by real-time fluorescence quantitative polymerase chain reaction. Measurement data among the three groups in normal distribution were analyzed by t test or one-way analysis of variance, pairwise comparisons using LSD- t test, non-normal distribution data were analyzed by Mann-Whitney test or Kruskal-Wallis H test, χ2 test was used for correlation analysis of categorical variables. Correlation analysis between variables were analyzed using Spearman correlation analysis. Results:① By comparing the AS group, disease control group and HC group, the expression levels of DcR3 mRNA and DR3 mRNA in the AS group were lower than those in disease control group and HC group, and DcR3 mRNA and DR3 mRNA in disease control group were lower than those in the HC group {DcR3mRNA: [6.21 (3.89, 10.70)]×10 -4vs [9.51 (5.89, 16.65)]×10 -4vs [17.81 (11.27, 24.20)]×10 -4, H=55.28, P<0.001; DR3 mRNA: [41.05 (24.09, 66.95)]×10 -4vs [58.28 (28.41, 94.38)]×10 -4vs [94.79 (54.07, 144.51)]×10 -4, H=37.10, P<0.001}. The expression level of TL1A mRNA in the AS group was higher than that in disease control group {[14.71(4.91, 42.22)]×10 -4vs [4.00(1.07, 16.60)]×10 -4vs [7.70 (3.52, 27.83)]×10 -4, H=17.71, P<0.001}; The expression level of Fas mRNA in AS group and disease control group was lower than that in HC group {[20.99(4.63, 62.89)]×10 -4vs [23.97(15.82, 38.99)]×10 -4vs [78.45 (27.32, 146.46)]×10 -4, H=31.17, P<0.001}. The expression level of FasL mRNA in AS group was higher than that in disease control group and HC group {[42.87(6.57, 91.21)]×10 -4vs [5.45(2.83, 10.32)]×10 -4vs [6.88 (4.57, 23.79)]×10 -4, H=46.42, P<0.001}. The expression level of LIGHTR mRNA in AS group was lower than that in disease control group {[52.66 (7.20, 143.21)]×10 -4vs [98.80 (53.11, 166.24)]×10 -4vs [63.47(40.85, 138.07)]×10 -4, H=11.96, P<0.001}. There were no significant differences in LIGHT mRNA and LTβR mRNA among all groups ( H=0.86, P>0.05; H=3.18, P>0.05). ②The expression levels of DcR3 mRNA, DR3 mRNA and Fas mRNA in ASA group and ASS group were lower than those in HC group. DcR3 mRNA in ASA group was higher than that in ASS group, and DR3 mRNA in ASA group was lower than that in ASS group {DcR3 mRNA: [7.28 (4.92, 16.56)]×10 -4vs [4.59 (2.49, 7.03)]×10 -4vs [17.81 (11.27, 24.20)]×10 -4, H=62.63, P<0.001; DR3 mRNA: [30.93(16.18, 66.66)]×10 -4vs [47.17(29.91, 67.40)]×10 -4vs [94.79(54.07, 144.51)]×10 -4, H=41.48, P<0.001; Fas mRNA: [20.04(3.29, 62.30)]×10 -4vs [22.49(5.63, 64.79)]×10 -4vs [78.45(27.32, 146.46)]×10 -4, H=23.54, P<0.001}. The expression levels of TL1A mRNA and LTβR mRNA in the ASA group were higher than those in the ASS group and the HC group {TL1A mRNA: [32.36(10.09, 97.84)]×10 -4vs [9.98(1.29, 21.63)]×10 -4vs [7.70(3.52,27.83)]×10 -4, H=21.14, P<0.001; LTβR mRNA: [6.13(2.16,20.06)×10 -4vs [2.13(0.53,8.04)]×10 -4vs [2.72 (1.24,5.73)]×10 -4, H=12.86, P<0.001}. The expression level of FasL mRNA in the ASA group and the ASS group was higher than that in the HC group {[60.70 (8.16, 106.16)]×10 -4vs [30.14 (5.37, 78.40)]×10 -4vs [6.88 (4.57, 23.79)]×10 -4, H=18.99, P<0.001}. The expression level of LIGHTR mRNA in ASS group was lower than that in HC group {[49.79(10.75, 168.48)]×10 -4vs [15.92(3.27, 105.91)]×10 -4vs [63.47(40.85, 138.07)]×10 -4, H=11.80, P<0.001]. There was no significant difference in LIGHT mRNA among all groups ( H=4.15, P>0.05). ③Spearman correlation analysis showed that DcR3 level was positively correlated with BASDAI score and hsCRP in AS patients ( r=0.52, P<0.001; r=0.35, P<0.01), and DR3 level was negatively correlated with BASDAI score, ESR and hsCRP level ( r=-0.28, P<0.001; r=-0.25, P<0.001; r=-0.31, P<0.001). TL1A was positively correlated with BASDAI score, ESR and hsCRP level ( r=0.23, P=0.046; r=0.26, P=0.015; r=0.25, P=0.017). Conclusion:DcR3 and its signal pathway-related molecules are differentially expressed in PBMCs of patients with AS, suggesting that they may participate in the occurrence and development of AS.
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Objective:The related literatures of ankylosing spondylitis in recent 10 years were visually analyzed by bibliometrics to explore the research hotspots and trends in this field.Methods:The Web of Science core collection database was used as the data source to retrieve relevant literatures on ankylosing spondylitis included from 2012 to 2021, and CiteSpace 5.8.R3 software was used to conduct keywords analysis of co-occurrence, burst, clustering and timeline, co-citation and burst analysis of references, and draw visual knowledge maps.Results:A total of 8 684 papers were included, and the overall number of publications showed a steady trend of increase, nearly doubled in the past 10 years. Thirteen papers with high academic influence were analyzed. Keywords such as pathogenesis, impact factors, epidemiology, treatment progression, and quality of life were hot research topics in recent years.Conclusion:In this study, through visual analysis of the literature in the field of ankylosing spondylitis research, it is found that secukinumab and ustekinomab are the future research hotspots and trends in this field.
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Objective:To investigate the clinical characteristics of patients with rheumatic diseases and abnormal liver function, as well as determine the proportion and severity of liver function abnormalities.Methods:Cross-sectional study. Data were collected from patients registered in the Chinese Rheumatism Date Center from 2011 to 2021. The rheumatic diseases analyzed in this study were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome (SS), ankylosing spondylitis (AS), and gout. Patient data, including demographic characteristics [ such as age, sex, body mass index,(BMI), and smoking history], liver function test results [including alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase(ALP), and total bilirubin], and use of anti-rheumatic immune drugs and liver-protective drugs, were collected and compared between groups with normal and abnormal liver functions. In addition, the proportions of abnormal liver function were compared between sex and age groups.Results:A total of 116 308 patients were included in this study, including 49 659 with RA, 17 597 with SLE, 9 039 with SS, 11 321 with AS, and 28 692 with gout. The lowest proportion of liver function abnormalities was observed in patients with RA[11.02% (5 470/49 659)], followed by those with SS[17.97% (1 624/9 039)] and AS [18.22% (2 063/11 321) ], whereas patients with SLE [21.14% (3 720/17 597) ] and gout [28.73% (8 242/28 692)] exhibited the highest proportion of these abnormalities. Elevated ALT, mostly classified as grade 1, was the most commonly noted liver function abnormality, whereas elevated ALP was the least common. Some patients who took liver-protective drugs had normal liver function, with the lowest percentage observed in patients with gout [7.45% (36/483) ] and ranging from 21.7% to 30.34% in patients with RA, SLE, SS, and AS. The proportion of liver function abnormalities was higher in males than in females for all disease types [RA: 13.8%(1 368/9 906) vs. 10.3%(4 102/39 753); SLE: 33.6% (479/1 424) vs. 20.0% (3 241/16 173); SS: 25.4%(111/437) vs. 17.6%(1 513/8 602); AS: 20.1%(1 629/8 119) vs. 13.6% (434/3 202); and gout: 29.3% (8 033/27 394) vs. 16.1% (209/1 298)]. In RA, SLE, and AS, the proportions of liver function abnormalities were similar across all age groups. In SS, the proportion of liver function abnormalities increased with age [<40 years: 14.9%(294/1 979); 40-59 years: 18.1%(858/4 741); ≥60 years: 20.4%(472/2 319)], whereas a reversal of this trend was observed in gout [<40 years: 34.9%(4 294/12 320); 40-59 years: 25.5%(2 905/11 398);≥60 years: 21.0%(1 042/4 971)].Conclusions:The proportions of combined liver function abnormalities in patients with rheumatologic diseases were high, and the utilization rates of liver-protective drugs were low. It is necessary to pay more attention to monitoring patients′ liver function, timely administer liver-protective drugs, and optimize liver-protective regimens during the treatment of rheumatic diseases.
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SUMMARY OBJECTIVE: The Oswestry Disability Index is considered the gold standard in the evaluation of disability in patients with chronic mechanical back pain. The aim of this study was to assess the applicability of Oswestry Disability Index in patients with ankylosing spondylitis and its relationship with disease assessment parameters for ankylosing spondylitis. METHODS: A total of 100 patients diagnosed with ankylosing spondylitis were included in the study group. The control group consisted of 50 individuals with nonspecific low back pain. The Oswestry Disability Index and Bath Ankylosing Spondylitis Disease Activity Index were applied to both groups. In addition, the Visual Analog Scale, the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein, the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate, the Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, and the Ankylosing Spondylitis Quality of Life scales were applied in the study group. the Erythrocyte Sedimentation Rate, C-Reactive Protein levels, and HLA-B27 analysis were noted as laboratory markers in ankylosing spondylitis patients. RESULTS: The scores of Oswestry Disability Index had a significant correlation with scores of Bath Ankylosing Spondylitis Disease Activity Index in ankylosing spondylitis patients (r=0.543) and in the control group (r=0.401). There was a significant correlation between the scores of Oswestry Disability Index and the Bath Ankylosing Spondylitis Functional Index (r=0.544), Bath Ankylosing Spondylitis Metrology Index (r=0.317), the Ankylosing Spondylitis Quality of Life (r=0.723), the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate (r=0.501), the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein (r=0.530), Visual Analog Scale-Rest (r=0.476), and Visual Analog Scale-Activity (r=0.441) values in patients with ankylosing spondylitis. CONCLUSION: Evaluation of Oswestry Disability Index in conjunction with Bath Ankylosing Spondylitis Disease Activity Index may warn the physician to interpret high Bath Ankylosing Spondylitis Disease Activity Index scores in the context of mechanical pain. Therefore, the use of Oswestry Disability Index in patients with ankylosing spondylitis will be beneficial.
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La espondilitis anquilosante es una enfermedad sistémica caracterizada por inflamación del esqueleto axial, las grandes articulaciones periféricas y los dedos, así como dolor, rigidez de la espalda y manifestaciones a otros niveles del organismo como puede ser en el ojo. Se presenta el caso de una paciente de 46 años de edad que acudió al Hospital Gustavo Aldereguía Lima, de Cienfuegos, por dolor lumbar y sintomatología urinaria refractaria a terapéutica habitual, por lo cual fue ingresada para estudio. Fue evaluada según su cuadro clínico y a través del empleo de exámenes complementarios, lo que permitió el diagnóstico de una espondilitis anquilosante. Se le impuso tratamiento con antinflamatorios no esteroideos y fue dada de alta médica con seguimiento por su área de salud. Por lo importante que resulta confirmar el diagnóstico temprano, antes de que ocurran deformidades irreversibles y así evitar secuelas e impotencia en los pacientes que la padecen, con lo cual se les garantiza una mayor calidad de vida, se decidió la presentación de este caso.
Ankylosing spondylitis is a systemic disease characterized by inflammation of the axial skeleton, large peripheral joints, and fingers, as well as pain, stiffness of the back, and manifestations at other levels of the body, such as the eye. We present the case of a 46-year-old patient who attended the Gustavo Aldereguía Lima Hospital, in Cienfuegos, due to lumbar pain and urinary symptoms refractory to usual therapy, for which she was admitted for study. She was evaluated according to her clinical picture and through the use of complementary tests, which allowed the diagnosis of ankylosing spondylitis. Treatment with non-steroidal anti-inflammatory drugs was prescribed and she was discharged with follow-up by her health area. Due to the importance of confirming the early diagnosis, before irreversible deformities occur and thus avoiding sequelae and impotence in patients who suffer from it, to guarantee them a better quality of life, it was decided to present this case.
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Objective:To investigate the clinical value of magnetic resonance imaging (MRI) in the early diagnosis of ankylosing spondylitis involving hip joint.Methods:One hundred and twenty-eight patients with ankylosing spondylitis involved in the hip joint were selected who were treated in the People′s Hospital of Longhua District from January 2017 to February 2020. The patients were divided into computed tomography(CT) group (64 cases) and MRI group (64 cases) according to the examination method of CT and MRI were performed respectively, and the incidence of abnormal hip joints were analyzed, and the prognostic treatment effects of the two groups were compared after following up.Results:Twenty-seven cases of fat deposition, 43 cases of subchondral bone marrow edema and 31 cases of inflammatory changes of tendon and ligament attachment were detected in MRI group, while CT didn′t showed these changes. Thirty-four cases of hip joint lesions were detected in CT group, the detection rate was 53.1%(34/64), and 56 cases of hip joint lesions were detected in MRI group, the detection rate was 87.50(56/64), the difference was statistically significant ( P<0.05). After treated for 3 months, the cure rate of the MRI group was higher than that of the CT group: 65.6%(42/64) vs. 34.4% (22/64), the difference was statistically significant ( χ2=18.11, P<0.05). Conclusions:MRI is an important imaging method for the early diagnosis of ankylosing spondylitis involving the hip joint, and its diagnostic sensitivity is better than that of CT.
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Objective:To investigate the effect of functional movement assessment on the recurrence of patients with ankylosing spondylitis (AS) after treat-to-target therapy.Methods:The clinical data of 61 patients with AS in Chengdu were collected including clinical symptoms and AS disease activity (ASDAS). After 24 weeks adalimumab treatment, motor function score of AS patients(ASDAS<1.3) was assessed by functional movement screen (FMS), then adalimumab was discontinued and the rest of the concurrent drugs were continued until the disease relapse or up to 1 year. The data of the two groups were compared using t-test analysis and Cox proportionate hazard model. Results:① The recurrence rate of patients with AS after treat-to-target therapy within 1 year follow-up was 57.4%; ② The recurrence group was younger [(27±7) vs (31±6), t=5.96, P=0.02], the ASADAS value was at the high end when adalimumab was withdrawal [(1.29±0.07) vs (0.87±0.16), t=177.31, P<0.01], and the FMS value was lower after treat-to-target [(12.9±2.7) vs (16.2±1.9), t=29.23, P<0.01], The time to reaching the treatment target was longer [(2.9±1.2) month vs (1.7±0.6) month, t=19.89, P<0.01] than the stable group; ③ The cut-off value of the FMS test of AS patients after treat-to-target therapy was 14.25 (sensitivity was 84.6%, specificity was 80%) . The time to treat-to-target was a risk factor for recurrence ( RR=2.285, P<0.05), and the FMS value after treat-to-target was a protective factor ( RR=0.625, P<0.05). Conclusion:After discontinuing the adalimumab, about half of the patients relapse. The time reaching the treatment target and the FMS value after treat-to-target therapy are the risk factors for disease recurrence.
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Objective:To detect the expression of interleukin 2 (IL-2)/Janus kinase 3/signal transduction and transcriptional activator 5 (JAK3/STAT5) signaling pathway in peripheral blood of patients with ankylosing spondylitis (AS) and explore its mechanism in the development and progression of AS.Methods:Clinical data, peripheral blood and laboratory tests of 30 patients with active AS (ASA), 30 patients with stable AS (ASS) and 50 healthy subjects (HC) were collected. The mRNA expression levels of JAK3, signal transduction and transcription activator 5a (STAT5a) and signal transduction and transcription activator 5b (STAT5b) were detected by quantitative real-time-polymerase chain reaction (RT-qPCR). The expression levels of JAK3, STAT5a and STAT5b proteins and phosphorylated proteins were detected by Western-blot. Plasma IL-2 concentration was determined by enzyme-linked immunosorbent assay (ELISA). Two independent samples t-test or one-way analysis of variance were used for measurement data consistent with normal distribution, LSD- t test was used for pairwise comparison between the three groups, Mann-Whitney U test or Kruskal-Wallis H test was used for non-normal distribution, χ2 test was used for correlation analysis of categorical variables. Spearman correlation analysis was used for correlation analysis between variables, and receiver operating characteristic (ROC) curve was used to evaluate the value of JAK3, STAT5a and STAT5b mRNA expression levels in monitoring AS activity. Results:① The mRNA expression levels of JAK3, STAT5a and STAT5b were significantly different among the three groups ( F=65.98, P<0.001; F=21.15, P<0.001; F=13.67, P<0.001). JAK3 mRNA expression in ASA group (2.5±0.9) was significantly higher than that in ASS group (1.1±0.4) and healthy subjects (1.0±0.5), the difference was statistically significant (both P<0.001). The mRNA expression level of STAT5a in ASA group (1.4±0.3) was significantly higher than that in ASS group (0.9±0.3) and healthy subjects group (1.0±0.3), the difference was statistically significant (both P<0.001). STAT5b mRNA expression level in ASA group (1.5±0.6) was significantly higher than that in ASS group (1.0±0.4) and healthy subjects (1.0±0.4), the difference was statistically significant (both P<0.001). The expression level of JAK3 mRNA in HLA-B27 positive group (1.9±1.0) was higher than that in HLA-B27 negative group (1.4±0.6), and the difference was statistically significant ( t=-2.22, P=0.032). The phosphorylation levels of JAK3, STAT5a and STAT5b showed statistically significant differences among the three groups ( F=91.56, P<0.001; F=25.15, P< 0.001; F=178.59, P<0.001). The phosphorylation level of JAK3 protein in ASA group (1.04±0.08) was significantly higher than that in ASS group (0.568±0.019) and healthy subjects (0.536±0.064), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5a protein in ASA group (1.166±0.096) was significantly higher than that in ASS group (0.923±0.018) and healthy subjects (0.911±0.017), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5b protein in ASA group (0.81±0.05) was significantly higher than that in ASS group (0.21±0.03) and healthy subjects (0.24± 0.07), the difference was statistically significant (both P<0.001). The difference of plasma IL-2 concentration among the three groups was statistically significant ( F=3.32, P=0.040). The IL-2 concentration in the ASA group [(110±40) pg/ml] was significantly higher than that in the ASS group [(89±40) pg/ml] and the healthy group [(88±39) pg/ml], the difference was statistically significant ( P=0.044, P=0.016). ② Spearman correlation analysis showed that STAT5a mRNA expression level was positively correlated with platelets in AS patients ( r=0.353, P=0.006). JAK3 mRNA expression level in ASA group was positively correlated with IL-2 concentration ( r=0.766, P<0.001), and negatively correlated with estimated glomerular filtration rate ( r=-0.485, P=0.007). STAT5a mRNA expression level was positively correlated with erythrocyte sedimentation rate ( r= 0.680, P<0.001), and STAT5b mRNA expression level was positively correlated with hypersensitive C-reactive protein (CRP) ( r=0.823, P<0.001). ③ The ROC curve showed that JAK3 mRNA expression level predicted the area under ROC curve (AUC) of ASA with a 95% CI of 0.920 (0.853, 0.987), sensitivity and specificity of 86.7% and 90.0%, respectively. STAT5a mRNA expression level predicted the AUC 95% CI of ASA was 0.874 (0.787, 0.961), and the sensitivity and specificity were 96.7% and 66.7%, respectively. STAT5b mRNA expression level predicted the AUC 95% CI of ASA was 0.749 (0.617, 0.881), and the sensitivity and specificity were 73.3% and 80.0%, respectively. Conclusion:This study suggests that IL-2/JAK3/STAT5 may be involved in the pathogenesis of AS, and JAK3 mRNA can be used as a biological indicator to monitor the activity of AS disease.
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Objective:To analyze the risk factors of patients with ankylosing spondylitis (AS) combined with premature coronary atherosclerotic heart disease (PCAD).Methods:A total of 74 patients with AS and coronary atherosclerotic heart disease (CAD) in Peking Union Medical College Hospital from January 1983 to July 2021 were enrolled. According to the age of onset of coronary heart disease, the 74 patients were divided into PCAD group and NPCAD (non-premature coronary heart disease) group. T test and Chi square test were used to analyze the data of the two groups, the risk factors for AS-PCAD were analyzed by multivariate Logistic regression. Results:① There were 37 cases in the PCAD group and 37 cases in the NPCAD group. In the PCAD group, there were 28 men and 9 women; wherease all were men in the NPCAD group. The difference was statistically significant ( χ2=10.25, P=0.001). ② Compared with the NPCAD group, the age of AS-PCAD group was younger [(23±10) years vs (29±12) years, t=-2.28, P=0.026], and the course from AS to CAD was shorter [(25±10) years vs (34±13) years, t=-3.00, P=0.004], hemoglobin (Hb) level was lower [(122±23) g/L vs(132±18) g/L, t=2.10, P=0.039], rate of anemia was higher [38.5%(14/37) vs 16.2%(6/37), χ2=4.39, P=0.037]. Proportion of increased C-reactive protein (CRP) was higher [65.5%(19/29) vs 35.5%(11/31), χ2=5.41, P=0.019]. ③ Juvenile onset AS (JoAS)[ OR(95% CI)=3.45(1.31, 9.10), P=0.012] and high levels of CRP [ OR (95% CI)=3.68 (1.44, 9.40), P=0.006] might berisk factors of AS-PCAD by multiple logisctic regression analysis. Conclusion:Patients with AS have a higher probability of PCAD, especially in those patients with JoAS, persistent inflammation and anemia. It is necessary to be alert to the risk of PCAD and early screening.
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Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.
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Objective:To predict the inflammatory activity of patients with ankylosing spondylitis (AS) after 12 weeks treatment with recombinant human tumor necrosis factor-α receptor Ⅱ immunoglobulinG Fc fusion protein (rhTNFR:Fc) by Doppler ultrasonography at baseline.Methods:A total of 60 patients with AS were selected, and their general clinical characteristics before and after treatment were compared. Meanwhile, Doppler ultrasonography of the sacroiliac joint was performed to compare the Doppler parameters before and after treatment, and the correlation between baseline Doppler ultrasonography and clinical characteristics was analyzed, along with its diagnostic performance. The pre-treatment and post-treatment parameters were compared to the measured data followed by paired t-test for normal distribution, and the counting data were paired with Chi- square test. Pearson correlation test was used to analyze the correlation between pretreatment ultrasound parameters and pre-treatment disease activity. All statistical tests were bilateral, with a statistically significant difference of P<0.05. Results:After treatment, the overall score [(1.4±1.0) points vs (6.0±1.8) points, t=17.80, P<0.001], night pain score [(1.6±1.2) points vs (5.7±1.5) points, t=15.80, P<0.001], back pain score [(1.9±1.3) points vs (5.5±1.2) points, t=16.39, P<0.001], morning stiffness [(12±6) min vs (38±21) min points, t=8.93, P<0.001], Bath ankylosing spondylitis disease activity index (BASDAI) [(1.1±0.6) vs (4.6±1.3), t=12.41, P<0.001], ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP) [(1.0±0.4) points vs (3.7±0.9) points, t=22.01, P<0.001] and ASDAS-erythrocyte sedimentation rate (ESR) [(1.0±0.7) points vs (4.0±0.8) points, t=20.10, P<0.001] of patients with ankylosing spondylitis were lower than those before treatment, and the differences were statistically significant ( P<0.001). Compared with AS patients before treatment, the color blood flow grading score was significantly lower after treatment [(1.7±0.8) points vs (3.9±1.1) points, t= 12.86, P<0.001). The post-treatment proportion of AS patients with bilateral sacroiliac joint blood flow signal was 67% (40/60), which was lower than 87% (52/60) before treatment, but the difference was not statistically significant ( P=0.251). After treatment, the peak systolic velocity (PSV), pulsatile index (PI) and resistance index (RI) were significantly higher than those before treatment [(30±17) cm/s vs (19±8) cm/s, t=-5.42, P<0.001; (1.55±0.69) vs (1.00±0.45), t=0.45, P<0.001; (0.81±0.11) vs (0.55±0.14), t=11.20, P<0.001)]. The end diastolic velocity (EDV) before and after treatment had no statistical significant differences [(6.7±2.5) cm/s vs (6.3±1.9) cm/s, t=0.80, P=0.428]. Baseline Doppler ultrasound parameters and pre-treatment clinical indicators showed that PI and RI were negatively correlated with BASDAI ( r=-0.49, P=0.005; r=-0.51, P<0.001) , and blood flow grades were positively correlated with BASDAI ( r=0.46, P=0.028). However, there were no significant correlation between PSV, EDV and BASDAI ( r=-0.12, P=0.176; r=0.03, P=0.756). Baseline Doppler ultrasound parameters were correlated with ASDAS-CRP ( r=-0.45, P=0.012; r=0.29, P<0.048; r=-0.52, P<0.035; r=-0.76, P<0.001; r=0.61, P<0.001). There was no correlation between EDV and ASDAS-ESR ( r=0.30, P=0.110), the other ultrasound Doppler parameters were correlated with ASDAS-ESR ( r=-0.36, P<0.001; r=-0.54, P<0.001; r=-0.61, P=0.021; r=0.41, P=0.028). The receiver operating characteristic curve was drawn with the baseline RI value as a variable. According to the ASDAS-CRP value, the diagnostic threshold for determining the presence or absence of AS activity after 12 weeks of treatment was 0.49, with an area under the curve of 0.817, sensitivity of 88.1%, specificity of 61.1%, positive predictive value of 66.7%, and negative predictive value of 86.1%. Conclusion:Baseline Doppler ultrasound correlates well with clinical indicators, among which baseline RI values is a good predictor of inflammatory activity status after rhTNFR:Fc treatment.
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Objective:To investigate the effect of baseline function movement assessment of ankylosing spondylitis (AS) on treatment outcomes.Methods:The clinical data of 90 patients with AS who met the medical insurance treatment for major disease in Chengdu were collected including clinical symptoms, functional movement screen (FMS) and ankylosing spondylitis disease activity score (ASDAS) after 24 weeks adalimumab treatment. They were divided into the non-treat-to-target group and the non-treat-to target group based on the ASDAS score, t-test or χ2 test was used to compare the differences between the two groups. Logistic regression model was used to analyze the influence of baseline FMS on the outcome of patients reaching the treatment target. Results:① The two groups were different in the FMS [(15.8±2.3) vs (12. 6±2.5), t=6.17, P<0.001], squat [(2.2±0.6) vs (1.7±0.5), t=3.57, P=0.001], hurdle spanning [(2.2±0.7) vs (1.8±0.6), t=2.11, P=0.038], straight lunge [(2.3±0.7) vs (1.7±0.5), t=4.23, P<0.001], shoulder flexibility [(2.5±0.6) vs (2.2±0.8), t=2.21, P=0.037], active straight leg raise [(2.1±0.6) vs (1.8±0.6), t=2.35, P=0.021], spinal stabilization pushups [(2.4±0.7) vs (1.8±0.8), t=3.76, P<0.001], body rotation stability [(2.2±0.7) vs (1.6±0.8), t=3.42, P=0.001] at baseline. ② The two groups were different in ASDAS score [(0.96±0.28) vs (2.19±0.52), t=14.69, P=0.000], FMS [(17.4±1.9) vs (12.7±2.8), t=9.77, P<0.001], deep squat [(2.6±0.5) vs (1.5±0.5), t=9.09, P<0.001], hurdle step [(2.2±0.6) vs (1.8±0.8), t=2.80, P=0.006], straight lunge [(2.6±0.6) vs (1.8±0.9), t=4.85, P<0.001], shoulder flexibility [(2.8±0.4) vs (2.5±0.5), t=2.10, P=0.038], active straight leg raise [(2.2±0.6) vs (1.9±0.8), t=2.46, P=0.016], spinal stability push-ups [(2.8±0.4) vs (1.6±0.7), t=10.36, P<0.001], and body rotation stability [(2.3±0.7) vs (1.6±0.8), t=4.76, P<0.001] at the end of the observation. ③ The cut-off value of the FMS for predicting whether AS patients meet the standard at baseline was 14.25 points (Sensitivity 0.733, specificity 0.800). ④ Logistic regression results showed that in the baseline, FMS series of action tests, squat [ OR (95% CI)=0.155 (0.035, 0.677), P=0.013], straight lunge [ OR (95% CI)=0.375 (0.148, 0.953), P=0.039], spinal stability push-ups [ OR(95% CI)=0.136(0.043, 0.436), P=0.001], and body rotation stability [ OR(95% CI)=0.308 (0.121, 0.780), P=0.013] were the influencing factors of the AS patient's treatment outcome ( P<0.05). Conclusion:The AS patients in the non-treat-to-target group have better FMS tests at baseline and at the end of the study than the non-treat-to-target group. Squats, straight lunges, remember stable push-ups, and body rotation stability are the influencing factors for the treatment outcomes of AS patients at baseline.
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Turner syndrome (TS) complicated with Madelung deformity and complex brachydactyly are rare clinically, and it is even rarer to combine with ankylosing spondylitis (AS). This article reports a case of a 36 year-old female patient who was admitted to the hospital with "ankylosing spondylitis" due to repeated back, hip and knee pain for 11 years and aggravated for 1 month. After admission, the karyotype showed "46, X, i (Xq)" due to short stature, dysplasia of secondary sexual characteristics, limb deformity etc, thus confirming TS. Further examination revealed bilateral Madelung deformity and complex brachydactyly characterized by shortening of the fourth metacarpal, multiple missing and shortened middle phalanxes. By reviewing the relevant literature, we believe that autoimmune diseases such as AS should be excluded in TS patients. TS aggravates the inflammatory response of AS, but the combination of TS and AS is more likely to be an accidental event. Patients with Madelung deformity should be careful to exclude TS. Madelung deformity and shortening of the fourth metacarpal are mainly associated with haploinsufficiency of SHOX gene. Brachydactyly characterized by multiple loss and shortening of the middle phalanx may be a new clinical manifestation of TS, especially the karyotype of 46, X, i (Xq). It is possible that there are some genes on the short arm of X chromosome, which regulate the number, growth and development of fingers. Early estrogen replacement therapy can greatly benefit patients.