This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint ...

Developmental bone disease may be present, with rheumatological disorders as the major symptoms, even in children. The major lesions encountered are early osteo arthritis, osteo chondromatosis and vertebral involvement with two leading types, pseudo Scheuermann's disease or pseudo ankylosing spondylitis. This paper presents the different features and lists the rheumatological problems in bone dysplasia.

In a retrospective study of 399 patients with ulcerative colitis, 27 patients had colitic arthritis, 17 had ankylosing spondylitis, and 20 had clubbing of the fingers. Colitic arthritis and ankylosing spondylitis were not related to severity, extent of involvement, or duration of colitis. A signific...

The disease activity and functional impact of ankylosing spondylitis (AS) is currently measured through various questionnaire instruments, the most popular of which are the Bath indices. However, Hindi versions for use in Indian patients are not available. This study aimed to fill this lacuna. Translation and cross-cultural adaptation of the instruments?Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitits Metrology Index (BASMI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and Health Assessment Questionnaire-Spondyloarthropathy (HAQ-S)?were done using standard guidelines. These were then self-administered to patients. The BASMI measurements, occiput-to-wall distance, chest expansion (in centimeters), total enthesis count, ESR, and C reacti...

Quantitative sacroiliac scintigraphy was performed in 41 patients with ankylosing spondylitis (Sp.a.) and in 90 control subjects. The sacroiliac/sacrum ratio (Intex ISG/sacrum) was calculated. We examined the correlation between activity ratio on the one hand and age, subjective complaints, erythrocyte sedimentation rate, and antiinflammatory therapy on the other. Significantly increased uptakes were found in the patient group as a whole compared with the controls. The activity index was highest in the early periods of the disease, so we conclude that scintigraphy is useful in the early diagnosis of Sp.a.

... America (SAA) Launches Public Service Announcements to Hasten Arthritis Diagnosis Van Nuys, July 15, 2010 /PRNewswire/ — Ankylosing spondylitis (AS) is a crippling form of arthritis that generally strikes young people in their teens ...

... with the inflammatory bowel diseases, ulcerative colitis and Crohn's disease. Fast facts The major symptom in most patients ... the FDA for use in ankylosing spondylitis are: infliximab ( Remicade ), which is used at a dose of ...

Insulin dependent diabetes mellitus (IDDM) is considered to be an autoimmune disease. IDDM is associated with other autoimmune diseases such as rheumatoid arthritis, autoimmune thyroid disease, multiple sclerosis, ankylosing spondylitis, psoriasis and systemic lupus erythematosus. Dermatomyositis (D...

New classification criteria for axial spondyloarthritis have been developed with the goal of increasing sensitivity of criteria for early inflammatory spondyloarthritis. However these criteria substantially increase heterogeneity of the resulting disease group, reducing their value in both research and clinical settings. Further research to establish criteria based on better knowledge of the natural history of non-radiographic axial spondyloarthritis, its aetiopathogenesis and response to treatment is required. In the meantime the modified New York criteria for ankylosing spondylitis remain a very useful classification criteria set, defining a relatively homogenous group of cases for clinical use and research studies. PMID:23100608

Four patients with ankylosing spondylitis sustained a traumatic spinal injury. In three cases, pseudoarthrosis developed at the discovertebral junction, while involvement of the neural arch occurred in the fourth. Although the diagnosis of ankylosing spondylitis was readily established on plain radiographs, magnetic resonance more effectively indentified the complicating injury and in two cases demonstrated the presence of cord compression. Computed tomography was also contributory in delineating bony and ligamentous abnormalities of the neural arch. (orig.)

Arachnoid ossificans is a rare type of chronic arachnoiditis characterised by the presence of calcification or ossification of the dura and arachnoid. There are a few reports of these findings in relation to various disease entities, but only one case has been reported in relation to ankylosing spondylitis. We describe a 76-year-old man of ankylosing spondylitis with arachnoiditis ossificans, who has suffered from low back pain and neuropathic leg pain. PMID:22198660

Abstract in portuguese OBJETIVO: Traduzir e adaptar para a língua portuguesa do Brasil o Bath Ankylosing Spondylitis of Metrodology Index (BASMI) - instrumento de mensuração metrológica de pacientes com espondilite anquilosante - além de avaliar a reprodutibilidade deste questionário. MÉTODOS: O Bath Ankylosing Spondylitis of Metrodology Index em versão língua portuguesa do Brasil foi obtida após processo de tradução e retro-tradução. Essa nova versão foi aplicada em 25 pacientes (more) consecutivos com espondilite anquilosante, que preenchiam os critérios modificados de Nova Iorque de 1984 e que estavam em acompanhamento na Unidade de Espondiloartropatia Soronegativa do Serviço de Reumatologia da Faculdade de Medicina de Universidade de São Paulo, de maio a novembro de 2005. Para avaliar a reprodutibilidade, o questionário foi aplicado aos pacientes por dois observadores fixos e independentes: A e B (Reumatologistas), no mesmo dia, para avaliar teste interobservador. Após 14 dias, o observador A reaplicou o questionário aos mesmos pacientes para avaliação de teste intra-observador. Todas as entrevistas foram feitas no período de manhã. O coeficiente de correlação de Pearson foi usado para avaliação da reprodutibilidade. RESULTADOS: Não houve conflito quanto a tradução e re-tradução do questionário Bath Ankylosing Spondylitis of Metrodology Index. Também não houve a necessidade de adaptação cultural. Todos os componentes do Bath Ankylosing Spondylitis of Metrodology Index apresentaram coeficiente estatisticamente significante para reprodutibilidade intra e interobservadores, com escores, respectivamente, variando entre 0,85 a 1,00, e 0,80 a 0,94. DISCUSSÃO: O Bath Ankylosing Spondylitis of Metrodology Index, versão para a língua portuguesa do Brasil, mostrou-se ser um instrumento reprodutível para ser utilizado na avaliação do índice de mobilidade de pacientes brasileiros com espondilite anquilosante. Abstract in english PURPOSE: To translate and adapt the Bath Ankylosing Spondylitis Methodology Index (BASMI) - a metrological measurement for the assessment of patients with ankylosing spondylitis to Brazilian-Portuguese and to analyze the applicability of the questionnaire. METHODS: The Brazilian-Portuguese version of the Bath Ankylosing Spondylitis Methodology Index was achieved through a translation and back-translation process. This new Bath Ankylosing Spondylitis Methodology Index vers (more) ion was administered to 25 consecutive patients with ankylosing spondylitis who met the 1984 New York criteria for ankylosing spondylitis and were followed in the Soronegative Spondyloarthropathy Unit of the Rheumatology Division, São Paulo University Medical School, from May to November 2005. In order to evaluate the applicability of the questionnaire, it was administered to patients by 2 separate observers, A and B (Rheumatologists), enabling inter-observer test analysis. After 2 weeks, the second interview was administered to the same patients by observer A only to analyze the intra-observer test. All interviews were conducted in the morning. The Pearson coefficient correlation was used to evaluate applicability. RESULTS: There was no conflict stemming from translation and re-translation of Bath Ankylosing Spondylitis Methodology Index questionnaire, and cross-cultural adaptation proved unnecessary. All components had statistically significant coefficients for intra- and inter-observational applicability, with scores ranging from 0.85 to 1.00 and 0.80 to 0.94, respectively. DISCUSSION: The Brazilian-Portuguese version of the Bath Ankylosing Spondylitis Methodology Index proved to be an applicable instrument for analyzing the mobility index of Brazilian patients with ankylosing spondylitis.

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapies in the management of patients with ankylosing spondylitis. This chronic inflammatory skeletal disorder, a subtype of spondyloarthritis, is characterized by inflammatory back pain and affects young adults causing important suffering and disability. Long-term use of conventional NSAIDs is associated with a risk of gastrointestinal complications. Etoricoxib is a specific cyclooxygenase 2 inhibitor with strong anti-inflammatory effects and a favorable pharmacokinetic profile for the management of inflammatory disorders. The drug has been associated with reduced severe gastrointestinal adverse events. However, the cardiovascular safety of cyclooxygenase 2 inhibitors has been debated. Areas covered: This review discusses etoricoxib in the treatment of ankylosing spondylitis. Literature searches were performed in PubMed, Web of Science, and the Cochrane library based on the terms "etoricoxib" and "ankylosing spondylitis" or "spondyloarthritis" as well as "safety" and "side-effects." Expert opinion: Etoricoxib is useful in the first-line management of ankylosing spondylitis patients. Its anti-inflammatory effects and relative protection against severe gastrointestinal side effects should be balanced with negative effects on the cardiovascular system and an overall subjective tolerance not better than that of conventional NSAIDs. Whether etoricoxib will also become a mainstay in the prevention of structural damage in ankylosing spondylitis is not yet clear. PMID:23126318

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Decreased bone mineral density (BMD) is a common complication of AS, with a prevalence range of 19 to 62 %. Many studies have shown decreased BMD in AS with long disease duration, but only a few studies investigated BMD in early AS. The prevalence of decreased BMD in early disease stages of AS has not yet been clearly described, and for that reason, we reviewed the literature which describes the prevalence of decreased BMD in AS patients with a short disease duration (<10 years). In this review, we included articles which used the modified New York criteria for the diagnosis of AS, included patients with a disease duration of less than 10 years, and used the WHO criteria for osteopenia and osteoporosis. Decreased BMD ...

This study aimed to develop a simplified version of the Ankylosing Spondylitis Disease Activity Score (ASDAS). The study included consecutive patients with ankylosing spondylitis according to modified New York and/or Assessment in Ankylosing Spondylitis 2009 criteria. Sociodemographic data and characteristics of the disease (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Ankylosing Spondylitis Quality of Life (ASQoL)) and erythrocyte sedimentation rate (ESR) were collected. ASDAS simplified version (SASDAS) was calculated as the simple linear sum of the five components of ASDAS which include: patient global assessment using visual analogue scale, back pain (BASDAI question no. 2), peripheral pain and swelling (BASDAI question no. 3), morning stiffness (BASDAI question no. 6), and ESR in millimeters per hour, divided by 10 so as to make it equivalent to the other scale's components. Eighty-six patients were included: 69 (80.2 %) were men with a median age of 46 years and median disease duration of 19 years. SASDAS showed an excellent correlation with the ASDAS (r?=?0.93). SASDAS also showed a good correlation with night pain (r?=?0.60), global pain (r?=?0.69), ASQoL (r?=?0.70), BASFI (r?=?0.75), and BASDAI (r?=?0.96). Using ASDAS cut-off values previously suggested, the corresponding cut-off values for SASDAS were as follows: from 0 to 7.8 (inactive disease), from 7.9 to 13.8 (moderate disease activity), from 13.9 to 27.6 (high disease activity), and above 27.6 (very high disease activity) with optimum sensitivity and specificity. SASDAS showed an excellent correlation with conventional clinical measures of disease activity, and it can be easily calculated and is simple to use in daily clinical practice. PMID:22895877

To evaluate ANA specificity using the fully automated multiplexed fluorescent microsphere immunoassay in patients affected either by rheumatoid arthritis or ankylosing spondylitis who developed strong positivity for ANA as assessed by indirect immunofluorescent method on HEp-2 cells during infliximab treatment. Three men affected by ankylosing spondylitis and 12 women affected by rheumatoid arthritis who developed ANA positivity at high titres during infliximab treatment underwent the identification of ANA specificity by multiplexed fluorescent microsphere immunoassay; moreover anti-DNA and anti-ENA antibodies were tested by indirect immunofluorescence and ELISA method, respectively. In 4 out of 15 cases, the determination of ANA reactivity by multiplexed fluorescent microsphere immunoassa...

Spondyloarthropathies (SpA) are a group of inflammatory arthritis which consist of ankylosing spondylitis (AS), reactive arthritis, arthritis/spondylitis associated with psoriasis (PsA), and arthritis/spondylitis associated with inflammatory bowel diseases. It is now more important than ever to diagnose and treat SpA early. New therapeutic agents including blockers of tumor necrosis factor have yielded tremendous responses not only in advanced disease but also in the early stages of the disease. Sacroiliitis on conventional radiography is the result of structural changes which may appear late in the disease process. However, magnetic resonance imaging (MRI) can visualize active inflammation at sacroiliac joints and spine in recent onset disease. The modified New York criteria, the European Spondyloarthropathy Study Group criteria and the Amor criteria do not include advanced imaging techniques like MRI which is very sensitive to the early Inflammatory changes. Assessment of SpondyloArthritis international Society has defined MRI methods for the assessment of sacroiliac joints and spine, criteria for inflammatory back pain and developed new criteria for classification of axial and peripheral spondyloarthritis. These new criteria are intended to be used for patients with SpA at the very early stage of their disease. Also, classification of psoriatic arthritis study group developed criteria for the classification of PsA. The widespread use of these criteria in clinical trials will provide evidence for a better definition of early disease and recognize many patients who may further develop classical AS or PsA. These efforts will guide therapeutic trials of potent drugs like biological agents in the early stage of these diseases. PMID:22474629

Background: The ILAR classification criteria define enthesitis related arthritis (ERA) as a subtype of juvenile idiopathic arthritis. It is the subtype most similar to adult ankylosing spondylitis. Axial disease is said to be a late feature, with lower limb arthritis and enthesitis prominent early symptoms. There have been no observational studies since the development of the ILAR criteria. The aim of this study was to identify ERA patients with axial disease and compare their clinical characteristics to those with peripheral disease. Methods: Patients with ERA were identified from those attending our adolescent rheumatology clinic. A retrospective case review was undertaken and a database of clinical manifestations, radiology and treatment compiled. A comparison of patients with confirmed...

DRESS syndrome (Drug Rash, Eosinophilia and Systemic Symptoms) represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as skin rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine induced DRESS syndrome, but myocardial involvement was rare. High index of suspicion is needed in every patient receiving these drugs for prompt diagnosis and early management. We report a case of a 56-year-old lady treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted and ultimately she developed to...

OBJECTIVE: To investigate the relationships between several health outcomes in ankylosing spondylitis (AS). METHODS: Baseline pretreatment data from 214 patients with AS participating in the AS Study for the Evaluation of Recombinant Infliximab Therapy were analysed. Measures of health-related qual...

Objective. To evaluate the cost effectiveness and cost utility of a 3-week course of combined spa therapy and exercise therapy in addition to standard treatment consisting of antfinflammatory drugs and weekly group physical therapy in ankylosing spondylitis (AS) patients. Methods. A total of 120 Dut...

Tumor necrosis factor (TNF) has been implicated in a number of arthritic disease states, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Adalimumab is the first fully human, high-affinity, recombinant immunoglobulin G1 (IgG1) anti-TNF monoclonal antibody. Adalimumab ...

Objective. To determine the efficacy of combined spa-exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS). Methods. A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients ea...

Golimumab, a human anti-TNF? IgG1. monoclonal antibody, was approved in the US and Canada in April 2009 as a treatment for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and is undergoing regulatory review in the EU for these indications. The product was developed by Centocor ...

Objective To assess the efficacy and safety of golimumab over 104 weeks in patients with active ankylosing spondylitis. Methods At baseline, patients with active ankylosing spondylitis (n=356) were randomly assigned (1:1.8:1.8) to subcutaneous injections of placebo (group 1), golimumab 50 mg (group 2) or golimumab 100 mg (group 3) every 4 weeks. At week 16, patients in groups 1 and 2 with golimumab 50 mg. Findings through week 24 were previously reported; those through week 104 are presented herein. Results At week 104, 38.5%, 60.1% and 71.4% of patients in groups 1, 2 and 3, respectively, had at least 20% improvement in the Assessment in SpondyloArthritis international Society response criteria (ASAS20); 38.5%, 55.8% and 54.3% had an ASAS40 response and 21.8%, 31.9% and 30.7% were in ASAS partial remission. Mean Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores were Golimumab safety through week 104 was similar to that through week 24. Conclusion Clinical response that was achieved by patients receiving golimumab through 24 weeks was sustained through 52 and 104 weeks. The golimumab safety profile appeared to be consistent with the known safety profile of tumour necrosis factor inhibitors. PMID:19401359

We present a 26-year-old man with edema, ascites and bloody diarrhea that later proved to be due to gastrointestinal and renal amyloidosis. Interestingly, he was also diagnosed as having ankylosing spondylitis,-possibly after a delay of 12 years. The obscure diagnosis and challenging treatment of secondary amyloidosis are further discussed. PMID:14677023

Patients with ankylosing spondylitis were asked to follow a 'klebsiella exclusion diet' for 5 months of a 10-month study. The same percentage of faecal samples were positive for klebsiella whether the patients were on or off the experimental diet. The diet also failed to influence variability of kle...

We determined the alleles of KIR3DL1 and KIR3DS1 in a cohort of British Caucasian ankylosing spondylitis (AS) patients and HLA-B27-positive controls. We found no association in frequencies of the alleles of these genes in AS. In addition, no differences were found when the patients and controls were differentiated by gender. PMID:19874556

The following topics were discussed in outline at a two day conference organized by I.B.C. Technical Services Ltd, February 1989, in London: radiation carcinogenesis mechanisms, environmental exposure, occupational exposure trends and comparisons, ICRP risk assessment and use of data including that of A-Bomb survivors, the ankylosing spondylitis study, UKAEA and AWE mortality studies, Sellafield, leukemia clusters and radiation hormesis.

The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (week 12 and week 24) evaluation was performed by one of the authors who was blind to the group allocation. Primary outcome measure was functional capacity. Evaluation was done using the Bath Ankylosing Spondylitis Functional Index (BASFI). Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Chest expansion, and ankylosing spondylitis quality of life (ASQOL) questionnaire. In group I, BASFI showed significant improvement at week 12 (P = 0.031) and week 24 (P = 0.007). In group II, this parameter was not found to have significantly changed at week 12 and week 24. Comparison of the groups showed significantly superior results for group I at week 24 (P = 0.023). We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients. Our study is the first clinical study designed to investigate the role of Pilates method in AS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS. PMID:21499876

Psoriatic arthritis is a diverse condition that may be characterized by peripheral inflammatory arthritis, axial involvement, dactylitis and enthesitis. Magnetic resonance imaging (MRI) allows visualization of soft tissue, articular and entheseal lesions, and provides a unique picture of the disease process that cannot be gained using other imaging modalities. This review focuses on the literature on MRI in psoriatic arthritis published from 1996 to July 2005. The MRI features discussed include synovitis, tendonitis, dactylitis, bone oedema, bone erosions, soft tissue oedema, spondylitis/sacroiliitis and subclinical arthropathy. Comparisons have been drawn with the more extensive literature describing the MRI features of rheumatoid arthritis and ankylosing spondylitis.

The Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) was built by adding five new questions related with cervical and lumbar spine functions to HAQ by Daltroy et al. (in J Rheumatol 17(7):946?945, 1990). The aim of this study was to adapt the added five items into Turkish and then to test its reliability and validity. New questions were adapted to Turkish according to ?translation-back translation? method. Seventy-nine patients with ankylosing spondylitis were asked with the Turkish version of HAQ-S (HAQ-S TV). To assess, construct validity patients were evaluated by HAQ, Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), Maastricht AS Enthesitis Score (MASES), Ankylosing Spondylitis Quality of Life (ASQoL), and labo...

ObjectivesThe prevalence of spondyloarthritis (SpA) and its prototype ankylosing spondylitis (AS) varies considerably in different parts of the world. With 20% of the world’s population in China, there is potential for a significant disease burden. Eight of the 10 articles providing primary data on the prevalence of SpA in China are in the Chinese language; our objective is to review all 10 articles for English readers.MethodsArticles were retrieved by search engines in both the English language (www.pubmed.gov) and Chinese language web sites (www.cnki.net). We limited our search to publications of the period 1994 to 2006, and the key words used were (entered as Chinese characters) “prevalence AND spondyloarthropathy,” “prevalence AND ankylosing spondylitis,...

Background: Juvenile ankylosing spondylitis (JAS) is a type of arthritis that affects the spine and the sites where the muscles, tendons, and ligaments are attached to bone, with frequent onset before 15 years of age preferably in boys. Currently, besides standard schemes of immunosuppresive therapy, administration of biological agents, influencing on various components of pathogenesis is most perspective. One of them consists in administration of monoclonal anti-TNF-a-antibodies, consisting in variable area of murine highly affinitive neutralizing monoclonal antibodies to TNF-a(2), combined to fragment of human IgG - infliximab. Methods: 58 patients with juvenile ankylosing spondylitis were enrolled in the study, from them there are 17 girls and 41 boys. Median age of the patients was 12 ...

Clinical and cerebral magnetic resonance imaging (MRI) findings in a patient with ankylosing spondylitis (AS) and multiple sclerosis-like (MS-like) syndrome are reported. Cerebral MRI demonstrated multiple, MS-like, scattered foci of signal abnormality, one of which showed contrast enhancement. Lesion dissemination in ''space and time'' is a hallmark for diagnosis of MS, and its demonstration by enhanced cerebral MRI prompted suspicion of coexistence of MS and AS in our patient. (orig.)

Osteopoikilosis (OPK) is a rare benign sclerosing disease of the skeleton and inherited as an autosomal dominant trait. OPK is associated with inflammatory rheumatic disorders, such as rheumatoid arthritis, scleroderma, reactive arthritis and familial Mediterranean fever (FMF). We report a rare case of OPK coexistent with ankylosing spondylitis and FMF. The patient presented multiple sclerotic lesions within and around the sacroiliac joints and a series of radiological diagnostic challenges.

Therapy with TNF blockers may induce cutaneous adverse events, but the development of morphea, a localized scleroderma lesion, is extremely infrequent. We describe a 37-year-old man with ankylosing spondylitis treated with adalimumab who developed morphea lesions in the lower limbs after 12?months of treatment. Adalimumab was discontinued, which resulted in progressive improvement in the skin lesions, with only mild hyperpigmentation remaining. We also review reports of morphea and other adverse cutaneous events related to anti-TNF treatment.

Abstract The development of biological drugs blocking tumour necrosis factor-alpha (TNF-a?) has had a dramatic impact on the treatment of inflammatory arthritis in recent years. Golimumab is a fully human monoclonal antibody which inhibits TNF-a?. It is licensed for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. In this review we evaluate the results of phase III studies using golimumab and explore the place of golimumab in the treatment of these diseases.

Abstract in spanish En esta segunda parte analizamos los inicios y la evolución de la Gota y de la Espondilitis Anquilosante. Relatamos nuevamente la importancia del arte en el desarrollo del conocimiento de estas enfermedades reumáticas. Abstract in english In this second part, we analyzed the beginning and the evolution of the Gout and Ankylosing Spondylitis. We relate again the importance of art in the development of knowledge of this rheumatic diseases.

Tofacitinib (CP-690,550; CP-690550; CP690550), an orally active immunosuppressant, is being developed by Pfizer for the treatment of rheumatoid arthritis, inflammatory bowel disease, dry eyes, ankylosing spondylitis, psoriasis, psoriatic arthritis, and for the prevention of transplant rejection. Tofacitinib specifically inhibits Janus activated kinase 3 (JAK3), which has a pivotal role in cytokine signal transduction that governs lymphocyte survival, proliferation, differentiation, and apoptosis. This review discusses the key development milestones and therapeutic trials of this drug. PMID:21171673

Objective Identify serum biomarkers modulated by golimumab treatment and associated with clinical response in patients with ankylosing spondylitis (AS). Methods Sera were collected at weeks 0, 4 and 14 from 100 patients with active AS in the GO–RAISE study. Patients were randomly assigned subcutaneous injections of placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks. Samples were tested for select inflammatory, bone and cartilage markers, and protein profiling was also performed. Results Golimumab treatment resulted in significant decreases in several serum proteins at weeks 4 and 14 compared with placebo. Patients who achieved clinical response at week 14, as assessed by a ?20% improvement in the Assessment in SpondyloArthitis international Society response criteria (ASAS 20), demonstrated a distinct biomarker profile with lower levels of acute phase reactants and inflammatory biomarkers compared with patients who did not. Notably, combinations of two or three biomarkers assessed at baseline were predictive of various clinical outcomes (ASAS 20, Bath ankylosing spondylitis disease activity index 50 or Bath ankylosing spondylitis functional index) using a logistic regression analysis, and the overall predictive values for these combined biomarkers were greater than observed for C-reactive protein (CRP) alone. Conclusion Golimumab modulated acute phase reactants and inflammatory markers in patients with active AS. Specific combinations of biomarkers at baseline demonstrated a stronger prediction for clinical efficacy than CRP alone. These data provide insights into the mechanism of golimumab on inflammatory processes driving AS pathology, and may have utility in managing the treatment of patients with AS. PMID:2249907

Osteological changes consistent with ankylosing spondylitis were observed in three males and one female skeleton recovered from four medieval sites-Velim, Koprivno, Buje, and Rijeka-all situated on Croatia's eastern Adriatic coast and its immediate hinterland. The skeletons present changes in the spine, ribs, sacrum, and innominates that are typical of ankylosing spondylitis that is a progressive, inflammatory disease of connective tissue calcification. The disease most commonly affects the sacroiliac joints, the joints of the spine, and the costovertebral joints. In the final stages of the disease, the vertebral bodies remodel and together with the associated syndesmophytes form a continuous, smooth bone surface that is sometimes referred to as "bamboo spine." The prevalence of this disorder in the analyzed Croatian samples is 4/303 or 1.3% and thus corresponds with frequencies recorded in modern European populations. Differential diagnosis rules out the possibility of DISH, rheumatoid arthritis, and melorheostosis. These are the first cases of ankylosing spondylitis identified in Croatian archaeological series. PMID:22210271

Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years, partially due to increased understanding of the pathogenesis of these diseases at the cellular and molecular levels. These conditions share some common mechanisms. Biologic therapies have provided a clear advance in the treatment of rheumatological conditions. Currently available TNF-targeting biologic agents that are licensed for at east one of the above-named diseases are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Biologic agents with a different mechanism of action have also been approved in rheumatoid arthritis (rituximab, abatacept, and tocilizumab). Although these biologic agents are highly effective, there is a need for improved management strategies. There is also a need for education of family physicians and other healthcare professionals in the identification of early symptoms of inflammatory arthritides and the importance of early referral to rheumatologists for diagnosis and treatment. Also, researchers are developing molecules - for example, the Janus kinase inhibitor CP-690550 (tofacitinib) and the spleen tyrosine kinase inhibitor R788 (fostamatinib) - to target other aspects of the inflammatory cascade. Initial trial results with new agents are promising, and, in time, head-to-head trials will establish the best treatment options for patients. The key challenge is identifying how best to integrate these new, advanced therapies into daily practice. PMID:21624184

Abstract in portuguese A espondilite anquilosante é uma doença reumática crônica de homens jovens que afeta principalmente o esqueleto axial e está associada ao HLA-B27 em 90% dos casos. A incidência de envolvimento cardiovascular em casos de espondilite anquilosante varia entre 10%-30%; foram descritos distúrbios de condução em 1%-9% dos pacientes com a doença. A maior parte do grupo acometido demonstra uma relação com doença de longa data. Este é o primeiro relato de bloqueio cardíaco completo em espondilite anquilosante precoce de nosso conhecimento. Abstract in english Ankylosing spondylitis (AS) is a chronic rheumatic disease of young men that affects mainly the axial skeleton and is associated with HLA-B27 in 90% of the cases. Incidence of cardiovascular involvement in AS ranges between 10%-30%; conduction disturbances have been described in 1%-9% of the patients with AS. The majority of the series show a relationship with longstanding disease. To our knowledge, this is the first report of complete heart block in early AS.

The objectives of this study were to evaluate the reliability of Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI) in Chinese ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA) patients. 664 AS patients by the revised New York criteria for AS and 252 USpA patients by the European Spondyloarthropathy Study Group criteria were enrolled. BASDAI and BASFI questionnaires were translated into Chinese. Participants were required to fill in BASFI and BASDAI questionnaires again after 24 h. Moreover, BASDAI and BASFI were compared in AS patients receiving Enbrel or infliximab before and after treatment. For AS group, BASDAI ICC: 0.9502 (95% CI: 0.9330-0.9502, ?=0.9702), BASFI ICC: 0.9587 (95% CI: 0.9521-0.9645, ?=0.9789). For USpA group, BASDAI ICC: 0.9530 (95% CI: 0.9402-0.9632, ?=0.9760), BASFI ICC: 0.9900 (95% CI: 0.9871-0.9922, ?=0.9950). In the AS group, disease duration, occipital wall distance, modified Schober test, chest expansion, ESR, and CRP showed significant correlation with BASDAI and BASFI (all P<0.01). In the USpA group, onset age, ESR, and CRP were significantly correlated with BASDAI (all P<0.05), while modified Schober test, ESR, and CRP were significantly associated with BASFI (all P<0.05). The change in BASDAI and BASFI via Enbrel or infliximab treatment showed a significant positive correlation (P<0.01). The two instruments have good reliability and reference value regarding the evaluation of patient's condition and anti-TNF-? treatment response. PMID:20012866

OBJECTIVES: To evaluate the efficacy and safety of adalimumab in patients with peripheral spondyloarthritis (SpA) not fulfilling the criteria for ankylosing spondylitis (AS) or psoriatic arthritis (PsA). METHODS: 40 patients with active peripheral SpA fulfilling the European Spondyloarthropathy Study Group or Amor criteria but not the criteria for AS or PsA were included in a randomised, double-blind, placebo-controlled clinical trial. Patients were treated 1?:?1 with adalimumab or placebo for 12 weeks, followed by an open label extension up to week 24. Safety and efficacy measurements were performed every 6 weeks, with the patient's global assessment of disease activity at week 12 as the primary endpoint. RESULTS: At week 12, the patient's and physician's global assessment of disease activity, swollen joint count, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and erythrocyte sedimentation rate improved significantly in the adalimumab group compared with the baseline values and compared with placebo. A similar improvement was seen upon adalimumab treatment from weeks 12 to 24 in the patients originally randomised to placebo, whereas the clinical response was maintained or even augmented at week 24 in the patients who received adalimumab from the start. ASDAS inactive disease and BASDAI50 responses were met in 42% of the adalimumab group versus 0%-5% in the placebo group at week 12 (p=0.001 and p=0.008, respectively), and were further increased at week 24. The number of adverse events was not different between the adalimumab and placebo groups. CONCLUSIONS: Adalimumab appears to be effective and well tolerated in SpA patients with peripheral arthritis, also in those patients not fulfilling the AS or PsA criteria. PMID:23139265

The study aims to assess and compare the efficiency of two different kinetic programmes, in order to improve the treatment of patients with ankylosing spondylitis (AS). MATERIAL AND METHOD: Our study included two samples (control and cases) of 30 patients admitted for AS and unilateral coxitis in the Clinic of Rheumatology and Medical Rehabilitation Iasi, between 2008-2009. Certain paramentres such as: age, body mass index, disease evolution, Schober test, index-earth test, inspir-expir index, BASDAI activity index, BASFI functional index, Health Assessment Questionaire (HAQ), pain, morning ankylosing inflammatory tests, and general state of health were assessed at every patient. RESULTS: No variation with statistical significance were registered between the two samples. The Pilates method used in the rehabilitation treatment of patients with AS could have a favourable effect on indices regarding mobility, as well as patients' perception about their disease. PMID:21500451

The course of axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS), is strongly influenced by the degree of disease activity over time, which is mainly based on inflammation, and by the impairment of function, which is based on structural damage-mainly, new bone formation-and inflammation. In AS, nonsteroidal anti-inflammatory agents are currently recommended as the first choice of medical therapy, and there is also a clear role for regular exercise and physiotherapy in order to preserve and prevent loss of spinal mobility. For patients who have insufficiently responded to conventional medications, there are now four biologics approved for the treatment of patients with active AS in many countries, all directed against TNF?: infliximab, etanercept, adalimumab, and golimumab; studies with certolizumab are currently ongoing. Several studies with patients classified as nonradiographic axSpA have also shown a good response to TNF blockers; in patients with early disease and high CRP levels, the response rates were even better. Long-term studies with TNF blockers have shown declining retention rates over time but sustained clinical efficacy in the patients who remained on treatment. States of drug-free remission are rarely reached and only for relatively short periods of time. More studies including magnetic resonance imaging (MRI) are needed to further examine the lack of effect of anti-TNF treatment on radiographic progression in the axial skeleton. Whether the effect of an early intervention with biologics will prevent the development of bone growth in patients with nonradiographic axial SpA remains to be seen. Biologics other than TNF blockers are currently not recommended for the treatment of patients with axSpA, because of insufficient evidence of clinically relevant efficacy. The anti-IL-17a antibody secukinumab may be efficacious, on the basis of a proof-of-concept trial. Finally, first data on biosimilars of TNF blockers have recently been presented. PMID:22855297

Diffuse idiopathic skeletal hyperostosis (DISH) is difficult to distinguish from various forms of inflammatory arthritis, including psoriatic arthritis (PsA), rheumatoid arthritis, and ankylosing spondylitis. A 67-year-old Japanese male had been treated for psoriasis vulgaris for 13?years. Numbness of his right arm and lower limbs and spinal stiffening had developed 7?years prior to his initial evaluation at our facility. He noticed pain mainly while exercising. There were symmetrical marginal syndesmophytes in the spine, from the thoracic vertebrae to the upper lumbar vertebrae, on radiological examinations. We therefore suspected DISH. Furthermore, ossifications of the posterior and anterior longitudinal ligaments were noted in the cervical spine. Laboratory examinations revealed a norma...

Abstract in portuguese O presente trabalho propõe uma revisão de epidemiologia, patogênese, quadro clínico, diagnóstico e tratamento da espondilite anquilosante e sua associação com alteração ocular com a devida condução da doença e suas manifestações. Os autores utilizaram em sua pesquisa os bancos de dados PubMed (MEDLINE), LILACS e Biblioteca do Centro de Estudos de Oftalmologia. A espondilite anquilosante é uma doença inflamatória crônica que acomete preferencialmente o es (more) queleto axial, podendo evoluir com rigidez e limitação funcional progressiva. Seu início costuma ocorrer por volta da segunda à terceira década de vida, preferencialmente em indivíduos do gênero masculino, caucasianos e HLA-B27-positivos. Sua etiologia e patogênese não são completamente elucidadas, e seu diagnóstico costuma ser tardio. O controle clínico e o tratamento são frequentemente satisfatórios.A uveíte anterior aguda é a manifestação extra-articular mais comum, ocorrendo em cerca de 20%-30% dos pacientes com espondilite anquilosante. Aproximadamente metade dos casos de uveíte anterior aguda está associada à presença do antígeno HLA-B27, podendo ser a primeira manifestação de uma doença reumatológica não diagnosticada, geralmente com boa resposta terapêutica e bom prognóstico. Concluímos que, para melhor avaliação e tratamento dos pacientes com uveíte, é importante maior integração entre oftalmologistas e reumatologistas. Abstract in english The present article reviews the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of ankylosing spondylitis and its association with ocular changes. The authors used the PubMed (MEDLINE), LILACS, and Ophthalmology Library databases. Ankylosing spondylitis is a chronic inflammatory disease that usually affects the axial skeleton and can progress to stiffness and progressive functional limitation. Ankylosing spondylitis usually begins around the second (more) to third decade of life, preferentially in HLA-B27-positive white males. Its etiology and pathogenesis are not completely understood, and its diagnosis is diffi cult. Clinical control and treatment are frequently satisfactory. Acute anterior uveíte is the most common extra-articular manifestation, occurring in 20%-30% of the patients with ankylosing spondylitis. Approximately half of the acute anterior uveíte cases are associated with the presence of the HLA-B27 antigen. It can be the first manifestation of an undiagnosed rheumatic disease, usually having a good prognosis and appropriate response to treatment. In conclusion, for better assessment and treatment of patients with uveitis, ophthalmologists and rheumatologists should work together.

Over the last decade, biologic therapeutic proteins have advanced the treatment of diseases such as rheumatoid arthritis (RA). Therapeutic antibodies such as infliximab, adalimumab, rituximab, tocilizumab, golimumab, certolizumab pegol, the receptor construct etanercept, and abatacept, an anticluster of differentiation (CD)80/anti-CD86 fusion protein, are used as treatment for RA and ankylosing spondylitis (AS). Infliximab, adalimumab, golimumab, certolizumab pegol, and etanercept are inhibitors of tumor necrosis factor (TNF), a key regulator of inflammation. Left untreated, progression of rheumatic diseases due to inflammation can lead to irreversible joint damage and serious disability. One limitation for the use of therapeutic antibodies is immunogenicity, the induction of antibodies by...

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapies in the management of patients with ankylosing spondylitis. This chronic inflammatory skeletal disorder, a subtype of spondyloarthritis, is characterized by inflammatory back pain and affects young adults causing important suffering and disability. Long-term use of conventional NSAIDs is associated with a risk of gastrointestinal complications. Etoricoxib is a specific cyclooxygenase 2 inhibitor with strong anti-inflammatory effects and a favorable pharmacokinetic profile for the management of inflammatory disorders. The drug has been associated with reduced severe gastrointestinal adverse events. However, the cardiovascular safety of cyclooxygenase 2 inhibitors has been debated. Areas covered: This review ...

Golimumab (Simponi, Centocor Ortho Biotech Inc., PA, USA) is the first transgenic human monoclonal antibody against TNF-alpha that has been approved in the treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Golimumab is synthesized using conventional hybridoma technique after immunizing transgenic mice containing human immunoglobulin genes. The constant region of golimumab is identical to that of infliximab, but the variable regions of golimumab have fully human sequences. In this article, we present the pharmacodynamic and pharmacokinetic properties as well as the clinical efficacy and tolerability of golimumab. PMID:20635999

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by symmetric arthritis leading to progressive erosion of cartilage and bone. Psoriatic arthritis and ankylosing spondylitis are also inflammatory arthritides that belong to the spondyloarthritides. Disease-modifying anti-rheumatic drugs and biologic therapies including anti-TNF agents are used in their treatment. The TNF antagonists have shown rapid and sustained therapeutic responses. However, a substantial number of patients fail to respond to anti-TNF agents or experience side effects. Golimumab is a human monoclonal antibody to TNF-a requiring less frequent administration compared with current anti-TNF products. Various trials have shown promising results in terms of efficacy and safety in methotrexate-n...

Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

Patients with ankylosing spondylitis (AS) have an approximately two-fold increased death rate compared to the general population, which is predominately caused by increased cardiovascular risk. The prevalence rate for myocardial infarction is approximately 2-3 fold increased as compared with the general population. The inflammatory process appears to have an important role in causing this excess cardiovascular risk. In this paper, we present a case of severe coronary artery disease which could be demonstrated clearly by computer tomography in a 27-year-old woman who is being followed with AS.   

Haplotype tagging SNPs of interleukin-23 receptor gene rs1004819, rs7517847, rs7530511, rs2201841, rs1343151 and rs10889677 were determined in 396 patients with rheumatoid arthritis, 190 patients with Crohn's disease, 206 patients with ankylosing spondylitis and 182 controls. Using regression analysis models the rs1004819, rs2201841, and rs10889677 SNPs were found to confer risk for Crohn's disease and ankylosing spondylitis, while rs1343151 had a protective effect in both of these diseases, and the rs2201841 and rs10889677 SNPs showed susceptibility nature for rheumatoid arthritis. Using these SNPs we could study the susceptibility haplotype profiles in these diseases with special attention to the rheumatoid arthritis, first in the literature. Seven different haplotypes could be differentiated. We found that the SNPs exert their susceptibility character in specific haplotype blocks: thus, for rheumatoid arthritis the rs1343151 SNP was risk factor only in a specific haplotype surrounding; this can explain the controversial results published so far about this variant. More importantly, we observed, that while a specific haplotype can confer risk for rheumatoid arthritis, the same haplotype tended to protect against the development of the other two diseases. The data presented here serve evidence for the need of haplotype analysis instead of just single standing SNP analysis when susceptibility to or protection against a certain disease are interpreted. PMID:23054009

While the physical impact of ankylosing spondylitis (AS) is central to clinical treatment, the sexual problems associated with AS are often overlooked. Sexual problems may be related to a variety of undocumented demographic parameters, physical impairments, and psychological problems. These associations were examined through a single-center cross-sectional study of 103 AS patients (78 males and 25 females) and 121 healthy individuals (73 males and 48 females). All participants provided information pertaining to sexual problems, sociodemographics, and clinical characteristics via written questionnaires including multiple-choice questions conducted independently in the clinical setting under physician supervision. Rates of both prevalence and severity of sexual dysfunctions in AS patients were much higher than those observed in healthy individuals. Bath Ankylosing Spondylitis (BAS) Disease Activity Index and two parameters of body image disturbance (distress and impairment in social functioning) correlated with impaired partner relationships (P < 0.05). BAS mobility index, impaired social functioning, and BAS functionality index were the most significant causes of impaired sexual function (P < 0.05) in AS patients. Both physical and psychological factors were shown to impact sexual relationships and function in Chinese AS patients. To more effectively manage AS in clinical settings, rheumatologists and nursing specialists should be aware of the condition's impact on sexual health, considering both physical outcomes, such as disease activity and physical function, as well as psychological well-being. PMID:23152087

Ankylosing spondylitis (AS) is a common inflammatory arthritic condition. Overt inflammatory bowel disease (IBD) occurs in about 10% of AS patients, and in addition 70% of AS cases may have subclinical terminal ileitis. Spondyloarthritis is also common in IBD patients. We therefore tested Crohn's disease susceptibility genes for association with AS, aiming to identify pleiotropic genetic associations with both diseases. Genotyping was carried out using Sequenom and Applied Biosystems TaqMan and OpenArray technologies on 53 markers selected from 30 Crohn's disease associated genomic regions. We tested genotypes in a population of unrelated individual cases (n = 2,773) and controls (n = 2,215) of white European ancestry for association with AS. Statistical analysis was carried out using a Cochran-Armitage test for trend in PLINK. Strong association was detected at chr1q32 near KIF21B (rs11584383, P = 1.6 × 10(-10), odds ratio (OR)?= 0.74, 95% CI:0.68-0.82). Association with disease was also detected for 2 variants within STAT3 (rs6503695, P = 4.6 × 10(-4). OR = 0.86 (95% CI:0.79-0.93); rs744166, P = 2.6 × 10(-5), OR = 0.84 (95% CI:0.77-0.91)). Association was confirmed for IL23R (rs11465804, P = 1.2 × 10(-5), OR = 0.65 (95% CI:0.54-0.79)), and further associations were detected for IL12B (rs10045431, P = 5.2 × 10(-5), OR = 0.83 (95% CI:0.76-0.91)), CDKAL1 (rs6908425, P = 1.1 × 10(-4), OR = 0.82 (95% CI:0.74-0.91)), LRRK2/MUC19 (rs11175593, P = 9.9 × 10(-5), OR = 1.92 (95% CI: 1.38-2.67)), and chr13q14 (rs3764147, P =?5.9 × 10(-4), OR = 1.19 (95% CI: 1.08-1.31)). Excluding cases with clinical IBD did not significantly affect these findings. This study identifies chr1q32 and STAT3 as ankylosing spondylitis susceptibility loci. It also further confirms association for IL23R and detects suggestive association with another 4 loci. STAT3 is a key signaling molecule within the Th17 lymphocyte differentiation pathway and further enhances the case for a major role of this T-lymphocyte subset in ankylosing spondylitis. Finally these findings suggest common aetiopathogenic pathways for AS and Crohn's disease and further highlight the involvement of common risk variants across multiple diseases. PMID:21152001

Objective To study the accuracy of diagnoses of spondylarthritides in computerized databases at the Minneapolis Veterans Affairs Medical Center. Methods Medical records were available and reviewed for a random sample of 184 patients from a cohort of 737 patients seen at the rheumatology clinic between January 1, 2001 and July 31, 2002. We compared 4 database definitions with the medical record gold standard of rheumatologists diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), or reactive arthritis (ReA): presence of 1) ?1 or 2) ?2 International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes for diagnoses of AS (720.0), PsA (696.0), and ReA (099.3, 711.11-711.19), and presence of 3) ?1 or 4) ?2 ICD-9 codes and prescription of a disease-modi...

Previous studies have found that the Fc receptor-like (FCRL) molecule, involved in controlling B cell signaling, may contribute to the autoimmune disease process. Many studies have reported the relation of FCRL gene family with SLE and RA. We hypothesized that FCRL4 may be a key gene for ankylosing spondylitis (AS) development. To test this hypothesis, we screened FCRL4 polymorphisms in the Chinese Han population. Five tag single nucleotide polymorphisms (SNPs), including rs14335, rs849826, rs10489674, rs2778003, and rs2777963, were selected. Using a case?control study, five tag SNPs, which captured the majority of known common variation within FCRL4 gene, were selected and genotyped by Multiplex Snapshot technique. We analyzed 299 patients and 300 controls from China. The genotype analysi...

The objective of this study is to evaluate the role of MMP-3 and MRI in assessing disease activity in sacroiliac joints of AS patients in comparison to the conventional measures Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Serum MMP-3 was measured in 30 patients who fulfilled the modified New York criteria for AS and in ten healthy volunteers. AS patients were categorized into those having high or low MMP-3 according to a cut-off value?=?7.1?ng/ml. MRI of the sacroiliac joints (SIJs) was performed on all patients. SIJs were evaluated for enhancement and subchondral bone marrow edema. Results of MMP-3 and findings on MRI were correlated with multiple clinical parameters including BASDAI, ESR and CRP. Serum MM...

Objective: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls. Methods: Twenty AS patients were compared to 24 healthy male subjects with regard to demographic data, urological examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies, and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments. Results: Demographic data were similar in AS and controls (p = 0.175). Varicocele was found significantly more frequently in AS patients than in controls (40% vs. 8%, p = 0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and...

We present the radiological features of a 42-years-old man with long-standing inactive ankylosing spondylitis (AS), demonstrating that arachnoiditis is a cause of a cauda equina syndrome (CES) in this disease. CT showed a dorsal arachnoid diverticulum causing scalloped erosion of the laminae, and punctate and curvilinear dural calcification. MRI revealed adhesion and convergence of the cauda equina dorsally into the arachnoid pouch, causing the dural sca to appear empty canal. To the best of our knowledge, dural calcification on CT is a new finding in AS, which may be related to the CES. Our findings support the hyopthesis that chronic adhesive arachnoiditis with subsequent loss of meningeal elasticity may be the main cause of CES in AS. (orig.)

The aim of this study was to identify the pulmonary abnormalities on high-resolution computed tomography (HRCT) in patients with ankylosing spondylitis (AS) and to examine the relationship with the duration of disease and pulmonary function test (PFT) results. Twenty male AS patients with a mean age of 37.1???9.4?years were enrolled in this study. The patients were assigned into 2 groups according to disease duration: patients with disease duration <10?years (n?=?10) and ?10?years (n?=?10). All patients underwent clinical examination, PFT and HRCT. HRCT revealed abnormalities in 14 patients (70%). The most common findings were apical fibrosis (45%) and emphysema (25%). HRCT findings were more prominent in late AS patients (disease duration ?10?years) (P?=?0.015). PFT were considered as abn...

A 46-year-old female patient with terminal ileum Crohn's disease and ankylosing spondylitis presented with recurrent angioedema and urticaria. Investigations ruled out hereditary angioedema, and environmental or food allergen triggers. She was diagnosed with chronic idiopathic urticaria with angioedema, and was treated with a trial of intravenous immunoglobulin immunotherapy, danazol, prednisone and hydroxyzine. Due to ongoing bowel and arthritic complaints, she was started on infliximab infusions and within 2 treatments, she had complete resolution of the angioedema and urticaria, as well as of the bowel and arthritic symptoms. Unfortunately she developed allergic reactions to the infliximab and was switched to another anti-tumor necrosis factor (TNF)-? agent, adalimumab. Since then, she has had no further angioedema or urticaria, and her Crohn's disease has been quiescent. This is the first known case report of chronic idiopathic urticaria with angioedema coexistent with Crohn's disease that was successfully treated with anti-TNF-? agents. PMID:23002350

A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 ± 10.7 years). Mean disease duration was 12.1 ± 8.5 years, and mean time from initial symptom to diagnosis was 5 ± 6.8 years (median 2 ye...

Ankylosing spondylitis (AS) is the prototype for spondyloarthritis primarily affecting young men. Geographic and ethnic variations exist in the prevalence and severity of AS and relate to the wide disparity in the frequency of human leukocyte antigen (HLA)-B27, a major genetic risk factor. The strength of the disease association with HLA-B27 is lower in most Arab populations (25?75?%) than in Western European populations (>90?%), and there is no association in sub-Saharan Africa, where the prevalence of HLA-B27 is <1?%. Other epidemiologic differences between European and African populations are the apparent later age at presentation in sub-Saharan Africa, and the high rate of spondyloarthropathies associated with human immunodeficiency virus infection. Diagnosis of AS is often delayed 8?1...

The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1?h was given by a certified trainer to 30 participants 3 times a week for 12?weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (we...

Genome-wide association studies (GWAS) search for associations between genetic variants and disease status, typically via logistic regression. Often there are covariates, such as sex or well-established major genetic factors, that are known to affect disease susceptibility and are independent of tested genotypes at the population level. We show theoretically and with data from recent GWAS on multiple sclerosis, psoriasis and ankylosing spondylitis that inclusion of known covariates can substantially reduce power for the identification of associated variants when the disease prevalence is lower than a few percent. Whether the inclusion of such covariates reduces or increases power to detect genetic effects depends on various factors, including the prevalence of the disease studied. When the disease is common (prevalence of >20%), the inclusion of covariates typically increases power, whereas, for rarer diseases, it can often decrease power to detect new genetic associations. PMID:22820511

Tumour necrosis factor alpha (TNF-a) is a key molecule of the inflammatory response and data derived from studies in experimental animal models and humans suggest that TNF-a may be implicated in the pathogenesis of various autoimmune and non-infectious inflammatory conditions. Over the past decade pharmaceutical agents directed against TNF-a (infliximab, adalimumab and etanercept) have been widely and successfully employed for the management of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis, psoriatic arthritis, juvenile idiopathic arthritis and inflammatory bowel disease, whereas two novel anti-TNF-a agents, golimumab and certolimumab pegol, recently entered the market for the treatment of RA, AS, Crohn's disease and psoriasis. Encouraged by the positive results obtaine...

Importance of the field: Twenty-five years ago, rheumatoid arthritis (RA) was a relentless disease, treated symptomatically because of the lack of effective, well tolerated medications which could halt disease in most patients. The introduction of methotrexate, sulfasalazine and leflunomide, and aggressive treatment, changed the prognosis of RA in the 1990s. Biologic therapies have dramatically changed the long-term prognosis of patients with rheumatoid and psoriatic arthritis and ankylosing spondylitis. Areas covered in this review: Unfortunately, no one single agent is fully effective in every patient. For this reason, another agent, golimumab (GLM), a TNF-a inhibitor (TNF-I) was developed. The basis of this review is all peer-reviewed manuscripts on GLM in the treatment of RA, psoriatic...

Background: Golimumab (GLM) is a tumor necrosis factor-a (TNF-a) inhibitor that was approved in the United States in 2009 for use with methotrexate (MTX) in adults with moderate to severe active rheumatoid arthritis (RA), and with or without MTX or other non-biologic disease-modifying antirheumatic drugs in adults with active psoriatic arthritis (PsA) or active ankylosing spondylitis (AS). GLM is administered as a 50-mg subcutaneous injection once a month. Objectives: The goals of this article were to review the current literature on GLM and to provide recommendations for the use of GLM based on the published information. Methods: The PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, International Pharmaceutical Abstracts, and other databases, as well as the Web s...

Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disease that often leads to cardiovascular complications including aortic regurgitation and conduction disturbances. Left ventricular (LV) systolic asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to evaluate LV systolic asynchrony noninvasively in patients with AS by using tissue synchrony imaging (TSI). Methods: Asynchrony was evaluated in 77 AS patients (61 male, mean age 36.4 10 years) and 40 controls (35 male, mean age 39.1 8.2 years). All study population underwent a comprehensive echocardiographic evaluation including TSI. The time to regional peak systolic velocity (Ts) during the ejection phase in LV was measured from TSI images by the si...

The purpose of this study was to compare chest expansion (CE) measurements in two arm positions of and between healthy subjects and subjects with ankylosing spondylitis (AS). Twenty-two subjects with AS with a mean age of 41.41 years and 25 healthy subjects with a mean age of 41.04 years were tested in two arm positions: hands on head, and arms at the sides. The tape measure was placed at the level of the xiphisternum. Each tester recorded three trials in both arm positions on two separate occasions which were 10 minutes apart. Results showed there was no significant difference in CE measurement between the two arm positions and between healthy subjects and subjects with AS. It was concluded, that CE may not be an appropriate measurement tool of chest wall or thoracic spine involvement in subjects with AS.   

The cauda equina syndrome (CES) is a rare neurological complication of ankylosing spondylitis (AS). Imaging diagnosis of CES in long-standing AS patients (CES-AS) using myelography, computed tomography (CT), and magnetic resonance imaging (MRI) were reported in the literature. They, however, demonstrate only the chronic abnormalities of CES-AS, i.e., dural ectasia, dorsal dural diverticula, and selective bone erosion at the posterior elements of the vertebrae. To our knowledge, imaging features of acute intradural inflammation in CES-AS were not described. We report a patient of CES-AS in whom MRI disclosed acute transverse myelitis and arachnoiditis along the lower spinal cord, and discuss the pathogenesis of CES-AS and the role of MRI in clinical management.

Objective: The risk of non-Hodgkin lymphoma is increased in rheumatoid arthritis (RA) but not in ankylosing spondylitis (AS). In RA, the degree of inflammation is closely associated with the lymphoma risk. Whether immunosuppressants such as methotrexate and TNFa antagonists affect the lymphoma risk in RA is unclear. The Epstein-Barr virus (EBV) may contribute to the pathogenesis of RA and may be involved in the development of lymphoma in patients taking methotrexate and/or TNFa antagonists, although these points remain debated. EBV load monitoring during immunosuppressive treatment may predict the occurrence of EBV-related lymphoma. Here, our objective was to prospectively measure the EBV load in patients receiving TNFa antagonists for RA or AS. Methods: We prospectively studied patients w...

Patients with ankylosing spondylitis (AS) suffer from an increased cardiovascular (CV) risk. The evidence for increased atherosclerotic disease is nowadays convincing, while the precise contribution of the so-called AS-specific (related) cardiac manifestations toward the increased CV risk still needs to be determined. Such studies should be performed in the near future, since they might have clinical consequences-for example, mandatory echocardiographic screening of AS patients. There appears to be a clear contribution of the "traditional" CV risk factors, as well as the underlying chronic inflammatory process, to the increased atherosclerotic risk in AS. Furthermore, there is accumulating evidence for an etiological role of inflammation in the AS-related cardiac manifestations. Nowadays, CV risk management appears necessary for AS patients, and this should consist of, on the one hand, assessment and treatment, if necessary, of the "traditional" CV risk factors, and, on the other hand, effective suppression of the inflammatory process. PMID:22791397

Reactive arthritis following infection with Yersinia is endemic in Scandinavian countries; the prevalence is low in the UK, however. We have reviewed the literature pertaining to Yersinia-related reactive arthritis in the UK and describe 12 patients who presented over a 3-year period with an asymmetrical seronegative polyarthropathy and serological evidence of recent Yersinia infection. Five patients recalled having a diarrhoeal illness prior to the onset of the arthropathy. None had a prior history of psoriasis, inflammatory bowel disease or ankylosing spondylitis. A history of urethral discharge was elicited from one patient. Extra-articular manifestations were seen in three patients (iritis in two, erythema nodosum in another). Four patients developed chronic joint disease after periods of 4, 6, 8, and 18 months, respectively. The prevalence of Yersinia-related arthritis in the UK may be higher than previously thought. PMID:1484936

The objective of this study is to assess the effects of Global Postural Reeducation (GPR) in patients with ankylosing spondylitis and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n?=?22) and a control group (n?=?16). Both groups were treated for more than 4?months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire?Spondyloarthropathies?HAQ-S), quality of life...

Professor Shi Qi is a famous traditional Chinese medicine doctor specializing in orthopaedics and traumatology, who has formatted a set of systematic protocols for the diagnosis and treatment of chronic musculoskeletal conditions. When it is time for using tonics in winter, he advocates applying herbal paste for treating chronic musculoskeletal diseases. This paper introduces Professor Shi Qi's commonly used prescription for treating chronic musculoskeletal conditions and puts forward demands and understandings in concocting herbal paste, experience in herbal paste for treating chronic musculoskeletal diseases such as cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis, lumbar muscle strain, ankylosing spondylitis, osteoporosis, knee osteoarthritis and avascular necrosis of femoral head, and the advantages of herbal paste for treating chronic musculoskeletal conditions as opposed to alternative treatments. PMID:22704421

Objectives: To describe cases of new onset of inflammatory bowel disease (IBD) in patients with inflammatory rheumatic disease (IRD) receiving anti-TNF-a therapy. Methods: A call for observations of such cases was sent to members of the French ''Club rhumatismes et inflammation''. Only patients without intestinal symptoms before introduction of anti TNF-a agents were included. Results: During a 2-year period, 16 patients were declared: nine men and seven women, mean age 41.5+/-17.4 years, 12 patients with ankylosing spondylitis, one with rheumatoid arthritis, one with psoriatic arthritis and two juvenile idiopathic arthritis with enthesitis related arthritis. Overall, 14 patients received etanercept and two had infliximab. The meantime frame between onsets of anti-TNF--a drugs and developm...

Ankylosing spondylitis (AS) is a chronic rheumatic disease that causes spinal rigidity with an increased risk of spinal fractures. We present a case report where a middle-aged man, in apparent good health, died following a fall from his bike. Postmortem computed tomography (CT) showed several fractures in the cervical and thoracic spine, with displacement into the spinal canal as well as spinal changes consistent with AS. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fractures that were facilitated by spinal rigidity from AS. Further investigation into the medical records revealed that the decedent had previously been treated for AS. This case report illustrates the importance of obtaining a detailed medical history when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of CT in the evaluation of the mechanism and manner of death.

Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22%). Conclusion: In our experience, MR imaging may detect inflammatory and/or erosive bone, soft tissue, cartilage, tendon, and joint abnormalities in AS patients, even if AS patients did not have clinical signs and symptoms of foot involvement. If these data prove to be confirmed in further MR studies, MR imaging may be of importance especially in early diagnosis of inflammatory changes in the foot.

In this study, serum antioxidant and oxygen derived free radical status of patients with ankylosing spondylitis (AS) was investigated and compared with that of age- and sex-matched healthy controls. The relationship of these parameters to disease activity indices was also examined. Thirty patients with AS not currently under disease-modifying antirheumatic drug (DMARD) treatment (e.g., sulfasalazine or methotrexate) (15 active and 15 inactive) and 16 age- and sex-matched healthy controls were included in the study. Catalase (EC 1.11.1.6), total (Cu-Zn and Mn) superoxide dismutase (SOD) (EC 1.15.1.1) activities, and malondialdehyde (MDA), nitrite (NO(2)(-)), and nitrate (NO(3)(-)) levels as indices of nitric oxide (NO) production were evaluated using appropriate methods. There was no statistically significant difference found in SOD activity or NO and MDA levels between active and inactive patients. Inactive patients showed no significant difference in all the measured oxidant/antioxidant parameters when compared to healthy controls. Active patients had significantly higher levels of MDA and catalase enzyme activity ( P=0.002 and P=0.007, respectively). There was no significant correlation between oxidant/antioxidant parameters and disease activity, C-reactive protein, erythrocyte sedimentation rate, or Bath Ankylosing Spondylitis Disease Activity Index (CRP, ESR, or BASDAI) in either group, except catalase enzyme activity, which had a significant correlation with CRP and ESR levels in active patients ( r=0.69 and P=0.004, r=0.52 and P=0.04, respectively). Our results indicate that oxidative stress and lipid peroxidation are accelerated in untreated patients with active AS. Serum catalase activity may be closely related to disease activity. In this regard, we underscore the likely benefit of some therapeutic interventions including high-potential antioxidants that will potentiate the antioxidant defense mechanism and reduce peroxidation in the management of AS. PMID:12811507

Radiologic examination of 43 patients revealed 47 lesions of a type which we have termed hemispherical spondylosclerosis (HSS). This term describes and includes the following essential and possible radiologic findings of the disease: 1) Hemispherical (or dome - or helmet-shaped ) sclerosis of the vertebra above the intervertebral disk. Thus it is a supradiscal HSS. 2) One or more small erosions of the inferior end plate of the vertebra involved. 3) Periosteal apposition on the anterior border of the vertebra along the length of the sclerosis. 4) New bone formation on the inferior end plate. 5) Anterior vertebral osteophytes. 6) Narrowing of the disk space below the affected vertebra. HSS occurs not only as a sequel of degenerative disk disease, but also in bacterial (tuberculous and non-tuberculous) spondylitis, ankylosing spondylitis, osteoid osteoma, and metastases of neoplasms. The differential diagnosis between inflammatory and non-inflammatory pathogenesis and etiology of HSS is described. The characteristic shape of HSS, its sites of predilection (L4 >> L5 > L3), and the preponderance of female sufferers from this painful condition are due to factors which, as yet, remain unknown.

Abstract in portuguese OBJETIVO: O objetivo deste estudo foi avaliar os resultados radiográficos, bem como, as complicações precoces e tardias, da técnica de osteotomia de subtração pedicular (PSO) em pacientes com deformidades sagitais fixas. MÉTODOS: Foram avaliados os prontuários e as radiografias panorâmicas em perfil, realizadas no pré- e pós-operatório, de nove pacientes. Todos foram submetidos à osteotomia ao nível lombar (três ao nível L3 e dois ao nível L2). No grupo e (more) studado, quatro pacientes possuíam o diagnóstico de espondilite anquilosante, três cifose lombar pós-artrodese, um cifoescoliose do adulto e um pseudo-hipoparatireoidismo. Foram avaliados os dados do prontuário como: ruptura da dura-máter, lesão neurológica, infecção e falha da síntese. A avaliação radiológica baseou-se nas incidências em perfil panorâmico ortostático das radiografias pré- e pós-operatórias, com a medição do ângulo de cifose torácica, lordose lombar e eixo sagital. RESULTADOS: Os achados radiográficos mostraram um aumento na lordose lombar de 14,6 ° para 44,7° (30°), enquanto que a cifose torácica permaneceu estável em 48°, redução do desequilíbrio sagital de 13,7 para 5,4mm. O tempo médio de cirurgia foi de 08h10min e sangramento médio de 2.460mL. Um paciente sofreu ruptura da dura-máter (durotomia), dois pacientes apresentaram infecção da ferida operatória, com necessidade de revisões e retirada do material de síntese em apenas um. Nenhum dos pacientes apresentou lesão neurológica. CONCLUSÃO: Embora seja um procedimento tecnicamente exigente, com perda sanguínea, elevado tempo cirúrgico e complicações severas, a osteotomia de subtração pedicular obteve uma significativa melhora na correção do equilíbrio sagital, sendo um recurso valioso para efetiva correção dos desequilíbrios posturais no plano sagital, como observada na espondilite anquilosante e complicações de cirurgias prévias. Abstract in spanish OBJETIVO: El objetivo de este estudio fue evaluar los resultados radiográficos y clínicos, así como las complicaciones precoces y tardías, de la técnica de osteotomía de sustracción pedicular en pacientes con deformidades sagitales fijas. MÉTODO: Se evaluaron las historias clínicas y las radiografías panorámicas de perfil, realizadas en el pre y postoperatorio, de 09 pacientes. Todos fueron sometidos a osteotomía a nivel lumbar. En el grupo estudiado, 4 pacien (more) tes tenían diagnóstico de espondilitis anquilosante, 3 de cifosis lumbar post artrodesis, 1 de cifoscoliosis de adulto y 1 de pseudohipoparatiroidismo congénito. Se evaluaron datos de la historia clínica tales como: durotomía, lesión neurológica, infección y falla de la síntesis. La evaluación radiológica se basó en las incidencias en perfil panorámico de las radiografías pre y postoperatorias, con la medida del ángulo de la cifosis torácica, lordosis lumbar y eje sagital. RESULTADOS: los hallazgos radiográficos mostraron aumento en la lordosis lumbar de 14,6º para 44,7º (30º), mientras que la cifosis torácica se mantuvo estable en 48º, reducción del desequilibrio sagital de 13,7 para 5,4 mm. El tiempo promedio de cirugía fue de 08:10h y el sangrado promedio de 2.460ml. Un paciente sufrió durotomía, dos pacientes presentaron infección de la herida operatoria, con necesidad de revisiones y retirada de material de síntesis sólo en uno. Ninguno de los pacientes presentó lesión neurológica. CONCLUSIÓN: aún siendo el procedimiento técnicamente exigente, con pérdida sanguínea y tiempo quirúrgico elevados, la osteotomía de sustracción pedicular logró una mejora significativa en la corrección del desequilibrio sagital, constituyendo un recurso valioso para la corrección efectiva de los desequilibrios posturales en el plano sagital. Abstract in english OBJECTIVE: The aim of this study was to assess the early and long term functional and radiographic outcomes of pedicle subtraction osteotomy (PSO) in patients with fixed sagittal deformities. METHODS: The medical records and radiographs performed during the pre- and post-operative period of nine patients with fixed sagittal deformities caused by ankylosing spondylitis (4 patients), flat back post-arthrodesis (3 patients), adult kyphoscoliosis (1 patient) and pseudohypopar (more) athyroidism (1 patient), were retrospectively reviewed. All patients were submitted to lumbar osteotomy (three at level L3 and two at level L2). Clinical data such as durotomy, neurologic injury, infection of the surgical wound, implant failure and pseudarthrosis were also assessed. Pre- and post-operative radiographic assessment was performed by measuring angles of thoracic kyphosis, lumbar lordosis and sagittal axis. RESULTS: In patients with lumbar osteotomy, final follow up radiographs showed an increase in lumbar lordosis from 14.6° to 44.7° (increase of 30°), whereas thoracic kyphosis remained stable from 46° to 48°. Sagittal imbalance reduced from 13.7 to 5.4mm, and thoracic kyphosis remained stable (48°). The mean time of surgery was 8 hours 10 minutes and mean bleeding was 2,460mL. No neurologic complications were found, but one patient showed durotomy and two patients showed wound infection requiring posterior surgical approach. CONCLUSIONS: Although the pedicle subtraction osteotomy requires great surgical skills and experience, due to the blood loss, long operative time and severe implications, this procedure reaches a significant improvement in sagittal imbalance as observed in ankylosing spondylitis and implications of previous surgeries.

Abstract in portuguese OBJETIVO: Descrever as principais alterações nos ombros de pacientes portadores de espondilite anquilosante (EA) por meio de ultra-som (US) e correlacionar os achados de imagem com a idade e o tempo de doença. MÉTODOS: Foram selecionados 35 pacientes com diagnóstico clínico de EA. Os pacientes foram submetidos a exame de ultra-sonografia dos ombros, sendo avaliados os tendões do manguito rotador quanto à sua ecotextura e espessura, o tendão do bíceps, a articula (more) ção acromioclavicular, os tubérculos umerais, a bursa subacromial-subdeltóidea, e a face posterior da articulação glenoumeral. Foram colhidos dados de tempo de doença, presença de dor nos ombros e freqüência das alterações das estruturas avaliadas. Os dados foram comparados com a idade e o tempo de doença, utilizando-se teste qui-quadrado e teste t de Student. RESULTADOS: Foi observada prevalência de 20% de alterações no manguito rotador, sendo 10% de tendinose/calcificação tendínea e 10% de rupturas tendíneas. A espessura média dos tendões do manguito rotador foi de 5,8 mm. As alterações ósseas nos tubérculos do úmero ocorreram em 84,3% dos ombros e as alterações acromioclaviculares em 54,3% dos ombros. CONCLUSÃO: Não há modificação da espessura dos tendões do manguito rotador relacionadas com o tempo de doença. Os principais achados de US, que se correlacionam com o tempo de doença na EA, são alterações ósseas nos tubérculos umerais e na articulação acromioclavicular. Não houve relação entre tempo de doença e presença de lesão tendínea. Abstract in english PURPOSE: To describe shoulder involvement and its prevalence with ultrasound in patients with ankylosing spondylitis and correlate the findings with age and duration of disease. METHODS: Ultrasound scans of both shoulders were performed in thirty five selected patients with clinical diagnosis of ankylosing spondylitis. Rotator cuff texture and thickness were evaluated as well as the biceps tendon, acromioclavicular joint, humeral head tuberosities, subacromial-subdeltoid (more) bursa, and posterior glenohumeral joint. Besides the prevalence of shoulder involvement, information about presence of pain and duration of disease were registered. The data were compared with age and duration of disease using chi-square and Student's t tests. RESULTS: The prevalence of rotator cuff disease was 20%; with 10% of tendinosis/tendon calcification and 10% of partial/full thickness tears. The mean rotator cuff thickness was 5.8 mm. Irregularities of the humeral head tuberosities were present in 84.3% of shoulders and acromioclavicular irregularities were present in 54.3% of shoulders. CONCLUSION: There was no change in rotator cuff thickness related with duration of disease. Bony irregularities in humeral head tuberosities and acromioclavicular joint were the main finding associated with duration of disease. There was no relation between duration of disease and presence of tendinous disease.

Abstract in spanish Fudamentos: La primoinfección por el virus varicela-zoster en el adulto adquiere una inusitada gravedad debido a complicaciones entre las que la neumonía es la más frecuente. Se estudian nueve pacientes diagnosticados de neumonía varicelosa. Pacientes y métodos: Se revisan retrospectivamente las peculiaridades clínico-terapéuticas y evolutivas de una serie de pacientes, tanto inmunocompetentes como inmunodeprimidos, diagnosticados en los últimos diez años en el H (more) ospital de Sant Pau de Barcelona. El diagnóstico de varicela se estableció por la aparición del típico rash en el contexto de una enfermedad febril. Se valoran los antecedentes de tabaquismo, embarazo y la presencia de enfermedades de base; analizando especialmente la gasometría arterial y la cifra plaquetar al ingreso. Resultados: Se estudian 9 pacientes, 4 hombres y 5 mujeres, con una edad media de 38 años. El 78% eran fumadores de más de 20 cigarrillos/día, uno cumplía criterios de bronquitis crónica, otro tenía una espondilitis anquilopoyética y tres se conocían portadores del virus de la inmunodeficiencia humana. Ninguna de las pacientes estaba embarazada. Los síntomas respiratorios se iniciaron entre el tercer y el quinto día de aparición del exantema, siendo los más frecuentes tos (89%), disnea (67%) y expectoración hemoptoica (22%). La gasometría arterial evidenció hipoxemia en cuatro (45%). Asimismo se objetivó trombocitopenia al ingreso en seis (66%). La radiografía de tórax mostró un patrón intersticial de predominio bibasal en todos los casos observándose un caso de derrame subpulmonar derecho. Se instauró terapia con aciclovir intravenoso en seis pacientes, foscarnet en uno y tratamiento sintomático en dos. Todos los pacientes siguieron una correcta evolución clínica no precisando ninguno de ellos ser ingresados en la U.C.I. Conclusiones: Los pacientes adultos con neumonía varicelosa que presentan insuficiencia respiratoria, trombopenia o son portadores de enfermedades de base deben recibir precozmente aciclovir por vía intravenosa. No obstante, si bien la mejoría clínica, biológica y radiológica serían más precoces con dicho tratamiento, la evolución parece igualmente favorable si sólo se instaura, por ejemplo, terapia sintomática con antitérmicos y antihistamínicos. Abstract in english Background: In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa. Methods: Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at (more) Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed. Results: Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit. Conclusions: Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antitermic and antihystaminic compounds.

Objective. To determine the prevalence of radiographic evidence of sacroiliitis in a large population of patients with psoriatic arthritis. Patients and design. Patients were recruited from 15 clinical centers. This was part of a large, multicenter study of patients with an established diagnosis of ankylosing spondylitis, psoriatic arthritis, or reactive arthritis. For this cohort, an established diagnosis of psoriatic arthritis was required, with cutaneous manifestations and involvement of at least three appendicular joints. At entry, patients were not selected for the presence of axial involvement. Radiographs - one anteroposterior view of the pelvis and one oblique view of each sacroiliac joint - were graded using the New York classification scale by a musculoskeletal radiologist masked to the specific diagnosis and clinical symptoms. Re-evaluation of 10% of the films 3 years later quantified intraobserver variability. Results. Two hundred and two patients with psoriatic arthritis were studied. Duration of the disease averaged 12 years; all patients had psoriasis and peripheral arthritis. The prevalence of radiographic evidence of sacroiliitis (grade 2 or higher) was 78%; 71% of these had grade 3 disease. Conclusions. Previously reported prevalence of sacroiliitis in patients with psoriatic arthritis ranges from 30% to 50%. The prevalence of radiographic evidence of sacroiliitis in this large multicenter cohort of patients with appendicular psoriatic arthritis was substantially higher. (orig.) With 3 figs., 4 tabs., 29 refs.

The alpha-particle-emitting radionuclides {sup 213}Bi, {sup 211}At, {sup 224}Ra are under investigation for the treatment of leukemias, gliomas, and ankylosing spondylitis, respectively. {sup 213}Bi and {sup 211}At were attached to monoclonal antibodies and used as targeted immunotherapeutic agents while unconjugated {sup 224}Ra chloride selectively seeks bone. {sup 225}Ac possesses favorable physical properties for radioimmunotherapy (10 d half-life and 4 net alpha particles), but has a history of unfavorable radiolabeling chemistry and poor metal-chelate stability. We selected functionalized derivatives of DOTA as the most promising to pursue from out of a group of potential {sup 225}Ac chelate compounds. A two-step synthetic process employing either MeO-DOTA-NCS or 2B-DOTA-NCS as the chelating moiety was developed to attach {sup 225}Ac to monoclonal antibodies. This method was tested using several different IgG systems. The chelation reaction yield in the first step was 93{+-}8% radiochemically pure (n=26). The second step yielded {sup 225}Ac-DOTA-IgG constructs that were 95{+-}5% radiochemically pure (n=27) and the mean percent immunoreactivity ranged from 25% to 81%, depending on the antibody used. This process has yielded several potential novel targeted {sup 225}Ac-labeled immunotherapeutic agents that may now be evaluated in appropriate model systems and ultimately in humans.

Ear-nose-throat (ENT) manifestations of connective tissue disorders represent a diagnostic challenge for clinicians as they often constitute the initial sign of an otherwise asymptomatic autoimmune disease. Moreover, in patients with known autoimmune rheumatic diseases, ENT manifestations can be overlooked. Hearing disturbances may be seen in patients with systemic lupus erythematosus, Wegener's granulomatosis, relapsing polychondritis, polyarteritis nodosa, Cogan's syndrome, Sjögren's syndrome, and less frequently in Churg-Strauss syndrome and Adamantiades-Behçet's disease. Nose and paranasal sinuses are variably affected during the course of Wegener's granulomatosis, Churg-Strauss syndrome, relapsing polychondritis and sarcoidosis. Recurrent mucosal ulcerations are common in systemic lupus erythematosus and Adamantiades-Behçet's disease. Xerostomia is a common feature of primary and secondary Sjögren's syndrome; salivary gland enlargement may be also seen in these patients, as well as in patients with sarcoidosis. The cricoarytenoid joint can be involved during the course of rheumatoid arthritis, ankylosing spondylitis and gout; osteoarthritic changes have also been described. Motility disorders of the upper and/or the lower portions of the esophagus have been reported in patients with dermatomyositis/polymyositis, systemic sclerosis and systemic lupus erythematosus. Trigeminal nerve dysfunction may occur in patients with Sjögren's syndrome, systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disease. Peripheral facial nerve palsy has been described to complicate the course of Sjögren's syndrome and sarcoidosis. PMID:15301251

Abstract in portuguese Estudos recentes relatam as características clínicas e epidemiológicas das espondiloartrites nas populações de diversos países ibero-americanos. O objetivo deste trabalho foi comparar os dados obtidos em um estudo epidemiológico brasileiro com os dados encontrados em diversos países ibero-americanos, que utilizaram um mesmo protocolo de investigação. A casuística brasileira apresentou maior frequência de pacientes com diagnóstico de espondilite anquilosante ( (more) 72,3% brasileiros vs. 57,7% ibero-americanos), estando associada ao sexo masculino (73,6% vs. 66,0%) e ao antígeno de histocompatibilidade HLA-B27 positivo (65,9% vs. 51,8%). Com relação ao tratamento, os pacientes brasileiros fizeram mais uso de anti-inflamatório não hormonal (AINH) (77,0% vs. 71,2%) e menor uso de esteroides (7,5% vs. 18,5%). Abstract in english Recent studies have outlined the clinical and epidemiological profile of the spondyloarthritides in Ibero-American countries. The objective of this study was to compare the data collected in a Brazilian epidemiological study with the data obtained from other Ibero-American countries that used the same protocol of investigation. The Brazilian series presented a higher frequency of patients with ankylosing spondylitis (72.3% Brazilian vs. 57.7% Ibero-American), being associ (more) ated with the male gender (73.6% vs. 66.0%) and histocompatibility antigen positive HLA-B27 (65.9% vs. 51.8%). Regarding the treatment, hormonal anti-inflammatory drugs - NSAIDS were more frequently prescribed to Brazilian patients (77.0% vs. 71.2%) and less often, corticosteroids (7.5% vs. 18.5%).

OBJECTIVE: The objective of this study was to identify the usage and accessibility problems faced by the disabled (whether in pain or not) users of assistive devices (conventional wheelchairs), identify physical barriers that limit their mobility, and recognize the socio-cultural practices excluding them from the design process of such devices. Another main purpose of this paper is to improve the ergonomic criteria that influence the design and manufacture of assistive devices. MATERIALS AND METHOD: Study population: 15 patients with any of the following diagnoses: ankylosing spondylitis, rheumatoid arthritis, or amputees using wheelchairs in Mexico and Colombia. Design: Qualitative study. Thematic analysis with a theoretical industrial design approach to employing usability testing for ergonomic analysis. RESULTS: We identified 6 issues associated with usability problems from the patient's standpoint: barriers for use of wheelchairs (usability and acceptability), creative adaptations, potential use of technical devices, independence, body perception and assistive devices, and architectural barriers. The ergonomic and usability requirements and the resulting level of independence vary across wheelchair users with chronic pain and those whose disability does not involve pain. The latter are more independent in their movements and decisions. CONCLUSIONS: User input is essential in the design of assistive devices. The proposal of "design from and for the user" must rely on both engineering and medical perspective on the ergonomy as well as the user interpretation of the environment and the experience of the disease. Thus we can arrive at a "user-centered design". PMID:22854174

A nonparametric and general method of linkage analysis has been developed and used to evaluate histocompatibility (HLA) linkage to ankylosing spondylitis (AS) from the data of Berg & Moller. The conditional logistic function has been used to establish linkage by stepwise modelling of transmission from parent to progeny. Logistic transmission models have been explored to better understand the relationship of HLA to AS. The alleles at HLA-A and -B were determined in 38 families (32 monoplex and 6 multiplex). We have found that linkage is supported in this data over the random transmission of alleles at only HLA-B. Models constructed at HLA-B are powerful with, for example, coefficients for B27 of 1.9 (S.E. = 0.4) and B40 of 1.6 (S.E. = 0.8) contributing to a model with {chi}{sup 2} = 30 with 2 df and p < 3x10{sup -7}. No models are found supporting linkage at HLA-A and, therefore, the data at HLA-A does not add support for linkage beyond that present at HLA-B (e.g., {chi}{sup 2} for improvement < 1). These results establish that HLA-B is linked to AS. They further provide evidence that the gene responsible for AS is located nearer to HLA-B than it is to HLA-A. Also, the analysis shows that a number of HLA-B alleles may contribute to the risk of AS, beyond the B27 allele which has repeatedly been associated with AS.

OBJECTIVES: Reactivation of Mycobacterium tuberculosis infection is a major complication in patients treated with anti-tumor necrosis factor (TNF) agents. We report on the 5 cases of active tuberculosis (TB) that developed in the Golimumab Phase 3 Program (3 rheumatoid arthritis, 1 psoriatic arthritis, and 1 ankylosing spondylitis) through 1 year among 2210 golimumab-exposed patients. METHODS: Data from global studies were used for an in-depth evaluation of the 5 cases of TB through week 52. Integrated safety data were evaluated for potential hepatotoxicity in patients treated with anti-TB therapy. RESULTS: No active TB developed among 317 patients receiving golimumab and treated for latent TB with isoniazid. Active TB occurred in 5 patients by week 52 (2 patients by week 24); all had negative screening TB tests (per local guidelines), and resided in countries with high background rates of TB. No deaths were due to TB. Across all groups (placebo and golimumab), alanine aminotransferase and aspartate aminotransferase elevations occurred in greater proportions of patients treated for latent TB infection versus not treated; elevations were largely mild (golimumab and anti-TB medication was generally well-tolerated. Clinicians should remain vigilant for development of active TB after initiation of TNF blockers, as prompt diagnosis and treatment can improve outcomes. PMID:22782640

TNF blockers have revolutionized the management of spondyloarthritis (SpA). To date, four anti-TNF? agents (etanercept, infliximab, adalimumab, golimumab) have been approved for the management of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The first objective in the management of AS and PsA with TNF inhibitors is to reduce disease activity to clinical remission or low disease activity. After remission has been achieved, this state should be maintained as long as possible. However, the financial burden associated with the cost of anti-TNF agents as well as concerns about their long-term safety suggest reducing the dosage of the drug or discontinuing the therapy in the hopes of drug-free remission. The aim of this review is to examine what has, till now, been published on this topic in axial SpA, which includes AS and non-radiographic axial SpA (nr-axSpA), peripheral SpA and PsA. Discontinuation of therapy in axial SpA is not possible in the majority of patients, while on the contrary, reducing the dosage often is. In some patients with peripheral SpA and PsA it is also possible to discontinue therapy and to achieve drug-free remission. PMID:22940233

German internist and neurologist Adolf von Strümpell (1853-1925) was a leading figure in German neurosciences around 1900 and helped to establish neurology as a discipline in its own right. He made contributions that were crucial to the development of the subject and in many cases his were the first descriptions of complex diseases such as Bechterew disease (ankylosing spondylitis), primary lateral sclerosis, hereditary spastic paraplegia, and syphilis. His Textbook of Special Pathology and Therapy of Internal Diseases, published in English as Text-book of Medicine for Students and Practitioners, and in particular the subvolume on neurological diseases, were the guiding manuals for the training in neurology for decades. However, despite his pioneering achievements, his name has almost become unknown within medical terminology. This article, therefore, wishes to revive an awareness not only of the most important stages in Strümpell's life in Erlangen, Leipzig, Breslau (Wroc?aw), and Vienna, but also of his scientific achievements, focusing primarily on his neurological studies. To this end, the article reviews his most important publications on the subject and seeks to evaluate their and hence Strümpell's impact on the understanding of certain illnesses. PMID:22527226

The aim of this study is to investigate sleep quality in patients with ankylosing spondylitis (AS) and to evaluate the relationship of the disease parameters with sleep disturbance. Eighty AS patients (60 males and 20 females) fulfilling the modified New York criteria, and 52 age- and gender-matched controls (33 males and 19 females) were enrolled in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Pain was measured by visual analogue scale. The disease activity and functional status were assessed by the Bath AS disease Activity Index and the Bath AS Functional Index. The Bath AS Metrology Index was used to evaluate mobility restrictions, and the Bath AS Radiology Index was employed to evaluate the radiological damage. The psychological status and quality of life were assessed with the hospital anxiety-depression scale and AS quality of life scale. The patients with AS had significantly more unfavourable scores in the subjective sleep quality, habitual sleep efficiency domains (p sleep quality (total PSQI score) was positively correlated with increased pain, poor quality of life, higher depressed mood, higher disease activity and mobility restrictions. Pain was also an independent contributor to poorer sleep quality (p = 0.002). The sleep quality is disturbed in patients with AS. The lower quality of sleep is greatly associated with the pain, disease activity, depression, quality of life and increased limitation of mobility. PMID:22940709

Abstract in spanish La pseudoartrosis vertebral es una espondilodiscitis aséptica que aparece como complicación tardía de la espondilitis anquilosante. Dos pacientes presentaron este proceso de destrucción discovertebral después de una caída espontánea. Los dos asociaron manifestaciones neurológicas por compresión medular, interviniéndose quirúrgicamente el primero. En el estudio de estas lesiones, las diferentes técnicas de imagen se complementan. Con radiología simple se puede (more) identificar en algunos casos la afección discovertebral. La tomografía axial computerizada delimita mejor estas lesiones y revela la fractura del arco posterior. Por último, el estudio con resonancia magnética aporta sensibilidad para la detección precoz, descarta la existencia de partes blandas paravertebrales que puedan ser de otro origen e identifica la compresión del cordón medular. Abstract in english Spinal pseudoarthrosis is an uncommon complication in patients with advanced ankylosing spondylitis which consists in destruction of the discovertebral junction. Two cases of spinal pseudoarthrosis at the thoracolumbar level after a spontaneous fall are reported. Because of the neural arch involvement and the spinal cord compression a stabilization was required. Different imaging techniques are complementaries in the study of this entity, conventional radiographs and comp (more) uted tomography may depicte bone abnormalities, but magnetic resonance allows a correct evaluation of spinal cord and soft tissue involvement.

Antigen HLA-B27 is a high-risk genetic factor with respect to a group of rheumatoid disorders, especially ankylosing spondylitis. A cDNA library was constructed from an autozygous B-cell line expressing HLA-B27, HLA-Cw1, and the previously cloned HLA-A2 antigen. Clones detected with an HLA probe were isolated and sorted into homology groups by differential hybridization and restriction maps. Nucleotide sequencing allowed the unambiguous assignment of cDNAs to HLA-A, -B, and -C loci. The HLA-B27 mRNA has the structure features and the codon variability typical of an HLA class I transcript but it specifies two uncommon amino acid replacements: a cysteine in position 67 and a serine in position 131. The latter substitution may have functional consequences, because it occurs in a conserved region and at a position invariably occupied by a species-specific arginine in humans and lysine in mice. The availability of the complete sequence of HLA-B27 and of the partial sequence of HLA-Cw1 allows the recognition of locus-specific sequence markers, particularly, but not exclusively, in the transmembrane and cytoplasmic domains.

This report presents a discussion on risk from ionizing radiations to human populations. Important new information on human beings has come mainly from further follow-up of existing epidemiological studies, notably the Japanese atomic bomb survivors and the ankylosing spondylitis patients; from new epidemiological surveys, such as the patients treated for cancer of the uterine cervix; and from combined surveys, including workers exposed in underground mines. Since the numerous and complex differences among the different study populations introduce factors that influence the risk estimates derived in ways that are not completely understood, it is not clear how to combine the different risk estimates obtained. These factors involve complex biological and physical variables distributed over time. Because such carcinogenic effects occur too infrequently to be demonstrated at low doses, the risks of low-dose radiation can be estimated only by interpolation from observations at high doses on the basis of theoretical concepts, mathematical models and available empirical evidence, primarily the epidemiological surveys of large populations exposed to ionizing radiation. In spite of a considerable amount of research, only recently has there has been efforts to apply the extensive laboratory data in animals to define the dose-incidence relationship in the low dose region. There simply are insufficient data in the epidemiological studies of large human populations to estimate risk coefficients directly from exposure to low doses. The risk estimates for the carcinogenic effects of radiation have been, in the past, somewhat low and reassessment of the numerical values is now necessary.

Livedoid vasculopathy has been accepted as a nonvasculitic disorder, but authentic vasculitis in the underlying subcutis can occur in cases of collagen disease and polyarteritis nodosa. We report a case of livedoid vasculopathy with underlying subcutaneous necrotizing venulitis in a 42-year-old carrier of hepatitis B virus. The patient also had a 15-year history of ankylosing spondylitis that was currently in remission. Skin lesions revealed superficial ulceration, purpura, atrophie blanche, and reticulate erythema on the lower extremities, and a skin biopsy showed a minimal dermal perivascular lymphocytic infiltrate with marked fibrin thrombi and fibrin deposits along luminal vessel walls, consistent with features of livedoid vasculopathy. However, necrotizing venulitis characterized by a predominant lymphocytic infiltrate in and around the vessel wall with marked fibrinoid vessel wall necrosis was found in the underlying subcutaneous tissue. A direct immunofluorescence study detected immunoglobulin M and C3 deposits in the papillary dermis. The patient responded well to oral aspirin and a prostaglandin analogue and was well controlled with a compression bandage. Vasculitic lesions in the underlying subcutis may have been overlooked in cases in which livedoid vasculopathy has been considered as a nonvasculitic disorder because our case demonstrates that livedoid vasculopathy can be accompanied by subcutaneous vasculitis. PMID:19384073

Ankylosing spondylitis (AS) is polygenic with contributions from the immunologically relevant genes HLA-B*27, ERAP1 and IL23R. A recent genome-wide association study (GWAS) identified associations (p~0.005) with the non-synonymous single nucleotide polymorphisms (nsSNPs), rs4077515 and rs3812571, in CARD9 and SNAPC4 on chromosome 9q that had previously been linked to AS. We replicated these associations in a study of 730 AS patients compared to 2879 historic disease controls, (rs4077515 p = 0.0004 odds ratio (OR) (95% confidence interval) = 1.2 (1.1-1.4); rs3812571 p = 0.0003 OR = 1.2 (1.1-1.4)). Meta-analysis revealed strong associations of both SNPs with AS, rs4077515 p = 0.000005 OR = 1.2 (1.1-1.3) and rs3812571 p = 0.000006 OR = 1.2 (1.1-1.3). We then typed 1604 AS cases and 1020 controls for 13 tagging SNPs; 6 showed at least nominal association, 5 of which were in CARD9. We imputed genotypes for 13 additional SNPs but none was more strongly associated with AS than the tagging SNPs. Finally, interrogation of an mRNA expression database revealed that the SNPs most strongly associated AS (or in strong linkage disequilibrium) were those most associated with CARD9 expression. CARD9 is a plausible candidate for AS given its central role in the innate immune response. PMID:9496193

Esophageal perforation in ankylosing spondylitis (AS) is a rare complication in anterior cervical spine surgery and has not been reported before. A 50-year-old patient with AS developed incomplete tetraplegia after minimal trauma. C5 pedicle fracture was diagnosed and treated predominantly by physical therapy until neurological symptoms progressed. Cervical spine MRI showed C6/7 fracture and spinal cord compression. The patient underwent dorsal laminectomy, C5-7 anterior cervical fusion using allograft iliac crest and CASPAR-plate fixation. Delayed esophageal perforation appeared 10 months postoperatively when he came first to our hospital. He complained of dysphagia and developed acute dyspnea. Posterior stabilization with two plates was performed followed by removal of the ventral plate and screws. The esophageal laceration was sutured. The patient was treated with antibiotics and percutaneous endoscopic gastrostomy. Position of fracture and implants were accurate at 18 months postoperatively. The patient had persistent minor neurological deficits (Frankel D) at last follow-up. We conclude that esophageal perforation after anterior spinal fusion is a rare complication. Minor traumas in patients with AS are unstable and can result in significant spinal injury. Dorsoventral stabilization should be performed to avoid further complications. PMID:15071748

Nineteen rheumatoid patients suffering from rheumatoid spondylitis with myelopathy were surgically treated using Luque segmental spinal instrumentation (SSI). We studied 7 cases of patients who underwent postoperative magnetic resonance imaging (MRI) evaluation after being treated with titanium Luque SSI. Titanium implants were imaged safely and there was no evidence of implant migration or local tissue heating effect. MRI also allowed postoperative cervical spine imaging without significant image distortion. This titanium Luque SSI method affords rigid fixation, allows early mobilization and MRI serial imaging in the patient`s lifelong medical care. (author).

The study assessed the usefulness of MRI and percutaneous nucleotomy in 13 patients with pyogenic spondylitis. The MRI manifestations obtained from 21 MRI scanning were analyzed according to disease stage. In 10 patients in the acute stage (ranging from 0.5 to 5 months after the onset), the adjacent vertebrae to the intervertebral disc were shown as low intensities on T1-weighted images and the vertebrae surrounding the intervertebral disc or above or below it were shown as high intensities on T2-weighted images. The areas shown as high intensities on T2-weighted images were restricted to the surrounding of the intervertebral disc early after the onset, and extended to the adjacent vertebrae above or below the intervertebral disc. Tumor-like findings in the para-spinal canal were seen in 6 patients. In the other 3 patients in the chronic stage, the areas shown as high intensities on T2-weighted images were surrounded with areas shown as low or no intensities. Roentgenologically proven osteosclerosis was shown as low or no intensities. In healing stage, areas shown as low intensities on T1-weighted images became band-like, and those shown as high intensities on T2-weighted images disappeared. Percutaneous nucleotomy, performed in 9 patients, was capable of diagnosing pyogenic spondylitis in 8 patients (88.9%). In conclusion, MRI was an extremely useful procedure in the early diagnosis of pyogenic spondylitis, as well as the assessment of the therapeutic effects and healing process. Percutaneous nucleotomy was effective in the confirmation diagnosis of this disease. (N.K.).

Anterior uveitis is the most common form of uveitis in most regions of the world. A recent study reported that 50 % of patients with anterior uveitis have a related systemic illness. The most common cause of anterior uveitis to date remains idiopathic (45-50 %), followed by HLA-B27-positive acute anterior uveitis. Ours is a retrospective study of the clinical records of 42 patients with anterior uveitis seen at a tertiary care eye hospital in south India. To diagnose the associated systemic disease, the investigations carried out were erythrocyte sedimentation rate, red and white blood cell counts, anti-nuclear antibody (ANA) analysis and HLA-B27 antigen determination. Based on clinical features, patients were also investigated for serum angiotensin-converting enzyme, high-resolution computed tomography scan, Mantoux test and QuantiFERON-TB Gold test. American College of Rheumatology criteria were followed to diagnose spondyloarthropathies and juvenile idiopathic arthritis (JIA). Of the 42 patients, 14 (33.33 %) were HLA-B27-positive and the remaining 28 (66.66 %) HLA-B27-negative. Overall, 32 of the 42 had no causative association, three patients were diagnosed with JIA, two with ankylosing spondylitis, two were associated with systemic tuberculosis, two with sarcoidosis and one with Vogt-Koyanagi-Harada syndrome. Our case series shows the incidence of various systemic diseases associated with anterior uveitis. Though the overall incidence of HLA-B27-positive acute anterior uveitis in our series (33 %) is similar to that in the Western literature, only 14 % of such patients were positive for a spondyloarthropathy. A few interesting cases like HLA-B27-positive, ANA-negative JIA presenting with chronic persisting anterior uveitis were also seen. PMID:22570117

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed agents for rheumatic disorders such as osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Despite the known association between NSAID use and gastropathy, however, only around one-third of patients at risk of NSAID-induced gastrointestinal toxicity receive adequate gastroprotection, and as many as 44% of these patients are non-adherent. We review the co-prescription of proton pump inhibitors (PPIs) for the prevention of NSAID-induced gastropathy, with a particular focus on the first fixed-dose NSAID/PPI formulation: ketoprofen/omeprazole modified-release capsules. The ketoprofen/omeprazole fixed-dose combination is available in doses of 100 mg/20 mg, 150 mg/20 mg or 200 mg/20 mg as a single capsule for once-daily administration. Ketoprofen monotherapy has been shown to be generally equivalent to other NSAIDs when used in the treatment of OA. In RA, ketoprofen has demonstrated equivalent efficacy to diclofenac, indometacin, piroxicam, aceclofenac, phenylbutazone, naproxen and flurbiprofen. Studies comparing ketoprofen with ibuprofen and sulindac in patients with RA have, in general, favoured ketoprofen. Studies in AS have generally reported similar efficacy between ketoprofen and phenylbutazone and pirprofen. Prophylaxis with omeprazole is effective for the prevention of gastroduodenal ulcers, maintenance of remission and alleviation of dyspeptic symptoms in NSAID recipients. Omeprazole is well tolerated, and adverse events are generally gastrointestinal in nature. The fixed-dose combination of ketoprofen and omeprazole has demonstrated bioequivalence to the respective monotherapies. The incidence of digestive symptoms and the need for dose reduction was reported to be lower with the combination than with its components. Ketoprofen/omeprazole modified-release capsules are the first fixed-dose NSAID/PPI formulation to be approved. This formulation ensures compliance with the gastroprotective prophylaxis, as whenever the NSAID is taken, the PPI is co-administered. Additionally, the once-daily formulation has the potential to improve adherence to anti-inflammatory therapy. PMID:22350497

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica de etiologia autoimune, cujo principal sintoma é a lombalgia crônica de caráter inflamatório, cujo tratamento e complicações representam um encargo considerável para a sociedade. Novas opções terapêuticas têm sido buscadas para o tratamento da dor lombar inflamatória refratária nos pacientes com EA. O objetivo foi apresentar dois pacientes portadores de EA com dor (more) lombar refratária ao uso de anti-inflamatórios não esteroides (AINES), que apresentaram importante melhora clínica com a duloxetina. RELATO DOS CASOS: Dois pacientes do sexo masculino com EA e dor lombar crônica inflamatória refratária ao uso de AINES, que usaram duloxetina (60 mg/dia) e apresentaram melhora clínica importante do quadro doloroso. CONCLUSÃO: A duloxetina se mostrou eficaz para a redução da intensidade da dor lombar crônica inflamatória em pacientes portadores de EA. Abstract in english BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease. Its major symptom is chronic inflammatory low back pain, which treatment and complications represent a considerable burden to society. New therapeutic options have been studied to treat refractory inflammatory low back pain in AS patients. The objective was to present two AS patients with low back pain refractory to non-steroid anti-inflammatory drugs (NSAIDs), who present (more) ed important clinical improvement with duloxetine. CASE REPORTS: Two male patients with AS and chronic inflammatory low back pain refractory to NSAIDs, who used duloxetine (60 mg/day) and presented major clinical improvement. CONCLUSION: Duloxetine was effective to decrease chronic inflammatory low back pain intensity in AS patients.

OBJECTIVE: To assess the association between treatment with anti-tumor necrosis factor-? (TNF-?) agents and the occurrence of hospitalizations, their causes and complications, compared to treatment with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). METHODS: A retrospective cohort study was conducted of patients with RA, AS, and PsA treated with anti-TNF-? agents between April 2002 and December 2007. Patients were assessed during the period of anti-TNF-? treatment (Group B) and compared to an equivalent period before initiation of anti-TNF-? therapy (Group A). All hospitalization charts were reviewed and diagnoses, comorbidities, concomitant medications, and clinical course were analyzed. Statistical analysis was performed using multivariate mixed Poisson regression. RESULTS: In the study period of 57 months, 735 hospitalization events of 327 patients were analyzed. Statistically significant decreases were seen in the total number of hospitalization events as well as hospitalizations due to exacerbation of rheumatic diseases in Group B compared to Group A (44.4 vs 74.2 and 21.9 vs 47.5 per 100 patient-years, respectively; p < 0.0001). More infectious events (7.4 in Group B compared to 4.6 per 100 patient-years in Group A; p = 0.043) were associated with anti-TNF-? treatment, older age, and underlying disease, because patients with RA had higher rates of infections compared to patients with PsA and patients with AS. CONCLUSION: The overall effect of anti-TNF-? therapy was a significant decline in total hospitalization events. The decrease was more prominent in patients with RA than in patients with AS and patients with PsA, and reflected the significant decrease in hospitalizations due to rheumatic disease exacerbation. The decrease was more pronounced than the observed increase in infectious events. PMID:23070992

PURPOSE: To compare mortality among patients with selected autoimmune diseases treated with anti-tumor necrosis factor alpha (TNF-?) agents with similar patients treated with non-biologic therapies. METHODS: Cohort study set within several large health care programs, 1998-2007. Autoimmune disease patients were identified using diagnoses from computerized healthcare data. Use of anti-TNF-? agents and comparison of non-biologic therapies were identified from pharmacy data, and mortality was identified from vital records and other sources. We compared new users of anti-TNF-? agents to new users of non-biologic therapies using propensity scores and Cox proportional hazards analysis to adjust for baseline differences. We also made head-to-head comparisons among anti-TNF-? agents. RESULTS: Among the 46?424 persons included in the analysis, 2924 (6.3%) had died by the end of follow-up, including 1754 (6.1%) of the 28?941 with a dispensing of anti-TNF-? agent and 1170 (6.7%) of the 17?483 who used non-biologic treatment alone. Compared to use of non-biologic therapies, use of anti-TNF-? therapy was not associated with an increased mortality in patients with rheumatoid arthritis (adjusted hazard ratio [aHR] 0.93 with 95% confidence intervals (CI) 0.85-1.03); psoriasis, psoriatic arthritis, or ankylosing spondylitis (combined aHR 0.81 with CI 0.61-1.06; or inflammatory bowel disease (aHR 1.12 with CI 0.85-1.46). Mortality rates did not differ to an important degree between patients treated with etanercept, adalimumab, or infliximab. CONCLUSION: Anti-TNF-? therapy was not associated with increased mortality among patients with autoimmune diseases. Copyright © 2012 John Wiley & Sons, Ltd. PMID:23065964

The objectives of the study were to investigate short and long-term changes and relations to treatment response of plasma interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), YKL-40, matrix metalloproteinase-3 (MMP-3), and total aggrecan in patients with spondyloarthritis (SpA) treated with tumor necrosis factor-alpha (TNFa) inhibitors and to compare with levels in healthy subjects. Biomarkers were measured in an observational cohort of 49 SpA patients (ankylosing spondylitis, n=32, and psoriatic arthritis, n=17) initiating TNFa inhibitor therapy (infliximab, n=38; etanercept, n=8; and adalimumab, n=3) and compared with levels in healthy subjects. Clinical parameters and biomarkers were measured at baseline, weeks 2, 6, and every 6-12 weeks for up to 3 years. Patients with co-morbidities (n=4), missing baseline samples (n=3), and adverse events (n=5) were excluded. Patients with SpA had compared with healthy subjects elevated IL-6 (median 8.5 ng/l (range, 0.98-64) vs. 1.3 (0.33-26)), VEGF (105 ng/l (22-752) vs. 45 (12-351)), YKL-40 (74 µg/l (14-572) vs. 43 (20-184)), and MMP-3 (43 µg/l (9.1-401) vs. 16 (2.5-47), p=0.001), whereas total aggrecan was lower (662 µg/l (223-2,219) vs. 816 (399-2,190), p=0.001). Two weeks after first treatment, all biomarker levels changed towards normal levels (p=0.03) in clinical responders (n=24), and persistent reductions over 3 years were found in IL-6, VEGF, YKL-40, and MMP-3. Only MMP-3 decreased (p=0.02) in non-responders (n=13). The study demonstrated changes of plasma IL-6, VEGF, YKL-40, MMP-3, and total aggrecan and a potential value for monitoring disease activity and treatment response in SpA patients. Larger prospective studies are required to clarify clinical utility of these biomarkers.

OBJECTIVES: The aim of this study was to assess the effects of anti-tumour necrosis factor (TNF) agents on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-negative and anti-hepatitis B core (HBc)-positive patients (HBV occult carriers) with rheumatic diseases. METHODS: Evidence of HBV reactivation after anti-TNF therapy in HBV occult carriers with a rheumatic disease was studied by summarising results and by performing meta-analysis analysis. RESULTS: A total of 468 HBsAg-negative and anti-HBc-positive patients with a rheumatic disease undergoing treatment with an anti-TNF agent were identified in nine studies. The anti-TNF agents used were etanercept in 269 cases, adalimumab in 95, and infliximab in 100 cases, and these were administered for rheumatoid arthritis (RA) in 327 patients, ankylosing spondylitis in 49, and psoriatic arthritis (PsA) in 73 patients. Follow-up periods ranged from 6 to 60 months. HBV reactivation in patients on an anti-TNF agent was reported in 8 cases (8/468 = 1.7%). Seven of these patients had RA and 1 had PsA. Seven patients received etanercept and one adalimumab. HBV-DNA was detectable in 7 of these 8 cases. Antiviral treatment was administered in 6 of the 8 (lamivudine in 2, entecavir in 4) and clinical outcomes were satisfactory in all 8 patients. CONCLUSIONS: HBV reactivation was found in 8 (1.7%) patients among 468 HBsAg-negative and anti-HBc-positive patients with rheumatic diseases treated with anti-TNF agents. Our data suggest that HBsAg-negative and anti-HBc-positive patients undergoing anti-TNF therapy need to be carefully monitored during anti-TNF therapy. PMID:23111095

Objective To evaluate golimumab's effect on MRI-detected spinal inflammation in ankylosing spondylitis (AS). Methods Patients were randomly assigned to subcutaneous injections of placebo (n=78), golimumab 50 mg (n=138), or golimumab 100 mg (n=140) every 4 weeks. An MRI substudy comprising 98 patients (placebo n=23, 50 mg n=37, 100 mg n=38) at eligible MRI substudy sites had serial spine MRI scans (sagittal plane, 1.5T scanners, T1 and short tau inversion recovery sequences) at baseline and weeks 14 and 104. Two blinded (treatment, image order) readers independently evaluated MRI spinal inflammation using AS spine MRI-activity (ASspiMRI-a) scores; reader scores were averaged. Changes from baseline to weeks 14 and 104 were compared among treatment groups using analysis of variance on van der Waerden normal scores both with (post-hoc) and without (prespecified) adjustment for baseline ASspiMRI-a scores. Results Median baseline ASspiMRI-a scores were lower in the 100 mg (3.5) than placebo (6.8) and 50 mg (7.8) groups. Median decreases in activity scores from baseline to week 14 were ?0.5 for placebo, ?3.5 for 50 mg (p=0.047 vs placebo), and ?1.5 for 100 mg (p=0.14 vs placebo). After adjusting for baseline ASspiMRI-a score imbalance, significant improvements were observed with both 50 mg (p=0.011) and 100 mg (p=0.002) versus placebo. ASspiMRI-a scores improvement achieved with golimumab was maintained at week 104. Improvement in ASspiMRI-a scores correlated with improvement in the recently developed AS disease activity score (ASDAS) and C-reactive protein (CRP) levels but not with other key AS clinical outcomes. Conclusion Golimumab significantly reduced MRI-detected spinal inflammation of AS; improvements were sustained to week 104 and correlated with improvement in ASDAS and CRP. PMID:11304108

OBJECTIVE: To compare three methods for calculating the Bath Ankylosing Spondylitis (AS) Metrology Index (BASMI) score using patients who participated in the GO-RAISE study. METHODS: Patients with active AS were randomly assigned in a 1:1.8:1.8 ratio to receive subcutaneous injections of placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks. Lumbar flexion, tragus-to-wall distance, lumbar side flexion, intermalleolar distance, and cervical rotation angle measurements at baseline, week 14, and week 24 were used to calculate the 2-step (BASMI(2) ), 10-step (BASMI(10) ), and linear (BASMI(lin) ) BASMI scores. RESULTS: BASMI(2) scores were generally lower than BASMI(10) and BASMI(lin) scores, which were nearly identical. Median changes from baseline to week 14 in the combined golimumab group were similar to those in the placebo group when using the BASMI(2) method (0.00 vs. 0.00, p = 0.288). The combined golimumab group showed significantly greater improvement from baseline to week 14 than the placebo group when using the BASMI(10) (-0.20 vs. 0.00, p = 0.018) and BASMI(lin) (-0.31 vs. -0.07, p = 0.015) calculation methods, with the latter showing the greatest difference between golimumab and placebo. The Guyatt's effect size was better for the BASMI(lin) and the BASMI(10) versus the BASMI(2) in the combined golimumab group at week 14 (0.58 and 0.53 vs. 0.42, respectively) and week 24 (0.76 and 0.69 vs. 0.61, respectively), despite the relatively short period to assess changes in spinal mobility. CONCLUSION: The BASMI(lin) method was the most sensitive to changes in range of motion exhibited by patients with AS who received golimumab. PMID:22740380

Behçet's disease (BD) is a multi-system inflammatory disorder, in which cytokine balance is polarized to Th1. In this study, the cell surface molecule expression, Th1/Th2, inflammatory cytokine levels in blood, and synovial fluid of CD3(+) T lymphocytes in BD were investigated. The study group consisted of 10 BD, 10 ankylosing spondylitis (AS) patients with peripheral arthritis, and 10 healthy subjects. Expression of cell surface molecules, intracellular IL-2, IL-5, IL-8, IL-10, IL-12, IFN-?, and TNF-? levels in CD3(+) T lymphocytes were determined by flow cytometry in synovial and peripheral blood mononuclear cells (PBMCs). Synovial and plasma cytokine levels were measured by ELISA and CBA. In PBMCs, CD4, CD25, HLA-DR expression and intracellular IL-12, and TNF-? levels of CD3(+) T lymphocytes were statistically increased in BD patients compared to healthy subjects. Compare to AS patients, CD25 and HLA-DR surface expression and intracellular IFN-? and TNF-? levels in T cells were significantly elevated in BD patients. In BD patients, there was an increase in IL-8 secretion; however, in AS patients, both Th1- and Th2-type cytokines were increased compare to healthy subjects. Intracellular cytokine expression did not show any difference in BD patients; however, IL-12 content of synovial fluid was significantly increased compared to AS patients. Our findings revealed that Th1 polarization occurred in both peripheral blood and synovial fluid of BD patients with arthritis. It is found no difference between synovial fluid analysis of BD and AS patients, showing the similarities in the pathogenesis of both diseases. PMID:22576660

Ankylosing spondylitis (AS) is polygenic with contributions from the immunologically relevant genes HLA-B*27, ERAP1 and IL23R. A recent genome-wide association screen (GWAS) identified associations (P approximately 0.005) with the non-synonymous single-nucleotide polymorphisms (nsSNPs), rs4077515 and rs3812571, in caspase recruitment domain-containing protein 9 (CARD9) and small nuclear RNA-activating complex polypeptide 4 (SNAPC4) on chromosome 9q that had previously been linked to AS. We replicated these associations in a study of 730 AS patients compared with 2879 historic disease controls (rs4077515 P=0.0004, odds ratio (OR)=1.2, 95% confidence interval (CI)=1.1-1.4; rs3812571 P=0.0003, OR=1.2, 95% CI=1.1-1.4). Meta-analysis revealed strong associations of both SNPs with AS, rs4077515 P=0.000005, OR=1.2, 95% CI=1.1-1.3 and rs3812571 P=0.000006, OR=1.2, 95% CI=1.1-1.3. We then typed 1604 AS cases and 1020 controls for 13 tagging SNPs; 6 showed at least nominal association, 5 of which were in CARD9. We imputed genotypes for 13 additional SNPs but none was more strongly associated with AS than the tagging SNPs. Finally, interrogation of an mRNA expression database revealed that the SNPs most strongly associated with AS (or in strong linkage disequilibrium) were those most associated with CARD9 expression. CARD9 is a plausible candidate for AS given its central role in the innate immune response. PMID:20463747

A single amino acid exchange between the major histocompatibility complex molecules HLA-B(*)2705 and HLA-B(*)2709 (Asp-116/His) is responsible for the emergence of distinct HLA-B27-restricted T cell repertoires in individuals harboring either of these two subtypes and could correlate with their differential association with the autoimmune disease ankylosing spondylitis. By using fluorescence depolarization and pK(a) calculations, we investigated to what extent electrostatic interactions contribute to shape antigenic differences between these HLA molecules complexed with viral, self, and non-natural peptide ligands. In addition to the established main anchor of peptides binding to HLA-B27, arginine at position 2 (pArg-2), and the secondary anchors at the peptide termini, at least two further determinants contribute to stable peptide accommodation. 1) The interaction of Asp-116 with arginine at peptide position 5, as found in pLMP2 (RRRWRRLTV; viral) and pVIPR (RRKWRRWHL; self), and with lysine in pOmega, as found in gag (KRWIILGLNK; viral), additionally stabilizes the B(*)2705 complexes by approximately 5 and approximately 27 kJ/mol, respectively, in comparison with B(*)2709. 2) The protonation state of the key residues Glu-45 and Glu-63 in the B-pocket, which accommodates pArg-2, affects peptide binding strength in a peptide- and subtype-dependent manner. In B(*)2705/pLMP2, protonation of Glu-45/Glu-63 reduces the interaction energy of pArg-2 by approximately 24 kJ/mol as compared with B(*)2705/pVIPR. B(*)2705/pVIPR is stabilized by a deprotonated Glu-45/Glu-63 pair, evoked by allosteric interactions with pHis-8. The mutual electrostatic interactions of peptide and HLA molecule, including peptide- and subtype-dependent protonation of key residues, modulate complex stability and antigenic features of the respective HLA-B27 subtype. PMID:18505734

OBJECTIVE: A robust association between polymorphisms in the non-major histocompatibility complex gene ERAP1 and ankylosing spondylitis (AS) in several populations was recently identified. The aim of the current study was to determine the level of association of ERAP1 polymorphisms with spondyloarthritis (SpA) in French/Belgian populations with particular attention to genotype-phenotype correlations. METHODS: We studied 734 independent SpA cases and 632 controls from two European cohorts. Five single-nucleotide polymorphisms (SNPs), rs27044, rs17482078, rs10050860, rs30187 and rs2287987 were genotyped, and case-control association analyses were carried using PLINK 1.07 software. Linkage disequilibrium and haplotypes were estimated with Haploview. Analysis was first carried out in SpA as a whole group, and then separately in AS and non-radiographic SpA (non-AS) patients. RESULTS: Consistent with previous studies conducted in AS, rs30187 was the most significantly associated SNP with SpA (p=0.008 in the French, and p=6.46×10(-4) in the Belgian cohorts). In the combined cohorts, this SNP was associated with both AS and non-AS (P(combined)=?3.9×10(-5) and P(combined)=?0.005, respectively). A similar trend was observed with other SNPs. The rs17482078/rs10050860/rs30187-CCT haplotype was significantly associated with increased risk of SpA in both cohorts (P(combined)=?9.08×10(-4)), including AS and non-AS (P(combined)=6.16×10(-4) and P(combined)=0.049, respectively), whereas the -TTC haplotype was associated with reduced risk of SpA, including AS and non-AS (P(combined)=2.36×10(-7), P(combined)=?5.69×10(-6) and P(combined)=?2.13×10(-4), respectively). CONCLUSIONS: This is the first study to show an association between several polymorphisms located in ERAP1 and SpA as a whole. Our findings demonstrate consistent association of the same SNPs and haplotypes with both AS and non-AS subtypes of SpA. PMID:22896742

OBJECTIVE: The Danish DANBIO registry has developed open-source software for touch screens in the waiting room. The objective was to assess the validity of outcomes from self-explanatory patient questionnaires on touch screen in comparison with the traditional paper form in routine clinical care. METHODS: Fifty-two AS patients and 59 RA patients completed Visual Analogue Scales (VASs) for pain, fatigue and global health, and Bath measures on Ankylosing Spondylitis Disease Activity Index (BASDAI) and Function Index (BASFI) (AS patients) or HAQs (RA patients) on touch screen and paper form in random order with a 1-h interval. Intra-class correlation coefficients (ICCs), 95% CIs and smallest detectable differences (SDDs) were calculated. RESULTS: ICC ranged from 0.922 to 0.988 (P < 0.001). The mean differences (95% CI) were: BASDAI [-0.5 (-14.5, 13.5) mm]; BASFI [-1.1 (-10.6, 8.4) mm]; Item 5 [-1.7 (-23.6, 20.2) mm] and Item 6 [-0.7 (-14.7, 13.3) mm] from BASDAI; HAQ score [0.023 (-0.183, 0.229)]. For VAS -0.4 to -2.8 mm (no significance for all except VAS global and VAS fatigue in RA). SDD for BASDAI was 14.0 mm; BASFI 9.5 mm; Item 5 21.8 mm; Item 6 14.0 mm; HAQ 0.206; VAS 11.1-18.8 mm. CONCLUSIONS: Self-explanatory touch screens based on the DANBIO open-source system generates valid results in AS and RA patients on completion of BASDAI, BASFI, HAQ and VAS scores for pain, fatigue and global health when compared with the traditional paper form. Implementation of touch screens in clinical practice is feasible and patients need no instruction.

OBJECTIVE: Increased body mass index (BMI) in patients with ankylosing spondylitis (AS) is associated with a greater burden of symptoms and poor perceptions of the benefits of exercise. In AS, the effect of obesity on disease characteristics and exercise perceptions is unknown. We evaluated the prevalence of obesity in AS, to assess the attitudes of patients toward exercise and to evaluate the effect of obesity on symptoms and disease activity. METHODS: Demographic data and disease characteristics were collected from 46 patients with AS. Disease activity, symptomatology, and functional disability were examined using standard AS questionnaires. BMI was calculated. Comorbidity was analyzed using the Charlson Comorbidity Index. Patients' attitudes toward exercise were assessed using the Exercise Benefits and Barriers Scale (EBBS). We compared the disease characteristics, perceptions regarding exercise, and functional limitations in those who were overweight to those who had a normal BMI. RESULTS: The mean BMI in the group was 27.4; 67.5% of subjects were overweight or obese. There was a statistically significant difference between those who were overweight and those with a normal BMI regarding their perceptions of exercise (EBBS 124.7 vs 136.6, respectively), functional limitation (Bath AS Functional Index 4.7 vs 2.5, Health Assessment Questionnaire 0.88 vs 0.26), and disease activity (Bath AS Disease Activity Index 4.8 vs 2.9). There was no difference between the groups in terms of their comorbid conditions or other demographic variables. CONCLUSION: The majority of patients in this AS cohort were overweight. They had a greater burden of symptoms, worse perceptions regarding the benefits of exercise, and enhanced awareness of their barriers to exercising. This is of particular concern in a disease where exercise plays a crucial role. PMID:23070993

Abstract in spanish Introducción. La exostosis múltiple hereditaria es un trastorno autosómico dominante caracterizada por excrecencias cartilaginosas múltiples, fundamentalmente, en huesos de las extremidades, y en la que se han descrito como asociados el síndrome de Langer Giedion, la leucemia mieloide aguda y la espondilitis anquilosante. Objetivo: describir el caso de un niño de 10 años de edad en el cual coexisten la exostosis múltiple hereditaria y síndrome de Down. Caso clín (more) ico. Paciente masculino de 10 años, con edad aparente mayor a la real, braquicefalia, fisuras palpebrales oblicuas, epicanto, puente nasal aplanado, retardo mental, con presencia de tumoraciones de 3 x 2 cm aproximados, localizadas en extremidades, cintura escapular y pélvica, con marcha claudicante y complemento cromosómico de 47, XY, +21. Conclusión. Parece tratarse del primer caso en donde coexisten el síndrome de Down y la exostosis múltiple. Abstract in english Introduction. Multiple hereditary exostoses is an autosomal dominant disorder characterized by multiple osteochondromas, fundamentally in bones of the extremities, and in which they have been described like the associates the syndrome of Langer Giedion, the acute myeloid leukemia and the ankylosing spondylitis. Objective: to describe the case of 10-year-old boy in which coexist multiple hereditary exostoses and Down's syndrome. Case report. Male patient with greater appar (more) ent age to the real one, brachycephaly, up slanting palpebral fissures, low nasal bridge, mental deficiency, and tumors presence of approximate 3 x 2 cm, located in extremities waist scapular and pelvic, with failing march and complement chromosomal of 47, XY, + 21. Conclusion. We report appears to be the first case of Down's syndrome with the coexistence of multiple exostoses.

STUDY DESIGN:: Retrospective comparative study. OBJECTIVE:: To elucidate the indications and limitations of conservative treatment for pyogenic spondylitis. SUMMARY OF BACKGROUND DATA:: The optimal strategy for treating pyogenic spondylitis, conservative or surgical, remains controversial. METHODS: Sixty-eight consecutive patients (44 males, 24 females, 62.6±13.8?y old) suffering pyogenic spondylitis were enrolled. Forty-three were successfully treated with conservative therapy including immobilization and administration of antibiotics (conservative treatment success [CTS] group). Twenty five patients underwent surgical intervention because of ineffective conservative treatment, (conservative treatment failure [CTF] group). Clinical parameters such as duration of symptoms, CRP at admission, durations of hospital stay and Frankel's score, and radiological parameters such as presence of epidural abscess, were investigated in both groups. RESULTS:: Duration of symptoms, CRP at admission, and duration of hospital stay were 1.72±1.02 months, 5.89±6.29?mg/dL, and 85.7±46.0 days respectively in the CTS group compared to 7.92±16.9 months, 2.22±3.08?mg/dL, and 95.0±28.0 days in the CTF group. Differences were significant. At follow-up, 100% of the CTS group and 84% of the CTF group were ambulatory. 86.1% of the CTS group lesions occurred at the lumbosacral region, whereas the majority (52%) of those in the CTF group were in the thoracic region. The incidence of epidural abscess was higher in the CTF group (84.0%) than in the CTS group (30.2%), and their greatest likelihoods were at the cervical/thoracic regions and lumbosacral region respectively? CONCLUSIONS:: The early phase of PS, in which the duration of disease between onset and admission was short and CRP at admission was active, was a good indication for conservative treatment regardless of the sites if there was neither paralysis nor worsening of kyphosis, and can even be an option for cases with mild paralysis due to epidural abscess occurring at the lumbosacral region. PMID:22614267

The prevalence of infraoccluded or impacted primary molars was reported to be from 1.3% to 8.9% of the population with higher incidence between siblings. This is a report of a rare case of a 10-year-and-11-month-old boy with a previously erupted primary maxillary right second molar that was restored by with an amalgam filling at about three years of age. After seven years, the said tooth was found X-ray photographically to be completely embedded into the alveolar bone with an “impacted” maxillary permanent second premolar. There was also mesial tipping of the adjacent permanent first molar. The management of this case included the use of a space regainer to correct the molar tipping, surgical removal of the ankylotic infraoccluded primary molar and the use of a palatal holding arch to correct the torsiversion. This report underscores the need for early recognition of infraoccluded/ankylosed primary teeth by dentists for regular monitoring and timely and appropriate intervention.   

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória, crônica, que acomete as articulações sacroilíacas, em graus variáveis a coluna vertebral e, em menor extensão as articulações periféricas. Dentre as formas de tratamento não medicamentoso, os grupos educacionais têm sido recomendados como importante coadjuvante no tratamento da doença. O objetivo deste estudo foi rever na literatura as evidências científicas sobre grupos (more) educacionais para pacientes com EA. MÉTODO: A revisão foi realizada nas Bases de dados LILACS, Medline, Web of Science e PEDro. Os termos para busca sistemática foram extraídos dos Descritores em Ciências da Saúde (DeCS). RESULTADOS: Foram localizados nove artigos científicos no período de 1990 a 2012. Na seleção e análise dos estudos foram utilizados critérios de inclusão e exclusão, incluído artigos científicos que abordassem principalmente os grupos educacionais como forma de tratamento para os pacientes com EA. CONCLUSÃO: A literatura a respeito dos grupos educacionais como coadjuvante no tratamento desses pacientes é escassa. Futuros estudos mostrando os formatos dos grupos, duração, quantidade e conteúdos das aulas devem ser realizados, bem como a avaliação de sua efetividade. Abstract in english BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting sacroiliac joints, the spine in different degrees and in lesser extension peripheral joints. Among non-pharmacological treatments, educational groups have been recommended as major coadjuvants to treat this disease. This study aimed at reviewing the literature on scientific evidences of educational groups for AS patients. METHOD: The following databases were reviewed: LILACS (more) , Medline, Web of Science and PEDro. Words for systematic search were extracted from Health Sciences Keywords (HSC). RESULTS: Nine scientific articles were found between 1990 and 2012. Inclusion and exclusion criteria were used to select and analyze studies, including scientific articles especially addressing educational groups as treatment approaches for AS patients. CONCLUSION: Literature on educational groups as coadjuvant to treat such patients is scarce. Further studies are needed to show group formats, number and content of classes, in addition to evaluating their effectiveness.

Abstract in portuguese OBJETIVO: Avaliar as complicações imediatas da aplicação de agentes anti-TNF? no Centro de Dispensação de Medicação deAlto Custo do HC-FMUSP. PACIENTES E MÉTODOS: Foram incluídos todos os pacientes que receberam agentes anti-TNF? entre agosto/2007 e março/2009.As complicações imediatas (até 1 hora após o término da aplicação) foram classificadas em leves (cefaleia, rash, tontura, prurido, náuseas), moderadas (febre, urticária, palpitação, d (more) or torácica, dispneia, variação da pressão arterial de 20 a 40 mmHg) ou graves (febre com calafrios, dispneia com sibilância, variação da pressão arterial > 40 mmHg). RESULTADOS: Foram avaliados 242 pacientes: 94 (39%) com artrite reumatoide, 64 (26%) com espondilite anquilosante, 32 (13%) com artrite psoriásica, 26 (11%) com artrite idiopática juvenil e 27 (11%) com outros diagnósticos. O número total de aplicações foi de 3.555, sendo 992 (28%) de adalimumabe, 1.546 (43%) de etanercepte e 1.017 (29%) de infliximabe. Complicações imediatas foram observadas em 39/242 (16%) pacientes. As complicações ocorreram em 45/3.555 (1,2%) aplicações. Estas foram mais frequentes com infliximabe comparado com adalimumabe (3,7% vs. 0,5%, P Abstract in english OBJECTIVE: To evaluate the immediate complications of anti-TNF? drugs at the "Center for Dispensation of High Cost Medications" of HC-FMUSP. PATIENTS AND METHODS: All patients who received anti-TNF? agents between August 2007 and March 2009 were included in this study. Immediate complications (up to 1 hour after the injection) were classified as mild (headache, rash, dizziness, itching, nausea), moderate (fever, urticaria, palpitation, chest pain, dyspnea, blood (more) pressure variations between 20 and 40 mmHg), or severe (fever with chills, dyspnea with wheezing, variations in blood pressure > 40 mmHg). RESULTS: Two hundred and forty-two patients were evaluated: 94 (39%) with rheumatoid arthritis, 64 (26%) with ankylosing spondylitis, 32 (13%) with psoriatic arthritis, 26 (11%) with juvenile idiopathic arthritis; and 27 (11%) with other diagnoses. A total of 3,555 injections were administered: 992 (28%) adalimumab, 1,546 (43%) etanercept, and 1,017 (29%) infliximab. Immediate adverse events were observed in 39/242 (16%) patients. Injectionrelated complications were observed in 46/3,555 (1.2%) injections. They were more common with infliximab than adalimumab (3.7% vs. 0.5%, P

Abstract in portuguese As manifestações otorrinolaringológicas nas doenças reumáticas representam um desafio diagnóstico para o reumatologista, o otorrinolaringologista e o médico generalista. Comumente, sintomas otorrinolaringológicos representam um sinal inicial de uma doença assintomática ou uma desordem auto-imune não diagnosticada, que freqüentemente exige um imediato e agressivo tratamento imunossupressor. Distúrbios auditivos podem ser vistos em pacientes com lúpus eritemat (more) oso sistêmico (LES), granulomatose de Wegener (GW), policondrite recidivante (PR), poliarterite nodosa, síndrome de Cogan, síndrome de Sjögren e menos freqüentemente na síndrome de Churg-Strauss e doença de Behçet. O nariz e seios paranasais são variavelmente afetados durante o curso da GW, síndrome de Churg-Strauss, PR e sarcoidose. Ulcerações mucosas recorrentes são comuns no LES e doença de Behçet. Xerostomia é uma manifestação comum da síndrome de Sjögren primária e secundária; aumento da glândula salivar pode ser visto nesses pacientes, assim como nos pacientes com sarcoidose. A articulação cricoaritenóide pode ser envolvida durante o curso da artrite reumatóide, espondilite anquilosante e gota; alterações osteoartríticas também têm sido descritas. Disfunção do nervo trigeminal pode ocorrer em pacientes com síndrome de Sjögren, esclerose sistêmica, LES e doença mista do tecido conjuntivo. Paralisia facial periférica tem sido descrita como complicação do curso da síndrome de Sjögren e sarcoidose. Abstract in english Otorhinolaryngologics manifestations of rheumatologic disorders represent a diagnostic challenge for the rheumatologist, the otorhinolaryngologist, and the general practicioner. Not uncommonly otorhinolaryngologics symptoms represent the initial sign of an otherwise asymptomatic or even undiagnosed autoimmune disorder which often calls for prompt and aggressive immunosuppressive treatment. Hearing disturbances may be seen in patients with systemic lupus erythematosus, Weg (more) ener's granulomatosis, relapsing polychondritis, polyarteritis nodosa, Cogan's syndrome, Sjögren's syndrome, and less frequently in Churg-Strauss syndrome and Behçet's disease. Nose and paranasal sinuses are variably affected during the course of Wegener's granulomatosis, Churg-Strauss syndrome, relapsing polychondritis and sarcoidosis. Recurrent mucosal ulcerations are common in systemic lupus erythematosus and Behçet's disease. Xerostomia is a common feature of primary and secondary Sjögren's syndrome; salivary gland enlargement may be also seen in these patients, as well as in patients with sarcoidosis. The cricoarytenoid joint can be involved during the course of rheumatoid arthritis, ankylosing spondylitis and gout; osteoarthritic changes have also been described. Trigeminal nerve dysfunction may occur in patients with Sjögren's syndrome, systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disease. Peripheral facial nerve palsy has been described to complicate the course of Sjögren's syndrome and sarcoidosis.

In this review we consider diseases associated with pathological mineralization/ossification, namely, ankylosing spondylitis (AS), osteoarthritis (OA), generalized artery calcification of infancy (GACI), vascular calcification as well as chondrocalcinosis (CC) and pseudo gout. Deciphering the key enzymes implicated in the calcification process is an objective of prime importance and the ultimate goal is to synthesize inhibitors of these enzymes in order to provide efficient alternate therapeutic strategies that will slow down the pathologic mineralization and complement the arsenal of anti-inflammatory drugs. One of the difficulties in the definition of diseases associated with pathologic mineralization/ossification lies in the controversial relationship between the type of calcification and the nature of the disease. Here, we propose to clarify this relationship by making a distinction between diseases associated with hydroxyapatite (HA) and calcium pyrophosphate dihydrate (CPPD) deposits. AS, OA, GACI and vascular calcification are usually characterized by mineralization/ossification associated with HA deposits, while CC and pseudo gout are mostly characterized by CPPD deposits. Although both HA and CPPD deposits may occur concomitantly, as in chronic pyrophosphate arthritis or in OA with CPPD, they are formed as a result of two antagonistic processes indicating that treatment of distinct diseases can be only achieved by disease-specific drug therapies. The hydrolysis of PPi, an inhibitor of HA formation, is mostly controlled by tissue non-specific alkaline phosphatase TNAP, while PPi production in the extracellular medium is controlled by ANK, a PPi transporter, and/or NPP1 which generates PPi from nucleotide triphosphates. Low PPi concentration may lead to a preferential deposition of HA while high PPi concentration will favor the formation of CPPD deposits. Thus, HA and CCPD deposition cannot occur concomitantly because they are determined by the Pi/PPi ratio which, in turn, depends on the relative activities of antagonistic enzymes, TNAP hydrolyzing PPi or ANK and NPP1 producing PPi. TNAP inhibitors could prevent HA formation in AS, in late OA, in GACI, as well as in vascular calcifications, while ANK or NPP1 inhibitors could slow down CCPD deposition in CC and pseudo gout. PMID:21517761

Abstract in spanish Objetivo.Determinar las vías utilizadas por las células mononucleares de sangre periférica (CMSP) de pacientes con espondilitis anquilosante para procesar a la rHSPGO de Klebsiella pneumoniae (rHSPGOKp) y las subpoblaciones de linfocitos T involucrados en la activación. Métodos. Se determinó la respuesta linfoproliferativa, por incorporación de ³H-TdR en CMSP, en presencia de la rHSPGOKp, en 14 pacientes con EA HLA-B27+y en 15 sujetos sanos HLA-B27-. La ruta de pr (more) ocesamiento y presentación de la rHSPGOKp se determinó por incorporación de ³H-TdR en las CMSP de los pacientes utilizando como células presentadoras a las CMSP homologas, preíncubadas con el antígeno y los inhibidores específicos: cloroquína, brefeldína A y N-acetil-L-leucil-L-leucil-L-nor-leucinal (LLnL), y fijadas con p-formaldehído. Se evaluaron las subpoblaciones de linfocitos T CD4+ y CD8+ que expresaron CD69, frente al antígeno, por citometría de flujo. Resultados. Ocho de los 14 pacientes y ninguno de los sujetos sanos, tuvo respuesta linfoproliferativa positiva (IE > 3.0) contra la rHSPGOKp (p Abstract in english Objective. To determine the processing pathways used by peripheral blood mononuclear cells (PBMC) and present the rHSP60Kp, and the T cell subpopulations involved in the response, in patients with ankylosing spondylitis (AS) Methods. The lymphoproliferative response to the rHSP60Kp in PBMC from 14 HLA-B27 + AS patients and 15 B27 healthy controls was assessed by ³H-TdR incorporation. The processing pathways for the rHSP60Kp were analyzed by ³H-TdR incorporation in fresh (more) PBMC from patients using homologous PBMC preincubated with the antigen and specific inhibitors: chloroquine, N-acetyl-L-leucil-L-leucil-L-nor-leucinal (LLnL) or brefeldin A (BFA), fixed with p-formaldehyde (fixed APC). The CD4+/CD8+ T cell subpopulation activated with the antigen was determined by three colours flow cytometry in PBMC from patients. Results. Eight out of fourteen patients showed positive lymphoproliferative responses to the rHSP60Kp while none of the healthy controls responded (p

Tumor necrosis factor (TNF)-targeted therapies are increasingly used for a rapidly expanding number of rheumatic and autoimmune diseases. With this use and longer follow-up periods of treatment, there are a growing number of reports of the development of autoimmune processes related to anti-TNF agents. We have analyzed the clinical characteristics, outcomes, and patterns of association with the different anti-TNF agents used in all reports of autoimmune diseases developing after TNF-targeted therapy found through a MEDLINE search of articles published between January 1990 and December 2006. We identified 233 cases of autoimmune diseases (vasculitis in 113, lupus in 92, interstitial lung diseases in 24, and other diseases in 4) secondary to TNF-targeted therapies in 226 patients. The anti-TNF agents were administered for rheumatoid arthritis (RA) in 187 (83%) patients, Crohn disease in 17, ankylosing spondylitis in 7, psoriatic arthritis in 6, juvenile RA in 5, and other diseases in 3. The anti-TNF agents administered were infliximab in 105 patients, etanercept in 96, adalimumab in 21, and other anti-TNF agents in 3. We found 92 reported cases of lupus following anti-TNF therapy (infliximab in 40 cases, etanercept in 37, and adalimumab in 15). Nearly half the cases fulfilled 4 or more classification criteria for systemic lupus erythematosus (SLE), which fell to one-third after discarding preexisting lupus-like features. One hundred thirteen patients developed vasculitis after receiving anti-TNF agents (etanercept in 59 cases, infliximab in 47, adalimumab in 5, and other agents in 2). Leukocytoclastic vasculitis was the most frequent type of vasculitis, and purpura was the most frequent cutaneous lesion. A significant finding was that one-quarter of patients with vasculitis related to anti-TNF agents had extracutaneous involvement. Twenty-four cases of interstitial lung disease associated with the use of anti-TNF agents were reported. In these patients, 2 specific characteristics should be highlighted: the poor prognosis in spite of cessation of anti-TNF therapy, and the possible adjuvant role of concomitant methotrexate. In conclusion, the use of anti-TNF agents has been associated with an increasing number of cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, SLE, and interstitial lung disease. PMID:17632266

...abnormal bone) growth in the spine is a hallmark of Ankylosing...tomography scans of the lumbar spine. It provides computer...Degenerative disk disease in the spine results in loss of disk...tomography's advantage over MRI is better image...

Abstract in spanish El objetivo de este estudio fue obtener información postmarketing sobre el uso de infliximab en un centro reumatológico de atención ambulatoria. Se realizó un análisis retrospectivo y prospectivo de las historias clínicas de pacientes con diagnóstico de artritis reumatoidea ( n=37 ), artritis psoriásica ( n=5 ), enfermedad mixta del tejido conectivo ( n=1 ) y espondilitis anquilosante ( n=2 ) que recibieron infliximab (3 mg / kg ) desde agosto de 2000 a junio de 2 (more) 003. El análisis descriptivo se realizó con porcentajes, media o mediana y desviación estándar o intervalo intercuartilo . La prueba de Wilcoxon se utilizó para el análisis apareado de dosis de antiinflamatorios no esteroideos y metotrexato , anterior y posterior a la administración de infliximab. Se consideraron significativos valores de p £ 0.05. Se incluyeron 45 pacientes a los que se les administraron un total de 207 infusiones. En 2 pacientes el infliximab se discontinuó debido a lumbalgia severa durante la infusión y en otros 2 por anafilaxia intrainfusional. Otras reacciones adversas ocurridas durante las infusiones fueron moderadas y respondieron adecuadamente al tratamiento estándar. Se presentó un caso de artritis séptica de rodilla por estafilococos. Un caso de artritis reumatoidea con insuficiencia renal compensada recibió infliximab en dosis de 1.9 mg / kg cada 30 días, sin cambios en la función renal. Al momento, ningún paciente ha desarrollado tuberculosis activa. Debido a la mejoría clínica, se redujo la dosis de corticoides en 14/39 (35.9%) pacientes, de antiinflamatorios no esteroideos en 15/43 (34.8%) y de metotrexato en 12/34 (35.3%). En esta serie de casos se muestra el perfil de seguridad de infliximab, la posibilidad de reducir la dosis de drogas concomitantes, así como algunos enfoques individuales sobre situaciones para las cuales no disponemos de guías basadas en la evidencia médica, y en las que los reumatólogos debemos tomar decisiones según las necesidades clínicas. Abstract in english The objective of this study was to obtain post-marketing information about the use of infliximab in an ambulatory setting. We studied?retrospectively and prospectively - the case records of patients with rheumatoid arthritis (n=37), psoriatic arthritis (n=5), mixed connective tissue disease (n=1), and ankylosing spondylitis (n=2) who received infliximab (3 mg/kg) from August 2000 to January 2003. Descriptive values were given as percentage, mean or median, and standard d (more) eviation or interquartile range. Wilcoxon test was used for paired analysis of pre/post doses of corticosteroids, non-steroidal anti-inflammatory drugs, and methotrexate therapy. A p value £ 0.05 was considered significant. Forty-five patients were included. A total of 207 infusions were administered. In 4 patients the treatment was permanently discontinued due to severe back pain during the infusion (2 cases) and serious anaphylactic reactions (2 cases). Other adverse reactions occurring during infusions were mild and successfully managed with standard treatment. A case of staphylococcal septic arthritis resolved with standard antibiotic treatment. No patient had evidence of active tuberculosis. One patient with rheumatoid arthritis and chronic renal insufficiency, received treatment with infliximab 1.9 mg/kg, every 30 days, with no changes in renal function. Due to improvement of symptoms, 14/39 (35.9%) patients could decrease the doses of corticosteroids, 15/43 (34.8%) decreased the doses of antiinflammatory drugs and 12/34 (35.3%) decreased methotrexate dosage. Although some questions remain to be elucidated, this case series shows the drug safety profile, the possibility to reduce concomitant drug doses, as well as individual approaches for situations where there are not yet guidelines available, so that rheumatologists have to make decisions based on clinical needs.

Abstract in portuguese INTRODUÇÃO: Os pacientes reumatológicos em terapia com antifator de necrose tumoral (anti-TNF, Tumor Necrosis Factor) são considerados imunodeprimidos. Neste sentido, a pesquisa de doenças infecciosas nesta população é imperiosa devido à alta morbidade e, por vezes, mortalidade associada a este quadro. OBJETIVOS: O presente trabalho teve por objetivo avaliar a frequência de soropositividade para os seguintes agentes infecciosos: Treponema pallidum (sífilis), Tr (more) ypanosoma cruzii (doença de Chagas), vírus da imunodeficiência humana adquirida (Human imunnodeficiency Virus - HIV) e hepatites B e C (HBV e HCV, respectivamente) em pacientes recebendo terapia anti-TNF. PACIENTES E MÉTODOS: Foram avaliados 143 pacientes reumatológicos em um estudo observacional, com artrite reumatoide, espondilite anquilosante, artrite psoriásica e outras doenças, em uso de terapia anti-TNF (adalimumabe, etanercepte e infliximabe) no período de setembro de 2007 a novembro de 2008. Foram coletados dados clínicos e demográficos, bem como uma amostra de sangue para a análise da presença de anticorpos contra os agentes infecciosos HIV (Aids), HBV e HCV (hepatites B e C, respectivamente), Treponema pallidum (sífilis) e Trypanosoma cruzii (doença de Chagas). RESULTADOS: A média de idade da população estudada foi de 45,78 ± 12,7 anos, sendo 60,1% do sexo feminino e 76,9% de cor branca. Treze (9%) dos pacientes apresentaram pelo menos uma sorologia positiva. Nenhum dos pacientes apresentou sorologia positiva para o Trypanosoma cruzii (doença de Chagas), bem como para HIV. Somente dois (1,4%) indivíduos apresentaram positividade para o Treponema pallidum (sífilis) (ELISA positivo e VDRL negativo). A frequência de anti-HBc total foi de 5% (7/140), sendo que todos estes foram positivos também para anti-HBs. O HBsAg foi negativo em todos os pacientes. Quatro pacientes tiveram HCV positivo, sendo que dois deles tinham PCR negativo para o vírus e os outros dois foram positivos e estavam estáveis. CONCLUSÃO: A frequência de soropositividade para certas doenças infecciosas em pacientes em terapia com anti-TNF é baixa. Os indivíduos que merecem maior atenção são aqueles com sorologia positiva para o HCV. Abstract in english INTRODUCTION: Patients with rheumatic diseases treated with anti-tumor necrosis factor (anti-TNF) are considered to be immunosuppressed. Therefore, investigation for infectious diseases is mandatory in this population due to the high morbidity and, occasionally, mortality associated with this condition. OBJECTIVES: The objective of the present study was to evaluate the frequency of seropositivity for the following infectious agents: syphilis, Chagas' disease, acquired hum (more) an immunodeficiency virus (HIV), and hepatitis B and C in patients under anti-TNF therapy. PATIENTS AND METHODS: This observational study evaluated 143 rheumatology patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and others, under anti-TNF therapy (adalimumab, etanercept, and infliximab) from September 2007 to November 2008. Clinical and demographic data, as well as presence of antibodies against HIV, hepatitis B and C, syphilis, and Chagas' disease, were evaluated. RESULTS: The study population had a mean age of 45.78 ± 12.7 years; 60.1% were females and 76.9% Caucasian. Thirteen (9%) patients had at least one positive serology. None of the patients had antibodies to Chagas' disease and HIV. Only two (1.4%) individuals were positive for syphilis (positive ELISA and negative VDRL). The frequency of total anti-HBc was 5% (7/140), and those patients were also positive for anti-HBs. All patients were negative for AgHBs. Four patients were HCV positive: and two of them had negative virus PCR and the other two were positive, but they were stable. CONCLUSION: The frequency of seropositivity for different infectious diseases in patients under anti-TNF therapy is low. Individuals with positive serology for hepatitis C deserve close attention.

This paper presents a summary of the evidence review group (ERG) report into the use of golimumab for the treatment of psoriatic arthritis (PsA). The main clinical effectiveness data were derived from a single phase III randomised controlled trial (RCT: GO-REVEAL) that compared golimumab with placebo for treating patients with active and progressive PsA who were symptomatic despite the use of previous disease-modifying antirheumatic drugs or non-steroidal anti-inflammatory drugs. The 14-week data showed that, compared with placebo, golimumab 50 mg significantly improved joint disease response as measured by American College of Rheumatology (ACR) 20 [relative risk (RR) 5.73, 95% confidence interval (CI) 3.24 to 10.56] and Psoriatic Arthritis Response Criteria (PsARC) (RR 3.45, 95% CI 2.49 to 4.87), and skin disease response as measured by the Psoriasis Area and Severity Index (PASI) 75 (RR 15.95, 95% CI 4.62 to 59.11). The 24-week absolute data showed that these treatment benefits were maintained. There was a significant improvement in patients' functional status as measured by the Health Assessment Questionnaire (HAQ) change from baseline at 24 weeks (-0.33, p golimumab, the manufacturer failed to provide longer-term data or to consider adverse event data of golimumab from controlled studies in other conditions, such as rheumatoid arthritis and ankylosing spondylitis. Although the adverse effect profile of golimumab appears similar to other anti-tumour necrosis factor (TNF) agents, the longer-term safety profile of golimumab remains uncertain. The manufacturer's submission presented a decision model to compare etanercept, infliximab, golimumab and adalimumab versus palliative care for patients with PsA. In the base-case model, 73% of the cohort of patients were assumed to have significant psoriasis (> 3% of body surface area). Estimates of the effectiveness of anti-TNF agents in terms of PsARC, HAQ change and PASI change were obtained from an MTC analysis of RCT data. The manufacturer failed to calculate incremental cost-effectiveness ratios (ICERs) correctly by comparing golimumab with palliative care instead of the most cost-effective alternative (etanercept). Despite the manufacturer's claim that golimumab is a cost-effective treatment option, the manufacturer's own model showed that golimumab is not cost-effective compared with other biologics when the ICERs are correctly calculated. None of the sensitivity analyses carried out by the manufacturer or the ERG regarding uncertainty in the estimates of clinical effectiveness, the acquisition and administration cost of drugs, the cost of treating psoriasis and the utility functions estimated to generate health outcomes changed this conclusion. However, a key area in determining the cost-effectiveness of anti-TNF agents is whether they should be treated as a class. If all anti-TNF agents are considered equally effective then etanercept, adalimumab and golimumab have very nearly equal costs and equal quality-adjusted life-years (QALYs), and all have an ICER of about £ 15,000 per QALY versus palliative care, whereas infliximab with a higher acquisition cost is dominated by the other biologics. PMID:21609657

Abstract in portuguese OBJETIVO: avaliar o perfil gestacional numa casuística de mulheres com espondilite anquilosante (EA) acompanhadas em um hospital universitário de referência. MÉTODOS: estudo retrospectivo avaliando 40 mulheres com EA, segundo os critérios modificados de New York, acompanhadas no Ambulatório de Espondiloartropatias da FCM-UNICAMP no período entre 1990 e 2004. Foram avaliados os dados referentes ao número de gestações, partos e abortos, bem como o comportamento da (more) doença durante a gestação naquelas pacientes que engravidaram após o início da EA. RESULTADOS: dentre as 40 mulheres avaliadas, 35 (87,5%) eram brancas e 27 (67,5%) eram HLA-B27 positivo, sendo que somente três (7,5%) referiam história familiar de EA. A média de idade de início foi de 29,9 anos e o tempo médio de doença foi de 15,5 anos. Nove pacientes (22,5%) nunca haviam engravidado, sendo que apenas uma paciente decidiu não engravidar por causa da EA. Trinta e uma pacientes apresentaram 83 gestações (média de 2,7 gestações/paciente), sendo sete após o início da doença. Ocorreram 71 partos e 12 abortos espontâneos (nenhum após o início da doença). Dentre as cinco pacientes que engravidaram após o início da EA, apenas uma apresentou piora da doença, associada ao comprometimento das coxofemorais. CONCLUSÕES: a análise do perfil gestacional da presente casuística indica que a fertilidade parece não ter sido afetada antes do início da EA e que a maioria das pacientes decide não engravidar após o início da doença. Abstract in english OBJECTIVE: To analyze the pregnancy profile in a group of female patients with ankylosing spondylitis (AS) followed at a referral university center. METHODS: Retrospective study analyzing 40 women with the diagnosis of AS according to the New York modified criteria followed at the Spondyloarthropathies Outpatient Clinic of the State University of Campinas in the period between 1990-2004. The number of pregnancies, deliveries and miscarriages was investigated, as well as t (more) he disease behavior during the pregnancy in those patients that got pregnant after AS onset. RESULTS: Among the 40 AS patients, 35 (87.5%) were Caucasians and 27 (67.5%) were HLA-B27 positive; 3 patients (7.5%) referred familial history of AS. The mean age of onset was 29.9 years old and the mean disease duration was 15.5 years. Nine patients (22.5%) never got pregnant; just one patient decided not to get pregnant because of AS. Thirty-one patients presented 83 pregnancies (an average of 2.7 pregnancies/patient), being seven after disease onset. There were 70 deliveries and 12 spontaneous miscarriages, but no miscarriages after AS onset. Among the 5 patients that got pregnant after disease onset, just 1 patient referred worsening of AS, related to hip involvement. CONCLUSIONS: In the present casuistic, fertility seemed not to be affected before disease onset and most patients decided not to get pregnant after AS onset.

... pregnancy on akylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis. Am J Reprod Immunol 28(3-4):235-7. Tey HL et al. (2010) Risk factors associated with having psoriatic arthritis in patients with ...

MRI shows various images according to the healing process in pyogenic spondylitis. The images indicate activities of inflammation. Signs of healing were decided as follows. T2-weighted image shows no high signal intensity at the focus in intercorporal space. Area of diffuse enhancement with Gadolinium-DTPA becomes smaller or diminished. Thirteen cases treated conservatively were evaluated prospectively for healing process using these signs. The MR images correlated with symptoms and the results of blood examination in twelve cases. MRI adds more confidence to the judgment of healing in the case of pyogenic spondylitis with no symptoms and normal results of blood examination. (author)

Three cases of cauda equina syndrome in long-standing ankylosing spondilitis are reported. In all vertebral scalloping and dural ectasia were confirmed by magnetic resonance imaging and computed tomography. MRI showed widening of the dural sac with signal intensity corresponding to cerebrospinal fluid. CT demonstrated asymmetrical lesions of the posterior elements of the lumbar spine. Myelography was not felt necessary to confirm the findings.

Abstract in spanish En el presente estudio se examinó la especificidad y la sensibilidad de los anticuerpos antipéptidos citrulinados cíclicos (CCP) en pacientes latinoamericanas con artritis reumatoidea (AR), así como su relación con la actividad de la enfermedad, manifestaciones extraarticulares (MEA), síntesis de citocinas (IL-4, IL-10, IL-12, TNF-µ e IFN-gamma ) y factor reumatoideo (FR) IgM e IgA, y con el polimorfismo del HLA-DRB1. Se examinaron 79 pacie (more) ntes con AR (69 con AR establecida y 10 con AR temprana sin previo tratamiento), 56 pacientes con espondilitis anquilosante (EA), 25 con lupus eritematoso sistémico (LES), 50 con síndrome de Sjögren primario (SSp) y diez individuos sanos. De las 69 pacientes con AR establecida, 36 fueron reevaluadas 2 años después. La actividad de la AR se examinó según los criterios del Colegio Americano de Reumatología. Los anticuerpos anti-CCP2, el FR y los niveles de citocinas se determinaron mediante inmunoensayo, y la genotipificación del HLA se llevó a cabo por reacción en cadena de la polimerasa utilizando mezclas de iniciadores específicos. Los anticuerpos anti-CCP se observaron en 96% de los pacientes con AR en la primera evaluación y en 86% en la segunda ( p=0,12), sin modificación significativa en los valores (131±58,7 vs. 130,6±67,1 UI). Su sensibilidad y especificidad global fue de 94% y 92%, respectivamente, pero cuando sólo se consideraron los niveles altos (>60 UI) fueron de 84% y 95%, respectivamente. La razón de probabilidades (RP) positiva fue de 12 y la RP negativa de 0,06. El valor predictivo (VP) positivo fue de 87% y el VP negativo de 96%. Los anticuerpos anti-CCP se observaron en 12% de los pacientes con LES y con SSp, en 2% de los de EA y en 10% de los controles sanos. En los pacientes con AR no se asociaron con la actividad de la enfermedad, MEA y alelos del HLA-DRB1. Tampoco se observaron correlaciones significativas entre sus valores y los niveles de citocinas. En conclusión, los anticuerpos anti-CCP tienen un interés diagnóstico para la AR en nuestra población, pero su utilidad en el seguimiento clínico es limitada y su síntesis es independiente del HLA-DRB1 y no se correlacionan con niveles de citocinas Th1/Th2. Abstract in english The specificity and sensitivity of anti-cyclic citrullinated peptide antibodies (anti-CCP) was examined in Latin-American patients with rheumatoid arthritis (RA). The variables considered included: 1) relation with the activity of disease, 2) extra-articular manifestations (EAM), 3) synthesis of cytokines (IL-4, IL-10, IL-12, TNF-alpha , and IFN-gamma ) and IgM and IgA rheumatoid factor (RF), and 4) the association with HLA-DRB1 polymorphism. Seventy-nine RA patients were (more) assessed (69 with established RA, and 10 with recent-onset RA not receiving any treatment), 56 with ankylosing spondylitis (AS), 25 with systemic lupus erythematosus (SLE), 50 with primary Sjögren?s syndrome (pSS), and 10 healthy individuals. Of the 69 patients with established RA, 36 were reexamined 2 years later. The activity of the RA was measured by criteria adopted by the American College of Rheumatology. Anti-CCP2, RF and cytokines levels were determined by ELISA. HLA genotypes were established by first, PCR sequence amplification using sequence-specific primers and then, complete sequencing of the product. Anti-CCP antibodies were observed in 96% of patients with RA during the first evaluation and in 86% at the second evaluation ( p=0.12). No significant change in antibody titre was observed between the two evaluations (131±58.7 and 130.6±67.1 IU, respectively). The overall sensitivity and specificity was 94% and 92%, respectively; however, at titres >60 IU, the values were 84% and 95%, respectively. The anti-CCP likelihood ratio positive test was 12 and the likelihood ratio negative test was 0.06. The positive predictive value was 87%, and the negative predictive value was 96%. Anti-CCP antibodies were observed in 12% of SLE and pSS patients, in 2% of AS patients, and in 10% of healthy controls. In RA patients, these antibodies were not associated with the activity of disease, EAM or HLA-DRB1 alleles; no significant correlation was observed between antibody titre and cytokines level. Although anti-CCP antibodies have potential as a diagnostic tool for RA, they are not useful for monitoring clinical activity or predicting the clinical course of disease. Antibody synthesis is HLA-DRB1 independent and not correlated with Th1/Th2 cytokines.

Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on...

The aim of this article is to report the clinical orthodontic treatment of an adult patient with 2 impacted maxillary canines. Traction was applied to the impacted teeth; however, after 7 months, the teeth were found to be ankylosed and were extracted. The extraction spaces were closed by moving the posterior teeth mesially with mini-implant anchorage. The results were satisfactory, with the premolars in the functional position of the canines.

Single-tooth alveolar osteotomy followed by distraction osteogenesis was applied to move an infrapositional ankylosed tooth to the normal position. A maxillary right canine of a 16-year-old female patient was at 6 mm infraposition compared with the maxillary left canine. Single-tooth alveolar osteotomy was performed under general anesthesia. After suturing the wound, an extrawound distraction device was attached to the crown of the ankylosed canine. The distance of movement was 7 mm. After the distraction movement, the fragment was fixed with wires and resin. The consolidation period was 2 months. During the treatment period, 2 complications associated with the roots occurred: injury of the root of the neighboring tooth during osteotomy and progressive inflammatory root resorption of the ankylosed tooth. The root fragments of the neighboring tooth fused spontaneously and the tooth did not show any symptoms of root resorption. The progressive inflammatory root resorption, which occurred at the cervical portion, was treated by removing the granulation in the resorption-lacuna and restoration with composite resin. It was suggested that root injury under sterile conditions probably promoted periodontal healing. Careful postoperative observation was necessary to detect and promptly treat the progressive inflammatory root resorption.   

A 72-year-old woman without a history of spinal injury was admitted to our hospital with prolonged severe back pain and high fever. Clinical laboratory findings and magnetic resonance imaging (MRI) revealed severe inflammation of the L2 and L3 lumbar vertebrae. Meropenem trihydrate administration improved her symptoms. Klebsiella pneumoniae isolated from the patient's blood indicated that the organism caused the spontaneous pyogenic spondylitis.   

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever, peritonitis/pleuritis, or arthritis attacks. Patients may have FMF-associated mutations of pyrin. The role of biologics such as anti-tumor necrosis factor (TNF) agents (infliximab, etanercept, adalimumab, golimumab) and anakinra, canakinumab, or rilonacept in the treatment of FMF needs to be clarified. Herein we present reports of three patients (all were positive for HLA B27) with typical spondylitis associated with FMF who were successfully managed with anti-TNF agents, along with a literature review. The patients were a 37-year-old man with concomitant Crohn's disease and amyloidosis who was treated with infliximab (INF, 5 mg/kg for 3 years) and switched to adalimumab (ADA), and two female patients (a 24-year-old and a 31-year-old) with FMF who developed severe spondylitis and who were also treated with ADA. Anti-TNF agents can control FMF attacks quite effectively and they reveal a promising role in the treatment of FMF-associated amyloidosis and spondylitis. PMID:21567247

Purpose: To assess the value of imaging by 0.1 T MR and by {sup 99m}Tc-HMPAO-labeled leukocytes in confirming skeletal infection in patients with soft-tissue infections and/or bone pathology. Methods: Thirty-nine anatomical sites (35 patients) with suspected bone infection were prospectively imaged with 0.1 T MR and {sup 99m}Tc-HMPAO-labeled leukocytes. Thirty-two infected areas were confirmed: 12 osteomyelitis (out of which 3 were spondylitis) and 27 soft-tissue infections (both bone and soft-tissue infection in 7 areas). Results: MR imaging showed 31 true-positive, 2 true-negative, 4 false-positive and one false-negative diagnosis of infection and scintigraphy 27, 7, 0 and 5 respectively. The sensitivity of MR for osteomyelitis was 100% (12/12) and of scintigraphy 42% (5/12), p<0.01. The specificity of MR and of scintigraphy for osteomyelitis were 81% (22/27) and 93% (25/27) respectively. The sensitivity of MR for soft-tissue infection was 96% (26/27) and specificity 75% (9/12). The corresponding figures for scintigraphy were 85% (23/27) and 100% (12/12). MR and scintigraphy were concordant with respect to the final diagnosis in 28/39 (72%) sites and discordant in 10 (26%). In one patient with Charcot osteoarthropathy a flase-positive finding was found by both methods. MR detected all 3 cases of spondylitis, scintigraphy one. Nonpyogenic inflammations and neuroarthropathic joints were indistinguishable from infection by MR. Conclusion: Combined imaging with MR and {sup 99m}Tc-labelled leukocytes is recommended in diagnostically complicated bone infections except for spondylitis where MR is the method of choice. Congruent positive findings are highly suggestive of infection, the extent of which can be determined. Congruent negative results exclude infection. (orig.).

A 50-year-old white woman presented with a 4-month history of low pain with lower extremity irradiation. Image studies showed inflammatory changes of the vertebral bodies and invertebral disk at L3-L4 level. Considering she had no previous spinal surgery, negative tests for tuberculosis and a positive history of exposure to brucellosis, further studies were done, and the serologic tests were positive for brucellar antibodies. Follow-up studies within the first two months demonstrated the progressive spinal changes in brucellar spondylitis. (author)

Fine-needle aspiration biopsy was performed in 92 patients with back pain and a lesion confirmed via X-ray of the spine. In 31 patients in whom X-ray findings had suggested spondylitis, fine-needle aspiration biopsy showed the presence of a tumour in three patients. Of 61 patients with radiographic findings suggestive of malignancy, 26 had benign unspecific lesions, and 35 patients had neoplastic lesions. There were four false negative cytological reports and one false positive report. Additional ESR determination was of no clinical value. There were no complications. Fine-needle aspiration biopsy of bone lesions is recommended as an easy, safe and very often a valuable diagnostic complement.

Single photon emission computed tomography (SPECT) using {sup 99m}Tc-HMDP was performed on 53 middle-aged or elderly patients (male 20, female, 33; age range, 40-80 years old) with lumbago, i.e., 25 patients with lumbar spondylosis, 15 with lumbar degenerative spondylolisthesis, 4 with spondylolytic spondylolisthesis, 3 with compression fracture, 3 with pulurent spondylitis, 2 with spondylous osteoporosis, and 1 with spinal osteodesmosis. {sup 99m}Tc-HMDP (740 MBq) was intravenously injected and regular SPECT was performed at 3 hours. Gamma camera was performed for about 10 seconds with 5deg intervals, and 36 steps (180deg) of collection was completed after about 6 minutes. The radioisotope accumulation, the presence or absence of sthenia, and its site were evaluated. Forty-seven (88.7%) patients showed excessive accumulation, i.e., 40 (75.5%) in peripheral vertebral osteophyte, 31 (58.5%) in vertebral articulations, and 10 (18.9%) in whole vertebral body. Significantly increased bilateral excessive accumulation was admitted in the vertebral articulations of sliding disc in degenerative spondylolisthesis. SPECT is considered useful in understanding the pathophysiology of degenerative lumber diseases. (S.Y.).

The authors describe a case report of a brachialgy uncovering a solitary bone destruction of C3 associated with epidural involvement. CT and MRI properly depicted the lesion and the loco-regional extension but failed to entertain the diagnosis of the causative tumor, a chordoma. Bis-phosphonates-({sup 99m}Tc) bone scintigraphy proved unconspicuous. Diagnosis was eventually established from the resection specimen, after decision of C3 spondyl-ectomy, C4 hemi-superior spondyl-ectomy and epidural extension excision. Immunohistochemistry study of the material was decisive in identifying the tumor. Cervical chordoma is a tricky diagnosis. Discussion underscores that the crux of diagnostic process is the double discrepancy firstly between extra-osseous and intra-osseous tumoral expansion, secondly between large tumoral mass obvious on multi-slice morphological imaging and negativity of bone scintigraphy, SPECT study included. Among the armamentarium of conventional scintigraphies and PET studies, methionine-({sup 11}C) PET emerges as the most promising anatomo-metabolic procedure to assess loco-regional tumoral expansion, tumoral viability, therapy efficiency, and, potentially, to search for metastases in chordoma. (author)

Abstract: Antinuclear antibodies (ANAs) have become routine laboratory parameters in clinical hospitals. However, ANA testing by indirect immunofluorescence (IIF) assays is not an automated laboratory test. Efforts are being made to develop easy and semi- or automated methods to screen for ANAs. We evaluated the clinical performance of a new ELISA developed to screen for connective tissue disease related ANAs. The presence of serum ANA was studied with a commercial ELISA (Varelisa ANA CTD Screen) in 472 patients (202 SLE, 41 Sjogren syndrome, 11 CREST, 59 rheumatoid arthritis, 30 seronegative spondyloarthropaties, 77 inflammatory bowel disease, 13 reactive arthritis, 11 giant cell arteritis, 28 ankylosing spondilitis). A hundred and five sera from healthy subjects were used as controls. Re...

Fifty-one patients with musculoskeletal infection were imaged by repeated MR imaging at ultra low-field and low-field strength. Soft-tissue infection, osteomyelitis, septic arthritis, and spondylitis were studied. The MR finding was scored according to the signal intensity (SI) on T2-weighted images (T2WI), and correlated with the values of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and peripheral white blood cell (WBC) count. There was a positive correlation between the MR score and both CRP and ESR, but no correlation between MR score and WBC. The MR score between the follow-up studies decreased significantly in accordance with clinical reconstitution. The MR finding according to the SI on T2WIs corresponded better to disease activity than did the CRP or ESR. (orig.).

Zusammenfassung Zur Erfassung der Krankheitsaktivit?t von Spondyloarthritiden (SpA) wird neben der Beurteilung von Entz?ndung und Funktionseinschr?nkung auch die Erhebung der Lebensqualit?t gefordert. Zur Erhebung der Lebensqualit?t bei ankylosierender Spondylitis (AS) stehen die krankheits?bergreifenden Messinstrumente SF-36, SF-12 und EQ-5D in deutscher Sprache zur Verf?gung, wobei in klinischen Untersuchungen ?berwiegend der SF-36 verwendet wurde. Im Vergleich zur Normalbev?lkerung leiden Patienten mit AS an einer eingeschr?nkten Lebensqualit?t. Bei Frauen und Patienten mit niedriger Schulbildung war die Lebensqualit?t besonders stark eingeschr?nkt. Auch bei der Psoriasisarthritis (PsA) ist die Erhebung der Lebensqualit?t ein allgemein anerkannter Bestandteil der Evaluation. Als Instrum...

Abstract in spanish La endoftalmitis bacteriana endógena es una patología poco frecuente con un pobre pronóstico visual, que requiere un diagnóstico y tratamiento precoz. Presentamos el caso de una paciente diabética que presentó una bacteriemia por Escherichia coli de origen urinario, con endoftalmitis endógena, meningitis y espondilitis secundaria. Fue tratada con antibioterapia intravenosa y tópica, consiguiendo un cese en la progresión y conservando la capacidad para percepción luminosa en el ojo afecto. Abstract in english The bacterial endogenous endophthalmitis is a slightly frequent pathology with a poor visual prognosis that needs a precocious diagnosis and treatment. We present the case of a diabetic patient who presented a Escherichia coli bacteremia of urinary origin, with endogenous endophthalmitis, meningitis and spondylitis. She was treated with intravenous and topic antibiotics, obtaining a cessation in the progression of the disease and preserving the capacity for luminous perception in the eye.

Zusammenfassung Der in der Dissertation des irischen Arztes Bernard Connor (1666?1698) aus Reims aus dem Jahr 1693 beschriebene Torso eines Mannes, dessen Knochen als Folge einer Spondylitis ankylosans zusammengewachsen waren, gilt allgemein als erstes Beispiel eines derartigen Skelettfundes. Diese Mitteilung muss jedoch im Zusammenhang mit fr?heren und bald darauf folgenden ?hnlichen Beobachtungen gesehen werden, die in der deutschen und vor allem in der englischen Literatur vorgestellt wurden. Damit wird das in Deutschland lange gebr?uchliche Eponym ?Morbus Str?mpell-Marie-Bechterew? weiter infrage gestellt. B.?Connor ist jedoch noch aus anderen medizin- und zeithistorischen Gr?nden eine sehr interessante Pers?nlichkeit des sp?ten 17. Jahrhunderts. Er zog sich mit naturwissenschaftlich o...

Objective The incidence of tuberculosis (TB) is increasing in both developing and developed worlds, and children, in particular, represent a high-risk group for acquiring the disease. TB of the central nervous system is the most severe, life-threatening form of TB in infants and children. Approximately 10% of all patients with TB have central nervous system involvement. Materials and methods We have selected four pediatric cases of unusual spinal TB that presented to our institution during the last 5?years. These include TB arachnoiditis, intramedullary spinal cord tuberculoma, TB spondylitis of the odontoid peg, and one child with tuberculous extradural abscess. Conclusion TB may involve the intramedullary, extramedullary intrathecal compartment, or the extrathecal vertebral compartment i...

Up to now 42 patients with clinically suspected diagnosis of sacroiliitis (including 19 patients with confirmed spondylitis ankylosans) and 12 healthy volunteers were examined via magnetic resonance tomography. In oblique sections parallel to the plane of the sacrum the signal intensity patterns from normal and pathological tissues of the sacroiliac articulations were evaluated by plain T1-weighted spin-echo sequences and T2*-weighted FLASH sequences. In addition we used a dynamic FLASH measurement following intravenous application of gadolinium-DTPA for quantitative calculation of signal-time courses. This method has proved to be capable of definitely differentiating normal findings of sacroiliac articulations from inflammatory changes (p = 0.0001) and also enables quantification of the inflammatory activity. PMID:8219116

Abstract in english We report a 61-year-old male with a four months history of progressive back pain, fever, weight loss and hematuria. A CAT scan showed a spondylitis with destruction of L1 and L2 vertebral bodies and a big pseudoaneurysm of the posterior wall of the visceral aorta. A hybrid approach was used to repair the lesion in two stages; a surgical superior mesenteric artery revascularization followed by the placement of an endovascular stent graft in the affected segment of the aort (more) a 48 hours later, excluding the lesion from circulation. In the postoperative period, no evidence of mesenteric vascular insufficiency was detected but the patient developed a systemic inflammatory response that was managed adequately. A CAT scan performed one month later confirmed the exclusion of the pseudoaneurysm. One year after surgery, the patient is able to walk and without evidences of infection or pseudoaneurysm.

Streptococcus suis, a major global porcine pathogen, is an emerging zoonosis in Southeast Asia that triggered a 2005 outbreak in China. S. suis causes meningitis, sepsis, and endocarditis in both pigs and humans and involves significant mortality. We report the case of a previously healthy 50-year-old dairy farmer who developed S. suis type 2 endocarditis complicated by pulmonary embolism and spondylitis. He experienced a high fever, chills, fatigue, and worsening low back pain in the 6 weeks prior to admission. On physical examination, he had lumbar spine tenderness and weakness of the left leg. Blood culture identified penicillin-sensitive S. suis type 2. Echocardiography showed vegetation on the tricuspid valve, and magnetic resonance imaging (MRI) showed signs of spondylitis. The man reported sudden chest pain several days after admission, which computed tomography (CT) showed what was diagnosed as a septic pulmonary embolism. He was treated with penicillin G for 4 weeks and gentamicin for the first 2 weeks, followed by 2 weeks of oral amoxicillin, after which his symptoms gradually improved. The infection source was probably his dairy herd, since calves often bit his fingers while feeding and S. suis was found in their oral mucus. Over 400 cases of human S. suis infection have been reported globally, but this is, to our knowledge, the first known case of bovine transmission. All of Japan's 8 other cases involved occupational swine exposure, 5 of whom had injuries to their fingers. This emerging situation should be made known to all possibly involved in unprotected direct contact with swine and cattle, particularly when the skin could be compromised by cuts or abrasions. PMID:19860257

Abstract in portuguese INTRODUÇÃO: a infecção da coluna vertebral pelo bacilo de Koch costuma ser devastadora, sendo necessários seu diagnóstico e tratamento precoce. OBJETIVO: avaliar o tratamento e o seguimento em relação à dor, cifose residual, imagem por ressonância magnética (RM), e a importância da biópsia correlacionando-a com o tratamento clínico. Métodos: estudo retrospectivo de 31 pacientes com diagnóstico de espondilite tuberculosa, fazendo uma análise estatística d (more) os dados descritivos: sexo, idade, status neurológico, segmento vertebral acometido, presença de abscesso e cifose residual, e suas correlações clínicas importantes comparando nossos casos com a literatura e correlacionando seus dados, tais como sexo e faixa etária mais comum, se a presença do abscesso influencia no déficit neurológico ou na cifose residual. RESULTADOS: a amostra identificou uma incidência em 23 homens e 8 mulheres. Foi identificado abscesso frio em 4 pacientes, sendo os que apresentaram uma grave deformidade final: a biopsia percutânea foi realizada em 19 pacientes com positividade em 5, não influenciando o tratamento do paciente. A dor pós-tratamento clínico apresentou melhora importante; foi utilizado esquema tríplice por um ano. CONCLUSÃO: o tratamento clínico da tuberculose deve ser iniciado assim que se suspeitar da doença e tiver imagens compatíveis com: corpo vertebral, diminuição da altura do espaço discal e elevação do ligamento longitudinal anterior. Na presença de cifose, o uso de um colete rígido deve ser ponderado, sendo ele o de Boston ou um colete gessado. A avaliação neurológica deve ser acompanhada com um intervalo curto, quinzenalmente nos primeiros três meses, pois se o tratamento clínico for ineficaz e o paciente apresentar déficit neurológico, o tratamento cirúrgico deve ser considerado. A biopsia é um exame de alta especificidade, mas de baixa sensibilidade. Quando positiva, reforça o tratamento medicamentoso. Abstract in spanish INTRODUCCIÓN: la infección de la columna vertebral por el bacilo de Koch acostumbra ser devastadora, siendo necesario el diagnóstico y tratamiento precoz. OBJETIVO: evaluar el tratamiento y el seguimiento en relación al dolor, cifosis residual, imagen en la resonancia magnética (RM) y la importancia de la biopsia correlacionándola con el tratamiento clínico. MÉTODOS: estudio retrospectivo de 31 pacientes con diagnóstico de espondilitis tuberculosa haciendo un an? (more) ?lisis estadístico de los datos descriptivos: sexo, edad, estatus neurológico, segmento vertebral comprometido, presencia de absceso y cifosis residual, así como sus correlaciones clínicas importantes comparando nuestros casos con la literatura y correlacionando sus datos con lo referente al sexo y la tasa etaria donde fue más común, si la presencia del absceso influyó en el déficit neurológico o en la cifosis residual. RESULTADOS: la muestra identificó una incidencia en 23 hombres y 8 mujeres. Fue identificado absceso frío en cuatro pacientes, siendo los que presentaron una grave deformidad final; la biopsia percutánea fue realizada en 19 pacientes con positividad en 5, no influyendo en el tratamiento del paciente. El dolor post tratamiento clínico presentó una mejoría importante; fue utilizado un esquema triple por un año. CONCLUSIÓN: el tratamiento clínico de tuberculosis debe ser iniciado así que la enfermedad fuera sospechada y tuviera imágenes compatibles con: el cuerpo vertebral, la disminución de la altura del espacio discal, y con la elevación del ligamento longitudinal anterior. En la presencia del cifosis, el uso de un chaleco rígido debe ser ponderado, siendo un Chaleco de Boston o un chaleco de yeso. La evaluación neurológica debe ser acompañada de un intervalo pequeño, quincenalmente en los primeros tres meses, pues si el tratamiento clínico fuera ineficaz y el paciente presentara déficit neurológico, el tratamiento quirúrgico debería ser considerado. La biopsia es un examen de alta especificidad, pero de baja sensibilidad. Si fuera positiva, refuerza el tratamiento medicamentoso. Abstract in english INTRODUCTION: the infection of the spine by the mycobacterium tuberculosis is often devastating, requiring early diagnosis and treatment. Objective: to assess the treatment and follow-up regarding the pain, residual kyphosis, image of magnetic resonance imaging (MRI), and importance of biopsy relating to the clinical treatment. METHODS: retrospective study of 31 patients with diagnosis tuberculous spondylitis making a statistical analysis, studying the data descrition: ge (more) nder, age, neurological status, spinal segment and kyphosis abscess, presence of residual kyphosis and their clinical correlations, comparing our major cases with literature and relashionship, and if the presence of abscess can influence in on neurological deficit or residual kyphosis. RESULTS: the sample identified an incidence in 23 men and 8 women; cold abscess was identified in 4 patients, and how those with a severe deformity final percutaneous biopsy was performed in 19 patients with positivity in 5, with no influence patient treatment. The pain after treatment showed significant improvement and we used triple drug regimen for one year. CONCLUSIONS: the clinical treatment of tuberculosis should start once the disease is suspected and have compatible images with: vertebral body, decreased disc space height, and elevation of the anterior longitudinal ligament. In the presence of kyphosis using a weighted vest to be hard, being the Boston vest or a plaster cast. The neurological evaluation should be accompanied, and with a short interval, fortnightly during the first three months, because if the clinical treatment is ineffective and the patient has neurological deficit surgical treatment should be considered. The biopsy is a test of high specificity but low sensitivity. When the test is positive it reinforces drug treatment.

... samples from abnormal areas. Current recommendations for early detection of colon cancer or polyps require colonoscopy for ... procedure that can detect colon cancer early. Early detection of cancer can lead to early treatment and ...

Abstract in portuguese Foram estudados 13 pacientes com cifose patológica de diferentes etiologias (Doença de Scheuermann, espondilite anquilosante, congênita, tuberculose vertebral, sequela de laminectomia e síndrome de Morquio), que foram submetidos ao tratamento cirúrgico. A cifose pré-operatória variou de 75 a 100 graus (média 73,3 graus) e a média dos valores após o tratamento cirúrgico foi de 42,3 graus. O tipo de tratamento realizado estava relacionado com as características (more) da cifose (raio longo ou curto, flexibilidade e magnitude), e são apresentadas as diferentes técnicas e filosofia de tratamento dos autores para o tratamento cirúrgico dessa modalidade de deformidade vertebral. Abstract in english Thirteen patients with pathologic kyphosis from different ethiologies (Scheuermann's disease, ankylosing spondilitis, congenital, vertebral tuberculosis, post laminectomy and Morquio's syndrome) who underwent surgical treatment were studied. Preoperative kyphosis ranged from 75° to 100° (average 73.3°) and postoperatively averaged 42.3°. The treatment performed was based on kyphosis characteristics (long or short radius, flexibility, magnitude). The different techniqu (more) es are presented as well as authors' philosophy for surgical treatment of this kind of vertebral deformity.

Antinuclear antibodies (ANAs) have become routine laboratory parameters in clinical hospitals. However, ANA testing by indirect immunofluorescence (IIF) assays is not an automated laboratory test. Efforts are being made to develop easy and semi- or automated methods to screen for ANAs. We evaluated the clinical performance of a new ELISA developed to screen for connective tissue disease related ANAs. The presence of serum ANA was studied with a commercial ELISA (Varelisa ANA CTD Screen) in 472 patients (202 SLE, 41 Sjögren syndrome, 11 CREST, 59 rheumatoid arthritis, 30 seronegative spondyloarthropaties, 77 inflammatory bowel disease, 13 reactive arthritis, 11 giant cell arteritis, 28 ankylosing spondilitis). A hundred and five sera from healthy subjects were used as controls. Receiver operator characteristics (ROC) analysis was carried out in order to optimize the cutoff. At target specificities of 80/90%, sensitivities of 80.8/ 73.9% were achieved. At the manufacturer's cutoff (ratio >or=1.0) sensitivity/specificity of 71.4/91.2% was found. At that cutoff, a positive likelihood ratio of 8.11 was found. For helping in the diagnosis of connective tissue diseases a test employing a subset of the most prevalent specificities reveals a good compromise as indicated by a high-positive likelihood ratio. However, the presence of ANAs in pathologies other than connective tissue diseases, such as SLE or Sjögren syndrome, may be of clinical significance as well. In these cases an IIF assay test is still mandatory, especially in autoimmune laboratories. PMID:17785321

Advances in the application of low reactive-level laser therapy (LLLT) in the treatment of rheumatologic disease entities are presented from the author's experience in a major rheumatology centre in Cologne, Germany. The literature is reviewed, showing clear evidence for the effectiveness of LLLT in this field. An uncontrolled clinical study on the effectiveness of LLLT using a 904 nm diode GaAs laser and a mixed 904 nm and 632.8 nm (HeNe) laser in the treatment of intractable chronic tendinopathies is reported, with effective rates well over 80% for pain both at rest and in motion. Mild and reversible side effects, which may , double-blind cross-over study on the effectiveness of LLLT for advanced (stage III-IV) ankylosing spondylarthritis using a mix of 904 nm and 632.8 nm laser energy gave effective pain attenuation, with significantly higher effectiveness shown by real as compared with sham LLLT. There was no significant effect on either laboratory tests or on spinal ROM. The effective rate for conventional chemotherapeutic agents, non steroid anti-inflammatory drugs (NSAIDs) is seen in the literature as high as 85%, but the side-effects are many and serious, even resulting in a very small percentage of cases in death. Although more research into actual mechanisms and pathways is needed, LLLT is presented as a safe, noninvasive, easy to apply and comparatively side-effect free modality offering the clinical rheumatologist an effective tool in the treatment of therapy-resistant rheurnatologic disease entities.   

Abstract in spanish Se presenta un caso de espondilitis anquilopoyética, de 6 años de evolución sin tratamiento adecuado, que llevó al paciente a una deformidad en flexión y limitación de los movimientos del raquis, por lo cual se decidió realizar el tratamiento quirúrgico para corregir la deformidad. Se realiza una revisión bibliográfica sobre la enfermedad, como parte del estudio para definir y planificar el tratamiento quirúrgico. Se muestran además los resultados obtenidos co (more) n la técnica empleada (osteotomía de sustracción transpedicular), con la que se logró la corrección planificada y una fijación estable en un segmento mínimo de la columna lumbar. Abstract in english Authors present a 6-years course ankilopoietic spondylitis case without a appropriate treatment causing a flexion deformity and rachis movement limitations who was operated on to correct the deformity. A bibliographic review as carried out on disease as part of study to define and plan surgical treatment. Results obtained using this technique (osteotomy of transpedicular substraction) are showed achieving the planned correction and a stable fixation in a minimal segment of lumbar spine.

Abstract in portuguese Os sintomas articulares constituem a manifestação extra-intestinal mais comum em pacientes com doença de Crohn e com retocolite ulcerativa. Reconhecida como artrite colítica, e mais recentemente, artrite enteropática, está classificada como uma das doenças do grupo das espondiloartropatias. Reconhecidamente, há dois padrões de acometimento articular: 1) periférico, habitualmente, associado aos períodos de atividade da doença intestinal e sem associação com o (more) antígeno HLA B27, e 2) axial, caracterizado por espondilite e sacroiliíte, com curso clínico e radiográfico independente da doença intestinal e associado ao HLA B27. Abstract in english Joint involvement is the most commom extraintestinal manifestation in patients with Crohn's disease and ulcerative colitis. The colitic arthritis, lately called enteropathic arthritis, is classified as one of the diseases of the spondyloarthropathies group. There are two patterns of joint involvement: 1) peripheral arthritis, usually coincides with exacerbations of the inflammatory bowel disease and is not associated with the HLA B27 antigen; and 2) axial involvement, cha (more) racterized by spondylitis and sacroiliitis, which the clinical course is independent of the intestinal disease, and has an association with HLA B27.

Retropharyngeal abscess commonly develops among infants and small children, and is associated with the severe inflammation of the retropharyngeal lymph nodes located in the retropharyngeal space. Retropharyngeal abscess causes cervical pain, swelling, contracture of the neck, and in rare cases inflammatory torticollis, all of which result from an inflammatory process that irritates the cervical muscles, nerves or vertebrae. Here we report a rare case of retropharyngeal abscess with a complication of torticollis. A 4-year-old girl suffered from severe retropharyngeal abscess spreading through the deep cervical fascia, as judged by magnetic resonance imaging of the neck. Blood analysis showed high degree of inflammatory reactions, and so the patient was transferred to our hospital ward. The inflammation caused spasms of the prevertebral muscles, eventually leading to torticollis. The surgical drainage was performed immediately under general anesthesia, and an anti-inflammation therapy with intravenously administered meropenem trihydrate and clindamycin was used together with traction therapy to relieve the symptoms of the patient. We must be careful about the existence of epidural abscess and infectious spondylitis when the retropharyngeal abscess causes torticollis. In conclusion, an anti-inflammation therapy using antibiotics, along with traction therapy, was effective to relieve the symptoms. In addition to repeated clinical examinations, cooperation with orthopedists and careful follow-up are necessary. We also discussed the relationship between acute torticollis and retropharyngeal abscess.   

We report here a case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis. An 89-year-old woman, who had been treated for tuberculous spondylitis and operated for tuberculous mastitis and peritonitis, was transferred to our hospital with high grade fever, lower abdominal pain and vomiting. An enhanced abdominal computed tomography (CT) revealed ascites and hypertrophy of the parietal peritoneum. Puncture and drainage of ascites were performed and revealed that a smear examination of the specimen was positive for acid-fast bacilli (Gaffky 1). Treatment by rifampicin, isoniazid and ethambutol for tuberculous peritonitis was started then halted because of drug-induced liver injury. After recovery of the liver damage improved, anti-tuberculosis drugs (rifampicin and streptomycin) were restarted. However two days after recommencing administration, repeated vomiting occurred. An abdominal X-ray showed intestinal obstruction. An ileus tube was inserted and she was treated conservatively, but her symptoms did not improve. Injection of contrast medium through the ileus tube showed obstruction of the upper jejunum, so open surgery was performed. Disseminated yellowish miliary tubercles were seen on the peritoneum and severe inflammatory adhesions were found between the jejunum and the ileum. After ablation of the adhesions, partial resections of jejunum and ileum were performed. Histological examination confirmed the diagnosis of tuberculous peritonitis. PMID:23047634

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...Head Start (including Early Head Start) programs. The purpose of this Consultation...Head Start (including Early Head Start) programs for each of the nine geographic...funds for Head Start and Early Head Start programs. Tribes wishing to...

...Head Start (including Early Head Start) programs. The purpose of this Consultation...Head Start (including Early Head Start) programs for each of the nine geographic...funds for Head Start and Early Head Start programs. Tribes wishing to...

This review describes the development of high specificity inflammation scintigraphy (IS) from its introduction into clinical medicine in the mid-seventies until the presently used methods (Tc-99m-labelled anti-granulocyte antibodies [MoAb]; in vitro Tc-HMPAO labeled autologous granulocytes) as well as the development of the non-specific (or alternative) IS. The basis of radiopharmaceutical uptake mechanisms and the technical aspects of the investigations are described. The IS results in osseous infections show a very high accuracy. Concerning practicability, the Tc-99m-MoAb has proved to represent the most suitable tracer. Two general limitations of IS, however, must be considered: a. Chronic osteomyelitides, practically spondylitis, can frequently not be visualized or even occur as cold lesions. b. post-traumatic tissue reorganization (e.g. following prosthetic device implantation) can cause an increased tracer uptake so that the differentiation from septic processes can be difficult and the possibility of false-positive interpretation is obvious. Among nuclear medicine procedures the conventional 3-phase bone scan which is very sensitive but non-specific should be the principal and first method. Especially if 3-phase bone scan is positive, IS using the Tc-99m labelled MoAb or Tc-99m-HMPAO granulocytes should be subsequently conducted. Both methods (non-specific and specific IS) should be employed with high priority in suspected acute/chronic osteomyelitis and prosthetic infection, and carefully integrated with other imaging modalities before invasive techniques are used. (orig.) [Deutsch] In dieser Uebersicht wird die Entwicklung der spezifischen Entzuendungsszintigraphie (ES) vom Beginn der klinischen Einsetzbarkeit (Mitte der 70er Jahre) bis zu den heute verwendeten Methoden (Tc-markierte Anti-Granulozyten-Antikoerper [MoAk]; in-vitro Tc-HMPAO markierte autologe Granulozyten) und die Entwicklung der unspezifischen (`alternativen`) ES dargestellt. Die Vorstellungen zum Anreicherungsmechanismus der verwendeten Radiopharmaka sowie die Untersuchungsablaeufe werden beschrieben. Die Ergebnisse fuer ossaere Entzuendungen zeigen eine gute bis sehr gute Treffsicherheit der ES. Aufgrund der Praktikabilitaet hat sich unter den verfuegbaren Tracern der Tc-99m-MoAk als am geeignetsten herausgestellt. Bei der Interpretation sind zwei generelle Limitationen der ES zu beachten: a. Chronische Osteomyelitiden, insbesondere zentrale Laesionen wie die Spondylitis, stellen sich haeufig nicht oder als Minderspeicherungen dar, woraus sich die Moeglichkeit falsch-negativer Befundung ergibt b. posttraumatische Umbauvorgaenge (z.B. Prothesen-Implantationen) koennen Mehrspeicherungen hervorrufen, so dass die Abgrenzung zu septischen Infektionen schwierig (Moeglichkeit einer falsch-positiven Befundung) ist. In der Reihenfolge nuklearmedizinischer Verfahren sollte immer die ausserordentlich sensitive 3-Phasen-Skelettszinitgraphie an erster Stelle stehen. Daran anschliessend sollte als spezifisches Verfahren die Untersuchung mit dem Tc-99m-markierten MoAk oder mit Tc-99m-HMPAO-Granulozyten stehen. Innerhalb anderer bildgebender Verfahren sollten beide Methoden bei V.a. akute/chronische Osteomyelitis und Protheseninfektion immer mit als erste diagnostische Massnahmen eingesetzt werden, bevor invasive Techniken zur Anwendung kommen. (orig.)

Abstract Background- Following early identification of deafness attention has now turned to early intervention of deaf children and their families. Improved outcomes associated with early identification and quality early intervention have been long predicated. However, the effectiveness of early intervention is mediated by parents' values, beliefs and preferences. How these mediate the nature of intervention is key to understand how early intervention impacts on outcomes. Methods- Eighty-two parents of early identified deaf children participated in a longitudinal study (UK). Data from parents were collected through postal questionnaires. Parents provided repeated data on My Views on Services questionnaire (at 6-month interval). They also filled in once the Trait Emotional Intelligence ques...

Abstract in spanish Introducción: La práctica de la momificación artificial de cuerpos humanos en América, fue común a la mayoría de las sociedades prehispánicas andinas, a las que pertenecen los muiscas. Objetivo: Caracterizar bioantropológica y paleopatológicamente la momia S010-IX. Materiales y métodos: Estudio historiográfico de campo y de caso, con uso de técnicas invasivas y no invasivas. Resultados: Individuo prehispánico, del siglo XIV, sexo masculino, de 25-30 años de (more) edad. Las características macroscópicas dentales y óseas sugieren que pertenece al patrón indígena americano. Presenta ausencia de miembro inferior izquierdo y muslo derecho. En la columna vertebral se observa una marcada cifosis angular, restos de un absceso prevertebral en forma de huso, una lesión de los cuerpos vertebrales T7 y T8, compatibles con una espondilitis tuberculosa conocida como Mal de Pott. Presenta un buen estado del complejo dentoalveolar. Conclusiones: Por primera vez se presenta evidencia de la existencia de tuberculosis, en época prehispánica, en una momia muisca del altiplano. Gracias al enfoque multidisciplinario se reconstruyó el contexto histórico, geográfico, paleopatológico, bioantropológico, cultural y cronológico de la momia, dándole la importancia a este bien patrimonial de la nación. Se proponen estudios de reconstrucción facial, preservación y manejo, y un análisis genético para confirmar la presencia de ADN de Mycobacterium tuberculosis. La posición ritual de la momificación, dificultó el estudio y las técnicas de medición. Abstract in english Introduction: The practice of artificial mummification of human corpses in America was common to most Andean pre-Hispanic societies to which the Muiscas belonged. Objective: bio-anthropologically and paleopathologically characterize the SO10-IX mummy. Materials and methods: Case and field history graphic study with invasive and non-invasive techniques. Results: Pre-Hispanic individual from the 14th century, male, 25 to 30 years of age. Macroscopic dental and osseous chara (more) cteristics suggest it fitting the American Indian pattern. Evident absence of lower left member and right thigh, and the vertebral column reveals marked angular kyphosis, a pre-vertebral abscess in spindle shape, a lesion of vertebrate bodies T7 and T8, compatible with tuberculous spondylitis known as Pott?s disease. Also noted is the good state of the dentoalveolar complex. Conclusions: For the first time, there is evidence of tuberculosis, in pre-Hispanic times, in a Muisca mummy from the Andean plateau (high plains). Due to the multidisciplinary approach, the historical, geographic, paleopathologic, bio-anthropologic, cultural, and chronological contexts of the mummy were reconstructed, granting importance to this national heritage asset. Two facial reconstruction studies are proposed, preservation and manipulation, and a genetic analysis to confirm the presence of Mycobacterium tuberculosis DNA. The ritual position of mummification caused difficulties in the study and measurement techniques.

... 2011) Personalized Unicompartmental Knee Implant Treats Early Stage Arthritis While Preserving Bone (Foundation Surgical Hospital, Houston, TX, ... 2011) Personalized Unicompartmental Knee Implant Treats Early Stage Arthritis While Preserving Bone (Foundation Surgical Hospital, Houston, TX, ...

... of a multi-ingredient product for treating early orgasm (premature ejaculation). Men also use it for erectile ... function in men with ED. Premature ejaculation (reaching orgasm too early) when a cream containing ginseng and ...

... HEAD START An Office of the Administration for Children and Families Early Childhood Learning & Knowledge Center (ECLKC) ... and Community Engagement Framework Infant/Toddler Programs Framework Child Development & Early Learning Framework School Readiness FAQs Policy & ...

... So what you’re saying is that the early intervention can help prevent further problems. Exactly. In ... to keep the knee from moving in the early stages of the recuperation and allow the patient ...

...Application for Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP...the students in obtaining a secondary school diploma and preparing for and succeeding...Application for Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR...

Early Detection, Diagnosis, and Staging TOPICS Document Topics GO » SEE A LIST » Can pancreatic cancer be found early? How is pancreatic cancer diagnosed? How is pancreatic cancer staged? Pancreatic cancer survival ...

Nov 13, 2009 ... Many of the flows first reached the surface at the weak, fractured ..... supporter of early Portuguese explorations along the African Coast, though not an ... history and a practical innovator during the early growth of our republic.

Meinhard Bayani Cardenas received the 2011 Early Career Hydrologic Sciences Award at the 2011 AGU Fall Meeting, held 5-9 December in San Francisco, Calif. The award is for significant early career contributions to hydrologic science.

Objective: Early nonresponse to antipsychotics appears to predict subsequent nonresponse to treatment when assessed in randomized controlled trials of predominately acute inpatients treated for schizophrenia. This study assessed the predictive accuracy of early nonresponse to treatment and its clini...

Background: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes: To confirm those studies we determined whether when compared with immobilization early active ...

Linguliform brachiopods were important components of early Cambrian benthic communities. However, exceptionally preserved soft parts in Cambrian linguliform brachiopods are extremely sparse, and the most important findings are from the early Cambrian Chengjiang Konservat Lagerstatte of Kunming, sout...

... Fisher Centers Alzheimer’s Disease News Blogs New Drug, Gantenerumab, Shows Early Promise Against Alzhei... Text Size: Email This Post Print This Post New Drug, Gantenerumab, Shows Early Promise Against Alzheimer’s An experimental drug ...