RESUMO
We investigated the role of the Stoke Ankylosing Spondylitis Spine Score (SASSS) in a longitudinal cohort study of 53 patients with AS, assessed 9 yr apart, and its relation to clinical, functional and laboratory measures of disease activity and outcome. We also examined the long-term predictive value of quantitative sacroiliac scintigraphy (QSS). SASSS correlated closely with clinical measures, including occiput-wall distance (OWD) (P < 0.001) and modified Schober (P < 0.001). QSS was significantly correlated with final X-ray score (P < 0.05). SASSS changed significantly (P < 0.001) over the study period; two patterns of change in spine score were discernible, one with little change in radiological score and the other showing marked progression. The SASSS is a useful, valid score, which correlates with clinical outcomes measures and which has identified specific patterns of radiographic progression in AS.
Assuntos
Índice de Gravidade de Doença , Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Adulto , Idoso , Estudos de Coortes , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prognóstico , Radiografia , Cintilografia , Espondilite Anquilosante/complicaçõesRESUMO
In view of the recognised influence of smoking on the disease course of psoriasis and ulcerative colitis, and the association of these diseases with seronegative spondyloarthritis, we investigated a possible effect on outcome in ankylosing spondylitis. Thirtyone non-smokers, 12 exsmokers, and 10 smokers, with definite ankylosing spondylitis of a median duration of 20 years, were studied using clinical values (modified Schober, finger floor distance, total spinal movement), radiological (lumbar spine x-ray score), functional index, and laboratory assessment (ESR, CRP, Igs). There were statistically significant differences in the outcome between smokers and non-smokers for finger floor distance (p < 0.01), Schober test (p < 0.01), total spinal movement (p < 0.001), occiput-wall distance (p < 0.01), functional index (p < 0.01), stiffness (p < 0.01), and spine x-ray scores (p < 0.02). There was no statistically significant difference between the groups with regard to disease duration or age at onset. We conclude that smoking is associated with poor long term outcome in patients with ankylosing spondylitis.
Assuntos
Índice de Gravidade de Doença , Fumar/efeitos adversos , Espondilite Anquilosante/complicações , Adulto , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/terapia , Fatores de Tempo , Resultado do TratamentoRESUMO
The association between gastrointestinal disorders and arthritis is well recognized. We describe a 54-yr-old man who presented with a seronegative oligoarthritis in whom the clinical picture was consistent with a hypertrophic osteoarthropathy. An occult septic focus was identified when a barium enema demonstrated a diverticular abscess, treatment of which led to a complete resolution of symptoms.
Assuntos
Artrite Infecciosa/diagnóstico , Abscesso/complicações , Abscesso/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/etiologia , Artrografia , Bário , Diagnóstico Diferencial , Divertículo do Colo/complicações , Divertículo do Colo/diagnóstico por imagem , Enema , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/diagnósticoRESUMO
A postal survey has revealed wide variation in attitudes towards the need for prophylactic antibiotics in patients with implants who develop intercurrent infections, or who undergo surgical procedures. The available evidence is insufficient to reach any firm conclusions, however any patient who has an implant should receive swift treatment for intercurrent infections.
Assuntos
Antibacterianos/uso terapêutico , Prótese Articular , Infecções Relacionadas à Prótese/prevenção & controle , Coleta de Dados , Odontólogos , Medicina de Família e Comunidade , Humanos , Ortopedia , Médicos , Padrões de Prática Médica , Reumatologia , Inquéritos e QuestionáriosRESUMO
Glucocorticoids were first used therapeutically in the late 1940s. While they have revolutionised the treatment of many diseases, they also have many side effects, including osteoporosis. Although osteoporosis has been recognised as an important complication since the first use of steroids, we are still a long way from understanding the pathophysiology of steroid-induced osteoporosis.
Assuntos
Glucocorticoides/efeitos adversos , Osteoporose Pós-Menopausa/induzido quimicamente , Osteoporose Pós-Menopausa/prevenção & controle , Idoso , Densidade Óssea/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/fisiopatologia , Fatores de RiscoRESUMO
I describe the design and implementation of a new rotation for career grade registrars in rheumatology, and discuss what this implies for both trainers and trainees involved in such rotations. Some problems have occurred in relation to the geography of the rotation and in the choice of research projects undertaken during the rotation. I suggest possible solutions for these problems.