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Sample records for axial spondyloarthritis treated

  1. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis

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    Schoels, M M; Braun, J; Dougados, M; Emery, P; Fitzgerald, O; Kavanaugh, A; Kvien, T K; Landewé, R; Luger, T; Mease, P; Olivieri, I; Reveille, J; Ritchlin, C; Rudwaleit, M; Sieper, J; Smolen, J S; de Wit, M; van der Heijde, D

    2014-01-01

    Background Current recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not been defined. An international expert panel has been convened to develop ‘treat-to-target’ recommendations, based on published evidence and expert opinion. Objective To review evidence on targeted treatment for axial and peripheral SpA, as well as for psoriatic skin disease. Methods We performed a systematic literature search covering Medline, Embase and Cochrane, conference abstracts and studies in http://www.clinicaltrials.gov. Results Randomised comparisons of targeted versus routine treatment are lacking. Some studies implemented treatment targets before escalating therapy: in ankylosing spondylitis, most trials used a decrease in Bath Ankylosing Spondylitis Disease Activity Index; in psoriatic arthritis, protocols primarily considered a reduction in swollen and tender joints; in psoriasis, the Modified Psoriasis Severity Score and the Psoriasis Area and Severity Index were used. Complementary evidence correlating these factors with function and radiographic damage at follow-up is sparse and equivocal. Conclusions There is a need for randomised trials that investigate the value of treat-to-target recommendations in SpA and psoriasis. Several trials have used thresholds of disease activity measures to guide treatment decisions. However, evidence on the effect of these data on long-term outcome is scarce. The search data informed the expert committee regarding the formulation of recommendations and a research agenda. PMID:23740234

  2. Golimumab for treatment of axial spondyloarthritis.

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    Rios Rodriguez, Valeria; Poddubnyy, Denis

    2016-02-01

    Axial spondyloarthritis comprises two forms: nonradiographic (nonradiographic axial spondyloarthritis) and radiographic (better known as ankylosing spondylitis), which are often considered as two stages of one disease. Historically, all currently available TNF-α inhibitors were first investigated in ankylosing spondylitis and later on in nonradiographic axial spondyloarthritis. This year, EMA has granted golimumab approval for the treatment of active nonradiographic axial spondyloarthritis based on the recently published data from the GO-AHEAD study. This article summarizes recent data on efficacy and safety of golimumab in the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis.

  3. Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents?

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    Keat, Andrew; Bennett, Alexander N; Gaffney, Karl; Marzo-Ortega, Helena; Sengupta, Raj; Everiss, Tamara

    2017-03-01

    A spectrum of disease extends beyond the rigid confines of ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) encompasses non-radiographic axSpA (nr-axSpA) in individuals without established radiographic changes but with other clinical/imaging axSpA features and AS in those with definite sacroiliac joint changes on pelvic X-rays. A broad consensus about the management of nr-axSpA is emerging among clinicians, but the evidence base remains open to question. To explore whether nr-axSpA and AS should be treated similarly, we examined the literature on their prevalence, natural history, disease burden, and treatment. There is strong evidence that nr-axSpA and AS are expressions of the same disease. Approximately 10% of patients with nr-axSpA will develop radiographic disease over 2 years; after >20 years, the figure may exceed 80%. Nr-axSpA patients have lower CRP and less spinal inflammation on MRI than AS patients but similar disease activity, pain, and quality-of-life impairment. Most patients with nr-axSpA manage well with conservative treatment, but a minority has severe disabling symptoms. Anti-TNF therapy has demonstrated similar efficacy and safety in nr-axSpA and AS. Current evidence does not clearly indicate that anti-TNF treatment can inhibit or limit bony progression of AS, the basis of conservative and anti-TNF treatment is control of symptoms and function. For some patients with nr-axSpA, the need for powerful treatments is as great as in some with AS; thus, treatment of axSpA should be consistent across the axSpA spectrum with anti-TNF agents being available, irrespective of radiographic change, according to the same criteria as those applied to AS.

  4. Axial Spondyloarthritis: An Evolving Concept

    Directory of Open Access Journals (Sweden)

    Nelly Ziadé

    2015-07-01

    Full Text Available Axial spondyloarthritis (AxSpA is the prototype of a family of inter-related yet heterogeneous diseases sharing common clinical and genetic manifestations: the spondyloarthritides (SpAs. The condition mainly affects the sacroiliac joints and axial skeleton, and has a clear classification scheme, wider epidemiological data, and distinct therapeutic guidelines when compared with other SpAs. However, the concept of AxSpA has not been immutable over time and has evolved tremendously on many levels over the past decades. This review identifies the evolution of the AxSpA concept at two levels. First, at the level of classification, the old classifications and rationales leading to the current Assessment of SpondyloArthritis international Society (ASAS classification are reviewed, and the advantages and drawbacks are discussed. Second, at the therapeutic level, current and future treatments are described and treatment strategies are discussed.

  5. How to diagnose axial spondyloarthritis early

    OpenAIRE

    Rudwaleit, M.; van der Heijde, D.; Khan, M.; Braun, J.; Sieper, J.

    2004-01-01

    Background: Chronic low back pain (LBP), the leading symptom of ankylosing spondylitis (AS) and undifferentiated axial spondyloarthritis (SpA), precedes the development of radiographic sacroiliitis, sometimes by many years.

  6. Health and imaging outcomes in axial spondyloarthritis

    NARCIS (Netherlands)

    Machado, P.M.

    2016-01-01

    This thesis focuses on the assessment and monitoring of health and imaging outcomes in axial spondyloarthritis (SpA) and the relationship between these outcomes. Four major contributions to the understanding and management of axial SpA were made: 1) the improvement and facilitation of the assessment

  7. How to treat ankylosing spondylitis and nonradiographic axial spondyloarthritis. Key practical messages from the 2015 American College of Rheumatology recommendations.

    Science.gov (United States)

    Uthman, Imad; Noureldine, Mohammad Hassan A; Arayssi, Thurayya; Chalhoub, Nathalie E; Akl, Elie A

    2016-03-24

    A panel of experts commissioned by the American College of Rheumatology have recently reviewed the literature related to the treatment of patients with ankylosing spondylitis and nonradiographic axial spondyloarthritis. They published a set of recommendations for the management of common clinical questions for both active and stable disease, including the appropriate use of nonsteroidal anti-inflammatory drugs, tumor necrosis factor inhibitors, rehabilitation, education, and preventive care. This article summarizes these recommendations and provides key practical messages for physicians taking care of these patients.

  8. «FLARES» IN AXIAL SPONDYLOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2016-01-01

    Full Text Available The clear definition of the concept of «flare in axial spondyloarthritis» is of paramount importance for clinical trials and routine practice in particular. It will be able to unify the characteristics of outcomes over a particular period of time on the one hand and to standardize therapeutic approaches on the other. On 4 February 2016, the journal Annals of Rheumatic Diseases published the on-line paper «Preliminary definitions of 'flare' in axial spondyloarthritis, based on pain, BASDAI and ASDAS-CRP: an ASAS initiative» by L. Gossec et al., which was devoted to this topic.

  9. Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis

    DEFF Research Database (Denmark)

    Glintborg, Bente; Sørensen, Inge J; Østergaard, Mikkel

    2017-01-01

    OBJECTIVE: To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders...

  10. Golimumab for the treatment of axial spondyloarthritis.

    Science.gov (United States)

    Gelfer, Gita; Perry, Lisa; Deodhar, Atul

    2016-01-01

    Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disease of the axial skeleton that includes ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Patients with AS experience chronic pain due to sacroiliac joint and spinal inflammation, and may develop spinal ankylosing with syndesmophyte formation. Tumor necrosis factor α inhibitors (TNFi) have shown promise in the management of AS and axSpA by targeting the underlying inflammatory process, and providing symptomatic relief. Whether they alter the progression of the disease is uncertain. Golimumab is a fully human IgG1 monoclonal antibody that targets and downregulates the pro-inflammatory cytokine TNF-α. The use of golimumab has been shown to reduce the signs and symptoms of axSpA as well as improve patient function and quality reported outcomes. This review focuses on the biological rationale and the results of clinical trials with golimumab for the treatment of axSpA.

  11. [Axial spondyloarthritis and ankylosing spondylitis].

    Science.gov (United States)

    Nordström, Dan; Kauppi, Markku

    2010-01-01

    Current classification criteria for ankylosing spondylitis do not allow diagnosis before radiographic changes are visible in sacroiliacal joints. The the new axial spondyloarthropathy (SpA) criteria include axial SpA without radiographic changes as well as established ankylosing spondylitis, recognizing them as a continuum of the same disease. This is of major importance as the burden of early SpA is comparable to that of later stage disease. Diagnosis relies on inflammatory MRI findings which is the most significant change compared to earlier criteria. Emerging data on the efficacy of tumor necrosis factor (TNF) alpha blocking therapies already in early but also in established disease have given new promising alternatives for treatment of this often very cumbersome disease, that rarely responds to classic DMARDs.

  12. The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis.

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    Deodhar, Atul; Strand, Vibeke; Kay, Jonathan; Braun, Juergen

    2016-05-01

    The term axial spondyloarthritis (axSpA) now is used frequently to describe patients with predominantly axial symptoms who fit into the spectrum of a well-recognised rheumatic disease that continues to be known as ankylosing spondylitis (AS). The 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria, developed to identify patients with early or atypical disease which could not be classified by the 1984 modified New York (mNY) criteria for AS, have led to a differentiation between non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA, which is largely synonymous with AS. The main reason to distinguish between these ends of the spectrum of axSpA was that tumor necrosis factor (TNF) inhibitors (TNFi) approved for AS could obtain additional labelling for nr-axSpA and be used to treat all patients manifesting clinical features of axSpA. These two terms are distinguished by the degree of 'radiographic sacroiliitis' assessed by conventional radiography, according to the 1984 mNY criteria for AS. Since this differentiation has been shown to be not very reliable, we argue that the terms nr-axSpA and AS should only be used for classification of patients with axSpA and not as separate diagnoses. Therefore, we propose that only the term axSpA be used to diagnose patients, unless there is a meaningful medical reason to differentiate nr-axSpA from AS. The available data justify performing randomised controlled trials designed to obtain regulatory approval for therapeutic agents in patients across the entire spectrum of axSpA.

  13. New treatment targets for axial spondyloarthritis.

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    Sieper, Joachim

    2016-12-01

    Axial spondyloarthritis (axSpA) patients can be divided into those with structural damage in the SI joint visible on X-rays, termed radiographic axSpA or AS, and those in an earlier phase of the disease, without structural damage in the SI joint, termed non-radiographic axSpA. TNF-blockers have been shown to be highly effective in the treatment of active axSpA. Interestingly, conventional DMARDs and also non-TNF-blocker biologics targeting IL-1, IL-6 and T cells (abatacept) are not effective. Recent interest has focused on the cytokines IL-23 and IL-17 as potential treatment targets in axSpA. An open-label trial with ustekinumab showed a good efficacy in AS patients. Two placebo-controlled phase 3 trials with a mAb blocking IL-17, secukinumab, showed a good reduction in disease activity, similar to that shown for TNF blockers. Probably triggered by inflammation, new bone formation is another hallmark in AS and a potentially important treatment target. However, a previously reported inhibitory effect of NSAID treatment could not be confirmed in a recent NSAID trial.

  14. [Diagnosis and therapy of axial spondyloarthritis including ankylosing spondylitis (Bechterew's disease)].

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    Poddubnyy, D; Sieper, J

    2012-07-01

    The term axial spondyloarthritis covers patients with established structural changes visible on x-ray in sacroiliac joints and/or in the spine (classical ankylosing spondylitis) but also patients with non-radiographic axial spondyloarthritis in whom early inflammatory signs of the disease can only be visualized with magnetic resonance imaging (MRI). The MRI technique plays an important role in the diagnosis of this disease and an early diagnosis is normally based on a combination of clinical, laboratory and imaging parameters. Only non-steroidal anti-inflammatory drugs and TNF-α blockers are effective in the treatment of axial spondyloarthritis. Patients with short disease duration and elevated acute phase reactant levels demonstrate best therapy response and, therefore, should be closely followed-up and consistently treated.

  15. Effectiveness of Adalimumab in Non-radiographic Axial Spondyloarthritis

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    Cantarini, Luca; Fabbroni, Marta; Talarico, Rosaria; Costa, Luisa; Caso, Francesco; Cuneo, Gian Luca; Frediani, Bruno; Faralli, Gabriele; Vitale, Antonio; Brizi, Maria Giuseppina; Sabadini, Luciano; Galeazzi, Mauro

    2015-01-01

    Abstract The primary aim of the study was to evaluate the long-term effectiveness of adalimumab (ADA) in a cohort of non-radiographic axial spondyloarthritis (nr-axSpA), and the secondary aims were to identify predictive factors of response and evaluate radiological progression. We evaluated 37 patients (male/female: 12/25; mean age 49 ± 14; mean disease duration: 6.3 ± 5.8) with active nr-axSpA (Assessment of SpondyloArthritis International Society criteria), despite the treatment with ≥1 nonsteroidal anti-inflammatory drug for at least 3 months, initiating the treatment with ADA 40 mg every other week. Patients were treated for 24 months, and evaluated at baseline, 6, 12, and 24 months. Outcome measures included Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index. Radiograph of the spine and sacroiliac joints and magnetic resonance of the sacroiliac joints were performed at baseline and according to the standard of assessment for the disease. The proportion of patients that achieved a BASDAI50 response at 6, 12 and 24 months was 51.3%, 70.3%, and 76.8%, respectively. Treatment was well tolerated with no unexpected adverse events and/or serious adverse events. All patients remained on treatment for 2 years, with a good compliance. We did not identify any predictive factor of response to therapy. Moreover, modified Stoke Ankylosing Spondylitis Spine Score and Spondyloarthritis Research Consortium of Canada scores showed a trend of improvement during the study period. ADA was effective on clinical and radiological outcomes at 2-year follow-up; thus, early treatment with ADA may prevent radiographic damage and be associated with low disease activity or remission. Moreover, data from this cohort study have confirmed safety and tolerability profile of ADA in nr-axSpA in the long term. PMID:26222847

  16. Chondrocyte activity is increased in psoriatic arthritis and axial spondyloarthritis

    DEFF Research Database (Denmark)

    Gudmann, Natasja Stæhr; Munk, Heidi Lausten; Christensen, Anne Friesgaard

    2016-01-01

    BACKGROUND: Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are chronic inflammatory rheumatic diseases with complex origins. Both are characterized by altered extracellular matrix remodeling in joints and entheses that results in destructive and osteochondral proliferative lesions...

  17. Etanercept for the treatment of non-radiographic axial spondyloarthritis.

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    Rios Rodriguez, Valeria; Poddubnyy, Denis

    2016-01-01

    Presently, tumor necrosis factor α antagonist therapy is the only effective alternative treatment to nonsteroidal anti-inflammatory drugs for the entire spectrum of axial spondyloarthritis, including non-radiographic and radiographic (=ankylosing spondylitis) forms. Recently, etanercept has been approved by the European Medicines Agency for the treatment of non-radiographic axial spondyloarthritis, increasing the number of available treatment options for this indication. The latest data on etanercept concerning clinical efficacy and safety in short-term and long-term treatment of patients with non-radiographic axial spondyloarthritis who do not respond to the first-line therapy with non-steroidal anti-inflammatory drugs suggests good efficacy and safety profiles similar to that observed previously in ankylosing spondylitis. This article reviews recent data on the efficacy and safety of etanercept and is focused on the treatment of non-radiographic axial spondyloarthritis. This article will also discuss the role of etanercept in the context of current and developing treatment options.

  18. Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis

    DEFF Research Database (Denmark)

    Ciurea, A.; Weber, U.; Stekhoven, D.

    2015-01-01

    Objective. To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers. The Journal of Rheumatology, Methods.We compared newly initiated TNF inhibition for axSpA in 363 patients...... was slightly higher in the hospital setting. Mean levels (+/- SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 +/- 1.0 vs 3.4 +/- 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response...

  19. ASAS classification criteria for axial spondyloarthritis: time to modify.

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    Akkoc, Nurullah; Khan, Muhammad A

    2016-06-01

    The relationship between ankylosing spondylitis and the recently proposed entity called axial spondyloarthritis with its radiographic and non-radiographic forms that have been defined by the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial spondyloarthritis (axSpA), is currently being debated. The Food and Drug Agency (FDA) had criticized the ASAS criteria and the studies which used these criteria to enroll patients in a clinical trial of certolizumab and adalimumab for the treatment of non-radiographic axial spondyloarthritis. The primary aim of classification criteria is to create homogenous patient populations for basic and clinical research. But the multi-arm construct of the ASAS criteria is a potential source of heterogeneity reducing their utility. Criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances. We provide evidence to conclude that it is time to modify the ASAS Criteria for axSpA, and we propose some of the steps that can be taken to start moving forward in improving the validity of these criteria.

  20. The genetics of ankylosing spondylitis and axial spondyloarthritis.

    Science.gov (United States)

    Robinson, Philip C; Brown, Matthew A

    2012-08-01

    Ankylosing spondylitis (AS) and spondyloarthritis are strongly genetically determined. The long-standing association with HLA-B27 is well described, although the mechanism by which that association induces AS remains uncertain. Recent developments include the description of HLA-B27 tag single nucleotide polymorphisms in European and Asian populations. An increasing number of non-MHC genetic associations have been reported, which provided amongst other things the first evidence of the involvement of the IL-23 pathway in AS. The association with ERAP1 is now known to be restricted to HLA-B27 positive disease. Preliminary studies on the genetics of axial spondyloarthritis demonstrate a lower HLA-B27 carriage rate compared with AS. Studies with larger samples and including non-European ethnic groups are likely to further advance the understanding of the genetics of AS and spondyloarthritis.

  1. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II)

    DEFF Research Database (Denmark)

    Rudwaleit, M; van der Heijde, D; Landewé, R

    2009-01-01

    OBJECTIVE: To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). METHODS: All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back...

  2. Old and new treatment targets in axial spondyloarthritis

    Science.gov (United States)

    Rios Rodriguez, Valeria; Poddubnyy, Denis

    2015-01-01

    Two main treatment targets in axial spondyloarthritis (axSpA) could be currently defined: (1) reduction of inflammation resulting in control of signs and symptoms such as pain and stiffness and (2) prevention or retardation of structural damage progression in the spine resulting in preservation of functional status and improvement in the long-term outcome. A good control of signs and symptoms could be successfully achieved nowadays in the majority of patients treated with non-steroidal anti-inflammatory drugs (NSAIDs—the first-line therapy in axSpA) and with tumour necrosis factor (TNF) α blockers (the second-line therapy, if NSAIDs fail). Several pipeline drugs including interleukin (IL) 17 and IL-23 antagonists might be helpful in the immediate future in achievement of this treatment target in case of inefficacy of NSAIDs and TNFα blockers. Retardation of radiographical spinal progression in axSpA—disease modification—is currently a much more challenging task than a good symptom control. In this review, we discuss symptomatic and possible disease-modifying properties of current and forthcoming treatment options for axSpA. PMID:26557376

  3. Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis?

    Science.gov (United States)

    Masi, Alfonse T

    2014-01-01

    Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hypertonicity was hypothesized as a potential excessive polymorphic trait which could contribute to chronic biomechanical overloading and exaggerated stresses at entheseal sites. Such a mechanism may help to integrate many of the characteristic host, pathological, and structural features of ankylosing spondylitis and axial spondyloarthritis. Biomechanical stress and strain were recently documented to correlate with peripheral entheseal inflammation and new bone formation in a murine model of spondyloarthritis. Ankylosing spondylitis has traditionally been classified by the modified New York criteria, which require the presence of definite radiographic sacroiliac joint lesions. New classification criteria for axial spondyloarthritis now include patients who do not fulfill the modified New York criteria. The male-to-female sex ratios clearly differed between the two patient categories - 2:1 or 3:1 in ankylosing spondylitis and 1:1 in non-radiographic axial spondyloarthritis - and this suggests a spectral concept of disease and, among females, milder structural alterations. Magnetic resonance imaging of active and chronic lesions in ankylosing spondylitis and axial spondyloarthritis reveals complex patterns, usually interpreted as inflammatory reactions, but shows similarities to acute degenerative disc disease, which attributed to edema formation following mechanical stresses and micro-damage. A basic question is whether mechanically induced microinjury and immunologically mediated

  4. [Inflammatory spinal diseases: axial spondyloarthritis : Central importance of imaging].

    Science.gov (United States)

    Baraliakos, X; Fruth, M; Kiltz, U; Braun, J

    2017-03-01

    The diagnosis of axial spondyloarthritis (axSpA) includes classical ankylosing spondylitis (AS) as well as earlier stages and abortive courses of the disease, in which structural alterations have not yet occurred. These are classified as non-radiographic axSpA (nr-axSpa). Inflammatory changes in the entire axial skeleton are characteristic for axSpA and can be visualized by magnetic resonance imaging (MRI), while in most patients structural alterations, such as new bone formation with syndesmophytes and ankylosis develop in the later course of the disease. These bony alterations can best be visualized by conventional radiography and by computed tomography. Certain MRI sequences are nowadays considered as the standard method for depiction of inflammatory changes in axSpA. The introduction of MRI has led to a paradigm shift for this disease because the inflammatory lesions characteristic for the disease can be visualized at an early stage using appropriate MRI sequences.

  5. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity.

    Science.gov (United States)

    Salaffi, Fausto; De Angelis, Rossella; Carotti, Marina; Gutierrez, Marwin; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola

    2014-08-01

    To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) (p axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.

  6. Axial spondyloarthritis: a new disease entity, not necessarily early ankylosing spondylitis.

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    Robinson, Philip Cameron; Wordsworth, Bryan Paul; Reveille, John D; Brown, Matthew A

    2013-02-01

    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.

  7. Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis

    DEFF Research Database (Denmark)

    Munk, Heidi Lausten; Gudmann, Natasja Staehr; Christensen, Anne Friesgaard

    2016-01-01

    The aim of the study was to assess the possible association between type II collagen turnover seromarkers and disease profile in patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Outpatients with axial SpA (n = 110) or PsA (n = 101) underwent clinical examination including...

  8. Bone mineral density in patients with early axial spondyloarthritis

    Directory of Open Access Journals (Sweden)

    E. E. Gubar

    2015-01-01

    Full Text Available Objective: to study bone mineral density (BMD of the lumbar spine (LS and femoral neck (FN in patients with early axial spondyloarthritis (SpA and to reveal its association with inflammatory disease activity.Subjects and methods. Seventy-three patients aged 18–45 years with inflammatory back pain lasting at least 3 months and not more than 5 years were examined. Axial SpA was diagnosed according to the 2009 ASAS criteria. BASDAI and ASDAS C-reactive protein (CRP values were used to estimate disease activity; BASFI was employed to evaluate functional status. The examination encompassed determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI of sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their injuries, densitometry of LS (LI-IV and FN. By taking into account the young age of patients, the Z-score was applied to measure BMD. The latter is considered lower if the Z-score is 1–2 standard deviations (SD in at least one of the segments under study.Results. The median Z-score was -0.7 (-1.3; -0.3 SD for FN and 0.9 (-1.6; -0.5 SD for LS. Reduced BMD in at least one of the segments under study was detected in 13 (17.8% patients: that in LS and FN in 11 (15.1% and 5 (6.8% patients, respectively. Lower BMD was observed in two segments in 3 (4.1% patients. No association was found between lower BMD and age, gender, disease activity (BASDAI, ASDAS, and laboratory inflammatory markers (erythrocyte sedimentation rate (ESR and CRP. A relationship was established between inflammatory changes according to the data of MRI of LS (MRI spondylitis and reduced BMD in the same segment. MRI spondylitis was detected in 8 patients. Five and 3 patients with spondylitis of LS were found to have lower and normal BMD in this segment, respectively. Six out of 65 patients without MRI spondylitis in LS had its reduced BMD and the remaining (n=59 patients had its normal BMD (p=0.0014.Conclusion. There was an

  9. ASDAS, BASDAI and different treatment responses and their relation to biomarkers of inflammation, cartilage and bone turnover in patients with axial spondyloarthritis treated with TNFα inhibitors

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Sørensen, Inge Juul; Garnero, Patrick

    2011-01-01

    To investigate the relation between ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis disease activity index (BASDAI) and treatment response and biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6), YKL-40), angiogenesis (vascular endothelial...... growth factor (VEGF)), cartilage (C-terminal crosslinking telopeptide of type II collagen (CTX-II), matrix metalloproteinase-3 (MMP-3), total aggrecan, cartilage oligomeric matrix protein) and bone (C-terminal crosslinking telopeptide of type I collagen, osteocalcin) turnover in 60 patients with axial...

  10. ASDAS, BASDAI and different treatment responses and their relation to biomarkers of inflammation, cartilage and bone turnover in patients with axial spondyloarthritis treated with TNF{alpha} inhibitors

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Sørensen, Inge Juul; Garnero, Patrick

    2011-01-01

    To investigate the relation between ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis disease activity index (BASDAI) and treatment response and biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6), YKL-40), angiogenesis (vascular endothelial...... growth factor (VEGF)), cartilage (C-terminal crosslinking telopeptide of type II collagen (CTX-II), matrix metalloproteinase-3 (MMP-3), total aggrecan, cartilage oligomeric matrix protein) and bone (C-terminal crosslinking telopeptide of type I collagen, osteocalcin) turnover in 60 patients with axial...

  11. Impact of Certolizumab Pegol on Patient‐Reported Outcomes in Patients With Axial Spondyloarthritis

    Science.gov (United States)

    Kivitz, A.; van Tubergen, A.; Deodhar, A.; Coteur, G.; Woltering, F.; Landewé, R.

    2015-01-01

    Objective Patient‐reported outcomes (PROs) provide an opportunity to collect important information relating to patient well‐being, which is often difficult for physicians to measure (e.g., quality of life, pain, fatigue, and sleep). Here we evaluate the effects of certolizumab pegol (CZP) on PROs during the 24‐week, double‐blind phase of the RAPID axial spondyloarthritis (SpA) trial, a phase 3 trial of axial SpA patients, including both ankylosing spondylitis (AS) and nonradiographic axial SpA patients. Methods A total of 325 patients with active axial SpA were randomized 1:1:1 to placebo, CZP 200 mg every 2 weeks, or CZP 400 mg every 4 weeks. The primary end point was the Assessment of SpondyloArthritis International Society criteria for 20% improvement in disease activity response at week 12, and has been reported previously. PROs included total back pain, nocturnal back pain, a daily pain diary, the Sleep Problems Index II (SPI) domain of the Medical Outcomes Study (MOS) Sleep Scale, fatigue, the Ankylosing Spondylitis Quality of Life (ASQOL) measure, and the Short Form 36‐item (SF‐36) health survey physical component summary (PCS), mental component summary (MCS), and domains. Results Patients treated with CZP reported significant improvements from week 1 for nocturnal back pain (placebo −0.6, CZP 200 mg every 2 weeks −1.9, and CZP 400 mg every 4 weeks −1.6; P < 0.001) and ASQOL (placebo −1.0, CZP 200 mg every 2 weeks −2.3, and CZP 400 mg every 4 weeks −1.9; P < 0.05) compared with placebo, while significant improvements in total back pain were seen from day 2. Patients treated with both CZP dosing regimens also had significantly greater improvements in fatigue, MOS‐SPI, SF‐36 PCS, MCS, and domains compared with placebo. Improvements were similar in both AS and nonradiographic axial SpA patients. Conclusion Both CZP dosing schedules rapidly improved patient well‐being, as measured by PROs, including pain, fatigue, sleep, SF‐36

  12. Spondyloarthritis

    NARCIS (Netherlands)

    M. Dougados; D. Baeten

    2011-01-01

    Spondyloarthritis is a group of several related but phenotypically distinct disorders: psoriatic arthritis, arthritis related to inflammatory bowel disease, reactive arthritis, a subgroup of juvenile idiopathic arthritis, and ankylosing spondylitis (the prototypic and best studied subtype). The past

  13. Diagnosis of spondyloarthritis of the axial skeleton; Diagnostik der Spondyloarthritiden am Achsenskelett

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, Kay-Geert A. [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie; Bollow, Matthias [Augusta-Kranken-Anstalt Bochum (Germany); Bochum Univ. (Germany)

    2009-09-15

    Conventional radiography is used as the first-line imaging test in evaluating the axial skeleton for manifestations of spondyloarthritis, which is a cover term for five entities: ankylosing spondylitis, psoriatric spondyloarthritis, reactive arthritis, enteropathic arthritis, and undifferentiated spondyloarthritis. However, as it often takes many years from the onset of clinical symptoms and the first appearance of radiographic changes, a cross-sectional imaging is warranted (CT and/or MRI) for early diagnosis. MRI sensitively detects early inflammatory stages of spondyloarthritis and can thus fill the gap by markedly reducing the interval between initial symptoms and diagnosis. The aim of this article is to show that all manifestations and forms of spondyloarthritis share the same pathogenetic inflammatory pattern, namely a mixture of bone destruction and bone proliferation: enthesis - enthesitis - enthesiophyte. An enthesis in the true sense is a fibrocartilaginous junction (uncalcified fibrocartilage - tidemark - calcified fibrocartilage) between a tendon, ligament, joint capsule, or fascia and bone. The sacroiliac joint is a special form, a so-called articular fibrocartilaginous enthesis. A wide range of images - including radiographs, CT scans, and MR images - will be presented to provide a comprehensive picture of the entheseal manifestations and inflammatory patterns of the sacroiliac joints, vertebral endplates and ridges, facet joints, costovertebral junctions, and spinal ligaments in spondyloarthritis. (orig.)

  14. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients.

    Science.gov (United States)

    Fabre, Stéphanie; Molto, Anna; Dadoun, Sabrina; Rein, Christopher; Hudry, Christophe; Kreis, Sarah; Fautrel, Bruno; Pertuiset, Edouard; Gossec, Laure

    2016-12-01

    Physical activity is recommended in axial spondyloarthritis (axSpA) but may be insufficiently performed. The objective of this study was to assess physical activity in axial spondyloarthritis and to explore its explanatory factors. This was a cross-sectional study of patients with definite axSpA. The level of physical activity (International Physical Activity Questionnaire-Long form, IPAQ-L), type of aerobic exercise and the Exercise Benefits and Barriers Score were collected. Multivariate logistic regression analyses were performed to explain levels of exercise at least as recommended by the World Health Organization. In all, 203 patients were included: mean age 46.0 ± 11.6 years, 108 (53.2 %) males, mean Bath Ankylosing Spondylitis Activity Index (0-100) 37.8 ± 19.9; 137 (68.8 %) were treated with TNF-inhibitors. In all, 111 patients (54.7 %) were exercising at least as recommended; 96 (47.2 %) were in the 'high physical activity' category. Aerobic exercise >30 min was performed at least once a week by 61 (30.0 %) patients; the most frequent activities were energetic walking (31.0 %) and swimming (21.2 %). Main perceived benefits of exercising were improving physical fitness and functioning of the cardiovascular system, and the main barrier was physical exertion. Patients with paid employment had lower levels of physical activity whereas other demographic variables, disease activity/severity or TNF-inhibitor treatment were not predictive. One half of these patients performed enough physical activity according to the recommendations, similarly to the French population. Levels of physical activity did not appear to be explained by disease-related variables. Physical activity should be encouraged in axSpA.

  15. Diagnostic utility of candidate definitions for demonstrating axial spondyloarthritis on magnetic resonance imaging of the spine

    DEFF Research Database (Denmark)

    Weber, Ulrich; Zhao, Zheng; Rufibach, Kaspar

    2015-01-01

    OBJECTIVE: A recent consensus statement has suggested ≥3 corner inflammatory lesions (CILs) or several corner fatty lesions (CFLs) as candidate criteria indicative of axial spondyloarthritis (SpA) on magnetic resonance imaging (MRI) of the spine. The aim of this study was to evaluate the diagnostic...

  16. Aspects of methodology in assessing inflammation and damage in rheumatoid arthritis and axial spondyloarthritis

    NARCIS (Netherlands)

    Navarro Compan, Maria Victoria

    2015-01-01

    This thesis is two-fold focused on rheumatoid arthritis and axial spondyloarthritis. It covers outstanding aspects of research methodology in the assessment of inflammation and damage in patients with these diseases. The studies pertaining to the first part of the thesis focus on rheumatoid arthrit

  17. Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome

    NARCIS (Netherlands)

    Maas, Fiona; Arends, Suzanne; van der Veer, Eveline; Wink, Freke; Efde, Monique; Bootsma, Hendrika; Brouwer, Elisabeth; Spoorenberg, Anneke

    2016-01-01

    Objective. To assess the prevalence of overweight and obesity in a large cohort of patients with axial spondyloarthritis (axSpA) in comparison with the general population. To explore the relationship of body mass index (BMI) with clinical outcome in axSpA. Methods. Patients from the Groningen Leeuwa

  18. Advances in classification, basic mechanisms and clinical science in ankylosing spondylitis and axial spondyloarthritis.

    Science.gov (United States)

    Robinson, P C; Benham, H

    2015-02-01

    The field of spondyloarthritis (SpA) has seen huge advances over the past 5 years. The classification of axial disease has been redefined by the axial SpA criteria that incorporate disease captured before radiographic damage is evident as well as established erosive sacroiliac joint disease. Our knowledge of genetics and basic immunological pathways has progressed significantly. In addition, revolutionary progress has been achieved with the availability of tumour necrosis factor inhibitors for treating patients with moderate to severe disease. In parallel, several of novel biomarkers have been identified that show significant promise for the future. Advances in magnetic resonance imaging have helped define positive disease. We have identified that T1 and short tau inversion recovery sequences are best for the diagnosis of axial SpA, and gadolinium contrast is not additive for diagnosis. Progress has been made in identifying potential agents and strategies that reduce radiographic progression. Several referral strategies aimed at appropriate identification of patients have been trialled and found to be effective. There is still substantial work ahead, but the advances of the last 5 years have made a huge and tangible difference at the clinical coalface, and we suggest that this trend will continue.

  19. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis

    DEFF Research Database (Denmark)

    Hermann, Kay-Geert A; Baraliakos, Xenofon; van der Heijde, Désirée M F M

    2012-01-01

    The aim of this study was to define characteristic MRI findings in the spine of patients with axial spondyloarthritis (SpA) and provide a definition of a positive spinal MRI for inflammation and structural changes.......The aim of this study was to define characteristic MRI findings in the spine of patients with axial spondyloarthritis (SpA) and provide a definition of a positive spinal MRI for inflammation and structural changes....

  20. Fat infiltration on magnetic resonance imaging of the sacroiliac joints has limited diagnostic utility in nonradiographic axial spondyloarthritis

    DEFF Research Database (Denmark)

    Weber, Ulrich; Pedersen, Susanne J; Zubler, Veronika

    2014-01-01

    To explore whether morphological features of fat infiltration (FI) on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) contribute to diagnostic utility in 2 inception cohorts of patients with nonradiographic axial spondyloarthritis (nr-axSpA).......To explore whether morphological features of fat infiltration (FI) on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) contribute to diagnostic utility in 2 inception cohorts of patients with nonradiographic axial spondyloarthritis (nr-axSpA)....

  1. The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: A critical appraisal for the pediatric rheumatologist

    Directory of Open Access Journals (Sweden)

    Burgos-Vargas Ruben

    2012-05-01

    Full Text Available Abstract This review refers to the origin and current state of the assessment of the SpondyloArthritis International Society (ASAS criteria for the classification of axial and peripheral spondyloarthritis (SpA and the possible implications in the pediatric population. The ASAS criteria evolved from the idea that the earlier the recognition of patients with ankylosing spondylitis, the better the efficacy of tumor necrosis factor blockers. Strategies included the development of new concepts, definitions, and techniques for the study of clinical signs and symptoms. Of relevance, the new definition of inflammatory back pain (IBP and the introduction of sacroiliitis by magnetic resonance imaging represented the most important advance in the early identification of AS in the “pre-radiographic stage” of the disease. AS is considered in this paper as a disease continuum with symptoms depending on age at onset. The application of those specific strategies in children and adolescents with SpA seems limited because the most important manifestation in the early stage of disease is not IBP, but peripheral arthritis and enthesitis. In this instance, the logical approach to juvenile onset SpA according to ASAS criteria should not be through the axial criteria but rather the peripheral set of criteria.

  2. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Sørensen, Inge Juul; Hermann, Kay-Geert A

    2010-01-01

    To investigate construct validity and responsiveness of the novel ankylosing spondylitis (AS) disease activity score (ASDAS) in patients with spondyloarthritis (SpA).......To investigate construct validity and responsiveness of the novel ankylosing spondylitis (AS) disease activity score (ASDAS) in patients with spondyloarthritis (SpA)....

  3. The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward.

    Science.gov (United States)

    van der Linden, Sjef; Akkoc, Nurullah; Brown, Matthew A; Robinson, Philip C; Khan, Muhammad A

    2015-09-01

    Classification criteria should facilitate selection of similar patients for clinical and epidemiologic studies, therapeutic trials, and research on etiopathogenesis to enable comparison of results across studies from different centers. We critically appraise the validity and performance of the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA). It is still debatable whether all patients fulfilling these criteria should be considered as having true axSpA. Patients with radiographically evident disease by the ASAS criteria are not necessarily identical with ankylosing spondylitis (AS) as classified by the modified New York criteria. The complex multi-arm selection design of the ASAS criteria induces considerable heterogeneity among patients so classified, and applying them in settings with a low prevalence of axial spondyloarthritis (SpA) greatly increases the proportion of subjects falsely classified as suffering from axial SpA. One of the unmet needs in non-radiographic form of axial SpA is to have reliable markers that can identify individuals at risk for progression to AS and thereby facilitate early intervention trials designed to prevent such progression. We suggest needed improvements of the ASAS criteria for axSpA, as all criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances.

  4. TUMOR NECROSIS FACTOR-α INHIBITORS IN THE TREATMENT OF AXIAL SPONDYLOARTHRITIS, INCLUDING ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    S. A. Lapshina

    2016-01-01

    Full Text Available The paper provides guidelines for the use of tumor necrosis factor-α  (TNF-α inhibitors in the treatment of patients with axial spondyloarthritis  (axSpA, including ankylosing spondylitis. It gives data on the efficacy of TNF-α inhibitors in patients with non-radiographic axSpA. By using international and Russian guidelines, the authors lay down indications for this therapy and criteria for evaluation of its efficiency and safety.

  5. The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity.

    Science.gov (United States)

    Martindale, Jane; Shukla, Rudresh; Goodacre, John

    2015-06-01

    Ankylosing spondylitis (AS) is a chronic inflammatory condition that has a significant impact on the quality of life and work productivity. New classification criteria have enabled earlier diagnosis of this condition. However, work productivity is an important issue that is still often overlooked during clinical assessments and consultations. This article focusses on the relationship between axial spondyloarthritis (axial SpA) and work productivity. It summarises the impact of this condition on work productivity, and it highlights the tools available to assess this. It also highlights the increasing role and potential of employers, health professionals and new treatments for enhancing work productivity for people with this condition.

  6. Update on the American College of Rheumatology/Spondyloarthritis Research and Treatment Network/Spondylitis Association of America axial spondyloarhtritis treatment guidelines project.

    Science.gov (United States)

    Ward, Michael M

    2014-06-01

    The American College of Rheumatology, the Spondyloarthritis Research and Treatment Network, and the Spondylitis Association of America have begun collaborating on a project to develop treatment guidelines for axial spondyloarthritis. The project will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, which is based on systematic literature reviews and quantitative evidence summaries, to develop treatment recommendations for the use of pharmacological interventions, rehabilitation, surgery, preventive care, and disease monitoring in patients with ankylosing spondylitis and axial spondyloarthritis.

  7. Coexistence of axial spondyloarthritis and thromboangiitis obliterans in a young woman

    Directory of Open Access Journals (Sweden)

    G. Lopalco

    2015-06-01

    Full Text Available A peculiar coexistence of axial spondyloarthritis and ischemia of the feet and the fourth finger of the left hand in a young woman, who was a heavy smoker, is discussed in this report. This picture was considered within the context of thromboangiitis obliterans. Positivity of anti-nuclear antibodies and mild elevation of inflammatory parameters were noted. Computed tomography angiograms of upper and lower limbs showed luminal narrowing and occlusion of the left humeral, left anterior/posterior tibial and right anterior tibial arteries. Daily iloprost perfusions were started, and smoking cessation was strongly recommended. Coldness and rest pain in the distal extremities improved within a few weeks. The possibility that spondyloarthritis might precede the clinical picture of thromboangiitis obliterans should be considered in heavy smokers.

  8. Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort

    Science.gov (United States)

    Turina, Maureen C; Yeremenko, Nataliya; van Gaalen, Floris; van Oosterhout, Maikel; Berg, Inger J; Ramonda, Ramona; Lebre, Cristina (M C); Landewé, Robert; Baeten, Dominique

    2017-01-01

    Introduction Decreasing the diagnostic delay in axial spondyloarthritis (axSpA) remains a major challenge. Here, we assessed the value of serum inflammatory biomarkers to distinguish early axSpA from other pathologies in a large cohort of patients referred with early back pain. Methods Serum c reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calprotectin were determined in the SPondyloArthritis Caught Early (SPACE) cohort (n=310), an early back pain inception cohort. Additionally, explorative serum biomarkers derived from the literature (interleukin-27 (IL-27), human β-defensin-2 (hBD-2) and lipcolin-2 (LCN-2)) were determined by ELISA in full-blown patients with ankylosing spondylitis (AS) (n=21) and healthy controls (n=20). Results Serum CRP and ESR levels were not elevated in early axSpA versus ‘control’ back pain patients. Serum calprotectin was elevated in early axSpA versus controls (p=0.01) but failed to identify early axSpA at the individual level (positive predictive value of 38.7%). As to explorative biomarkers, serum levels of IL-27 were not detectable, and hBD-2 and LCN-2 serum levels were not elevated in full-blown AS versus healthy controls (p=0.572, p=0.562, respectively). Therefore, these markers were not further determined in the SPACE cohort. Conclusions None of the candidate serum inflammatory markers were useful as diagnostic markers in the early phase of axSpA. PMID:28123777

  9. Active axial spondyloarthritis: potential role of certolizumab pegol

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    Ranatunga S

    2014-02-01

    Full Text Available Sriya Ranatunga, Anne V Miller Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA Abstract: The axial spondyloarthropathies are a group of chronic inflammatory diseases that predominantly affect the axial joints. This group includes ankylosing spondylitis and nonradiographic axial spondyloarthropathy. While the pathogenesis of axial spondyloarthropathies is not clear, immunologically active tissues primarily include the entheses, ie, the areas where ligaments, tendons, and joint capsules attach to bone and to the annulus fibrosis at the vertebrae. One of the major mediators of the immune response in this group of diseases is tumor necrosis factor-alpha (TNFα. Blockade of TNFα results in reduced vascularity and inflammatory cell infiltration in the synovial tissues of affected joints. Certolizumab pegol (CZP is an Fc-free, PEGylated anti-TNFα monoclonal antibody. CZP has unique properties that differ from other available TNFα inhibitors by virtue of its lack of an Fc region, which minimizes potential Fc-mediated effects, and its PEGylation, which improves drug pharmacokinetics and bioavailability. It has been shown in clinical trials that CZP improves patient outcomes and reduces inflammation in the sacroiliac joints and spine in both ankylosing spondylitis and nonradiographic axial spondyloarthropathies. These data support CZP as a treatment option for axial spondyloarthropathies. Keywords: axial spondyloarthropathy, certolizumab pegol, anti-tumor necrosis factor-alpha, therapy

  10. A Comparison of Disease Burden in Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis

    Science.gov (United States)

    Michelsen, Brigitte; Fiane, Ragnhild; Diamantopoulos, Andreas P.; Soldal, Dag Magnar; Hansen, Inger Johanne W.; Sokka, Tuulikki; Kavanaugh, Arthur; Haugeberg, Glenn

    2015-01-01

    Objective The main objective of this study was to compare disease burden in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA). Methods In this cross-sectional study, all the RA (1093), PsA (365) and ax-SpA (333) patients who visited the out-patient clinic of the Hospital of Southern Norway Trust during the year 2013 were included; the RA patients all had a RA diagnosis verified by the treating rheumatologist, the PsA patients all fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria and the ax-SpA patients all fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for ax-SpA. Patient-reported health status, demographic variables, medications, and composite scores of disease activity were assessed. The main analyses were performed using General Linear Models adjusted for age, sex and multiple comparisons. Correlation analyses were performed using Spearman’s rho. Results The reported pain, joint pain, patient’s global assessment and fatigue were similar in PsA and ax-SpA, but significantly lower in RA. The 28-joint Disease Activity Score (DAS28) (0.3±0.1, p = 0.003), Clinical Disease Activity Index (CDAI) (1.0±0.4, p = 0.028) and Routine Assessment of Patient Index Data 3 (RAPID3) (0.4±0.1, p = 0.004) were all significantly higher in PsA vs. RA. RAPID3 showed moderate to high correlation with DAS28 (rho = 0.521, p<0.001) and CDAI (rho = 0.768, p<0.001) in RA and PsA, and with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (rho = 0.902, p<0.001) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.865, p<0.001) in ax-SpA and PsA. Conclusion In conclusion, patient- reported outcome measures were similar in our population of PsA and ax-SpA patients, but significantly lower for the RA patients. Composite disease activity measures were lower in RA than in PsA and ax-SpA, but the magnitude of these differences was small and probably not of

  11. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.

    Directory of Open Access Journals (Sweden)

    Brigitte Michelsen

    Full Text Available The main objective of this study was to compare disease burden in rheumatoid arthritis (RA, psoriatic arthritis (PsA and axial spondyloarthritis (ax-SpA.In this cross-sectional study, all the RA (1093, PsA (365 and ax-SpA (333 patients who visited the out-patient clinic of the Hospital of Southern Norway Trust during the year 2013 were included; the RA patients all had a RA diagnosis verified by the treating rheumatologist, the PsA patients all fulfilled the ClASsification for Psoriatic ARthritis (CASPAR criteria and the ax-SpA patients all fulfilled the Assessment of SpondyloArthritis international Society (ASAS classification criteria for ax-SpA. Patient-reported health status, demographic variables, medications, and composite scores of disease activity were assessed. The main analyses were performed using General Linear Models adjusted for age, sex and multiple comparisons. Correlation analyses were performed using Spearman's rho.The reported pain, joint pain, patient's global assessment and fatigue were similar in PsA and ax-SpA, but significantly lower in RA. The 28-joint Disease Activity Score (DAS28 (0.3±0.1, p = 0.003, Clinical Disease Activity Index (CDAI (1.0±0.4, p = 0.028 and Routine Assessment of Patient Index Data 3 (RAPID3 (0.4±0.1, p = 0.004 were all significantly higher in PsA vs. RA. RAPID3 showed moderate to high correlation with DAS28 (rho = 0.521, p<0.001 and CDAI (rho = 0.768, p<0.001 in RA and PsA, and with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI (rho = 0.902, p<0.001 and Bath Ankylosing Spondylitis Functional Index (BASFI (0.865, p<0.001 in ax-SpA and PsA.In conclusion, patient- reported outcome measures were similar in our population of PsA and ax-SpA patients, but significantly lower for the RA patients. Composite disease activity measures were lower in RA than in PsA and ax-SpA, but the magnitude of these differences was small and probably not of clinical significance. Our study indicates that

  12. Spontaneous, drug-induced, and drug-free remission in peripheral and axial spondyloarthritis.

    Science.gov (United States)

    Poddubnyy, Denis; Gensler, Lianne S

    2014-10-01

    In spondyloarthritis (SpA), spontaneous remission is best described in reactive arthritis, a form of peripheral SpA. Prior SpA observational studies suggested that a significant percentage of patients reached spontaneous remission; however, these patients were followed up under older, broader European Spondyloarthropathy Study Group (ESSG) criteria or were not defined by specific criteria. In general, they were mixed populations of peripheral and axial disease, and the subsets were not differentiated when assessing end points such as remission. There are limited data on the natural history of axial SpA, in part because of the evolution of the criteria with the more recently developed Assessment of SpondyloArthritis International Society (ASAS) criteria, including the designation of non-radiographic axial SpA and peripheral SpA. Clinical trials have been conducted with various remission end points including withdrawal of therapy to determine remission maintenance. The following review addresses the potential for remission in axial and peripheral SpA based on the data from both observational studies and clinical trials.

  13. An appraisal of golimumab in the treatment of severe, active nonradiographic axial spondyloarthritis

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    Paccou J

    2016-07-01

    Full Text Available Julien Paccou, René-Marc Flipo Department of Rheumatology, Lille University Hospital, Lille, France Abstract: Golimumab (Simponi® is a fully human tumor necrosis factor α inhibitor (TNFi antibody administered subcutaneously. In the European Union, golimumab is indicated for the treatment of adults with severe, active axial spondyloarthritis (axSpA, which includes both ankylosing spondylitis (AS and nonradiographic axSpA (nr-axSpA. In the US, it is indicated for the treatment of adults with active AS only. This article reviews the efficacy and tolerability of golimumab in nr-axSpA patients compared to other TNFi agents (adalimumab, infliximab, etanercept, and certolizumab pegol. In one ongoing, well-designed controlled study (GO-AHEAD, data at 16 weeks showed that treatment with golimumab (50 mg every 4 weeks was effective in improving the clinical signs and symptoms of disease in nr-axSpA patients. In addition, 16 weeks of treatment with golimumab reduced inflammation in the sacroiliac joints and spine in patients with nr-axSpA. Moreover, objective evidence of active inflammation at baseline, such as a positive magnetic resonance imaging scan and/or an elevated CRP level, was a good predictor of treatment response to golimumab. Golimumab was generally well tolerated in this study, with a tolerability profile consistent with that seen in previous clinical trials for other indications. Although additional long-term data are needed, current evidence indicates that golimumab is an effective option for the treatment of nr-axSpA. However, in the absence of comparative head-to-head trials, there is no recommended hierarchy for the first prescription of a TNFi agent for the treatment of either nr-axSpA or AS. Keywords: axial spondyloarthritis, nonradiographic axial spondyloarthritis, ankylosing spondylitis, golimumab, tumor necrosis factor α inhibitor, therapy

  14. Recent Advances in Imaging of the Axial Skeleton in Spondyloarthritis for Diagnosis, Assessment of Treatment Effect, and Prognostication

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Maksymowych, Walter P

    2015-01-01

    In the last few years, many studies have investigated the role of imaging for improved diagnosis, assessment of treatment effects, and determining prognosis in patients with axial spondyloarthritis (SpA). Recent research has primarily focused on the utility of magnetic resonance imaging (MRI......) for improved diagnosis of patients with non-radiographic axial SpA, and in particular on the classification utility of the MRI criteria as defined by the Assessment of Spondyloarthritis International Society (ASAS). New and more sensitive methods for evaluation of MRI of the sacroiliac joints have been...

  15. Drug levels, immunogenicity and assessment of active sacroiliitis in patients with axial spondyloarthritis under biologic tapering strategy.

    Science.gov (United States)

    Almirall, Miriam; Gimeno, Ramón; Salman-Monte, Tarek Carlos; Iniesta, Silvia; Lisbona, Maria Pilar; Maymó, Joan

    2016-04-01

    The aim of the study was to assess drug levels, immunogenicity and sacroiliitis on MRI in patients with axial spondyloarthritis under biologic tapering strategy. Consecutive patients with axial spondyloarthritis who remained in low disease activity more than 1 year after dose tapering of infliximab and adalimumab were included. Plasma drug concentrations of TNF inhibitors and anti-drug antibodies were determined, and MRI of sacroiliac joints was evaluated. Of twenty patients included, eighteen had therapeutic drug levels, no patient had anti-drug antibodies, and no patient had active sacroiliitis on MRI. These data could support the biologic tapering strategy and their maintenance over time.

  16. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group

    DEFF Research Database (Denmark)

    Lambert, Robert G W; Bakker, Pauline A C; van der Heijde, Désirée

    2016-01-01

    . CONCLUSION: The definition of a positive MRI for classification of axial SpA should continue to primarily depend on the imaging features of 'active sacroiliitis' until more data are available regarding MRI features of structural damage in the sacroiliac joint and MRI features in the spine and their utility......OBJECTIVES: To review and update the existing definition of a positive MRI for classification of axial spondyloarthritis (SpA). METHODS: The Assessment in SpondyloArthritis International Society (ASAS) MRI working group conducted a consensus exercise to review the definition of a positive MRI...... for inclusion in the ASAS classification criteria of axial SpA. Existing definitions and new data relevant to the MRI diagnosis and classification of sacroiliitis and spondylitis in axial SpA, published since the ASAS definition first appeared in print in 2009, were reviewed and discussed. The precise wording...

  17. Pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis: efficacy of anti-tumor necrosis factor α therapy.

    Science.gov (United States)

    Bruzzese, Vincenzo

    2012-12-01

    We report the case of a patient with a simultaneous presence of pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis. This condition differs from both the PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis) syndrome, in which arthritis is absent, and the PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome, in which suppurative hidradenitis is lacking. Our patient failed to respond to etanercept therapy, whereas all dermatologic and rheumatic manifestations completely regressed following infliximab infusion. We therefore propose that simultaneous presence of pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and seronegative spondyloarthritis might represent a distinct syndrome that could be termed the PASS syndrome. Tumor necrosis factor α therapies seem to play selective roles.

  18. DOES BONE MINERAL DENSITY CHANGE IN EARLY AXIAL SPONDYLOARTHRITIS?

    Directory of Open Access Journals (Sweden)

    E. E. Gubar

    2016-01-01

    Full Text Available The rate of osteoporosis (OP and the mechanism  of its development in patients with ankylosing spondylitis (AS and other spondyloarthrititides (SpA have not been sufficiently investigated. Steady-state  inflammatory disease activity is anticipated  to be the leading factor of OP in AS.Objective: to investigate lumbar spine (LS and femoral neck (FN  bone mineral density (BMD  in patients with early axial SpA (axSpA and to reveal its association with inflammatory disease activity.Subjects and methods. A total of 150 patients (59 men and 91 women aged 18 to 45 years with inflammatory back pain for ≥3 months and ≤5 years were examined. The diagnosis of axSpA was established in accordance  with the 2009 ASAS criteria. BASDAI and ASDAS-CRP were used to assess activity and functional status was evaluated with BASFI. The examination  included determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI  of the sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their involvement,  and densitometry of LS (LI–IV  and FN. By taking into account the patients’ young age, the Z score was used to estimate BMD. The Z-score -2 SD or lower in at the least one of the regions examined is considered to be diminished BMD. Results and discussion. The median Z-score was -0.7 [-1.3; -0.2] SD for FN and -0.9 [-1.6; -0.6] SD for LS. Reduced BMD in at the least one of the regions examined was diagnosed in 27 (18.0% patients. There was lower BMD in LS in 21 (14.0% patients and in FN in 8 (5.3%. Two (1.3% patients were diagnosed as having osteopenia in the two examined regions. There was no association between diminished BMD and age, gender, disease activity assessed with BASDAI, ASDAS-СRP, erythrocyte sedimentation rate (ESR and C-reactive protein (CRP. An association was found between inflammatory LS changes, as evidenced by MRI (MRI spondylitis, and reduced BMD in at least one of the examined regions. MRI

  19. Magnetic resonance imaging in diffuse idiopathic skeletal hyperostosis: similarities to axial spondyloarthritis.

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    Arad, Uri; Elkayam, Ori; Eshed, Iris

    2017-03-31

    Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition that involves calcification and ossification of the spinal ligaments and entheses. While, characteristic magnetic resonance imaging (MRI) lesions of the spine in patients with axial spondyloarthritis, another enthesitis-related disease, have been described and defined, there is a paucity of information regarding the MRI findings in DISH. The aim of this study was to describe the MRI findings of patients with DISH. We collected computed tomography studies with findings characteristic of DISH and that also had corresponding and concurrent MRI studies of the spine. For each patient, sagittal T1-weighted and STIR MRI sequences were evaluated for anterior/posterior vertebral corners of bone marrow edema (BME) and fat deposition. In total, we assessed 156 vertebral units in 10 patients that had both radiographic evidence of DISH and available MRI studies of the spine. Lesions consistent with BME corners were detected in five patients, and in three of them, three separate sites were involved, a finding that is suggestive of axial spondyloarthritis (SpA) according to the ASAS/OMERACT consensus statement. Fat deposition corners were detected in eight patients and in seven of them, several sites were involved. Spinal MRI lesions that are characteristic of axial SpA were commonly observed in a cohort of patients with DISH. This bears relevance to cases with diagnostic uncertainty and may imply overlapping pathogenetic mechanisms for new bone formation in both SpA and DISH. Further study is indicated to better characterize the similarities and differences between the MRI lesions of DISH and SpA.

  20. Predictive Factors of Clinical Response of Infliximab Therapy in Active Nonradiographic Axial Spondyloarthritis Patients

    Science.gov (United States)

    Lin, Zhiming; Liao, Zetao; Huang, Jianlin; Ai, Maixing; Pan, Yunfeng; Wu, Henglian; Lu, Jun; Cao, Shuangyan; Li, Li; Wei, Qiujing; Tang, Deshen; Wei, Yanlin; Li, Tianwang; Wu, Yuqiong; Xu, Manlong; Li, Qiuxia; Jin, Ou; Yu, Buyun; Gu, Jieruo

    2015-01-01

    Objectives. To evaluate the efficiency and the predictive factors of clinical response of infliximab in active nonradiographic axial spondyloarthritis patients. Methods. Active nonradiographic patients fulfilling ESSG criteria for SpA but not fulfilling modified New York criteria were included. All patients received infliximab treatment for 24 weeks. The primary endpoint was ASAS20 response at weeks 12 and 24. The abilities of baseline parameters and response at week 2 to predict ASAS20 response at weeks 12 and 24 were assessed using ROC curve and logistic regression analysis, respectively. Results. Of 70 axial SpA patients included, the proportions of patients achieving an ASAS20 response at weeks 2, 6, 12, and 24 were 85.7%, 88.6%, 87.1%, and 84.3%, respectively. Baseline MRI sacroiliitis score (AUC = 0.791; P = 0.005), CRP (AUC = 0.75; P = 0.017), and ASDAS (AUC = 0.778, P = 0.007) significantly predicted ASAS20 response at week 12. However, only ASDAS (AUC = 0.696, P = 0.040) significantly predicted ASAS20 response at week 24. Achievement of ASAS20 response after the first infliximab infusion was a significant predictor of subsequent ASAS20 response at weeks 12 and 24 (wald χ2 = 6.87, P = 0.009, and wald χ2 = 5.171, P = 0.023). Conclusions. Infliximab shows efficiency in active nonradiographic axial spondyloarthritis patients. ASDAS score and first-dose response could help predicting clinical efficacy of infliximab therapy in these patients. PMID:26273654

  1. Efficacy, safety and cost per responder of biologics in the treatment of non-radiographic axial spondyloarthritis.

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    Olivieri, Ignazio; Fanizza, Caterina; Gilio, Michele; Ravasio, Roberto

    2016-01-01

    Anti-tumour necrosis factor (TNF) agents are recommended as second-line therapy for patients with axial spondyloarthropathies. This analysis reviewed data on studies investigating the efficacy and tolerability of anti-TNF agents in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who had failed first-line non-steroidal anti-inflammatory (NSAID) treatment. Efficacy data from RCTs were used to calculate the number needed to treat (NNT) for individual anti-TNFs and then the cost per responder was determined to provide an indication of the value of each therapy. A systematic literature review and analysis of search results over the period January 2008 to September 2014 identified four randomised placebo-controlled trials that were included in the analysis. Adalimumab, etanercept and certolizumab pegol were all effective and well tolerated in patients with nr-axSpA. A patient was more likely to reach ASAS20 or ASAS40 when treated with etanercept or adalimumab, the NNT was lowest for adalimumab, and the risk of adverse events was higher with certolizumab pegol 200 mg every 2 weeks. The cost per responder (NNT) was lowest for adalimumab, followed closely by certolizumab 400 mg every 4 weeks, intermediate for certolizumab 200 mg every 2 weeks and highest for etanercept. Although all anti-TNF agents were associated with clinical improvement in patients with nr-axSpA, adalimumab presented a better cost per responder than etanercept and certolizumab pegol.

  2. Human brucellosis mimicking axial spondyloarthritis: a challenge for rheumatologists when applying the 2009 ASAS criteria.

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    Ye, Cong; Shen, Gui-Fen; Li, Shou-Xin; Dong, Ling-Li; Yu, Yi-Kai; Tu, Wei; Zhu, Ying-Zi; Hu, Shao-Xian

    2016-06-01

    Although the development of the 2009 SpA classification criteria by Assessment of SpondyloArthritis international Society (ASAS) represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis (axSpA), the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including SpA. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having axSpA in central China. The results showed that clinical manifestations of axSpA could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from axSpA according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.

  3. Role of Physical Evaluation in the Early Identification of Axial Spondyloarthritis: A Research Proposal

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    Castro, Marcelo P; Stebbings, Simon M; Milosavljevic, Stephan; Bussey, Melanie D

    2015-01-01

    The aim of this study was to present a rationale to explore the use of clinical tests for the sacroiliac joints to detect early axial spondyloarthritis (SpA) and to suggest a protocol to validate these clinical tests. Based on the European Guidelines for Diagnosis and Treatments of Pelvic Girdle Pain, we propose a set of six clinical tests to identify the likely presence of inflammation in the sacroiliac joints associated with early axial SpA. As magnetic resonance imaging (MRI) is the current gold standard used to identify inflammation in the sacroiliac joints, the results of the proposed set of clinical tests are compared with those from the MRI examinations. We hypothesize that specific clinical tests, which combine pain provocation and functional tests, for assessing the sacroiliac joints will help to identify early active inflammation at the sacroiliac joints in axial SpA. If such tests prove to be sensitive and specific, they could add further value to the diagnostic classification criteria for axial SpA. PMID:26448694

  4. THE EARLY DIAGNOSIS AND CLINICAL FEATURES OF AXIAL SPONDYLOARTHRITIS AT THE EUROPEAN CONGRESS OF RHEUMATOLOGY 2015

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    E. E. Gubar

    2016-01-01

    Full Text Available The European  League Against Rheumatism (EULAR  Congress (EULAR-15 was held in Rome on 10–13 June 2015. One of the most important  aspects of the Congress was the problem of spondyloarthritis  (SpA. Reports on the pathogenesis of SpA, including a relationship between the inflammatory processes and the mechanisms  of bone proliferation, occupied a prominent place in the program of the Congress. The fundamental  importance  of proinflammatory cytokines, such as interleukin 17 (IL17/IL23, for SpA was the subject of wide speculation. As in previous years, many reports were dedicated to the early diagnosis of SpA, the comparison of different SpA classification criteria, and the progression of non-radiographic axial SpA to ankylosing spondylitis. Much time was devoted to the results of the latest studies visualizing sacroiliitis and spondylitis.

  5. Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis.

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    Kilic, Gamze; Kilic, Erkan; Ozgocmen, Salih

    2014-12-01

    This article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables. Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥ 7) and 71 (22.5%) for anxiety (HADS-A score ≥ 10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety. Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the

  6. Classification criteria for psoriatic arthritis and ankylosing spondylitis/axial spondyloarthritis.

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    Rudwaleit, Martin; Taylor, William J

    2010-10-01

    The concept of spondyloarthritides (or spondyloarthropathies, SpAs) that comprises a group of interrelated disorders has been recognised since the early 1970s. While the European Spondyloarthropathy Study Group (ESSG) criteria and the Amor criteria have been developed to embrace the entire group of SpAs, new criteria for psoriatic arthritis have been developed recently. The Classification of Psoriatic Arthritis (CASPAR) study, a large one of more than 1000 patients, led to a new set of validated classification criteria for psoriatic arthritis. Since their publication in 2006 the CASPAR criteria are widely used in clinical studies. In ankylosing spondylitis, the 1984 modified New York criteria have been used widely in clinical studies and daily practice but are not applicable in early disease when the characteristic radiographical signs of sacroiliitis are not visible but active sacroiliitis is readily detectable by magnetic resonance imaging (MRI). This led to the concept of axial SpA that includes patients with and without radiographical damage; candidate criteria for axial SpA were developed based on proposals for a structured diagnostic approach. These criteria were validated in the Assessment of Spondyloarthritis International Society (ASAS) study on new classification criteria for axial SpA, a large international prospective study. In this new criteria, sacroiliitis showing up on MRI has been given as much weight as sacroiliitis on radiographs, thereby also identifying patients with early axial SpA. Both the CASPAR and the ASAS criteria for axial SpA are likely to be of use as diagnostic criteria.

  7. The oral microbiome of patients with axial spondyloarthritis compared to healthy individuals

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    Jordan E. Bisanz

    2016-06-01

    Full Text Available Background. A loss of mucosal tolerance to the resident microbiome has been postulated in the aetiopathogenesis of spondyloarthritis, thus the purpose of these studies was to investigate microbial communities that colonise the oral cavity of patients with axial spondyloarthritis (AxSpA and to compare these with microbial profiles of a matched healthy population. Methods. Thirty-nine participants, 17 patients with AxSpA and 22 age and gender-matched disease-free controls were recruited to the study. For patients with AxSpA, disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI. All participants underwent a detailed dental examination to assess oral health, including the presence of periodontal disease assessed using probing pocket depth (PPD. Plaque samples were obtained and their bacterial populations were profiled using Ion Torrent sequencing of the V6 region of the 16S rRNA gene. Results.Patients with AxSpA had active disease (BASDAI 4.1 ± 2.1 [mean ± SD], and a significantly greater prevalence of periodontitis (PPD ≥ 4 mm at ≥4 sites than controls. Bacterial communities did not differ between the two groups with multiple metrics of α and β diversity considered. Analysis of operational taxonomic units (OTUs and higher levels of taxonomic assignment did not provide strong evidence of any single taxa associated with AxSpA in the subgingival plaque. Discussion. Although 16S rRNA gene sequencing did not identify specific bacterial profiles associated with AxSpA, there remains the potential for the microbiota to exert functional and metabolic influences in the oral cavity which could be involved in the pathogenesis of AxSpA.

  8. Defining functioning categories in axial Spondyloarthritis: the role of the ASAS Health Index.

    Science.gov (United States)

    Di Carlo, Marco; Lato, Valentina; Di Matteo, Andrea; Carotti, Marina; Salaffi, Fausto

    2017-01-06

    The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is an inclusive questionnaire, able to describe the total impairments and restrictions due to axial spondyloarthritis (axSpA). Considering the relationship between ASAS HI and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, the aim of this study is to establish the ASAS HI cut-off values for functioning categories employing the ASDAS-CRP disease activity states in axSpA patients. ASAS HI and ASDAS-CPR were obtained from 140 consecutive axSpA patients, divided in the four ASDAS-CRP disease activity categories. High and very high disease activity were considered together. The ASAS HI cut-offs were obtained from the arithmetic mean, rounded off to the closest whole number, of the 75th percentile mean value of a lower rank and the 25th percentile mean value of the adjacent higher rank. This approach was applied in the transition from inactive disease and moderate disease activity, and in the transition from moderate disease activity and high/very high disease activity. Twenty-three patients were classified as having inactive disease, 36 were classified as having moderate disease activity, and 81 were in a high/very high disease activity state. Using the approach of the 75th-25th percentile mean values of adjacent disease activity states, the ASAS HI cut-offs resulted: ≤4 to dinstinguish a normal functioning, >4 and ≤8 to distinguish a moderate impairment of functioning, and >8 to distinguish a severe impairment of functioning. ASAS HI seems a reliable tool to define functioning categories in patients with axSpA.

  9. A UK Best Practice Model for Diagnosis and Treatment of Axial Spondyloarthritis

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    Rebecca Adshead

    2015-07-01

    Full Text Available Objectives: To examine the combined effectiveness of a care pathway for patients with suspected inflammatory back pain (IBP in conjunction with an educational campaign targeting primary and secondary care and the local community. Methods: Between June 2010 and June 2013, general practitioners referred patients fulfilling the Berlin IBP criteria into our Early Inflammatory Back Pain Service (EIBPS. Investigations were undertaken in line with our service model pathway and consultant rheumatologists made a diagnosis based on the Assessment of SpondyloArthritis international Society criteria. A concurrent educational awareness campaign addressing IBP and axial spondyloarthritis (AxSpA, aimed at primary and secondary care colleagues and the local community, was undertaken in order to assist early identification of IBP. Results: Of the 222 patients referred into the EIBPS, 57 (26% were newly diagnosed with AxSpA. A diagnosis of AxSpA was made in 48% of the patients with IBP or >1 SpA feature. The median time between onset of back pain and diagnosis was 3.1 years (mean: 5.7 years. Treatment with nonsteroidal anti-inflammatory drugs was initiated or continued as appropriate in 68/71 patients (96%; new and previously diagnosed AxSpA patients. All patients (100% meeting the National Institute for Health and Care Excellence criteria for tumour necrosis factor inhibitor therapy were offered treatment, with 14 patients (45% starting this treatment within 6 months of their initial EIBPS appointment. Conclusion: Our EIBPS provides a best practice model for assessment and management of patients with suspected IBP in the UK. The pathway facilitates prompt admission of appropriate patients into the service and assists early diagnosis and management of AxSpA patients.

  10. Does body mass index (BMI) influence the Ankylosing Spondylitis Disease Activity Score in axial spondyloarthritis?

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    Rubio Vargas, Roxana; van den Berg, Rosaline; van Lunteren, Miranda; Ez-Zaitouni, Zineb; Bakker, Pauline A C; Dagfinrud, Hanne; Ramonda, Roberta; Landewé, Robert; Molenaar, Esmeralda; van Gaalen, Floris A; van der Heijde, Désirée

    2016-01-01

    Objective Obesity is associated with elevated C reactive protein (CRP) levels. The Ankylosing Spondylitis Disease Activity Score (ASDAS) combines patient-reported outcomes (PROs) and CRP. We evaluated the effect of body mass index (BMI) on CRP and on ASDAS, and studied if ASDAS can be used in obese axial spondyloarthritis (axSpA) patients to assess disease activity. Methods Baseline data of patients with chronic back pain of short duration included in the SPondyloArthritis Caught Early (SPACE) cohort were used. Collected data included BMI and ASDAS. Patients were classified according to the ASAS axSpA classification criteria and BMI (overweight ≥25 and obese ≥30). Correlation and linear regression analyses were performed to assess the relation between BMI and ASDAS. Linear regression models were performed to assess if age or gender were effect modifiers in the relation between BMI and CRP, and between BMI and ASDAS. Results In total, 428 patients were analysed (n=168 axSpA; n=260 no-axSpA). The mean age was 31.1 years, 36.9% were male, 26.4% were overweight and 13.3% obese, median CRP was 3 mg/L and the mean ASDAS was 2.6. Gender was the only factor modifying the relationship between BMI and CRP as BMI had an influence on CRP only in females (β=0.35; p<0.001). Correlations between BMI and CRP or PROs were generally weak, and only significant for CRP in female patients. BMI was not related to ASDAS in axSpA patients. Conclusions ASDAS is not affected by BMI in axSpA patients. Therefore, based on our data it is not necessary to take BMI in consideration when assessing disease activity using ASDAS in axSpA patients. PMID:27403336

  11. Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis?

    OpenAIRE

    Masi, Alfonse T.

    2014-01-01

    Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hype...

  12. Golimumab in radiographic and nonradiographic axial spondyloarthritis: a review of clinical trials

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    Toussirot E

    2016-07-01

    Full Text Available Eric Toussirot,1–5 Charline Vauchy,1 Delphine Binda,1 Fabrice Michel6 1Clinical Investigation Center in Biotherapy, Intitut National de la Santé et de la Recherche Médicale CIC-1431, 2Fédération Hospitalo-Universitaire Integrated Center for Research in inflammatory Diseases, 3Department of Rheumatology, University Hospital of Besançon, Besançon, France; 4Department of Therapeutics, 5Equipe d’accueil EA 4266: “Pathogenic Agents and Inflammation”, University of Franche-Comté, 6Department of Neuromuscular Examinations and Diseases, University Hospital of Besançon, Besançon, FranceAbstract: Axial spondyloarthritis (Ax SpA refers to chronic inflammatory rheumatic diseases that mainly affect the axial skeleton, leading to erosions and new bone formation in the sacroiliac joints and/or the spine. Ax SpA includes the radiographic form of the disease, ie, ankylosing spondylitis (AS, and the nonradiographic Ax SpA (non-Rx Ax SpA forms. Anti-tumor necrosis factor alpha (TNFα agents are used in the treatment of Ax SpA in patients who do not respond to or are intolerant to nonsteroidal anti-inflammatory drugs. In these patients, anti-TNFα agents show promising results by targeting the inflammatory process and providing symptomatic relief. Golimumab is a fully human anti-TNFα agent that is currently approved for the treatment of both AS and non-Rx Ax SpA in Europe. This review focuses on the results of clinical trials with golimumab for the treatment of AS (GO-RAISE studies and non-Rx Ax SpA (GO-AHEAD study and on the effects of this agent on imaging findings (radiographic progression, magnetic resonance imaging inflammation as well as on biological parameters. Overall, golimumab is a valid therapeutic option in patients with AS and non-Rx Ax SpA in Europe.Keywords: anti-TNFα, golimumab, axial spondyloarthritis

  13. Golimumab in radiographic and nonradiographic axial spondyloarthritis: a review of clinical trials.

    Science.gov (United States)

    Toussirot, Eric; Vauchy, Charline; Binda, Delphine; Michel, Fabrice

    2016-01-01

    Axial spondyloarthritis (Ax SpA) refers to chronic inflammatory rheumatic diseases that mainly affect the axial skeleton, leading to erosions and new bone formation in the sacroiliac joints and/or the spine. Ax SpA includes the radiographic form of the disease, ie, ankylosing spondylitis (AS), and the nonradiographic Ax SpA (non-Rx Ax SpA) forms. Anti-tumor necrosis factor alpha (TNFα) agents are used in the treatment of Ax SpA in patients who do not respond to or are intolerant to nonsteroidal anti-inflammatory drugs. In these patients, anti-TNFα agents show promising results by targeting the inflammatory process and providing symptomatic relief. Golimumab is a fully human anti-TNFα agent that is currently approved for the treatment of both AS and non-Rx Ax SpA in Europe. This review focuses on the results of clinical trials with golimumab for the treatment of AS (GO-RAISE studies) and non-Rx Ax SpA (GO-AHEAD study) and on the effects of this agent on imaging findings (radiographic progression, magnetic resonance imaging inflammation) as well as on biological parameters. Overall, golimumab is a valid therapeutic option in patients with AS and non-Rx Ax SpA in Europe.

  14. Occasional presence of herpes viruses in synovial fluid and blood from patients with rheumatoid arthritis and axial spondyloarthritis.

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    Burgos, Rubén; Ordoñez, Graciela; Vázquez-Mellado, Janitzia; Pineda, Benjamín; Sotelo, Julio

    2015-10-01

    Viral agents have been suspected as participants of immune-mediated disorders. In the case of rheumatic diseases, the synovial joint cavity represents a secluded area of inflammation which could harbor etiological agents. We analyzed by polymerase chain reaction the possible presence of DNA from various herpes viruses in blood and synovial fluid from patients with either rheumatoid arthritis (n = 18), axial spondyloarthritis (n = 11), or osteoarthritis (n = 8). Relevant findings were as follows: DNA from varicella zoster virus was found in synovial fluid but not in blood mononuclear cells from 33 % of patients with rheumatoid arthritis and in 45 % of patients with axial spondyloarthritis but not in patients with osteoarthritis. Also, DNA from herpes simplex viruses 1 and 2 was found both in the blood and in the synovial fluid from 33 % of patients with rheumatoid arthritis. Our results indicate the occasional presence of DNA from herpes viruses in patients with rheumatoid arthritis or with axial spondyloarthritis. However, these findings might represent a parallel epiphenomenon of viral activation associated either with immunosuppressive therapy or with primary immune disturbances, rather than the etiological participation of herpes viruses in these disorders.

  15. Comparing the diagnostic utility of sacroiliac spectral CT and MRI in axial spondyloarthritis

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    Zhang, Ping; Yu, Kai Hu; Guo, Rui Min; Ran, Jun; Liu, Yao; Morelli, John; Runge, Val A

    2016-01-01

    Objective: To compare the clinical value of sacroiliac spectral CT and MRI in diagnosing axial spondyloarthritis (SpA). Methods: 137 patients with low back pain and suspected axial SpA were recruited. 76 patients were diagnosed with axial SpA, and 49 patients were diagnosed with non-specific low back pain (nLBP). Each patient underwent spectral CT and MRI examinations of the sacroiliac joints. Water- and calcium-based material decomposition images were reconstructed for quantitative analysis. The marrow-to-muscle ratios of water and calcium concentrations and short tau inversion recovery (STIR) signal intensity, as well as Hounsfield units in the ilium and sacrum were compared between nLBP and patients with axial SpA. Results: Spectral CT is comparable with MRI for the detection of bone marrow oedema, and it is superior to MRI for detection of osseous sclerosis and erosions. MRI is superior to spectral CT in detecting enthesitis and synovitis. There were statistically significant differences in STIR signal intensity, water concentration and calcium concentration ratios as well as CT values between nLBP and patients with axial SpA (p < 0.05) in the ilium. There was a statistically significant but weak correlation between ratios of water concentration and STIR signal intensity in both the ilium and sacrum (p < 0.05). Overall, the iliac water concentration was most sensitive for detection of patients with SpA. The positive likelihood ratio of the STIR signal intensity ratio was the highest. The diagnostic odds ratio of the calcium concentration ratio was the highest, and its negative likelihood ratio was the lowest. Conclusion: Spectral CT not only depicts findings of chronic sacroiliitis (i.e. bone erosion and sclerosis), but also can detect and quantify the extent of marrow oedema in patients with SpA with activity sacroiliitis. The sensitivity of MRI for diagnosis of early synovitis and enthesitis remains superior. The combination of spectral CT and MRI may

  16. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?

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    Baraliakos, X; Braun, J

    2015-01-01

    The development of the axial spondyloarthritis and ankylosing spondylitis (ASAS) classification criteria has had several implications for our understanding of the entire spectrum of spondyloarthritides (SpA). Going beyond the modified New York criteria, which concentrate on conventional radiographs of the sacroiliac joints (SIJ) for the classification of ankylosing spondylitis, the ASAS criteria add active inflammation of the SIJ as obtained by MRI and human leucocyte antigen (HLA) B27 to classify patients with chronic back pain starting at a young age as axial SpA (axSpA). AxSpA should be considered as one disease that includes AS, the radiographic form, as well as the non-radiographic (nr-axSpA) form. Similarities and differences between these subgroups have been described in 3 studies: 1 local study, 1 national study (German SpA Inception Cohort) and 1 international study mainly conducted to test the efficacy of a tumour necrosis factor α blocker. Most clinical features and assessments of axSpA showed the same prevalence in patients with and without radiographic changes. However, some differences have been observed: the male:female ratio, the proportion of patients with objective signs of inflammation such as bone marrow oedema as detected by MRI, and the proportion of patients with increased levels of C reactive protein were higher in patients with AS. Importantly, these factors have also been identified as prognostic factors for more severe disease in terms of new bone formation. Thus, nr-axSpA may represent an early stage of AS but may also just be an abortive form of a disease which does cause much pain but which may also never lead to structural changes of the axial skeleton. Since the cut-off between nr-axSpA and AS is artificial and unreliable, we think that the term nr-axSpA should not be used for diagnosis but only for classification for historical reasons. PMID:26557375

  17. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?

    Science.gov (United States)

    Baraliakos, X; Braun, J

    2015-01-01

    The development of the axial spondyloarthritis and ankylosing spondylitis (ASAS) classification criteria has had several implications for our understanding of the entire spectrum of spondyloarthritides (SpA). Going beyond the modified New York criteria, which concentrate on conventional radiographs of the sacroiliac joints (SIJ) for the classification of ankylosing spondylitis, the ASAS criteria add active inflammation of the SIJ as obtained by MRI and human leucocyte antigen (HLA) B27 to classify patients with chronic back pain starting at a young age as axial SpA (axSpA). AxSpA should be considered as one disease that includes AS, the radiographic form, as well as the non-radiographic (nr-axSpA) form. Similarities and differences between these subgroups have been described in 3 studies: 1 local study, 1 national study (German SpA Inception Cohort) and 1 international study mainly conducted to test the efficacy of a tumour necrosis factor α blocker. Most clinical features and assessments of axSpA showed the same prevalence in patients with and without radiographic changes. However, some differences have been observed: the male:female ratio, the proportion of patients with objective signs of inflammation such as bone marrow oedema as detected by MRI, and the proportion of patients with increased levels of C reactive protein were higher in patients with AS. Importantly, these factors have also been identified as prognostic factors for more severe disease in terms of new bone formation. Thus, nr-axSpA may represent an early stage of AS but may also just be an abortive form of a disease which does cause much pain but which may also never lead to structural changes of the axial skeleton. Since the cut-off between nr-axSpA and AS is artificial and unreliable, we think that the term nr-axSpA should not be used for diagnosis but only for classification for historical reasons.

  18. A Randomized, Double‐Blind, Placebo‐Controlled, Sixteen‐Week Study of Subcutaneous Golimumab in Patients With Active Nonradiographic Axial Spondyloarthritis

    Science.gov (United States)

    van der Heijde, D.; Dougados, M.; Maksymowych, W. P.; Scott, B. B.; Boice, J. A.; Berd, Y.; Bergman, G.; Curtis, S.; Tzontcheva, A.; Huyck, S.; Weng, H. H.

    2015-01-01

    Objective Axial spondyloarthritis (SpA) is a chronic inflammatory disease characterized by back pain and stiffness. The objective of this study was to determine whether golimumab is superior to placebo in patients with nonradiographic axial SpA. Methods This phase III, double‐blind, randomized, placebo‐controlled trial was performed to evaluate subcutaneous golimumab (50 mg) versus placebo in patients ages ≥18 years to ≤45 years who had active nonradiographic axial SpA according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for ≤5 years since diagnosis, high disease activity, and an inadequate response to or intolerance of nonsteroidal antiinflammatory drugs. Patients were randomized 1:1 to receive golimumab or placebo subcutaneously every 4 weeks. The primary end point was 20% improvement according to the ASAS criteria (ASAS20) at week 16. Key secondary end points were an ASAS40 response, ASAS partial remission, 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and change in the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) index for sacroiliac (SI) joint inflammation (SPARCC score). Results Of the 198 patients randomized, 197 were treated (97 received golimumab, and 100 received placebo). The mean age of the patients was 31 years, and 57.1% were male. At baseline, the mean ± SD BASDAI was 6.5 ± 1.5, the mean ± SD ASDAS was 3.5 ± 0.9, and the mean ± SD SPARCC score was 11.3 ± 14.0. The primary end point, an ASAS20 response, was achieved by significantly more patients in the golimumab group compared with the placebo group (71.1% versus 40.0%; P < 0.0001). An ASAS40 response was also achieved by significantly more patients in the golimumab group compared with the placebo group (56.7% versus 23.0%; P < 0.0001). The incidence of adverse events did not differ meaningfully between groups. Conclusion Patients with active

  19. Biomarkers for diagnosis, monitoring of progression, and treatment responses in ankylosing spondylitis and axial spondyloarthritis.

    Science.gov (United States)

    Reveille, John D

    2015-06-01

    With the growing awareness of the impact of chronic back pain and axial spondyloarthritis and recent breakthroughs in genetics and the development of novel treatments which may impact best on early disease, the need for markers that can facilitate early diagnosis and profiling those individuals at the highest risk for a bad outcome has never been greater. The genetic basis of ankylosing spondylitis has been considerably advanced, and HLA-B27 testing has a role in the diagnosis. Knowledge is still incomplete of the rest of the genetic contribution to disease susceptibility, and it is likely premature to use extensive genetic testing (other than HLA-B27) for diagnosis. Serum and plasma biomarkers have been examined extensively in assessing disease activity, treatment response, and as predictors or radiographic severity. For assessing disease activity, other than C-reactive protein and erythrocyte sedimentation rate, the most work has been in examining cytokines (particularly interleukin 17 and 23), matrix metalloproteinase (MMP) markers (particularly MMP3). For assessing those at the highest risk for radiographic progression, biomarkers of bony metabolism, cartilage and connective tissue degradation products, and adipokines have been most extensively assessed. The problem is that no individual biomarkers has been reproducibly shown to assess disease activity or predict outcome, and this area still remains an unmet need, of relevance to industry stakeholders, to regulatory bodies, to the healthcare system, to academic investigators, and finally to patients and providers.

  20. Enthesitis in patients with psoriatic arthritis, axial spondyloarthritis and healthy subjects assessed by ‘head-to-toe’ whole-body MRI and clinical examination

    DEFF Research Database (Denmark)

    Poggenborg, René Panduro; Eshed, Iris; Østergaard, Mikkel

    2015-01-01

    OBJECTIVES: To investigate the ability of whole-body MRI (WBMRI) to detect axial and peripheral enthesitis in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), and in healthy subjects (HS). Furthermore, to develop MRI enthesitis indices based on WBMRI and validate...

  1. Optimisation of rheumatology assessments - the actual situation in axial spondyloarthritis including ankylosing spondylitis.

    Science.gov (United States)

    Braun, J; Kiltz, U; Baraliakos, X; van der Heijde, D

    2014-01-01

    The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and magnetic resonance imaging (MRI), and laboratory results such as HLA B27 and CRP are important tools for classification and diagnosis of SpA. The Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of SpA since 1995, has published on assessments and outcome parameters in SpA. The publication of classification criteria for axSpA has now largely replaced the 1984 criteria for AS. However, the established cut-off between AS and nr-axSpA, 'definite' structural changes in the sacroiliac joints, has been recently debated because of limited reliability. Since imaging plays an important role in all criteria sets, the ASAS group has recently published definitions for inflammatory changes in the SIJ and the spine. The most important domains in AS are disease activity, function, spinal mobility, structural damage, and quality of life, some of which are discussed in this manuscript. For axSpA there are two major tools to assess disease activity, the BASDAI and the ASDAS, one for function, the BASFI, and several mobility measures including the BASMI. The AS Health Index (AS-HI) is introduced elsewhere in this supplement.

  2. Low-dose modified-release prednisone in axial spondyloarthritis: 3-month efficacy and tolerability

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    Bandinelli F

    2016-11-01

    Full Text Available Francesca Bandinelli,1 Francesco Scazzariello,1 Emanuela Pimenta da Fonseca,2 Mittermayer Barreto Santiago,2 Claudio Marcassa,3 Francesca Nacci,1 Marco Matucci Cerinic1 1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 2Service of Rheumatology, Hospital Santa Isabel, Escola de Medicina e Saúde Pública, Bahia, Brazil; 3Maugeri Clinical and Scientific Institutes, IRCCS, Veruno, Novara, Italy Background: Oral glucocorticoids (GCs have been shown to be effective in reducing the inflammatory symptoms of rheumatoid arthritis, but their use is not supported by evidence in spondyloarthritis (SpA. Modified-release (MR oral prednisone taken at bedtime has been shown to be more effective than immediate-release prednisone taken in the morning. The efficacy of low-dose MR prednisolone in patients with SpA is unknown. Patients and methods: This single-center cohort study retrospectively assessed the effectiveness and safety of 12-week low-dose MR prednisone (5 mg daily, bedtime administration in GC-naïve adult patients with symptomatic axial SpA. A 50% improvement of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI or a final BASDAI score of <4 according to disease activity at baseline was chosen as the primary outcome parameter after MR prednisone. Results: Fifty-seven patients were evaluated; of them, 41 had an active disease (BASDAI score of ≥4 at baseline. MR prednisone significantly reduced BASDAI (from 5.5±2.6 to 3.0±2.8, P<0.001 as well as inflammatory symptoms, pain, fatigue and morning stiffness. The overall response rate after MR prednisone was 52.6% (53.7% in patients with active SpA and 50.0% in patients with low-active disease; nonsignificant. At multivariable analysis, none of the considered clinical findings independently predicted the response to MR prednisone in subjects with active SpA. Overall, seven patients (11.8% had nonserious adverse drug reactions after MR prednisone

  3. Effectiveness of Adalimumab in Non-radiographic Axial Spondyloarthritis: Evaluation of Clinical and Magnetic Resonance Imaging Outcomes in a Monocentric Cohort.

    Science.gov (United States)

    Cantarini, Luca; Fabbroni, Marta; Talarico, Rosaria; Costa, Luisa; Caso, Francesco; Cuneo, Gian Luca; Frediani, Bruno; Faralli, Gabriele; Vitale, Antonio; Brizi, Maria Giuseppina; Sabadini, Luciano; Galeazzi, Mauro

    2015-07-01

    The primary aim of the study was to evaluate the long-term effectiveness of adalimumab (ADA) in a cohort of non-radiographic axial spondyloarthritis (nr-axSpA), and the secondary aims were to identify predictive factors of response and evaluate radiological progression.We evaluated 37 patients (male/female: 12/25; mean age 49 ± 14; mean disease duration: 6.3 ± 5.8) with active nr-axSpA (Assessment of SpondyloArthritis International Society criteria), despite the treatment with ≥1 nonsteroidal anti-inflammatory drug for at least 3 months, initiating the treatment with ADA 40 mg every other week. Patients were treated for 24 months, and evaluated at baseline, 6, 12, and 24 months. Outcome measures included Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index. Radiograph of the spine and sacroiliac joints and magnetic resonance of the sacroiliac joints were performed at baseline and according to the standard of assessment for the disease.The proportion of patients that achieved a BASDAI50 response at 6, 12 and 24 months was 51.3%, 70.3%, and 76.8%, respectively. Treatment was well tolerated with no unexpected adverse events and/or serious adverse events. All patients remained on treatment for 2 years, with a good compliance. We did not identify any predictive factor of response to therapy. Moreover, modified Stoke Ankylosing Spondylitis Spine Score and Spondyloarthritis Research Consortium of Canada scores showed a trend of improvement during the study period.ADA was effective on clinical and radiological outcomes at 2-year follow-up; thus, early treatment with ADA may prevent radiographic damage and be associated with low disease activity or remission. Moreover, data from this cohort study have confirmed safety and tolerability profile of ADA in nr-axSpA in the long term.

  4. An appraisal of golimumab in the treatment of severe, active nonradiographic axial spondyloarthritis.

    Science.gov (United States)

    Paccou, Julien; Flipo, René-Marc

    2016-01-01

    Golimumab (Simponi(®)) is a fully human tumor necrosis factor α inhibitor (TNFi) antibody administered subcutaneously. In the European Union, golimumab is indicated for the treatment of adults with severe, active axial spondyloarthritis (axSpA), which includes both ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA). In the US, it is indicated for the treatment of adults with active AS only. This article reviews the efficacy and tolerability of golimumab in nr-axSpA patients compared to other TNFi agents (adalimumab, infliximab, etanercept, and certolizumab pegol). In one ongoing, well-designed controlled study (GO-AHEAD), data at 16 weeks showed that treatment with golimumab (50 mg every 4 weeks) was effective in improving the clinical signs and symptoms of disease in nr-axSpA patients. In addition, 16 weeks of treatment with golimumab reduced inflammation in the sacroiliac joints and spine in patients with nr-axSpA. Moreover, objective evidence of active inflammation at baseline, such as a positive magnetic resonance imaging scan and/or an elevated CRP level, was a good predictor of treatment response to golimumab. Golimumab was generally well tolerated in this study, with a tolerability profile consistent with that seen in previous clinical trials for other indications. Although additional long-term data are needed, current evidence indicates that golimumab is an effective option for the treatment of nr-axSpA. However, in the absence of comparative head-to-head trials, there is no recommended hierarchy for the first prescription of a TNFi agent for the treatment of either nr-axSpA or AS.

  5. An appraisal of golimumab in the treatment of severe, active nonradiographic axial spondyloarthritis

    Science.gov (United States)

    Paccou, Julien; Flipo, René-Marc

    2016-01-01

    Golimumab (Simponi®) is a fully human tumor necrosis factor α inhibitor (TNFi) antibody administered subcutaneously. In the European Union, golimumab is indicated for the treatment of adults with severe, active axial spondyloarthritis (axSpA), which includes both ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA). In the US, it is indicated for the treatment of adults with active AS only. This article reviews the efficacy and tolerability of golimumab in nr-axSpA patients compared to other TNFi agents (adalimumab, infliximab, etanercept, and certolizumab pegol). In one ongoing, well-designed controlled study (GO-AHEAD), data at 16 weeks showed that treatment with golimumab (50 mg every 4 weeks) was effective in improving the clinical signs and symptoms of disease in nr-axSpA patients. In addition, 16 weeks of treatment with golimumab reduced inflammation in the sacroiliac joints and spine in patients with nr-axSpA. Moreover, objective evidence of active inflammation at baseline, such as a positive magnetic resonance imaging scan and/or an elevated CRP level, was a good predictor of treatment response to golimumab. Golimumab was generally well tolerated in this study, with a tolerability profile consistent with that seen in previous clinical trials for other indications. Although additional long-term data are needed, current evidence indicates that golimumab is an effective option for the treatment of nr-axSpA. However, in the absence of comparative head-to-head trials, there is no recommended hierarchy for the first prescription of a TNFi agent for the treatment of either nr-axSpA or AS. PMID:27468228

  6. COMPARATIVE EVALUATION OF PATIENTS WITH ANKYLOSING SPONDYLITIS AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

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    I. А. Cherentsova

    2016-01-01

    Full Text Available Objective: to study clinical presentations, disease activity, and functional impairments  in patients with ankylosing spondylitis (AS and non-radiographic axial spondyloarthritis  (nr-axSpA.Subjects and methods. A total of 153 patients were examined in the period 2010 to 2013. They were divided into two groups: 1 119 patients with a valid diagnosis of AS; 2 34 with nr-axSpA. BASDAI, BASFI, BASMI, MASES, erythrocyte sedimentation rate, and HLA-B27 antigen were determined  in both groups. The mean age of the patients was 36.5±0.7 years and 27.0±1.2 years and the disease duration 14.7±0.6 and 4.1±0.5 years in Groups 1 and 2, respectively.Results and discussion. Among the patients with AS and those with nr-axSpA, men accounted  for 68.9 and 70.6%, respectively. The axial type was predominant in both groups (53.7% in Group 1 and 67.6% in Group 2. The mean visual analogue scale (VAS pain score was 40.6±1.6 mm in Group 1 and 31.6±2.4 mm in Group 2 (p < 0.01. High BASDAI was seen in 51.2% of the patients with AS and 41.1% of those with nr-axSpA. Group 2 had significantly lower mean BASDAI values (3.4±0.2  than Group 1 (4.0±0.1.  Functional impairments  by BASFI were more obvious in the patients with AS ((3.2±0.2 than in those with nr-axSpA (1.5±0.2.  BASFI >4 was not noted in Group 2. Higher BASMI scores were found in the patients with AS (1.9±0.1  than in those with nr-axSpA (0.5±0.1. Conclusion. The ASAS criteria for axSpA enable one to establish its diagnosis in the early stage until stable functional impairments  emerge. In the pre-radiographic stage, the patients have lower disease activity and pain.

  7. Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis?

    DEFF Research Database (Denmark)

    Weber, Ulrich; Zubler, Veronika; Zhao, Zheng

    2015-01-01

    OBJECTIVE: To assess the incremental diagnostic value of spine MRI evaluated separately from and combined with sacroiliac joint (SIJ) MRI in non-radiographic axial spondyloarthritis (nr-axSpA) compared with SIJ MRI alone. METHODS: The study sample comprised two independent cohorts A/B of 130...

  8. CLINICAL PROFILE OF PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS (RUSSIAN COHORT OF PATIENTS

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    E. E. Gubar'

    2014-01-01

    Full Text Available Objective: to study clinical manifestations of axial spondyloarthritis (axSpA fulfilling ASAS criteria and to evaluate Russian version of modified New York criteria for the diagnosis of AS in Russian patients.Subjects and methods. Authors examined 73 patients aged 18–45 years suffering from inflammatory back pain for a period from 3 months to 5 years. BASDAI and ASDAS-CRP were used to assess activity, whereas BASFI – to evaluate functional status. Examination included: assessment of HLA-B27 rate, X-ray of pelvis and lumbar spine, ultrasonography of hip joints and calcaneal regions, magnetic-resonance imaging (MRI of sacroiliac joints, lumbar spine and hip joints (if clinical signs of injury are present, densitometry of lumbar spine (LII–IV and femoral neck.Results. Mean age of patients was 28.3±6.4 years, mean duration of disease – 19.9±14.4 months. HLA-B27 was found in 94.5% of patients. Mean BASDAI value was 4.1±1.9; ASDAS – 2.7±1.3; BASFI – 2.6±2.1. Peripheral arthritis was observed in 65.8% of cases, coxitis – in 31.5%, calcaneal enthesitis – in 61.6%, dactylitis – in 19.2%, low bone mineral density – in 17.8%. MRI showed inflammatory changes of axial skeleton in 84.9% of patients, active sacroiliitis (SI – in 72.6%. X-ray revealed definite SI in 49.3% of patients («classic» AS. According to MRI data, 30.1% of patients with active SI and without structural changes of sacroiliac joints had pre-radiological stage of AS (by Russian version of modified New York criteria. 74.0% of patients fulfilled both sets of ASAS criteria for axSpA, 5.5% – met only I criteria set, whereas 20.5% – only II criteria set. Three groups of patients were defined. The first included patients with radiologically proven SI, the second – with MRI-proven SI and the third – patients without SI. Significant difference between the groups was detected either by gender (number of males in groups I and II exceeded that in group

  9. Analysis of HLA-B15 and HLA-B27 in spondyloarthritis with peripheral and axial clinical patterns

    Science.gov (United States)

    Londono, John; Santos, Ana Maria; Peña, Paola; Calvo, Enrique; Espinosa, Luis R; Reveille, John D; Vargas-Alarcon, Gilberto; Jaramillo, Carlos A; Valle-Oñate, Rafael; Avila, Mabel; Romero, Consuelo; Medina, Juan F

    2015-01-01

    Objective Human leucocyte antigen (HLA) B27 and HLA-B15 are associated with spondyloarthritis (SpA). Recent Assessment of SpondyloArthritis international Society (ASAS) criteria emphasise a distinction between SpA with axial and peripheral patterns. We analysed whether HLA-A, HLA-B and HLA-DRB1 alleles could associate with these patterns. Methods We studied 100 healthy individuals and 178 patients with SpA according to European Spondyloarthropathy Study Group (ESSG) criteria. Patients were then classified according to ASAS criteria, the axial spondyloarthritis pattern (axSpA) being defined by ascertained sacroiliitis and the peripheral pattern (pSpA) by enthesitis and/or arthritis in extremities. A combined ax/p pattern was also considered. Results Only HLA-B27 and HLA-B15 alleles were associated with SpA. ASAS criteria for axSpA were met in 152 patients (12 with isolated axSpA and 140 with a combined ax/p patterns). When the ASAS peripheral criteria were applied, 161 patients met these criteria (13 with isolated pSpA and 148 with a combined ax/p pattern). HLA-B27 was found in 83% of patients with axSpA and 43% of ax/pSpA patients according to axASAS. HLA-B27 occurred in 7% controls but not in any patient with isolated pSpA. HLA-B15 was encountered in 31% of patients with isolated pSpA and 20% of ax/pSpA patients according to pASAS criteria. Moreover, 2 healthy controls, but none of our patients with isolated axSpA were positive for HLA-B15. Conclusions Our data suggest that the presence of HLA-B15 favours the development of isolated/combined peripheral rather than isolated axSpA, while HLA-B27 promotes an isolated/combined axial disease and excludes a peripheral pattern. HLA-B15 should be considered in addition to HLA-B27 when diagnosing patients with SpA according to ASAS criteria. PMID:26560062

  10. Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus.

    Science.gov (United States)

    Hammoudeh, Mohammed; Abdulaziz, Sultana; Alosaimi, Hanan; Al-Rayes, Hanan; Aldeen Sarakbi, Hussam; Baamer, Matouqa; Baraliakos, Xenofon; Dahou Makhloufi, Chafia; Janoudi, Nahid; Shirazy, Khalid; Sieper, Joachim; Sukhbir, Uppal

    2016-04-01

    Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region.

  11. Anti-TNF agents for the treatment of active non-radiographic axial spondyloarthritis

    Directory of Open Access Journals (Sweden)

    I. Olivieri

    2013-03-01

    Full Text Available The spondyloarthritis (SpA complex includes ankylosing spondylitis (AS, reactive arthritis, psoriatic arthritis, arthritis related to inflammatory bowel disease and forms that do not meet established criteria for these definite categories which are designated as undifferentiated SpA. In the early 1990s, two sets of classification criteria were suggested with the purpose to cover the whole clinical spectrum of SpA: the Amor criteria and the European Spondylarthropathy Study Group (ESSG criteria...

  12. Comparison of rates of referral and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign.

    Science.gov (United States)

    Harrison, Andrew A; Badenhorst, Christoffel; Kirby, Sandra; White, Douglas; Athens, Josie; Stebbings, Simon

    2014-07-01

    The objective of this research is to measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA). A television advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. A retrospective analysis was made of referrals received by the three rheumatology services 3 months before the campaign started and 3 months after the campaign ended. The age, gender, number of referrals for suspected AS and number of referrals resulting in a diagnosis of axial SpA were recorded. Independent analysis showed that the awareness campaign reached 82 % of the primary target audience. In the 3 months after the awareness campaign, there was a significant increase in referrals for suspected AS compared with the 3 months before the campaign (54 vs. 88, 63 %, p = 0.0056). Referrals for other conditions did not change. The number of referrals resulting in a diagnosis of axial SpA also increased (27 vs. 44, 63 %, p = 0.0576). The mean ages of the patients referred and of those diagnosed with axial SpA did not change. The male/female ratio was 1:1 among the referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and an increase in the diagnosis of axial SpA in clinics.

  13. Biological therapies for spondyloarthritis

    OpenAIRE

    Bruner, Vincenzo; Atteno, Mariangela; Spanò, Angelo; Scarpa, Raffaele; Peluso, Rosario

    2014-01-01

    Biological therapies and new imaging techniques have changed the therapeutic and diagnostic approach to spondyloarthritis. In patients with axial spondyloarthritis, tumor necrosis factor α (TNFα) inhibitor treatment is currently the only effective therapy in patients for whom conventional therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) has failed. TNFα inhibitor treatment is more effective in preventing articular damage in peripheral joints than in axial ones. It is important to tr...

  14. Prevalence of CT features of axial spondyloarthritis in patients with Crohn's disease.

    Science.gov (United States)

    De Kock, Isabelle; Hindryckx, Pieter; De Vos, Martine; Delrue, Louke; Verstraete, Koenraad; Jans, Lennart

    2017-05-01

    Background The sacroiliac joint and spine are seen on abdominal computed tomography (CT) and may show structural lesions as part of spondyloarthritis. Purpose To determine the prevalence of CT features of spondyloarthritis in patients with Crohn's disease (CD). Material and Methods A retrospective study of structural lesions of spondyloarthritis on abdominal CT was performed. The sacroiliac joints and spine of 120 patients were studied: study group I consisted of 40 patients with known CD and inflammatory back pain, group II involved 40 patients with CD without inflammatory back pain, and group III consisted of 40 patients without known joint or inflammatory bowel disease. Recorded CT features included sclerosis, erosions or ankylosis of the sacroiliac joint, enthesopathy, spinal syndesmophytes, and costovertebral joint lesions. Results CT showed structural lesions of the sacroiliac joints in 19/40 (48%) patients with CD and inflammatory back pain (sclerosis [n = 14; 35%], erosions [n = 14; 35%], ankylosis [n = 3; 8%]), in 8/40 (8%) patients with CD without inflammatory back pain (sclerosis [n = 3; 8%], erosions [n = 4; 10%], ankylosis [n = 3; 8%]), and in 3/40 (8%) patients without known joint or bowel disease (sclerosis [n = 2; 5%], ankylosis [n = 1; 3%]). Syndesmophytes were exclusively seen in group I (n = 6; 15%). Conclusion CT of the abdomen in patients with CD and inflammatory back pain shows structural lesions of the sacroiliac joint, entheses, or spine in almost half of the patients. Awareness and knowledge of these findings may guide the referring clinician to further clinical evaluation, imaging, and biomarker evaluation of the disease.

  15. Electronic assessment of disease activity and functioning in patients with axial spondyloarthritis: challenges and unmet needs.

    Science.gov (United States)

    Kiltz, Uta; Boonen, Annelies; Braun, Juergen; Richter, Jutta G

    2016-01-01

    The dynamic clinical course of rheumatic conditions indicates a need for regular collection of information on health status to monitor disease activity and functional status. Patient-reported outcomes measures (PROMs) are playing a key role in the evaluation of symptoms and functioning and health, and are crucial in the initiation of treatment in those patients. In recent years, electronic assessments of PROMs (so called ePROMs) have been introduced. This report summarises some of the rationale, opportunities, and results using ePROMs in patients with spondyloarthritis (SpA).

  16. PROBLEMS IN THE THERAPY OF AXIAL SPONDYLOARTHRITIS IN THE PROCEEDINGS OF THE EULAR CONGRESS 2015 (ROME, 10–13 JUNE 2015

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    O. A. Rumyantseva

    2016-01-01

    Full Text Available The Congress considered the issues pertinent  to the latest approaches to therapy for axial spondyloarthritis  (axSpA, as well as the problems associated with a search for axSpA-modifying anti-rheumatic drugs. Reports on the results of therapy with nonsteroidal  anti-inflammatory drugs and biological agents (tumor necrosis factor-α  and interleukin 17/23 inhibitors were of the most relevance.

  17. Does the reason for discontinuation of a first TNF inhibitor influence the effectiveness of a second TNF inhibitor in axial spondyloarthritis?

    DEFF Research Database (Denmark)

    Ciurea, Adrian; Exer, Pascale; Weber, Ulrich

    2016-01-01

    BACKGROUND: With regard to switching tumor necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA), conflicting results have been reported as to whether the effectiveness of a second TNFi depends on the reason for discontinuation of the first TNFi. METHODS: Patients with a clinical...... (p = 0.003). At least moderate disease activity as defined by an Ankylosing Spondylitis Disease Activity Score using the erythrocyte sedimentation rate (ASDAS-ESR)

  18. CLINICAL HETEROGENEITY OF EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF CLINICAL AND RADIOLOGICAL FINDINGS IN CRIMEA’S PATIENTS

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    A. V. Petrov

    2015-01-01

    Full Text Available Ankylosing spondylitis (AS is characterized  by considerable variation in the rate of development of structural changes in the vertebral column and joints. As of now, the clinical and laboratory predictors of progression of undifferentiated axial spondyloarthritis  (SpA to AS have not been adequately explored.         Objective: to study the clinical features of early axial SpA in view of radiographic changes in the sacroiliac and hip joints and spinal column.Subjects and methods. The rate of different clinical syndromes of axial SpA was analyzed in 162 patients. The study included less than 35-year-old  patients with a 2-to-5-year history of axial SpA that was first diagnosed according to the 2009 ASAS criteria, by excluding psoriatic and reactive arthritis and inflammatory  bowel diseaserelated arthritis.Results and discussion. The examinees were diagnosed with undifferentiated SpA (52.5%, advanced AS (43.2%, and late AS (in the presence of syndesmophytes (4.3%. 38.3% of patients had peripheral arthritis (PA, 8.6% – dactylitis, 28.4% – enthesitis , and 4.9% – uveitis. The patients with advanced AS had higher C-reactive  protein (CRP  levels (38.7 [22.3; 45.8] and lower rates of PA (27% than those with undifferentiated axial SpA (14.4 [4.2;18.6] mg/l and 48%, respectively; p < 0.05. The patients with late AS had more commonly enthesitis (71.4% and HLA-B27 (100% than those with undifferentiated axial SpA (31.4 and 78.8% and those with advanced AS (22.3 and 81.4%, respectively; p < 0.05. Radiographic  narrowing of the hip joint space was accompanied by increases in the rate of enthesitis up to 56.2% and HLA-B27 up to 93.7% (the remaining patients exhibited 24.6 and 79.5% increases, respectively (p < 0.05.Conclusion. High CRP levels, presence of enthesitis and HLA-B27 may be regarded as predictors for rapid progression of structural changes in patients with early axial SpA.DOI: http://dx.doi.org/10.14412/1995-4484-2015-139-142

  19. USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS FOR THE TREATMENT OF AXIAL SPONDYLOARTHRITIS, INCLUDING ANKYLOSING SPONDYLITIS, MONITORING THEIR EFFICACY AND SAFETY (DRAFT GUIDELINES OF THE EXPERT SPONDYLOARTHRITIS DIAGNOSIS AND TREATMENT GROUP

    Directory of Open Access Journals (Sweden)

    I. Z. Gaidukova

    2016-01-01

    Full Text Available The paper gives the draft guidelines elaborated  by the Expert Spondyloarthritis  Diagnosis and Treatment Group  by order of the Association of Rheumatologists  of Russia. The guidelines include the essentials of how to use nonsteroidal  anti-inflammatory drugs in axial spondyloarthrititides, including ankylosing spondylitis, contain  instructions  for how long they should be administered, and describe possible patient  management tactics in the most common  clinical situations and a preferential  algorithm for evaluating the efficiency and safety of treatment.

  20. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain

    Science.gov (United States)

    van Hoeven, Lonneke; Vergouwe, Yvonne; de Buck, P. D. M.; Luime, Jolanda J.; Hazes, Johanna M. W.; Weel, Angelique E. A. M.

    2015-01-01

    Objectives To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP) suspected for axial spondyloarthritis (axSpA). Design Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation. Participants Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years. Main Outcome The number of axSpA patients according to the ASAS criteria. Methods The referral rule (CaFaSpA referral rule) was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants. Results The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0). The percentage of identified axSpA patients was 16% (n=95). External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]). In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%. Conclusions The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA. PMID:26200904

  1. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Lonneke van Hoeven

    Full Text Available To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP suspected for axial spondyloarthritis (axSpA.Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation.Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years.The number of axSpA patients according to the ASAS criteria.The referral rule (CaFaSpA referral rule was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants.The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0. The percentage of identified axSpA patients was 16% (n=95. External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]. In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%.The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.

  2. No diagnostic utility of antibody patterns against Klebsiella pneumoniae capsular serotypes in patients with axial spondyloarthritis vs. patients with non-specific low back pain

    DEFF Research Database (Denmark)

    Hermansen, L T; Loft, A G; Christiansen, A A

    2017-01-01

    OBJECTIVES: To investigate whether antibody response patterns against Klebsiella pneumoniae capsular serotypes can discriminate patients with axial spondyloarthritis (axSpA) from patients with non-specific low back pain (LBP). METHOD: Immunoglobulin (Ig)G and IgA antibodies against K. pneumoniae...... ankylosing spondylitis (AS) served as the negative and positive control groups. RESULTS: There was no difference in IgG and IgA seropositivity against all serotypes between the axSpA, non-axSpA, and LBP groups. No significant correlations were found between anti-Klebsiella antibodies and age, gender, HLA-B27...

  3. The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis.

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    Terlemez, Rana; Akgün, Kenan; Palamar, Deniz; Boz, Sinan; Sarı, Hidayet

    2017-03-30

    The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.

  4. Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review.

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    Leverment, Shaaron; Clarke, Emily; Wadeley, Alison; Sengupta, Raj

    2017-02-01

    This review explores the prevalence and factors associated with disturbed sleep for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis in order to clarify consistent findings in this otherwise disparate research field. The association of physical, demographic and psychological factors correlating with poor sleep was explored, and the effectiveness of interventions assessed. Ten electronic databases were searched: AMED, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, OpenGrey and BASE. Following application of inclusion and exclusion criteria, 29 articles were critically assessed on the basis of methodology, experimental design, ethics and quality of sleep data, leading to the selection of 15 studies for final review. Poor sleep was reported in 35-90% of patients with axial spondyloarthritis and is more prevalent within this clinical population compared to healthy control subjects. Disturbed sleep is an important aspect of disease for patients and reflects the severity of disease activity, pain, fatigue and functional disability. However, the direction of this relationship is undetermined. Associations with age, gender, years spent in education, quality of life and depression have also been demonstrated. Anti-TNF medication is effective in reducing poor sleep, and exercise has also produced beneficial results. Future research into poor sleep should take account of its multifactorial nature. There is also a current lack of research investigating non-pharmacological interventions or combination therapies. A standardised, validated measurement of poor sleep, appropriate for regular patient screening, would be a useful first step for future research.

  5. Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients - baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice

    DEFF Research Database (Denmark)

    Wallman, Johan K; Kapetanovic, Meliha C; Petersson, Ingemar F

    2015-01-01

    BACKGROUND: The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence...

  6. Physical activity assessment in patients with axial spondyloarthritis compared to healthy controls: a technology-based approach.

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    Thijs Willem Swinnen

    Full Text Available INTRODUCTION: Traditionally, assessment in axial Spondyloarthritis (aSpA includes the evaluation of the capacity to execute tasks, conceptualized as physical function. The role of physical activity, defined as movement-related energy expenditure, is largely unknown and almost exclusively studied using patient-reported outcome measures. The aims of this observational cross-sectional study are to compare physical activity between patients with aSpA and healthy controls (HC and to evaluate the contribution of disease activity to physical activity differences between groups. METHODS: Forty patients with aSpA were matched by age, gender, period of data acquisition in terms of days and season to 40 HC. Physical activity was measured during five consecutive days (three weekdays and two weekend days using ambulatory monitoring (SenseWear Armband. Self-reported disease activity was measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI. Differences in physical activity between patients with aSpA and HC were examined with Wilcoxon signed-rank tests and a mixed linear model. Difference scores between patients and HC were correlated with disease activity. RESULTS: Average weekly physical activity level (Med(IQR; HC:1.54(1.41-1.73; aSpA:1.45(1.31-1.67,MET and energy expenditure (HC:36.40(33.43-41.01; aSpA:34.55(31.08-39.41,MET.hrs/day were significantly lower in patients with aSpA. Analyses across intensity levels revealed no significant differences between groups for inactivity and time spent at light or moderate physical activities. In contrast, weekly averages of vigorous (HC:4.02(1.20-12.60; aSpA:0.00(0.00-1.20,min/d, very vigorous physical activities (HC0.00(0.00-1.08; aSpA:0.00(0.00-0.00,mind/d and moderate/(veryvigorous combined (HC2.41(1.62-3.48; aSpA:1.63(1.20-2.82,hrs/d were significantly lower in patients with aSpA. Disease activity did not interact with differences in physical activity between patients with aSpA and HC

  7. Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study.

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    Silje Halvorsen Sveaas

    Full Text Available BACKGROUND: Physical therapy is recommended for the management of axial spondyloarthritis (axSpA and flexibility exercises have traditionally been the main focus. Cardiovascular (CV diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases. Therefore, the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. METHODS: In a single blinded randomized controlled pilot study the exercise group (EG performed 12 weeks of endurance and strength exercise while the control group (CG received treatment as usual. The primary outcome was the Ankylosing Spondylitis (AS Disease Activity Score (ASDAS. Secondary outcomes included patient reported disease activity (Bath AS Disease Activity Index [BASDAI], physical function (Bath AS Functional Index [BASFI], and CV risk factors measured by arterial stiffness (Augmentation Index [Alx] and Pulse Wave Velocity [PWV], cardiorespiratory fitness (VO2 peak and body composition. ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences, and Mann Whitney U-test was used for outcomes with skewed residuals. RESULTS: Twenty-eight patients were included and 24 (EG, n = 10, CG, n = 14 completed the study. A mean treatment effect of -0.7 (95%CI: -1.4, 0.1 was seen in ASDAS score. Treatment effects were also observed in secondary outcomes (mean group difference [95%CI]: BASDAI: -2.0 (-3.6, -0.4, BASFI: -1.4 (-2.6, -0.3, arterial stiffness (estimated median group differences [95% CI]: AIx (%: -5.3 (-11.0, -0.5, and for PVW (m/s: -0.3 (-0.7, 0.0, VO2 peak (ml/kg/min (mean group difference [95%CI]: 3.7 (2.1, 5.2 and trunk fat (%: -1.8 (-3.0, -0.6. No adverse events occurred. CONCLUSION: High intensity exercise improved disease activity and reduced CV risk factors in

  8. [Spondyloarthritis: new names for old acquaintances].

    Science.gov (United States)

    van der Horst-Bruinsma, Irene E

    2014-01-01

    After rheumatoid arthritis, ankylosing spondylitis (AS) is one of the most common rheumatic diseases. AS belongs to the spondyloarthritis group which is characterised by inflammation of the spine and has a strong genetic association with the HLA-B27 antigen. Recently, the Assessment of SpondyloArthritis International Society has introduced new international classification criteria for spondyloarthritis, i.e. axial and peripheral manifestations AS is one of the known axial spondyloarthritides but it is also a type of axial spondyloarthritis that does not show radiographic abnormalities, but has the same symptoms and risk factors that characterise axial spondylarthritis. This form is known as non-radiographic axial spondylarthritis. Peripheral spondyloarthritis is characterised by peripheral arthritis, enthesitis and dactylitis. Examples of peripheral spondyloarthritides are psoriatic arthritis and reactive arthritis, previously known as Reiter's syndrome.

  9. IgG subclass antibodies to human and bacterial HSP60 are not associated with disease activity and progression over time in axial spondyloarthritis

    DEFF Research Database (Denmark)

    Carlsen, Thomas Gelsing; Hjelholt, Astrid Johannesson; Jurik, Anne Grethe

    2013-01-01

    INTRODUCTION: Spondyloarthritis (SpA), an interrelated group of rheumatic diseases, has been suggested to be triggered by bacterial infections prior to the development of an autoimmune response that causes inflammation of the spinal and peripheral joints. Because human heat shock protein 60 (HSP60......), recently renamed HSPD1, and bacterial HSP60 are highly homologous, immunological cross-reactivity has been proposed as a mechanism of disease initiation. However, previous investigations of the humoral immune response to HSP60 in SpA patients have lacked determination of immunoglobulin G (IgG) subclasses...... of three reactive arthritis-related bacteria; human HSP60; and the microorganisms Chlamydia trachomatis and C. pneumoniae were determined by ELISA. Serum samples collected from 2004 to 2006 and in 2010 and 2011 from 39 axial SpA patients were analyzed and compared with samples from 39 healthy controls...

  10. Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study.

    Science.gov (United States)

    Kilic, Erkan; Kilic, Gamze; Akgul, Ozgur; Ozgocmen, Salih

    2015-06-01

    The aim of this study was to assess discriminant validity of Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) and to compare with The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) as clinical tools for the measurement of disease activity in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Also, the cut-off values for ASDAS-CRP in nr-axSpA and AS is revisited. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and were assessed for disease activity, quality of life and functional measures. The discriminatory ability of ASDAS-CRP and ASDAS-ESR was assessed using standardized mean differences and receiver operating characteristic (ROC) curves analysis. Optimal cut-off values for disease activity scores were calculated. Two hundred and eighty-seven patients with axSpA (nr-axSpA:132, AS:155) were included in this study. Two ASDAS versions and BASDAI had good correlations with patient's and physician's global assessment in both groups. Discriminatory ability of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in patients with nr-axSpA and AS when the patients were assigned into low and high disease activity according to the ASAS partial remission, patient's and physician's global assessment scores (based on the comparison of ROC curves). ASDAS cut-off values are quite similar between groups indicating that ASDAS-CRP works similarly well in nr-axSpA and AS. The performance of ASDAS to discriminate low and high disease activity and cut-off values are quite similar in patients with AS and non-radiographic axial SpA.

  11. Disease-modifying Antirheumatic Drugs (DMARD) and Combination Therapy of Conventional DMARD in Patients with Spondyloarthritis and Psoriatic Arthritis with Axial Involvement.

    Science.gov (United States)

    Simone, Davide; Nowik, Marcin; Gremese, Elisa; Ferraccioli, Gianfranco F

    2015-11-01

    Treatment with nonsteroidal antiinflammatory drugs (NSAID) is the recommended first-line therapy in patients with axial spondyloarthritis (axSpA); and for those patients who have persistently active disease, the introduction of tumor necrosis factor-α (TNF-α) inhibitors is indicated. Conventional nonbiological disease-modifying antirheumatic drugs (DMARD), although effective and used in clinical practice for peripheral arthritis, are not recommended. Few studies have been conducted with the aim of evaluating the effect of conventional DMARD, either alone or in combination, in axSpA. As for psoriatic arthritis (PsA), DMARD are widely used, but few trials are available about their effects on axial involvement, which is not often assessed as a primary outcome in clinical trials. In rheumatoid arthritis, combination therapy of 2 or more conventional DMARD appears to confer better response than methotrexate monotherapy, and may even be a viable alternative to TNF-α inhibitors. In peripheral PsA, combination therapy can be used after treatment failure with 1 DMARD, but few studies have been conducted. However, available evidence for the combination of conventional DMARD indicates a lack of any significant benefit on axial symptoms; thus this treatment approach does not represent an effective alternative to anti-TNF-α therapy.

  12. Brucellosis in spondyloarthritis mimicking an exacerbation.

    Science.gov (United States)

    Garip, Y; Eser, F; Erten, S; Yilmaz, O; Yildirim, P

    2014-01-01

    Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

  13. Fat Metaplasia on Sacroiliac Joint Magnetic Resonance Imaging at Baseline Is Associated with Spinal Radiographic Progression in Patients with Axial Spondyloarthritis

    Science.gov (United States)

    Kang, Kwi Young; Kim, In Je; Yoon, Min A; Hong, Yeon Sik; Park, Sung-Hwan; Ju, Ji Hyeon

    2015-01-01

    Objective To study the relationship between inflammatory and structural lesions in the sacroiliac joints (SIJs) on MRI and spinal progression observed on conventional radiographs in patients with axial spondyloarthritis (axSpA). Methods One hundred and ten patients who fulfilled the ASAS axSpA criteria were enrolled. All underwent SIJ MRI at baseline and lumbar spine radiographs at baseline and after 2 years. Inflammatory and structural lesions on SIJ MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Spinal radiographs were scored using the Stoke AS Spinal Score (SASSS). Multivariate logistic regression analysis was performed to identify predictors of spinal progression. Results Among the 110 patients, 25 (23%) showed significant radiographic progression (change of SASSS≥2) over 2 years. There was no change in the SASSS over 2 years according to the type of inflammatory lesion. Patients with fat metaplasia or ankyloses on baseline MRI showed a significantly higher SASSS at 2 years than those without (p<0.001). According to univariate logistic regression analysis, age at diagnosis, HLA-B27 positivity, the presence of fat metaplasia, erosion, and ankyloses on SIJ MRI, increased baseline CRP levels, and the presence of syndesmophytes at baseline were associated with spinal progression over 2 years. Multivariate analysis identified syndesmophytes and severe fat metaplasia on baseline SIJ MRI as predictive of spinal radiographic progression (OR, 14.74 and 5.66, respectively). Conclusion Inflammatory lesions in the SIJs on baseline MRI were not associated with spinal radiographic progression. However, fat metaplasia at baseline was significantly associated with spinal progression after 2 years. PMID:26271099

  14. Fat Metaplasia on Sacroiliac Joint Magnetic Resonance Imaging at Baseline Is Associated with Spinal Radiographic Progression in Patients with Axial Spondyloarthritis.

    Directory of Open Access Journals (Sweden)

    Kwi Young Kang

    Full Text Available To study the relationship between inflammatory and structural lesions in the sacroiliac joints (SIJs on MRI and spinal progression observed on conventional radiographs in patients with axial spondyloarthritis (axSpA.One hundred and ten patients who fulfilled the ASAS axSpA criteria were enrolled. All underwent SIJ MRI at baseline and lumbar spine radiographs at baseline and after 2 years. Inflammatory and structural lesions on SIJ MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC method. Spinal radiographs were scored using the Stoke AS Spinal Score (SASSS. Multivariate logistic regression analysis was performed to identify predictors of spinal progression.Among the 110 patients, 25 (23% showed significant radiographic progression (change of SASSS≥2 over 2 years. There was no change in the SASSS over 2 years according to the type of inflammatory lesion. Patients with fat metaplasia or ankyloses on baseline MRI showed a significantly higher SASSS at 2 years than those without (p<0.001. According to univariate logistic regression analysis, age at diagnosis, HLA-B27 positivity, the presence of fat metaplasia, erosion, and ankyloses on SIJ MRI, increased baseline CRP levels, and the presence of syndesmophytes at baseline were associated with spinal progression over 2 years. Multivariate analysis identified syndesmophytes and severe fat metaplasia on baseline SIJ MRI as predictive of spinal radiographic progression (OR, 14.74 and 5.66, respectively.Inflammatory lesions in the SIJs on baseline MRI were not associated with spinal radiographic progression. However, fat metaplasia at baseline was significantly associated with spinal progression after 2 years.

  15. Assessment of MRI abnormalities of the sacroiliac joints and their ability to predict axial spondyloarthritis: a retrospective pilot study on 110 patients

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    Larbi, Ahmed; Viala, Pierre; Baron, Marie Pierre; Taourel, Patrice; Cyteval, Catherine [Hopital Lapeyronie, Medical Imaging Department, Montpellier Cedex 5 (France); Molinari, Nicolas [Hopital Lapeyronie, Medical Data Processing Department, Montpellier Cedex 5 (France); Lukas, Cedric [Hopital Lapeyronie, Rheumatology Department, Montpellier Cedex 5 (France)

    2014-03-15

    To assess sacroiliac joint (SIJ) modifications on MRI and their ability to predict axial spondyloarthritis (SpA) with the purpose of identifying parameters for future prospective studies. Retrospective study was carried out of 110 consecutive patients referred for SIJ MRI with coronal, axial short TI inversion recovery (STIR), and axial T1 sequences over 6 months. Factors associated with SpA, including MRI SIJ modifications (fat deposition, structural abnormalities on T1-weighted images, and bone marrow edema [BME] on STIR sequences) and age were explored using multivariate logistic regression. The reference diagnosis was made 1-1.5 years later based on clinical, radiological, and biological findings, according to Assessment of SpondyloArthritis International Society (ASAS) criteria. Twenty-eight patients were diagnosed with SpA (female/male: 19/9, age 41 ± 13 years). Abnormal findings were found in up to 21 % of patients without SpA (including 11 % with BME), versus 64 % of SpA patients (50 % with BME). A threshold age of 42.6 years was found to discriminate SpA patients (ROC AUC: 0.71, 95 % CI: 0.59-0.81). BME location in the sacral (OR: 7.07 [1.05, 47.6], p = 0.044) and both sacral and iliac areas (OR: 36.0 [5.61, 231], p = 0.0002), as well as age (OR: 0.95 [0.92, 0.98], p = 0.0019) were found to be independent predictors of SpA. 83.6 % of patients were effectively diagnosed using BME location and patient age in a classification and regression tree (CART) algorithm (sensitivity: 61 %, specificity: 91 %, PPV: 71 %, NPV: 87 %). The BME location combined with the patient's age (threshold 42.6 years) could help predict SpA. Further studies are required before these features can be used by radiologists to boost their confidence in reporting SIJ MRI. (orig.)

  16. Juvenile Spondyloarthritis

    Science.gov (United States)

    Gmuca, Sabrina; Weiss, Pamela F.

    2015-01-01

    Purpose of review To provide a comprehensive update of the pathogenesis, diagnostic imaging, treatments, and disease activity measurements of juvenile spondyloarthritis (JSpA). Recent findings Genetic and microbiome studies have provided new information regarding possible pathogenesis of JSpA. Recent work suggests that children with JSpA have decreased thresholds for pain in comparison to healthy children. Additionally, pain on physical examination and abnormalities on ultrasound of the entheses are not well correlated. Treatment guidelines for juvenile arthritis, including JSpA, were published by the American College of Rheumatology and are based on active joint count and presence of sacroiliitis. Recent studies have established the efficacy of tumor necrosis factor inhibitors in the symptomatic treatment of axial disease, though their efficacy for halting progression of structural damage is less clear. Newly developed disease activity measures for JSpA include the Juvenile Arthritis Disease Activity Score and the JSpA Disease Activity index. In comparison to other categories of juvenile arthritis, children with JSpA are less likely to attain and sustain inactive disease. Summary Further microbiome and genetic research may help elucidate JSpA pathogenesis. More randomized therapeutic trials are needed and the advent of new composite disease activity measurement tools will hopefully allow for the design of these greatly needed trials. PMID:26002028

  17. Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set

    DEFF Research Database (Denmark)

    Kiltz, U; van der Heijde, D; Boonen, A

    2016-01-01

    INTRODUCTION: The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English...

  18. [The specificity and limitations of sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis in patients with chronic low back pain].

    Science.gov (United States)

    Wang, Y Y; Zhao, Z; Luo, G; Li, Y; Zhang, J L; Huang, F

    2016-11-01

    Objective: To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain. Methods: We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology, the PLA General Hospital from January 2013 to December 2015, including clinical manifestations, laboratory examinations and MRI data of sacroiliac joints. Results: There were 238 men and 152 women recruited. A total of 326 cases were diagnosed as axial SpA, including 216 men and 110 women with mean age (27.10±8.64) years and mean duration (7.64±3.50) months. Among these 326 patients, 243 (74.5%) were HLA-B27 positive. The other 64 patients were considered as diagnoses rather than SpA (non-SpA), consisting of 22 men and 42 women with mean age (31.29±7.76) years and mean duration (5.75±2.90)months. Non-SpA group had 10 (15.6%) patients with HLA-B27 positive. There were 68.1% and 65.0% SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively. Although there were 25.0% non-SpA patients with bone marrow edema and 7.8% with bone erosion in MRI of sacroiliac joint, the scores of bone marrow edema 0.00(0.00, 0.75) and bone erosion [0.00(0.00, 0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00(0.00, 4.00), bone erosion scores 1.00(0.00, 3.00); PSacroiliac joint MRI is a valuable method to diagnose axial SpA in patients with chronic low back pain. Yet it still has some limitations. Clinical presentations and spinal MRI would be helpful in some patients.

  19. [Evidence-based recommendations on diagnostics and therapy of axial spondyloarthritis : S3 guidelines of the German Society of Rheumatology (DGRh) in cooperation with the Association of the Scientific Medical Societies in Germany (AWMF)].

    Science.gov (United States)

    Kiltz, U; Rudwaleit, M; Sieper, J; Braun, J

    2017-03-01

    The clinical course of axial spondyloarthritis (SpA) is variable and characterized by chronic back pain and extraspinal manifestations, such as asymmetrical arthritis, dactylitis and enthesitis. Extra-articular manifestations in the eyes (anterior uveitis), skin (psoriasis) and intestines (chronic inflammatory bowel disease) are also frequent manifestations in patients with SpA. Due to the heterogeneity of disease manifestations and the partial concentration on structural alterations in the sacroiliac joints visible in X‑ray images, the diagnosis is often delayed for many years. An important step in the direction of improved early recognition of axial SpA was establishment of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009, which focused on the initally deep-seated back pain and chronicity in relatively young patients as well as the importance of magnetic resonance imaging and HLA B 27 determination in the early stages of the disease. In order to achieve the foundations for an effective and timely therapy of affected patients, in 2014 on the initiative of the German Society of Rheumatology, S3 guidelines on axial SpA including Bechterew's disease and early forms were formulated in cooperation with other specialist societies. This article gives an overview of the contents of the S3 guidelines on axial SpA.

  20. Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis: associations with disease activity, smoking and HLA-B27.

    Science.gov (United States)

    Munk, Heidi Lausten; Gudmann, Natasja Staehr; Christensen, Anne Friesgaard; Ejstrup, Leif; Sorensen, Grith Lykke; Loft, Anne Gitte; Bay-Jensen, Anne C; Siebuhr, Anne Sofie; Junker, Peter

    2016-04-01

    The aim of the study was to assess the possible association between type II collagen turnover seromarkers and disease profile in patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Outpatients with axial SpA (n = 110) or PsA (n = 101) underwent clinical examination including disease activity measures and HLA-B27 typing. The procollagen IIA N-terminal peptide (PIIANP) and a matrix metalloproteinase-generated type II collagen fragment (C2M) were quantified in serum by ELISA. C2M was higher in SpA than in controls, 0.41 versus 0.36 ng/ml (p = 0.004), while PIIANP did not differ between patients and healthy subjects, 2252 versus 2142 ng/ml (p = 0.13). However, DMARD-naïve SpA patients had higher PIIANP, 2461 ng/ml (p = 0.01) and C2M, 0.44 ng/ml (p = 0.0007) levels than controls, and PIIANP correlated with CRP (ρ = 0.34). C2M was lower in SpA smokers, 0.36 ng/ml versus non-smokers, 0.43 ng/ml (p = 0.02), while PIIANP was higher in HLA-B27 positive, 2312 ng/ml versus negative patients, 2021 ng/ml (p = 0.03). In PsA, PIIANP and C2M did not differ between patients and controls, but PIIANP was elevated in patients not receiving DMARDs, 2726 ng/ml. In PsA, PIIANP and C2M did not differ according to smoking and HLA-B27. Cartilage degradation assessed by C2M is increased in SpA irrespective of treatment but not in PsA. Cartilage synthesis reflected by PIIANP is increased in untreated SpA and PsA. PIIANP correlates with CRP in SpA while not in PsA. In DMARD-naïve SpA but not in PsA, HLA-B27 positivity and smoking are associated with a chondro-proliferative metabolic pattern.

  1. Optimizing the MRI protocol of the sacroiliac joints in Spondyloarthritis: which para-axial sequence should be used?

    Energy Technology Data Exchange (ETDEWEB)

    Giraudo, Chiara; Weber, Michael; Platzgummer, Hannes; Kainberger, Franz; Schueller-Weidekamm, Claudia [Medical University of Vienna, Vienna General Hospital, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Vienna (Austria); Magnaldi, Silvia [Fondazione Poliambulanza Istituto Ospedaliero, Dipartimento di Radiologia e Diagnostica per Immagini, Brescia (Italy); Puchner, Antonia [Medical University of Vienna, Vienna General Hospital, Division of Rheumatology, Department of Internal Medicine III, Vienna (Austria)

    2016-01-15

    To assess the diagnostic value of para-axial T2w-TSE (paT2) and fat-suppressed proton density (paPD-FS) MRI sequences for the evaluation of the sacroiliac joint (SIJ) of patients with axial Spondylarthritis (SpA). One hundred and six patients with clinical findings suggestive of SpA underwent an MR protocol of the SIJ with additional paPD-FS (41 patients) and paT2 (105 patients). Acute (bone marrow oedema [BME], enthesitis, capsulitis, synovitis) and chronic findings (erosions, ankylosis) were assessed by paPD-FS and compared with the gold standard post-contrast sequences, whereas chronic features (because of the lack of fat suppression) were evaluated on paT2 and compared with pcT1. paPD-FS demonstrated high sensitivity (98.9 %) and specificity (99.1 %) for BME; sensitivity and specificity for synovitis and enthesitis were 100 %; 85.7 % and 100 %, respectively, for capsulitis. paPD-FS and paT2 showed 100 % sensitivity and specificity for ankylosis; for erosions, paT2 demonstrated 85.3 % sensitivity and 100 % specificity, whereas paPD-FS, respectively, 98 % and 100 %. PaT2 and paPD-FS provided precious information enabling an accurate interpretation of the heterogeneous findings of SpA. paPD-FS showed good results in detecting acute and chronic lesions and its inclusion in a routine MR examination of the SIJ could increase the diagnostic performance of a pre-contrast protocol. (orig.)

  2. Association of obesity with patient-reported outcomes in patients with axial spondyloarthritis: a cross-sectional study in an urban Asian population.

    Science.gov (United States)

    Lee, Yi Xuan; Kwan, Yu Heng; Png, Wan Yu; Lim, Ka Keat; Tan, Chuen Seng; Lui, Nai Lee; Chew, Eng Hui; Thumboo, Julian; Østbye, Truls; Fong, Warren

    2017-04-04

    To determine if obesity is associated with poorer patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA), we conducted a cross-sectional study using data of the PRESPOND registry from a tertiary referral center in Singapore between 2011 and 2015. Demographics, clinical, and PRO variables were collected. Patients were divided into three categories: normal (BMI < 23 kg/m(2)), overweight (23 kg/m(2) ≤ BMI < 27.5 kg/m(2)) and obese (BMI ≥ 27.5 kg/m(2)), using Asian BMI classification. The dependent variables are Pain score, Bath Ankylosing Spondylitis Patient Global Score (BAS-G), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Health Assessment Questionnaire (HAQ), and Medical Outcomes Study Short Form 36 version 2 (SF-36). Multivariate regression analyses were performed with these dependent variables and obesity categories, adjusting for confounders. Among 194 patients with axSpA, 32% are overweight while 22% are obese. We found that obese patients had significant poorer pain (β: 11.87, 95%CI 2.13, 21.60) and BAS-G scores (β: 10.18, 95%CI 1.59, 18.76) when compared to normal BMI patients. However, obesity was not associated with BASDAI (β 0.50, 95%CI -0.22, 1.22), BASFI (β 0.08, 95%CI -0.66, 0.81), HAQ (β -0.07, 95%CI -0.21, 0.06), physical component summary (β -0.02, 95%CI -4.47, 4.44), and mental component summary (β -2.85, 95%CI -7.57, 1.88) of SF-36. Obesity was associated with pain score and BAS-G but not with BASDAI, BASFI, HAQ, and SF-36. Further study is needed to examine the causal relationship between obesity and poorer PROs.

  3. In axial spondyloarthritis, never smokers, ex-smokers and current smokers show a gradient of increasing disease severity - results from the Scotland Registry for Ankylosing Spondylitis (SIRAS).

    Science.gov (United States)

    Jones, Gareth T; Ratz, Tiara; Dean, Linda E; Macfarlane, Gary J; Atzeni, Fabiola

    2016-11-29

    Objectives To examine the relationship between smoking, smoking cessation, and disease characteristics/quality of life (QoL) in spondyloarthritis. Methods The Scotland Registry for Ankylosing Spondylitis collects data from clinically diagnosed patients with spondyloarthritis. Clinical data, including Bath Ankylosing Spondylitis indices of disease activity (BASDAI) and function (BASFI), was obtained from medical records. Postal questionnaires provided information on smoking status and QoL (Ankylosing Spondylitis QoL questionnaire; ASQoL). Linear and logistic regression quantified the effect of smoking, and smoking cessation, on various disease-specific and QoL outcomes, adjusting for age, sex, deprivation, education and alcohol status. Results are presented as regression coefficients (β) or odds ratios (OR) with 95% confidence intervals. Results 946 participants provided data (male 73.5%, mean age 52yrs). Current smoking was reported by 22%, and 38% were ex-smokers. Ever smokers experienced poorer BASDAI (β = 0.5; 0.2 to 0.9) and BASFI (β = 0.8; 0.4 to 1.2), and reported worse QoL (ASQoL, β = 1.5; 0.7 to 2.3). Compared to current smokers, ex-smokers reported lower disease activity (BASDAI, β = -0.5; -1.0 to -0.04) and significantly better QoL (ASQoL, β = -1.2; -2.3 to -0.2). They also were more likely to have a uveitis history (OR = 2.4; 1.5 to 3.8). Conclusions Smokers with spondyloarthritis experience worse disease than never smokers. However, we provide new evidence that, among smokers, smoking cessation is associated with lower disease activity and better physical function and QoL. Clinicians should specifically promote smoking cessation as an adjunct to usual therapy in patients with spondyloarthritis. This article is protected by copyright. All rights reserved.

  4. The diagnostic utility of MRI in spondyloarthritis

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Weber, Ulrich; Østergaard, Mikkel

    2012-01-01

    The recently developed Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial and peripheral spondyloarthritis (SpA) are the first criteria ever to include findings on magnetic resonance imaging (MRI) of the sacroiliac joints. Features indicating sacroiliac...... joint inflammation on MRI are weighted equally to structural changes on conventional radiography, and thus MRI has become an important tool for use in daily practice to evaluate patients with clinically suspected early spondyloarthritis. However, MRI can also detect structural changes such as erosions...... and fat infiltrations, and recent studies suggest that assessment of both inflammatory and structural changes of the sacroiliac joints may improve the diagnostic utility of MRI. The present article reviews the evidence for the use of sacroiliac joint and spinal MRI to assess patients with axial...

  5. Routine Assessment of Patient Index Data 3 score (RAPID3) correlates well with Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in the assessment of disease activity and monitoring progression of axial spondyloarthritis.

    Science.gov (United States)

    Danve, Abhijeet; Reddy, Anusha; Vakil-Gilani, Kiana; Garg, Neha; Dinno, Alexis; Deodhar, Atul

    2015-01-01

    Routine Assessment of Patient Index Data 3 (RAPID3) is a composite index, very useful for assessment of disease activity of various rheumatic diseases including RA. If RAPID3 can also reliably measure disease activity in axial spondyloarthritis (axSpA), it may prove to be a practical and effective quantitative assessment tool in busy practices. We studied the association of RAPID3 with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Patients with Ankylosing Spondylitis (AS) seen from 2007 to 2012 were classified as having AS or non-radiographic axial spondyloarthritis (nr-axSpA) using modified New York criteria and Assessment of SpondyloArthritis International Society criteria, respectively. Patients with simultaneous BASDAI and RAPID3 scores were enrolled (N = 112; 105 with AS, seven with nr-axSpA). Multiple regression and nonparametric receiver operating characteristics were used. Baseline mean (SD) BASDAI and RAPID3 were 4.2 (2.5) and 3.8 (2.3), respectively. Multiple linear regressions modeled a quadratic relationship between BASDAI and RAPID3 for 321 observations in 112 patients with axSpA (1) cross-sectionally: BASDAI predicted by RAPID3 (β = 1.171; s.e. = 0.113, p < 0.001) and RAPID3(2) (β = -0.037; s.e. = 0.014, p = 0.011) with an adjusted R (2) of 0.676; and (2) longitudinally: BASDAI predicted by RAPID3 (β = 1.196; s.e. = 0.111, p < 0.001), RAPID3(2) (β = -0.042; s.e. = 0.014, p = 0.004), and visit number (β = -0.142; s.e. = 0.038, p < 0.001) with an adjusted R (2) of 0.689. RAPID3 (correctly classified) corresponded to BASDAI scores of 2, 4, and 6: 1.40 (85.8 %), 3.33 (81.9 %), and 5.43 (87.1 %), respectively. RAPID3 correlates well with BASDAI in monitoring axSpA patients (including AS) in cross-sectional and longitudinal follow-up. Since it also correlates with measures of disease activity of other rheumatic diseases including RA, RAPID3 could be an attractive measure

  6. «TREAT-TO-TARGET» (T2T STRATEGY IN SPONDYLOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2014-01-01

    Full Text Available The paper briefly presents some specific characteristics of development of a treat-to-target (T2T strategy for spondy- loarthritis (SA. The reasons for some inconsistencies between the current concept of SA and the name of the paper presenting the program are described shortly. A complete Russian translation of the T2T strategy for this disease is given and major problems in its development are outlined. The main goal of therapy is shown to achieve clinical remission or low disease activity; however, there has not yet been a final definition of this condition. 

  7. Spondyloarthritis with onset after age 45.

    Science.gov (United States)

    Olivieri, Ignazio; D'Angelo, Salvatore; Padula, Angela; Leccese, Pietro; Palazzi, Carlo

    2013-12-01

    The ASAS (Assessment in SpondyloArtrhritis international Society) classification criteria for axial and peripheral spondyloarthritis permit to classify patients with age at disease onset less than 45 years. Nevertheless, these two forms of spondyloarthritis may begin after the age of 45. With the longer duration of the life expectancy, patients with this late-onset form of spondyloarthritis may be more frequently recognized in the near future. A small percentage (ranging from 3.5 to 6 %) of patients with axial SpA, as defined by the modified New York criteria, have onset of their disease after 45 years of age. Relatively more frequent is the late onset form of peripheral spondyloarthritis with the characteristics of undifferentiated spondyloarthritis. Its clinical spectrum is as broad as it is in children and very young adults. Psoriatic arthritis frequently begins over the age of 45 and occasionally after the age of 60. Some old studies had suggested than elderly-onset psoriatic arthritis is more severe than younger-onset disease, but a recent study found no such difference, and further studies are needed.

  8. Eighth International Congress on Spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Anna Georgiyevna Bochkova

    2013-03-01

    Full Text Available In 1998 the First Congress of the European Ankylosing Spondylitis (AS Working Group was held and attended by 9 leading experts from Germany and the Netherlands. Much scientific and organizational work has been done for 14 years, causing all spondyloarthritis (SA studies to be coordinated and discussed by the working group experts thrice a year. A regular SА congress is held at Ghent, Belgium, every 2 years. In 2009, the working group was renamed the Assessment of SpondyloArthritis international Society (ASAS having about 90 members from more than 30 countries. The results of the society’s activity were new classification criteria for axial (2009 and peripheral (2011 SA, criteria for authentic sacroiliitis and spondylitis according to MRI data; guidelines for AS treatment, those for the use TNF inhibitors in SA, and the Ankylosing Spondylitis Disease Activity Score.

  9. The FAt Spondyloarthritis Spine Score (FASSS)

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Zhao, Zheng; Lambert, Robert Gw

    2013-01-01

    Studies have shown that fat lesions follow resolution of inflammation in the spine of patients with axial spondyloarthritis (SpA). Fat lesions at vertebral corners have also been shown to predict development of new syndesmophytes. Therefore, scoring of fat lesions in the spine may constitute both...

  10. Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages

    Science.gov (United States)

    Kiltz, U; van der Heijde, D; Boonen, A; Bautista-Molano, W; Burgos-Vargas, R; Chiowchanwisawakit, P; Duruoz, T; El-Zorkany, B; Essers, I; Gaydukova, I; Géher, P; Gossec, L; Grazio, S; Gu, J; Khan, M A; Kim, T J; Maksymowych, W P; Marzo-Ortega, H; Navarro-Compán, V; Olivieri, I; Patrikos, D; Pimentel-Santos, F M; Schirmer, M; van den Bosch, F; Weber, U; Zochling, J; Braun, J

    2016-01-01

    Introduction The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. Methods Translation and cross-cultural adaptation has been carried out following the forward–backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. Results The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option ‘not applicable’ was added to two items of the ASAS HI to improve appropriateness. Discussion This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures. PMID:27752358

  11. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Wichuk, Stephanie; Chiowchanwisawakit, Praveena

    2014-01-01

    INTRODUCTION: Radiography is an unreliable and insensitive tool for the assessment of structural lesions in the sacroiliac joints (SIJ). Magnetic resonance imaging (MRI) detects a wider spectrum of structural lesions but has undergone minimal validation in prospective studies. The Spondyloarthritis...... Research Consortium of Canada (SPARCC) MRI Sacroiliac Joint (SIJ) Structural Score (SSS) assesses a spectrum of structural lesions (erosion, fat metaplasia, backfill, ankylosis) and its potential to discriminate between therapies requires evaluation. METHODS: The SSS score assesses five consecutive coronal...... slices through the cartilaginous portion of the joint on T1-weighted sequences starting from the transitional slice between cartilaginous and ligamentous portions of the joint. Lesions are scored dichotomously (present/absent) in SIJ quadrants (fat metaplasia, erosion) or halves (backfill, ankylosis...

  12. Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis.

    Science.gov (United States)

    Regel, Andrea; Sepriano, Alexandre; Baraliakos, Xenofon; van der Heijde, Désirée; Braun, Jürgen; Landewé, Robert; Van den Bosch, Filip; Falzon, Louise; Ramiro, Sofia

    2017-01-01

    To assess the efficacy and safety of non-biological therapies in patients with axial spondyloarthritis (axSpA) to inform the update of the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA. A systematic literature review (2009-2016) of all non-pharmacological treatments, non-biological drugs (except targeted synthetic disease-modifying antirheumatic drugs (DMARDs)) and surgical therapies was performed. Randomised controlled trials (RCTs) and clinical controlled trials were assessed for efficacy and safety, while observational studies with a comparator were assessed for safety. All relevant efficacy and safety outcomes were included. Study heterogeneity precluded data pooling. If possible, Cohen's effect size was calculated for non-pharmacological treatments. In total, 45 papers and 2 abstracts were included. Studies on non-pharmacological treatments were very heterogeneous but overall confirmed a benefit for regular exercises, with small improvements in disease activity, function and spinal mobility. New studies on non-steroidal anti-inflammatory drugs (NSAIDs) confirmed their efficacy and new safety signals were not found. NSAIDs used continuously compared with on-demand did not reduce the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) mean change over 2 years in patients with ankylosing spondylitis with normal C reactive protein (CRP; ≤5 mg/L) (1 'negative' RCT (0.9 vs 0.8; p=0.62)), while for patients with high CRP, conflicting results were found (1 'positive' RCT (0.2 vs 1.7; p=0.003), 1 'negative' RCT (1.68 vs 0.96; p=0.28)). No new trials were found for conventional synthetic DMARDs (csDMARDs). Short-term high-dose systemic glucocorticoids showed limited efficacy. Regular exercises may improve several outcomes. Efficacy and safety of NSAIDs in axSpA are confirmed. Glucocorticoids are not proven to be effective in axSpA and new data on cs

  13. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis

    Science.gov (United States)

    Regel, Andrea; van der Heijde, Désirée; Braun, Jürgen; Baraliakos, Xenofon; Landewé, Robert; Van den Bosch, Filip; Falzon, Louise; Ramiro, Sofia

    2017-01-01

    Objectives To update the evidence for the efficacy and safety of (b)biological and (ts)targeted-synthetic disease-modifying anti-rheumatic drugs (DMARDs) in patients with axial spondyloarthritis (axSpA) to inform the 2016 update of the Assessment of SpondyloArthritis international Society/European League Against Rheumatism (ASAS/EULAR) recommendations for the management of axSpA. Methods Systematic literature review (2009–2016) for randomised controlled trials (RCT), including long-term extensions, strategy trials and observational studies (the latter was only for safety assessment and a comparator was required). Interventions were any bDMARD or tsDMARD. All relevant efficacy and safety outcomes were included. Results 76 papers and 24 abstracts fulfilled the inclusion criteria. Large treatment effects were found both in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) for all tumour necrosis factor inhibitors (TNFi) (NNT to achieve ASAS40 response ranged between 2.6–5.2 for r-axSpA and 2.3–5.4 for nr-axSpA). For nr-axSpA, efficacy was superior for those who had objective signs of inflammation (positive C reactive protein or inflammation on MRI-SI). Secukinumab 150 mg has shown efficacy in two phase 3 RCTs (NNT to achieve ASAS40 response: 3.4 and 4.0). Ustekinumab and tofacitinib have shown positive results in phase 2/proof-of-concept trials; trials with apremilast, rituximab, interleukin (IL)-6 antagonists and abatacept have failed their primary end points. New (unknown) safety signals were not found in the trials but long-term observational safety data for TNFi are still scarce. Conclusions New evidence supports the efficacy and safety of TNFi both in r-axSpA and nr-axSpA. Secukinumab is the first drug targeting the IL-17 pathway in r-axSpA that has shown efficacy. PMID:28176964

  14. Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis

    Science.gov (United States)

    Regel, Andrea; van der Heijde, Désirée; Braun, Jürgen; Landewé, Robert; Van den Bosch, Filip; Falzon, Louise; Ramiro, Sofia

    2017-01-01

    To assess the efficacy and safety of non-biological therapies in patients with axial spondyloarthritis (axSpA) to inform the update of the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA. A systematic literature review (2009–2016) of all non-pharmacological treatments, non-biological drugs (except targeted synthetic disease-modifying antirheumatic drugs (DMARDs)) and surgical therapies was performed. Randomised controlled trials (RCTs) and clinical controlled trials were assessed for efficacy and safety, while observational studies with a comparator were assessed for safety. All relevant efficacy and safety outcomes were included. Study heterogeneity precluded data pooling. If possible, Cohen's effect size was calculated for non-pharmacological treatments. In total, 45 papers and 2 abstracts were included. Studies on non-pharmacological treatments were very heterogeneous but overall confirmed a benefit for regular exercises, with small improvements in disease activity, function and spinal mobility. New studies on non-steroidal anti-inflammatory drugs (NSAIDs) confirmed their efficacy and new safety signals were not found. NSAIDs used continuously compared with on-demand did not reduce the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) mean change over 2 years in patients with ankylosing spondylitis with normal C reactive protein (CRP; ≤5 mg/L) (1 ‘negative’ RCT (0.9 vs 0.8; p=0.62)), while for patients with high CRP, conflicting results were found (1 ‘positive’ RCT (0.2 vs 1.7; p=0.003), 1 ‘negative’ RCT (1.68 vs 0.96; p=0.28)). No new trials were found for conventional synthetic DMARDs (csDMARDs). Short-term high-dose systemic glucocorticoids showed limited efficacy. Regular exercises may improve several outcomes. Efficacy and safety of NSAIDs in axSpA are confirmed. Glucocorticoids are not proven to be effective in axSpA and new

  15. Magnetic resonance imaging in spondyloarthritis--how to quantify findings and measure response

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Poggenborg, René Panduro; Axelsen, Mette Bjørndal

    2010-01-01

    Sensitive and reliable tools for monitoring disease activity and damage, and for prognostication, are essential in the management of patients with spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis. Magnetic resonance imaging (MRI) allows direct visualisation of inflammat......Sensitive and reliable tools for monitoring disease activity and damage, and for prognostication, are essential in the management of patients with spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis. Magnetic resonance imaging (MRI) allows direct visualisation...... of inflammation in peripheral and axial joints, and peripheral and axial entheses, and has dramatically improved the possibilities for early diagnosis and objective monitoring of the disease process in spondyloarthritis. Truthful, discriminative and feasible scoring systems are available for the assessment...... of inflammatory activity in the spine and sacroiliac joints in axial spondyloarthritis and in the hands of patients with peripheral psoriatic arthritis. Various systems for assessment of damage in axial and peripheral joints are available, but further studies are needed to document their value in clinical trials...

  16. Imaging in Spondyloarthritis

    DEFF Research Database (Denmark)

    Weber, Ulrich; Jurik, Anne Grethe; Lambert, Robert G W;

    2016-01-01

    provided by structural lesions alongside with active changes. A focus is on emerging limitations and challenges with increasing use of imaging in spondyloarthritis. We discuss the ongoing controversy as to whether sacroiliac joint MRI due to its superior reliability and ability to depict both structural...... modalities will not become the gold standard for diagnosis of spondyloarthritis, which remains a process of composite deduction based on complementary information obtained from clinical, laboratory, and imaging assessment....

  17. Juvenile Spondyloarthritis Treatment Recommendations

    OpenAIRE

    Tse, Shirley; Burgos-Vargas, Ruben; Colbert, Robert A

    2012-01-01

    No specific recommendations for the treatment of juvenile spondyloarthritis have been established. Important differences exist in how spondyloarthritis begins and progresses in children and adults, supporting the need for pediatric-specific recommendations. Recently published recommendations for the treatment of juvenile arthritis consider children with sacroiliitis in a separate group, and allow for more accelerated institution of a TNF inhibitor depending on disease activity and prognostic ...

  18. Spondyloarthritis: recognition, imaging, treatment

    OpenAIRE

    Berg, Rosaline van den

    2014-01-01

    Spondyloarthritis (SpA) is a heterogeneous group of rheumatic diseases, characterized by sacroiliac-joint inflammation (sacroiliitis), peripheral and extra-articular complaints. The lack of diagnostic criteria makes diagnosing SpA challenging, yet, classification criteria are available. We tested the performance (sensitivity, specificity) of various classification criteria; the recently developed Assessment of SpondyloArthritis international Society (ASAS) criteria outperformed all other crit...

  19. Molecular Pathogenesis of Spondyloarthritis

    DEFF Research Database (Denmark)

    Carlsen, Thomas Gelsing

    This dissertation includes a presentation of knowledge on the molecular pathogenesis of spondyloarthritis achieved through a PhD programme at Aalborg University from 1.12.2011 - 1.12.2014. Work was carried out in the Laboratory of Medical Mass Spectrometry, headed by: Professor Svend Birkelund...... and Immunology in San Diego, USA. Research was conducted on biological material from patients suffering from spondyloarthritis and healthy donors, to whom I dedicate this work....

  20. Spine and sacroiliac joints on magnetic resonance imaging in patients with early axial spondyloarthritis: prevalence of lesions and association with clinical and disease activity indices from the Italian group of the SPACE study

    Directory of Open Access Journals (Sweden)

    M. Lorenzin

    2016-09-01

    Full Text Available Our aim was to determine the prevalence of spine and sacroiliac joint (SIJ lesions on magnetic resonance imaging (MRI in patients with early axial spondyloarthritis (axSpA and their correlation with disease activity indices. Sixty patients with low back pain (LBP (≥3 months, ≤2 years, onset ≤45 years, attending the SpA-clinic of the Unità Operativa Complessa Reumatologia of Padova [SpondyloArthritis-Caught-Early (SPACE study], were studied following a protocol including physical examination, questionnaires, laboratory tests, X-rays and spine and SIJ MRI. Positive spine and SIJ MRI and X-rays images were scored independently by 2 readers using the SPARCC method, modified Stoke ankylosing spondylitis spine score and New York criteria. The axial pain and localization of MRI-lesions were referred to 4 sites: cervical/thoracic/lumbar spine and SIJ. All patients were classified into three groups: patients with signs of radiographic sacroiliitis (r-axSpA, patients without signs of r-axSpA but with signs of sacroiliitis on MRI (nr-axSpA MRI SIJ+, patients without signs of sacroiliitis on MRI and X-rays (nr-axSpA MRI SIJ-. The median age at LBP onset was 29.05±8.38 years; 51.6% of patients showed bone marrow edema (BME in spine-MRI and 56.7% of patients in SIJ-MRI. Signs of enthesitis were found in 55% of patients in the thoracic district. Of the 55% of patients with BME on spine-MRI, 15% presented presented a negative SIJMRI. There was a significant difference between these cohorts with regard to the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ score. The site of pain correlated statistically with BME lesions in thoracic and buttock districts. Since positive spine-MRI images were observed in absence of sacroiliitis, we can hypothesize that this finding could have a diagnostic significance in axSpA suspected axSpA.

  1. Spondylodiscitis (Andersson lesion in psoriatic spondyloarthritis: a rare event successfully treated with an anti-TNF therapy.

    Directory of Open Access Journals (Sweden)

    Vincenzo Bruzzese

    2016-04-01

    Full Text Available Spondylodiscitis (Andersson lesion is an infrequent and late complication of advanced ankilosing arthritis. Scanty data on the efficacy of anti-TNF therapy for these lesions are available. To our knowledge, only few cases of spondylodiscitis occurring in patients with psoriatic arthritis were reported in literature. We describe the case of a patient with psoriatic arthritis who early developed Andersson lesions successfully treated with infliximab plus methotrexate therapy.

  2. Magnetic resonance imaging in spondyloarthritis--how to quantify findings and measure response

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Poggenborg, René Panduro; Axelsen, Mette Bjørndal;

    2010-01-01

    Sensitive and reliable tools for monitoring disease activity and damage, and for prognostication, are essential in the management of patients with spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis. Magnetic resonance imaging (MRI) allows direct visualisation...... and clinical practice. The present article reviews key aspects of the status and recent important advances in MRI in spondyloarthritis, focussing on available MRI tools for assessing activity and damage in peripheral and, particularly, axial joints....

  3. Spondyloarthritis : recognition, imaging, treatment

    NARCIS (Netherlands)

    Berg, Rosaline van den

    2014-01-01

    Spondyloarthritis (SpA) is a heterogeneous group of rheumatic diseases, characterized by sacroiliac-joint inflammation (sacroiliitis), peripheral and extra-articular complaints. The lack of diagnostic criteria makes diagnosing SpA challenging, yet, classification criteria are available. We tested th

  4. The clinical analysis for the whole-spine magnetic resonance imaging of axial spondyloarthritis%中轴型脊柱关节炎全脊柱磁共振成像的临床研究

    Institute of Scientific and Technical Information of China (English)

    罗贵; 赵征; 朱剑; 张江林; 黄烽

    2014-01-01

    目的 通过观察中轴型脊柱关节炎(SpA)患者脊柱受累的磁共振成像(MRI)表现,探讨脊柱MRI病变与临床间的相关性.方法 选中轴型SpA患者,收集其临床资料,进行全脊柱MRI扫描,分析MRI表现,分析脊柱MRI病变与Bath强直性脊柱炎病情活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎计量指数(BASMI)、夜间腰背痛评分[采用视觉模拟尺(VAS)评价]、腰背痛VAS评分、患者对疾病总体评价(采用VAS评价)、强直性脊柱炎疾病活动评分(ASDAS)、ESR、C反应蛋白(CRP)间的相关关系.结果 本研究共纳入33例中轴型SpA患者,其中29例出现MRI异常表现,Romanus病灶(又称椎角炎)29例,Andersson病灶(又称椎间盘炎)11例,椎小关节炎2例,韧带骨赘4例;急性椎角炎、慢性椎角炎、慢性椎间盘炎及脊柱总病变数与BASMI呈正相关(r =0.440,P<0.05;r =0.483,P<0.05;r =0.421,P<0.05;r=0.589,P<0.05),慢性椎间盘炎与BASFI呈正相关(r=0.392,P<0.05),但脊柱各种病变与BASDAI、腰背痛VAS评分、夜间腰背痛VAS评分、患者对疾病总体评价、ASDAS、ESR、CRP无显著相关性(P值均>0.05).结论 中轴型SpA MRI表现与反映脊柱功能的指标存在相关性,能更好地指导临床治疗.%Objective To investigate spinemagnetic resonance imaging(MRI) findings in patients with axial spondyloarthritis (SpA) and to analyze the correlation between imaging and clinical manifestation.Methods The clinical data of patients with axial SpA were recorded.All patients underwent whole spine MRI scanning.The MRI findings of spinal involvement were explored.Moreover,the correlation between lesions in spinal MRI and Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI),Bath Ankylosing Spondylitis Metrology Index (BASMI),nocturnal pain visual analogue scale (VAS) score,back pain VAS score,global disease activity VAS score

  5. Imaging of axial spondyloarthritis including ankylosing spondylitis.

    Science.gov (United States)

    Braun, J; Baraliakos, X

    2011-03-01

    New bone formation of the vertebral column is pathognomonic for ankylosing spondylitis (AS), while acute and/or chronic changes in the sacroiliac joints are relevant for diagnosis. The 'gold standard' for assessment of structural changes in AS are conventional radiographs, while MRI is useful to assess inflammation. Recent MRI studies have shown that the lower half of the thoracic spine is most commonly affected in AS. Scoring tools for spinal inflammation such as the ASspiMRI-a have been proposed, successfully used in large clinical trials and compared in a multireader experiment; none was finally preferred by OMERACT. Quantification of structural spinal AS changes is performed by the modified Stokes AS Spine Score (mSASSS), which evaluates lateral cervical and lumbar radiographs. Two years was identified as the shortest possible follow-up time based on the reliability and sensitivity to change of the mSASSS. A potential disadvantage of the mSASSS is that the thoracic spine is not included. Recent data based on the mSASSS have suggested that tumour necrosis factor blockers do not inhibit radiographic progression in AS. Since the mean radiographic change is reported to be less than 1 syndesmophyte over 2 years, the sensitivity to change of the mSASSS has been questioned. However, in one study where continuous non-steroidal anti-inflammatory drugs use was compared with on-demand use, a difference between these two methods of drug intake was reported. The face and construct validity of the mSASSS has been criticised because a score of ´1´ contains a mixture of osteodestructive (erosions) and osteoproliferative changes (squaring and sclerosis). A new scoring system, the RASSS, which concentrates only on bone formation and which includes the lower part of the thoracic spine is currently being evaluated. The relationship between inflammation and new bone formation in AS has recently been investigated. Low sclerostin and DKK-1 serum levels, both inhibitors of bone formation, were found to be associated with syndesmophyte formation in patients with AS.

  6. 中轴型脊柱关节病活动性骶髂关节炎1H-MRS初探%Evaluation of1H-MRS in detecting active sacroiliitis in patients with axial spondyloarthritis

    Institute of Scientific and Technical Information of China (English)

    庄儒耀; 郭仕涛; 黄钟杰; 黄瑞滨; 肖征宇; 刘源

    2015-01-01

    目的:探讨中轴型脊柱关节病活动性骶髂关节炎1H-MRS频谱特征及意义。材料与方法对10例经临床和常规MRI确诊为中轴型脊柱关节病活动性骶髂关节炎患者(病例组,含活动组和非活动组)及同期11例健康志愿者(对照组)行双侧骶髂关节斜冠状面FSE序列T1WI、STIR序列T2WI,1H-MRS检查。常规MRI图像由2名MR诊断医师在工作站盲法分别进行阅片。应用LCModel软件对MRS资料进行后处理,观察水峰、脂质峰位置,记录水脂比并作统计学分析。结果所有研究对象均获得满意的骶髂关节频谱图,可观察到多个代谢物波峰:位于0.9 ppm的甲基峰,位于1.3 ppm、1.6 ppm、2.0 ppm的亚甲基峰,位于5.3 ppm的乙烯基峰及位于4.7 ppm的水峰。活动组、非活动组和对照组水脂比分别为(1.71±1.14)、(0.43±0.08)、(0.42±0.23);活动组水脂比高于对照组及非活动组,差异有统计学意义(Z=-4.46、-2.92,均P0.05)。结论1H-MRS可以在常规MRI基础上量化骶髂关节炎的水肿程度,有望成为评价骶髂关节炎症活动性的一种无创性的新手段。%AbstractObjective: To evaluate the value and characteristics of proton magnetic resonance spectroscopy (1H-MRS) in detecting active Sacroiliitis in patients with axial Spondyloarthritis (SpA).Materials and Methods:1H-MRS and conventional MRI examinations were done oblique coronary on bilateral SIJs of 21 participants, involving 10 patients (the case group, including active a.nd inactive case groups) underwent clinical and conventional MRI evaluation for axial SpA active sacroiliitis and 11 healthy volunteers (the control group). The conventional MRI images were transmitted to two experienced radiologists respectively to read, evaluate at the workstation under the blind method. The spectrum image analysis was carried out with the LCModel software, and water to lipid ratio (WLR) was calculated for statistical analysis.Results:1H

  7. The concept of spondyloarthritis: where are we now?

    Science.gov (United States)

    Garg, Neha; van den Bosch, Filip; Deodhar, Atul

    2014-10-01

    The term spondyloarthritis (SpA) encompasses a group of diseases characterized by inflammation in the spine and in the peripheral joints, and other clinical features such as uveitis, dactylitis, psoriasis, inflammatory bowel disease, and association with human leukocyte antigen (HLA) B27. The spectrum of SpA encompasses axial spondyloarthritis (axSpA) and peripheral spondyloarthritis including psoriatic arthritis (PsA), reactive arthritis (ReA), and inflammatory bowel disease-associated arthritis. In recent years, there has been tremendous progress in understanding the natural history and pathogenetic mechanisms underlying SpA leading to the development of effective treatments. It has become imperative to identify the disease early, and accurately, to avail patients of effective treatments in a safe manner. The development of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria has been a welcome advance in this regard. This article provides a historical evolution of the concept of SpA, from the Rome Criteria to the ASAS criteria, current issues and barriers with the use of ASAS criteria, and the work that still needs to be done moving forward.

  8. Physical activity in spondyloarthritis: a systematic review

    LENUS (Irish Health Repository)

    O’Dwyer, Tom

    2014-10-01

    Physical activity (PA) is associated with numerous health-related benefits among adults with chronic diseases and the general population. As the benefits are dose-dependent, this review aims to establish the PA levels of adults with spondyloarthritis and to compare these to the general population. Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE\\/PubMed, PEDro, AMED, CINAHL) were systematically searched from inception to May 2014 using medical subject headings and keywords. This was supplemented by searching conference abstracts and hand-searching reference lists of included studies. Eligible studies were randomized controlled trials and observational studies of adults with SpA in which free-living PA or energy expenditure levels were measured. Subjects less than 18 years or with juvenile-onset SpA were excluded. Outcomes included objective and self-report measurements. Two reviewers independently screened studies for inclusion and assessed methodological quality using the Cochrane risk of bias tool and the RTI item bank. From the 2,431 records reviewed, nine studies involving 2,972 participants were included. This review focused on qualitative synthesis. Meta-analyses were not undertaken due to differences in study design, measurement tools, and participant characteristics. This heterogeneity, coupled with the risk of bias inherent in the included observational studies, limits the generalizability of findings. Objective measurements suggest PA levels may be lower among adults with spondyloarthritis than in healthy population controls. Self-reported PA and self-reported rates of adherence to PA recommendations varied largely across studies; higher disease activity was associated with lower self-reported PA levels. Physical activity levels may be lower in adults with axial spondyloarthritis, with higher disease activity associated with lower PA levels.

  9. 伴发葡萄膜炎的中轴型脊柱关节炎临床特征分析%Analysis of clinic features of patients with axial spondyloarthritis complicated with uveitis

    Institute of Scientific and Technical Information of China (English)

    陈玉铃; 李挺; 沈洁; 信维伟; 王晓栋; 叶霜

    2016-01-01

    目的:观察中轴型脊柱关节炎伴发葡萄膜炎的发生率,探讨伴发葡萄膜炎的中轴型脊柱关节炎的临床特征。方法收集218例中轴型脊柱关节炎患者,比较葡萄膜炎组与无葡萄膜炎组患者在人口学因素、临床特征、使用药物、生存质量等方面的差异,采用t检验及χ2检验进行统计学分析。结果中轴型脊柱关节炎伴发葡萄膜炎的发生率为24.3%。葡萄膜炎组的病程[(156±140)个月]长于无葡萄膜炎组[(84±98)个月](t=-3.473,P=0.001),起病到确诊时间[(90±105)个月]长于无葡萄膜炎组[(47±65)个月](t=-2.818,P=0.006),就诊到确诊时间[(67±97)个月]长于无葡萄膜炎组[(34±55)个月](t=-2.366,P=0.021),HLA­B27阳性率(97.7%)高于无葡萄膜炎组患者(74.2%)(t=5.822,P=0.016),BASMI得分(3.3±2.0)高于无葡萄膜炎组(2.4±1.9)(t=-3.141,P=0.002),生物制剂使用率(64.2%)高于无葡萄膜炎组患者(46.7%)(t=4.907,P=0.027)。结论在急性前葡萄膜炎患者中应仔细询问病史、及时检测HLA­B27,加强风湿科与眼科会诊制度,以期早期诊治中轴型脊柱关节炎,减少葡萄膜炎的发作及功能受损。%Objective To investigate the prevalence of uveitis associated with axial spondyloarthritis (ax­SpA), and analyze the features of patients with ax­SpA accompanying uveitis. Methods Two hundred and eighteen patients with ax­SpA were recruited. The differences in demographic factors, clinical features, the use of drugs and the quality of life were compared between uveitis group and non­uveitis group by using t­tests andχ2 tests. Results The prevalence of uveitis associated with ax­SpA was 24.3%. Uveitis group had longer disease duration [(156±140) month] compared to the non­uveitis group [(84±98) month] (t=-3.473, P=0.001), longer duration from disease onset to diagnosis [(90±105) month

  10. Epidemiology of Spondyloarthritis

    OpenAIRE

    Stolwijk, Carmen; Boonen, Annelies; van Tubergen, Astrid; John D Reveille

    2012-01-01

    Spondyloarthritis (SpA) represents a group of interrelated diseases with common clinical features and a close association with HLA-B27. Figures on the incidence and prevalence of diseases vary highly dependent on methodological differences between studies, the case definition used to classify disease and on the prevalence of HLA-B27 in the population studied. When summarizing the available literature, incidence rates of SpA are mainly based on the ESSG criteria and range between 0.48 and 63/1...

  11. The kaleidoscopic presentation of the spondyloarthritis concept in a female patient.

    Science.gov (United States)

    De Langhe, Ellen; Lories, Rik; Maenaut, Kristin; De Vlam, Kurt

    2011-12-01

    Spondyloarthritis is a group of chronic joint diseases that share clinical, pathological and genetic features and is divided into distinct diagnostic entities, including ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-associated spondyloarthritis, reactive arthritis, juvenile onset and undifferentiated spondyloarthritis. Since the spectrum of spondyloarthritides is wider than the sum of aforementioned disorders suggests, the term "Spondyloarthritis concept" might prove to be appropriate. Here, we present a case in which many features of the spondyloarthritis concept, but also unexpected osteitis in the skull and tibia, emerge during the disease course. A 45-year-old HLA-B27 positive woman with a family history of psoriasis, a former diagnosis of ankylosing spondylitis, reactive arthritis and fulminating acne, was referred to our department with a painful tibial swelling, symmetrical polyarthritis and severe headache. Conventional radiography and bone scintigraphy demonstrated large osteolytic lesions on the left parietal side of the skull and the right anterior tibia. She was treated with surgery and pamidronate. Etanercept treatment was initiated as the arthritis deteriorated and was replaced by infliximab when new onset Crohn's disease became apparent. This case is the illustration of spondyloarthritis as a disease concept, covering the entire spectrum, from ankylosing spondylitis, urogenital reactive arthritis and psoriatic arthritis to inflammatory bowel disease. Cases like this illustrate that the clinical classification of spondyloarthritis patients into distinct diagnostic entities is bypassing the value of the "concept" and provides support for the new classification criteria that were recently proposed.

  12. PROBLEMS OF SPONDYLOARTHRITIS IN THE PROCEEDINGS OF THE EULAR-2013 CONGRESS (MADRID, 12–15 JUNE 2013

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2014-01-01

    Full Text Available The EULAR-2013 Congress took place in Madrid on 12–15 June 2013. The problem of spondyloarthritis (SA was one of the significant aspects at this scientific forum. It should be primarily pointed out that the congress presented a T2T (treat-to-target initiative to treat this disease. According to this concept, the main goal of SA therapy, as that for rheumatoid arthritis, is remission or low activity although there is no clear definition of these conditions in SA. A con- siderable amount of time was devoted to the results of recent SA pathogenesis investigations, including the role of interleukin 23. Discussions around the proposed SA classification concerning the criteria for mainly axial and periph- eral SAs and their clinical variety did not cease either. Reports on already well-known and novel treatment options and their efficiency during long term follow up held a prominent position at the congress. 

  13. Progress in spondylarthritis. Immunopathogenesis of spondyloarthritis: which cells drive disease?

    Science.gov (United States)

    Melis, Lode; Elewaut, Dirk

    2009-01-01

    Spondyloarthritides, or SpA, form a cluster of chronic inflammatory diseases with the axial skeleton as the most typical disease localisation, although extra-articular manifestations such as intestinal inflammation may frequently occur during the course of the disease. This review summarises recent progress in our understanding of the immunopathogenesis of SpA with special emphasis on the cellular constituents considered to be responsible for the initiation and/or perpetuation of inflammation. There are several arguments favouring a role for haematopoietic cells in the pathophysiology of spondyloarthritis, including HLA-B27-associated dendritic cell disturbances, HLA-B27 misfolding properties and T helper 17 cells. In addition, recent studies have pointed toward a pivotal role for stromal cells. A major challenge, however, remains to determine how recently identified genetic associations such as interleukin-23 receptor polymorphisms may influence cellular targets in spondyloarthritis.

  14. EULAR RECOMMENDATIONS FOR THE USE OF IMAGING IN SPONDYLOARTHRITIS IN CLINICAL PRACTICE

    DEFF Research Database (Denmark)

    Mandl, P; Navarro-Compán, V; Terslev, L

    2014-01-01

    Objectives: To develop evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis. Methods: The task force comprised an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries. Twelve key questions...

  15. Decreased plasma levels of soluble CD18 link leukocyte infiltration with disease activity in spondyloarthritis

    DEFF Research Database (Denmark)

    Kragstrup, Tue Wenzel; Jalilian, Babak; Hvid, Malene

    2014-01-01

    INTRODUCTION: Spondyloarthritis (SpA) comprises a group of diseases often associated with HLA-B27 and characterized by inflammation of the entheses and joints of the axial skeleton. The inflammatory process in SpA is presumably driven by innate immune cells but still poorly understood. Thus, new...

  16. Chronic widespread pain in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    F. Atzeni

    2014-06-01

    Full Text Available The pain associated with spondyloarthritis (SpA can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP that characterises fibromyalgia (FM. The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

  17. Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies

    Science.gov (United States)

    Caso, Francesco; Costa, Luisa; Del Puente, Antonio; Di Minno, Matteo Nicola Dario; Lupoli, Gelsy; Scarpa, Raffaele; Peluso, Rosario

    2015-01-01

    Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. The therapy target of spondyloarthritis relies mainly in improving patients’ quality of life, controlling articular inflammation, preventing the structural joints damage and preserving the functional abilities, autonomy and social participation of patients. Among these, traditional disease-modifying antirheumatic drugs have been demonstrated to be effective in the management of peripheral arthritis; moreover, in the last decade, biological therapies have improved the approach to spondyloarthritis. In patients with axial spondyloarthritis, tumor necrosis factor α inhibitors are currently the only effective therapy in patients for whom conventional therapy with nonsteroidal anti-inflammatory drugs has failed. The aim of this review is to summarize the current experience and evidence about the pharmacological approach in spondyloarthritis patients. PMID:26568809

  18. 肿瘤坏死因子抑制剂治疗放射学阴性中轴性脊柱关节炎的新进展%Advances in TNF inhibitors therapy in patients with radiographic negative axial spondyloarthritis

    Institute of Scientific and Technical Information of China (English)

    冀肖健; 朱剑; 张江林

    2015-01-01

    肿瘤坏死因子(tumor necrosis factor,TNF)抑制剂在强直性脊柱炎(ankylosing spondylitis,AS)患者中已有明确疗效.为了更好地随访具有AS潜在风险的患者,有学者提出放射学阴性脊柱关节炎(axial nonradiographic spondyloarthritis,nraxSpA)这一概念.近年来越来越多的研究旨在探究TNF抑制剂对nr-axSpA患者的早期疗效.研究发现,TNF抑制剂治疗nr-axSpA的疗效至少与AS相同,甚至很有可能优于AS,并且治疗越早治疗反应越好.本文对TNF抑制剂治疗放射学阴性中轴性脊柱关节炎的新进展进行综述.

  19. ON THE TERMINOLOGY OF SPONDYLOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2015-01-01

    Full Text Available By the end of the first decade of the 21st century, spondyloarthritis studies have accumulated a certain number of terms that are obsolete, but used by physicians in their everyday speech, on the one hand, and a great variety of different definitions, on the other hand. In January 2014, the first organizational meeting of the Expert Group on Spondyloarthritis, Association of Rheumatologists of Russia, decided that its primary task should be to order the terminology used in this area. The authors primarily collected the terms, which had been already used in medical vocabulary, and then divided them into two categories: obsolete definitions and terms to be finalized and unified. This publication gives guidelines for using the medical terms relevant to spondyloarthritis and separately discusses how to correctly write the term sacroiliitis.

  20. 放射学阴性中轴型脊柱关节炎和强直性脊柱炎临床误诊分析%The re-evaluation of 140 patients diagnosed as ankylosing spondylitis and nonradiographic axial spondyloarthritis

    Institute of Scientific and Technical Information of China (English)

    金笛儿; 赵丽丹; 阎小萍; 郝冬林; 刘晶; 赵岩

    2013-01-01

    Objective To re-evaluate the diagnoses of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and analyze the incidence and reason of misdiagnosis.Methods Patients who were previously diagnosed as AS and nr-axSpA before referrals to Peking Union Medical College Hospital (PUMCH) were re-evaluated by three rheumatologists of PUMCH according to the modified New York criteria for AS and Assessment of SpondyloArthritis international Society (ASAS) axial SpA classification criteria for nr-axSpA.Results Totally 87 prior AS patients and 53 prior nr-axSpA patients were enrolled in this study.After re-evaluation,57 patients were still diagnosed as AS and 16 patients were still diagnosed as nr-axSpA.The misdiagnosis incidences were 34.48% and 69.81%,respectively.The misdiagnosis incidence of nr-axSpA was higher than that of AS (P < 0.01).Conclusions The misdiagnosis of AS were mainly due to the misjudgment of sacroiliac joints by CT.The misdiagnosis of nr-axSpA were mainly due to the misjudgment of sacroiliac joints by magnetic resonance imaging.Moreover,the misuse of ASAS axial SpA classification criteria contributed to the misdiagnosis also.%目的 分析放射学阴性中轴型脊柱关节炎(SpA)和强直性脊柱炎(AS)误诊原因.方法 选曾拟诊为放射学阴性中轴型SpA 53例和AS 87例患者,收集临床资料并完善检查,依据1984年修订的纽约AS标准、2009年国际脊柱关节炎协会(ASAS)制定的中轴型SpA分类标准,由我科三位专家重新诊断,并分析误诊原因.结果 (1)曾拟诊为AS 87例、放射学阴性中轴型SpA 53例的患者,经再评估后仍诊断为AS 57例,放射学阴性中轴型SpA 16例,25例诊断为其他疾病,放射学阴性中轴型SpA的误诊率为69.81%,高于AS(34.48%).(2)相对于AS,放射学阴性中轴型SpA女性比例高,发病年龄低,病程短,HLA-B27阳性率低.(3)误诊原因分析:最常见学原因是骶髂关节影像学误读,其次是HLA-B27误

  1. Spondyloarthritis oder Morbus Bechterew: Neue Klassifikation der axialen Spondyloarthritis mit Morbus Bechterew als Endstadium

    Directory of Open Access Journals (Sweden)

    Schirmer M

    2011-01-01

    Full Text Available Mit einer Prävalenz von 0,6–1,9 % ist die axiale Spondyloarthritis (SpA der Sammelbegriff für eine Gruppe von entzündlichen rheumatischen Krankheiten, die vor allem das axiale Skelett und die Insertionsstellen der Sehnen am Knochen (Enthesen betreffen. Je nach Subtyp der SpA besteht eine unterschiedlich starke Assoziation mit dem MHC-I-Antigen HLA-B27. Entsprechend der „Assessment of Spondyloarthritis International Society“ (ASAS wird die SpA anhand der prädominant betroffenen Region in die periphere und die axiale Form unterteilt. Die aktuelle Klassifikation der axialen SpA erfolgt mittels der 2009 veröffentlichten ASAS-Kriterien. Bei Sakroiliitis in der Bildgebung müssen ≥ 1 SpAParameter, bei positivem HLA-B27-Befund ≥ 2 andere SpA-Parameter für die Klassifikation als SpA vorhanden sein. SpA-Parameter sind entzündlicher Rückenschmerz, Arthritis, Familienanamnese, Uveitis anterior, entzündliche Darmerkrankung, Psoriasis, Daktylitis, Enthesitis, gutes Ansprechen auf NSAR und HLA-B27-Positivität. Die Sensitivität dieser Kriterien liegt bei 82,9 %, die Spezifität bei 84,4 %. Für die axiale Beteiligung der Psoriasis arthropathica werden auch die ähnlichen CASPAR-Kriterien verwendet. Für die Klassifikation des Morbus Bechterew werden die 1984 modifizierten New York-Kriterien verwendet, bei denen neben spezifischen klinischen Kriterien radiologisch eine Sacroiliitis Grad 2 oder mehr bilateral oder Grad 3–4 unilateral vorhanden sein muss. Bei schwerem Verlauf kann prinzipiell jede Form der SpA mit einer axialen Beteiligung in einen Morbus Bechterew übergehen. Somit ist der Morbus Bechterew sowohl ein Subtyp der SpA, als auch eine mögliche Spätform anderer Subtypen. Zur Verlaufs- bzw. Therapiekontrolle werden sowohl bei axialer SpA als auch bei Morbus Bechterew spezifische Scores verwendet, um Krankheitsaktivität und Funktionsveränderungen zu dokumentieren (BASFI, BASDAI, ASDAS.

  2. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

    DEFF Research Database (Denmark)

    Mandl, P; Navarro-Compán, V; Terslev, L

    2015-01-01

    A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role...

  3. The changing clinical picture and epidemiology of spondyloarthritis.

    Science.gov (United States)

    van Tubergen, Astrid

    2015-02-01

    In the past decade, major progress has been made in the recognition, classification and treatment of spondyloarthritis (SpA). Classification criteria have been developed for axial and peripheral SpA by the Assessment of SpondyloArthritis international Society (ASAS) as a response to new insight into the clinical picture and unmet needs. The ASAS criteria have contributed to a better understanding of the full spectrum of axial and peripheral SpA and of the potential for treatment. However, whether all patients fulfilling these criteria should be considered as having true SpA is a matter of debate. Furthermore, the implementation of the ASAS criteria might lead to an increase in the reported prevalence of SpA, as patients who were previously unidentified could now be classified as having the disease, which might have consequences for healthcare budgets. In this Review, the changes in the clinical picture and epidemiology of SpA are discussed in light of the ASAS classification criteria for SpA.

  4. Seronegative reactive spondyloarthritis and the skin.

    Science.gov (United States)

    Generali, Elena; Ceribelli, Angela; Massarotti, Marco; Cantarini, Luca; Selmi, Carlo

    2015-01-01

    Spondyloarthritidies represent a group of conditions affecting the axial and peripheral muscoloskeletal apparatus and are often associated with psoriasis, infections, and inflammatory bowel diseases. Other diseases included in this category are psoriatic arthritis, ankylosing spondylitis, and enteropathic arthritis. Reactive arthritis is an elusive spondyloarthritis, commonly occurring 1 to 3 weeks after a digestive or a genitourinary tract infection, in which microorganisms do not infect the joint directly. Reactive arthritis is classically characterized by large-joint arthritis, urethritis in men and cervicitis in women, and eye inflammation (usually conjunctivitis or uveitis) but encompasses numerous other symptoms and signs, including manifestations of dermatologic interest such as keratoderma blenorrhagicum and circinate balanitis. The diagnosis of reactive arthritis is clinical, and the infectious agent cannot always be identified due to disease latency after the infection. Most cases are self-limiting, but reactive arthritis may become chronic in 30% of cases. Treatment options include anti-inflammatory drugs, steroids, and sulfasalazine; biologic agents, such as tumor necrosis factor α (TNF-α) blockers, have been recently used, but there are only a few randomized clinical trials on the treatment of reactive arthritis. The effectiveness of antimicrobials needs further evaluation.

  5. Gut inflammation and microbiome in spondyloarthritis.

    Science.gov (United States)

    Kabeerdoss, Jayakanthan; Sandhya, Pulukool; Danda, Debashish

    2016-04-01

    Spondyloarthritis (SpA) is chronic inflammatory disease involving joints and the spine. Bowel inflammation is common in SpA, which may be classified as acute or chronic. Chronic gut inflammation is most common in SpA patients with axial involvement as compared to those presenting with peripheral involvement alone. The pathogenesis of gut inflammation in SpA could be explained by two factors-over-activation of immunological cells and altered gut microbiome. This is exemplified by SpA animal models, namely HLA-B27-expressing transgenic animals and SKG mice models. Immunological mechanisms include homing of activated T cells from gut into synovium, excess pro-inflammatory cytokines secretion by immune cells such as IL-23 and genetic variations in immunological genes. The evidence for role of gut microbiome in SpA is gradually emerging. Recently, metagenomic study of gut microbiome by sequencing of microbial nucleic acids has enabled identification of new microbial taxa and their functions in gut of patients with SpA. In SpA, the gut microbiome could emerge as diagnostic and prognostic marker of disease. Modulation of gut microbiome is slated to have therapeutic potential as well.

  6. Low-κ' dielectric properties of UV-treated bi-axially oriented polypropylene films

    Science.gov (United States)

    Dervos, C. T.; Tarantili, P. A.; Athanassopoulou, M. D.

    2009-07-01

    A 40 µm multilayer bi-axially oriented polypropylene (BOPP) film, was fabricated by the tenter process and its dielectric response was investigated after applying combined action of UV, humidity and heat. Dissipation factor (tan δ) and relative dielectric constant measurements were performed via the capacitance method for frequencies 20Hz-1 GHz. These results show that the relative dielectric constant (κ') reduces towards ultra low values (1.8) with an increasing number of applied UV-condensation cycles without any subsequent increase in the dielectric loss. Having no added physical porosity and absence of fluorine atoms, the irradiated BOPP structures offer significant advantages over poly(tetrafluoroethylene) PTFE due to reduced polarization effects, lower dielectric constant values and chemical stability to the adjacent copper or aluminium conductors. Possible application fields are dry type high-voltage capacitors and insulation within electronic components.

  7. Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis

    Science.gov (United States)

    Mitulescu, TC; Popescu, C; Naie, A; Predeţeanu, D; Popescu, V; Alexandrescu, C; Voinea, LM

    2015-01-01

    Background: Spondyloarthritis (SpA) is associated with an array of peripheral manifestations. Our study aims to evaluate extra-articular manifestations of SpA in a Romanian academic clinical setting and to observe their associations with different disease measures. Methods: The study was designed to note the extra-articular manifestations of SpA patients in a cross-sectional and retrospective manner. Records included demographics, inflammation markers, SpA clinical characteristics, treatment regimes, associated osteoporosis and cardiovascular morbidity. Data were assessed by using appropriate non-parametric tests. Results: A total of 126 SpA patients were included. The most common extra-articular manifestations were skin involvement in the form of psoriasis (34.1%), eye involvement in the form of acute anterior uveitis (8.7%) and dactylitis (7.2%). Compared to patients with no record of uveitis, uveitis-affected cases were more frequently males, more frequently diagnosed with ankylosing spondylitis, but less frequently dyslipidemic and diagnosed with psoriasis. Psoriasis-affected patients were older and had a higher prevalence of peripheral SpA diagnosis, but a lower prevalence of radiographic sacroiliitis. Conclusions:Acute anterior uveitis in SpA predominantly affects males with AS. This is relevant both to clinical and fundamental science, since its management requires both ophthalmology and rheumatology clinical settings. Psoriasis was associated more frequently with peripheral SpA. Abbreviations: AHT = arterial hypertension, AS = ankylosing spondylitis, ASAS = Assessment in SpondyloArthritis international Society, aSpA = axial spondyloarthritis, BASFI = Bath Ankylosing Spondylitis Functional Index, BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, DM2 = type 2 diabetes mellitus, HLA = human leukocyte antigen, IBD = inflammatory bowel disease, MRI = magnetic resonance imaging, m

  8. Synovial cell production of IL-26 induces bone mineralization in spondyloarthritis.

    Science.gov (United States)

    Heftdal, Line Dam; Andersen, Thomas; Jæhger, Ditte; Woetmann, Anders; Østgård, René; Kenngott, Elisabeth E; Syrbe, Uta; Sieper, Joachim; Hvid, Malene; Deleuran, Bent; Kragstrup, Tue W

    2017-04-02

    Spondyloarthritis (SpA) is characterized by inflammation and new bone formation and can be treated by inhibition of the proinflammatory cytokines TNF-α and IL-17A. IL-26 is considered a proinflammatory cytokine, predominantly related to Th17 cells. In the present study, we investigate IL-26 expression in SpA patients, and examine the in vitro production of IL-26 by synovial cells and the effects of IL-26 on human osteoblasts. IL-26 was measured by ELISA in plasma and synovial fluid (SF) of 15 SpA patients and in plasma samples from 12 healthy controls. Facet joints from axial SpA patients were stained for IL-26 and analyzed by fluorescence microscopy. Synovial fluid mononuclear cells, C-C motif chemokine receptor 6 memory Th17 cells, and fibroblast-like synoviocytes (FLSs) were isolated, and supernatants were analyzed for IL-26 content by ELISA. FLSs were further stained for IL-26 production and the myofibroblast marker α-smooth-muscle-actin (αSMA) and analyzed by flow cytometry. Human osteoblasts were cultured in the presence of IL-26, and the degree of mineralization was quantified. We found that IL-26 levels in SF were increased compared with plasma (P < 0.0001). Moreover, IL-26 expression was found in facet joints of axial SpA patients within the bone marrow. IL-26 secretion was primarily found in αSMA(+) myofibroblasts. In contrast, Th17 cells did not produce detectable amounts of IL-26. Human osteoblasts treated with IL-26 showed increased mineralization compared with untreated osteoblasts (P = 0.02). In conclusion, IL-26 seems to be produced by myofibroblasts in the inflamed synovium and could be a possible facilitator of bone mineralization in SpA.

  9. Role of whole-body magnetic resonance imaging in diagnosing early spondyloarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Mager, Ann-Kathrin; Althoff, Christian E. [Department of Radiology, Charite - Universitaetsmedizin Berlin, Campus Mitte, Chariteplatz 1, 10117 Berlin (Germany); Sieper, Joachim [Department of Rheumatology, Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin (Germany); Hamm, Bernd [Department of Radiology, Charite - Universitaetsmedizin Berlin, Campus Mitte, Chariteplatz 1, 10117 Berlin (Germany); Hermann, Kay-Geert A. [Department of Radiology, Charite - Universitaetsmedizin Berlin, Campus Mitte, Chariteplatz 1, 10117 Berlin (Germany)], E-mail: kgh@charite.de

    2009-08-15

    Ankylosing spondylitis is the prototypical spondyloarthritis. Early diagnosis has gained clinical importance with the advent of new therapeutic options such as TNF-{alpha} inhibitors, which can dramatically improve clinical outcome when initiated early. Whole-body MRI can contribute important diagnostic information for detecting early forms of spondyloarthritis because it enables evaluation of all important joints that may be involved in the disease process as a one-stop shop modality. MRI allows much more accurate diagnostic evaluation of the thoracic spine, which is affected in the majority of patients. This article provides an overview of the use of whole-body magnetic resonance imaging (MRI) in the spondyloarthritides. The recommendations given reflect the most recent scientific data and expert opinions. The focus of this review is on MRI findings at both the axial and the appendicular skeleton and the technical feasibility of whole-body MRI in the clinical setting.

  10. VEGF inhibition as possible therapy in spondyloarthritis patients: Targeting bone remodelling.

    Science.gov (United States)

    Lacout, Alexis; Carlier, Robert Yves; El Hajjam, Mostafa; Marcy, Pierre Yves

    2017-04-01

    Spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases that predominantly affects the axial skeleton, causing pain and stiffness. Human bone is highly dynamic organ that interacts with a wide array cells and tissues. Process of bone remodelling relies on a delicate balance between bone formation and bone resorption, orchestrated by osteoblasts and osteoclasts. Disruption of this homeostatic balance of bone removal and replacement can manifest as inappropriate new bone formation found in spondylarthritis. We hypothesize that VEGF may promote bone remodelling, stimulate angiogenesis, and both osteoclastic and osteoblastic activity. Anti VEGF may be tested as a dedicated therapy to prevent bone remodelling in spondyloarthritis patients, namely in cases of aggressive disease. Bone remodelling could be monitored by using [18F]Fluoride PET scan.

  11. A psychometric analysis of outcome measures in peripheral spondyloarthritis

    Science.gov (United States)

    Turina, Maureen C; Baeten, Dominique L; Mease, Philip; Paramarta, Jacqueline E; Song, In-Ho; Pangan, Aileen L; Landewé, Robert

    2016-01-01

    Objectives To assess the discriminatory capacity of various outcome measures and response criteria in patients with peripheral spondyloarthritis (pSpA). Methods Data originated from two randomised controlled trials, ABILITY-2 and Tnf Inhibition in PEripheral SpondyloArthritis (TIPES). Continuous outcome measures included patient's global assessment (PGA)/physician's global assessment of disease (PhGA), C-reactive protein (CRP), tender joint counts (TJC)/swollen joint counts (SJC), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Dichotomous response criteria included Peripheral SpondyloArthritis Response Criteria (PSpARC), American College of Rheumatology (ACR), ASDAS and BASDAI response criteria. The capacity to discriminate between adalimumab and placebo groups was assessed by standardised mean differences (SMD) for continuous variables, and Pearson's χ2 for dichotomous response criteria. Results Within each trial, the composite indices for axial SpA assessment, ASDAS-CRP (SMD: −0.63 and −0.89 in ABILITY-2 and the TIPES trial, respectively) and BASDAI (SMD: −0.50 and −0.73), and the single-item measures PGA (SMD: −0.47 and −1.12) and PhGA (SMD: −0.64 and −0.87) performed better than other single-item measures, such as CRP (SMD: −0.18 and −0.53), SJC or TJC. In general, the PSpARC and ACR response criteria discriminated better than ASDAS and BASDAI response criteria. Conclusions The axial SpA-specific ASDAS-CRP and BASDAI, but also PGA and PhGA, demonstrated good discriminatory ability in patients with pSpA. The pSpA-specific pSpARC response criteria and the rheumatoid arthritis-specific ACR response criteria also discriminated well. To fully capture typical pSpA manifestations, it may be worth developing new pSpA-specific indices with better performance and face validity. Trial registration numbers ABILITY-2: NCT01064856; TIPES: EUDRACT 2008-006885-27. PMID:26245756

  12. The specificity and limitations of sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis in patients with chronic low back pain%骶髂关节MRI对慢性腰背痛患者确诊中轴脊柱关节炎的特异性与局限性

    Institute of Scientific and Technical Information of China (English)

    王炎焱; 赵征; 罗贵; 李艳; 张江林; 黄烽

    2016-01-01

    Objective To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain.Methods We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology,the PLA General Hospital from January 2013 to December 2015,including clinical manifestations,laboratory examinations and MRI data of sacroiliac joints.Results There were 238 men and 152 women recruited.A total of 326 cases were diagnosed as axial SpA,including 216 men and 110 women with mean age (27.10 ± 8.64) years and mean duration (7.64 ± 3.50) months.Among these 326 patients,243 (74.5%) were HLA-B27 positive.The other 64 patients were considered as diagnoses rather than SpA (non-SpA),consisting of 22 men and 42 women with mean age (31.29 ± 7.76) years and mean duration (5.75 ±2.90)months.Non-SpA group had 10 (15.6%) patients with HLA-B27 positive.There were 68.1% and 65.0% SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively.Although there were 25.0% non-SpA patients with bone marrow edema and 7.8 % with bone erosion in MRI of sacroiliac joint,the scores of bone marrow edema 0.00 (0.00,0.75) and bone erosion [0.00(0.00,0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00 (0.00,4.00),bone erosion scores 1.00 (0.00,3.00);P < 0.05].The scores of fat infiltration [1.00 (0.00,4.25),1.00 (0.00,4.00)] and bone sclerosis [0.00 (0.00,1.00),0.00(0.00,1.75)] were not statistically different between two groups.Diagnostic sensitivity of bone marrow edema and bone erosion for axial SpA were 56.4% and 64.1% respectively,specificity were 93.8% and 92.2% respectively.The positive predictive value of bone marrow edema and bone erosion for axial SpA were 9.09 and 8.21,negative predictive value were 0.46 and 0.38.Diagnositic sensitivity of

  13. 中轴型脊柱关节病活动性骶髂关节炎磁共振扩散加权成像意义初探%Evaluation of DWI in detecting active sacroiliitis in patients with axial spondyloarthritis

    Institute of Scientific and Technical Information of China (English)

    庄儒耀; 郭仕涛; 黄钟杰; 肖征宇; 刘源

    2014-01-01

    目的:探讨中轴型脊柱关节病活动性骶髂关节炎磁共振扩散加权成像( DWI )的意义。方法对8例经临床和常规MRI确诊为中轴型脊柱关节病活动性骶髂关节炎患者(病例组)及同期11例健康志愿者(对照组)行双侧骶髂关节斜冠位 FSE 序列 T1 WI、STIR 序列 T2 WI、SS-SE-EPI 序列 DWI ( b 值:0,300 s/mm2)扫描。将获得的常规MRI、DWI、表观弥散系数( ADC)、指数化表观弥散系数( EADC)图由2名MR诊断医师在工作站盲法分别进行阅片、图像评价及测量各侧骶髂关节旁骨髓ADC值、EADC值并作统计学分析。结果对照组骶髂关节旁骨髓在DWI图上呈均匀稍低信号,ADC图上呈均匀低信号,EADC图上呈均匀高信号。病例组关节旁骨髓水肿灶在 DWI 图、ADC 图上呈高信号, EADC 图上呈低信号。 b 值为300 s/mm2时,病例组各侧骶髂关节旁骨髓水肿灶ADC值均高于对照组,EADC值均低于对照组,差异均有统计学意义(Z=-3.115、-2.814、-3.002、-3.115、-3.115、-2.714、-2.889、-3.115,均P<0.05)。结论DWI可以直接观察炎症水肿灶的范围及信号改变,还可以通过ADC值、EADC值对炎症病变水肿程度定量分析,有助于骶髂关节炎的早期诊断和病情活动性的判定。%Objective To evaluate the value of DWI in detecting active sacroiliitis in patients with axial spondyloarthritis ( SpA) .Methods DWI and conventional MRI examinations were done oblique coronary on bilateral SIJs of 19 participants,involving 8 patients (the case group) underwent clinical and conventional MRI evaluation for axial SpA active sacroiliitis and 11 healthy volunteers(the control group).The conventional MRI,DWI,ADC,EADC images were transmitted to two experienced radiologists respectively to read ,evaluate and measure ( the ADC values and EADC values ) at the workstation under the blind method .The experimental data were

  14. The Intestinal Microbiome in Spondyloarthritis

    Science.gov (United States)

    Gill, Tejpal; Asquith, Mark; Rosenbaum, James T.; Colbert, Robert A.

    2015-01-01

    Purpose of the review Microbial dysbiosis in the gut is emerging as a common component in various inflammatory disorders including spondyloarthritis (SpA). The depth of this influence has begun to be realized with next generation sequencing of the gut microbiome providing unbiased assessment of previously uncharted bacterial populations. Recent findings Decreased numbers of Firmicutes, a major phyla of gut commensals, especially the species Faecalibacterium prausnitzii and Clostridium leptum have been found in various inflammatory disorders including SpA and IBD, and could be an important link between SpA and gut inflammation. Multiple studies in ankylosing spondylitis, psoriatic arthritis, juvenile SpA and animals models of SpA are revealing common bacterial associations among these diseases as well as IBD. Summary We are beginning to appreciate the complex relationship between the gut microbiome and host immune regulation and dysregulation in health and disease. Potentially important differences have been revealed in SpA, but cause and effect relationships remain far from established. Many critical questions remain to be answered before we can apply new knowledge to improve therapeutics in SpA. PMID:26002022

  15. Uveitis in Spondyloarthritis: An Overview.

    Science.gov (United States)

    Cantini, Fabrizio; Nannini, Carlotta; Cassarà, Emanuele; Kaloudi, Olga; Niccoli, Laura

    2015-11-01

    Autoimmune anterior uveitis (AU) accounts for at least half of the cases of noninfectious uveitis, and similarly to spondyloarthritis (SpA), its occurrence is related to HLA-B27 positivity. AU is significantly more frequently found in HLA-B27-positive subjects with SpA and is characterized by unilateral eye involvement, marked tendency to recur with involvement of both eyes in alternate fashion, and has good prognosis in the majority of cases. The estimated frequency of SpA in patients with AU is around 50%, whereas AU in SpA has been reported in at least 30% of cases. Across the SpA disease spectrum, AU has a frequency peak of 33.4% in patients with ankylosing spondylitis, while the estimated prevalence in psoriatic arthritis (PsA) and inflammatory bowel disease-associated SpA is 2%-25%, and 25%, respectively. In early PsA, the frequency of AU has been found in 9% of patients. The wide range of prevalence reported in PsA may be explained by the variable sets of classification criteria used for patient selection and the different length of followup. AU may precede the clinical features of SpA, may be present at diagnosis, or may complicate the SpA clinical course. However, the occurrence of AU in SpA as well as AU flares has been reduced through treatment of SpA with anti-tumor necrosis factor-α agents.

  16. Defining enthesitis in spondyloarthritis by ultrasound

    DEFF Research Database (Denmark)

    Terslev, Lene; Naredo, E; Iagnocco, A

    2014-01-01

    Objective: To standardize ultrasound (US) in enthesitis. Methods: An Initial Delphi exercise was undertaken to define US detected enthesitis and its core components. These definitions were subsequently tested on static images taken from Spondyloarthritis (SpA) patients in order to evaluate...

  17. One year in review 2016: spondyloarthritis.

    Science.gov (United States)

    Parma, Alice; Cometi, Laura; Leone, Maria Comasia; Lepri, Gemma; Talarico, Rosaria; Guiducci, Serena

    2017-01-01

    Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. Recently, novel insights into the epidemiology, pathogenesis and treatment of these diseases have been provided. Herewith, we present an overview ofthe most significant literature contributions published over the past year.

  18. One year in review 2015: spondyloarthritis.

    Science.gov (United States)

    Giovannini, L; Orlandi, M; Lodato, C; Cioffi, E; Tenti, S; Bardelli, M; Talarico, R; Guiducci, S

    2015-01-01

    Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. Recently, novel insights into the epidemiology, pathogenesis and treatment of these diseases have been provided. Herewith, we provide an overview of the most significant literature contributions published over the year.

  19. METHOTREXATE IN THE TREATMENT OF COXITIS IN EARLY SPONDYLOARTHRITIS: ARE THERE PROSPECTS?

    Directory of Open Access Journals (Sweden)

    T. V. Dubinina

    2015-01-01

    Full Text Available Hip joint injury, coxitis, is a characteristic manifestation of ankylosing spondylitis. Coxitis therapy has not been elaborated so far. There are few publications on the efficacy of tumor necrosis factor-α inhibitors. Alternative pharmacotherapies, including use of methotrexate, have not fully been studied. The study describes clinical cases of coxitis treated in patients with early spondyloarthritis.

  20. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients.

    Science.gov (United States)

    Conigliaro, Paola; Chimenti, Maria Sole; Ascolani, Marta; Triggianese, Paola; Novelli, Lucia; Onali, Sara; Lolli, Elisabetta; Calabrese, Emma; Petruzziello, Carmelina; Pallone, Francesco; Perricone, Roberto; Biancone, Livia

    2016-02-01

    Spondyloarthritis (SpA) and inflammatory bowel disease (IBD) are chronic autoinflammatory diseases that partially share the genetic predisposition and the unchecked inflammatory response linking the gut to the joints. The coexistence of both conditions in patients and the increased cross-risk ratios between SpA and IBD strongly suggest a shared pathophysiology. The prevalence of Enteropathic-related Spondyloarthritis (ESpA) in IBD patients shows a wide variation and may be underestimated. It is well accepted that the management of joint pain requires rheumatological expertise in conjunction with gastroenterologist assessment. In this view, we aimed at assessing, in a prospective study performed in a combined Gastro-Intestinal and Rheumatologic "GI-Rhe" clinic: (1) the prevalence of ESpA and other rheumatologic diseases in IBD patients with joint pain; (2) the features of the ESpA population; and (3) the diagnostic delay and the potential impact of the combined assessment. From November 2012 to December 2014, IBD patients with joint pain referring to a dedicated rheumatologist by the IBD-dedicated gastroenterologist were enrolled. Clinical and biochemical evaluations, joint involvement and disease activity assessment, diagnostic delay, and treatment were recorded. IBD patients (n=269) with joint pain were jointly assessed in the "GI-Rhe" Unit. A diagnosis of ESpA was made in 50.5% of IBD patients with joint pain. ESpA patients showed a peripheral involvement in 53% of cases, axial in 20.6% and peripheral and axial in 26.4% of cases. ESpA patients had a higher prevalence of other autoimmune extra-intestinal manifestations and received more anti-TNF treatment compared with IBD patients. A mean diagnostic delay of 5.2 years was revealed in ESpA patients. Patients with joint disease onset in the 2002-2012 decade had reduced diagnostic delay compared with those with onset in the 1980-1990 and 1991-2001 decades. Diagnostic delay was further reduced for patients with joint

  1. Diagnosis of spondyloarthritis: should we need new criteria?

    Directory of Open Access Journals (Sweden)

    I. Z. Gaidukova

    2015-01-01

    Full Text Available A large number of classification criteria for spondyloarthritis (SpA are simultaneously used in modern rheumatology in the almost complete absence of diagnostic criteria. This poses a number of problems, among which there are two most important ones: 1 the frequent use of classification criteria to make a diagnosis in real clinical practice; 2 the possibility of stating different nosological entities of SpA in one patient in the presence of the same clinical picture.Objective: to investigate the specific features of the diagnosis of SpA and the use of its classification criteria in clinical practice.Subjects and methods. The investigation enrolled 119 patients with the established diagnosis of ankylosing spondylitis (AS, psoriatic arthritis (PsA, undifferentiated axial or peripheral SpA. Whether their clinical picture complied with the modified New York criteria, the European Spondyloarthropathy Study Group (ESSG criteria, the Amor criteria, and the Assessment of Spondyloarthritis International Society (ASAS classification criteria for axial and peripheral SpA and whether the Russian version of the modified New York criteria complied with the Classification criteria of Psoriatic ARthritis (CASPAR were determined in the patients.Results. Sixty-three patients diagnosed with AS (M45, 44 with PsA (M07.0-07.3, 8 with undifferentiated SpA (M46.9, and 4 with nonradiographic axial SpA (M46.8 were followed up by attending physicians. The latter diagnosed AS in 10 patients who met the ASAS criteria for axial PsA but not the modified New York criteria. Twenty-one patients diagnosed as having PsA simultaneously met both the CASPAR criteria and the modified New York criteria, which could establish the diagnosis of AS in these cases. Eighty-one (68.0% out of the 119 patients met the Amor criteria; 98 (82.3% patients, the ESSG criteria; 91 (76.5%, the ASAS criteria for axial SpA; 18 (15.1%, the ASAS criteria for peripheral SpA; 76 (63.8%, the modified New York

  2. Progress in spondylarthritis. Spondyloarthritis: lessons from imaging.

    Science.gov (United States)

    Maksymowych, Walter P

    2009-01-01

    The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations. MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation, especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI.

  3. Progress in spondylarthritis. Spondyloarthritis: lessons from imaging

    OpenAIRE

    2009-01-01

    The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding location...

  4. Bone edema of the whole vertebral body: an unusual case of spondyloarthritis.

    Science.gov (United States)

    Ortolan, Augusta; Lazzarin, Paolo; Lorenzin, Mariagrazia; Rampin, Lucia; Ramonda, Roberta

    2017-01-01

    Spondyloarthritis (SpA) is usually characterized by early inflammatory involvement of the sacroiliac joints (SI), which constitutes one of the most important classification criteria according to the SpondyloArthritis International Society (ASAS). These criteria do not include inflammatory spine lesions which can be detected on MRI, although spine involvement is very common in axial SpA. This is because spine MRI lesion often retrieved in SpA are not very specific, and can be found in many other diseases such as malignancy and osteoarthritis. Here we present the case of a 33-year old woman who presented a worsening low back pain, with a thoracic spine MRI showing bone marrow edema (BME) of the whole T8 vertebral body. Owing to this peculiar presentation, together with the unresponsiveness of the pain to nonsteroidal anti inflammatory drugs (NSAIDs) and a slight increase of the biomarker CA19-9, a malignancy was suspected. Therefore, the patient underwent bone scintigraphy, Single positron emission computed tomography (SPET/TC), positron emission tomography and repeated MRI without reaching a diagnosis. Finally, when SI joints MRI was performed, BME of the SI joints emerged: this was fundamental to formulate the diagnosis of axSpA.

  5. PALLIATIVE CARE IN SPONDYLOARTHRITIS: IS THERE A NEED FOR THIS?

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2015-01-01

    Full Text Available Objective: to estimate the rehabilitation  or palliative care needs of patients with spondyloarthritis  (SpA and to determine the specific features of palliative care in them.Subjects and methods. The literature on the investigated problem was analyzed using the electronic resources of Pubmed,  Medline,  and E-library. The authors obtained data based on the prospective follow-up of 182 patients with SpA in January 2010 to March 2014 (PROGRESS study. The degree of axial skeletal immobility (Bath Ankylosing Spondylitis Metrology Index (BASMI was estimated; the presence of irreversible organ changes (uveitis-induced visual loss, chronic renal failure due to amyloidosis, etc., and X-ray changes of the joints and spine were specified. The number of people with varying degrees of disability and that of those needing surgery were taken into account.Results. The investigation showed that mobility changes and disability might progress rapidly in patients with SpA: in 2010 to 2014, the number of disable patients with SpA increased from 20.5 to 48.9%. In 2014, more than one third (37.8% of the patients needed rehabilitation  and orthopedic  correction; 5 (2.74% patients had IV functional class and required nursing and palliative care.Conclusion. SpA is a chronic disease that can lead to a rapid functional impairment. Chronic  pain, loss of mobility, vision deterioration, amyloidosis, and other causes show the need for palliative care in some patients with SpA. Special tools for evaluating the health status of patients with SpA should be elaborated to determine whether the patient needs rehabilitation  and palliative care.

  6. Carotid intima-media thickness in spondyloarthritis patients

    Directory of Open Access Journals (Sweden)

    Thelma Larocca Skare

    Full Text Available CONTEXT AND OBJECTIVE Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT in spondyloarthritis (SpA patients and correlate this with clinical parameters and inflammatory markers. DESIGN AND SETTING Cross-sectional analytical study at Rheumatology Outpatient Clinic, Evangelical University Hospital, Curitiba. METHODS IMTs (measured using Doppler ultrasonography of 36 SpA patients were compared with controls. The IMT in SpA patients was associated with inflammatory markers, like erythrocyte sedimentation rate (ESR, C-reactive protein (CRP and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; and with clinical parameters, like axial or peripheral involvement, dactylitis, HLA B27, uveitis occurrence, Bath Ankylosing Spondylitis Functional Index (BASFI and lipid profile. RESULTS The mean IMT in SpA patients was 0.72 ± 0.21 mm; in controls, 0.57 ± 0.13 mm (P = 0.0007. There were no associations with ESR, CRP, BASDAI or clinical data. In univariate analysis, greater IMT was seen in patients with longer disease duration (P = 0.014; Pearson R = 0.40; 95% confidence interval, CI = 0.06 to 0.65; higher triglycerides (P = 0.02; Spearman R = 0.37; 95% CI = 0.03 to 0.64; and older age (P = 0.0014; Pearson R 0.51; 95% CI = 0.21 to 0.72. CONCLUSION SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients.

  7. Radionuclide Methods in the Diagnosis of Sacroiliitis in Patients with Spondyloarthritis: An Update

    Directory of Open Access Journals (Sweden)

    Karina Zilber

    2016-10-01

    Full Text Available Sacroiliitis, inflammation of the sacroiliac joint (SIJ, is the hallmark of ankylosing spondylitis and spondyloarthritis (SpA in general. The arsenal of recommended diagnostic modalities for imaging of the SIJ is scanty and, in practice, includes only conventional X-rays and magnetic resonance imaging (MRI. This review suggests that bone scintigraphy, particularly single-photon emission computed tomography (SPECT with calculation of indices, or SPECT in combination with low-dose computed tomography (CT can be a sensitive and specific tool for the diagnosis of sacroiliitis and can be used as part of the individualized approach to the diagnosis of axial SpA. In addition, [18F]fluoride positron emission tomography (PET/CT imaging and immunoscintigraphy, using labeled monoclonal anti-cytokine antibodies, are promising methods of current scientific interest in this field.

  8. Wnt/β-catenin signaling plays a key role in the development of spondyloarthritis

    Science.gov (United States)

    Xie, Wanqing; Zhou, Lijiang; Li, Shan; Hui, Tianqian; Chen, Di

    2015-01-01

    Spondyloarthritis (SpA) is a group of diseases consisting of psoriatic arthritis (PsA), reactive arthritis, arthritis related to inflammatory bowel disease (a subgroup of juvenile idiopathic arthritis), and ankylosing spondylitis (the prototype of SpA). Axial bone formation and the combination of concurrent erosion and new bone formation are specific characteristics of SpA disease. The use of anti-proinflammatory cytokines, such as inhibitors of tumor necrosis factor α (TNF-α), appears to be the greatest advance in the treatment of SpA over the past 20 years. However, TNF-α blockers do not halt new bone formation. Recent clinical observations and animal studies demonstrate that Wnt signaling proteins and natural Wnt inhibitors, such as DKK1 and sclerostin, are likely to play important roles in the process of ankylosis in SpA, and could potentially serve as therapeutic targets for the treatment of SpA. PMID:26629686

  9. Wnt/β-catenin signaling plays a key role in the development of spondyloarthritis.

    Science.gov (United States)

    Xie, Wanqing; Zhou, Lijiang; Li, Shan; Hui, Tianqian; Chen, Di

    2016-01-01

    Spondyloarthritis (SpA) is a group of diseases consisting of psoriatic arthritis (PsA), reactive arthritis, arthritis related to inflammatory bowel disease (a subgroup of juvenile idiopathic arthritis), and ankylosing spondylitis (the prototype of SpA). Axial bone formation and the combination of concurrent erosion and new bone formation are specific characteristics of SpA disease. The use of antiproinflammatory cytokines, such as inhibitors of tumor necrosis factor α (TNF-α), appears to be the greatest advance in the treatment of SpA over the past 20 years. However, TNF-α blockers do not halt new bone formation. Recent clinical observations and animal studies demonstrate that Wnt signaling proteins and natural Wnt inhibitors, such as DKK1 and sclerostin, are likely to play important roles in the process of ankylosis in SpA, and could potentially serve as therapeutic targets for the treatment of SpA.

  10. Axial myopathy

    DEFF Research Database (Denmark)

    Witting, Nanna; Andersen, Linda K; Vissing, John

    2016-01-01

    musculature involvement in the majority of myopathies in which paraspinal musculature was examined. Even in diseases named after a certain pattern of non-axial muscle affection, such as facioscapulohumeral and limb girdle muscular dystrophies, affection of the axial musculature was often severe and early...

  11. Current practice of therapeutic drug monitoring of biopharmaceuticals in spondyloarthritis.

    Science.gov (United States)

    Medina, Frédéric; Placensia, Chamaida; Goupille, Philippe; Paintaud, Gilles; Balsa, Alejandro; Mulleman, Denis

    2017-04-04

    Treatment of spondyloarthritis (SpA) has greatly improved in the biopharmaceutical era. These compounds, primarily tumor necrosis factor (TNF) inhibitors, are effective, but some patients may show poor response, sometimes due to the presence of anti-drug antibodies (ADAs). In some instances, clinicians may increase or taper the dose, depending on the clinical response. Besides the current clinical practice, a tailored strategy based on drug monitoring is emerging as a way to improve the use of these drugs. However, the relevance of this therapeutic drug monitoring (TDM) of biopharmaceuticals for SpA is still unknown. In this literature review, we examined the most relevant articles dealing with the concentration-response relation, ADA detection, and pharmacokinetics in SpA treated with biopharmaceuticals. ADAs were associated with low or undetectable concentration of monoclonal antibodies. The relation between drug concentration and clinical response in SpA is debated, some studies showing an association and others not. Therefore, TDM of biopharmaceuticals for SpA requires a better understanding of the association among the pharmacokinetics, pharmacodynamics, and immunogenicity of these drugs.

  12. Enteropathic Spondyloarthritis: From Diagnosis to Treatment

    Directory of Open Access Journals (Sweden)

    Rosario Peluso

    2013-01-01

    Full Text Available Enteropathic arthritis (EA is a spondyloarthritis (SpA which occurs in patients with inflammatory bowel diseases (IBDs and other gastrointestinal diseases. Diagnosis is generally established on the medical history and physical examination. It was, generally, made according to the European Spondyloarthropathy Study Group (ESSG criteria. Rheumatic manifestations are the most frequent extraintestinal findings of IBD with a prevalence between 17% and 39%, and IBD is associated, less frequently, with other rheumatic disease such as rheumatoid arthritis, Sjogren syndrome, Takayasu arteritis, and fibromyalgia. Although the pathogenesis of EA has not been plainly clarified, the most popular theory supposes that joint inflammation occurs in genetically predisposed subjects with bacterial gut infections, provided an important evidence for a possible relationship between inflammation of the gut mucosa and arthritis. The management of patients with EA requires an active cooperation between the gastroenterologist and rheumatologist.

  13. Spondyloarthritis: from unifying concepts to improved treatment.

    Science.gov (United States)

    Paramarta, Jacqueline E; Baeten, Dominique

    2014-09-01

    Spondyloarthritis (SpA) is a chronic immune-mediated inflammatory disease with diverse phenotypic manifestations including spondylitis, arthritis, enthesitis and extra-articular manifestations (psoriasis, uveitis, inflammatory bowel disease). The common genetic risk factors, the strong familial aggregation and the overlapping immunopathology suggest that these different phenotypic manifestations share common pathogenic pathways. This concept is further strengthened by the good clinical response of all different SpA manifestations to TNF-blocking therapies. However, the phenotypic diversity of SpA is still a major challenge in properly diagnosing, classifying and monitoring the disease and may lead to undertreatment of less typical SpA cases such as undifferentiated SpA. The optimal use of current treatments and the development of novel therapies, including compounds targeting the IL-23/IL-17 axis, thus requires a detailed understanding of both the clinical presentation and the underlying pathogenic pathways in SpA.

  14. The Prevalence of Sacroiliitis and Spondyloarthritis in Patients with Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Senol Kobak

    2014-01-01

    Full Text Available Introduction. Sarcoidosis is a chronic granulomatous disease, which can involve different organs and systems. Coexistence of sarcoidosis and spondyloarthritis has been reported in numerous case reports. Purpose. To determine the prevalence of sacroiliitis and spondyloarthritis in patients previously diagnosed with sarcoidosis and to investigate any possible relation with clinical findings. Materials and Methods. Forty-two patients with sarcoidosis were enrolled in the study. Any signs and symptoms in regard to spondyloarthritis (i.e., existence of inflammatory back pain, gluteal pain, uveitis, enthesitis, dactylitis, inflammatory bowel disease, and psoriasis were questioned in detail and biochemical tests were evaluated. Sacroiliac joint imaging and lateral heel imaging were performed in all patients. Results. Sacroiliitis was found in 6 of the 42 (14.3% sarcoidosis patients and all of these patients were female. Common features of the disease in these six patients were inflammatory back pain as the major clinical complaint, stage 2 sacroiliitis as revealed by radiological staging, and the negativity of HLA B-27 test. These six patients with sacroiliitis were diagnosed with spondyloarthritis according to the criteria of ASAS and of ESSG. Conclusion. We found spondyloarthritis in patients with sarcoidosis at a higher percentage rate than in the general population (1–1.9%. Controlled trials involving large series of patients are required for the confirmation of the data.

  15. Enthesitis: The clue to the pathogenesis of spondyloarthritis?

    Science.gov (United States)

    Miceli-Richard, Corinne

    2015-12-01

    The term "spondyloarthritis" designates a group of conditions whose shared characteristic is inflammation at the interface between the bone and either the tendons and ligaments or the joint capsule. This interface, known as the enthesis, can be the site of ossification in spondyloarthritis. The advent of high-performance imaging techniques such as magnetic resonance imaging has rekindled interest in the enthesis by providing new insights into the sequence that leads to entheseal ossification. These techniques have established initial inflammation and fatty metaplasia as key events that precede ossification. The pathophysiological mechanisms that trigger the initial inflammation probably involve multiple factors such as mechanical stress and the presence of resident cells responsive to interleukin-23 and capable of releasing proinflammatory cytokines. Research into the triggers of entheseal inflammation and ossification may thus provide the clue to the pathophysiology of spondyloarthritis.

  16. Herpes simplex type 2 encephalitis and methotrexate medication: a fortuitous or causative association in a patient with spondyloarthritis?

    Science.gov (United States)

    Lupo, Julien; Dos Santos, Ophélie; Germi, Raphaele; Baccard-Longère, Monique; Stahl, Jean-Paul; Epaulard, Olivier; Morand, Patrice

    2016-11-23

    It is unclear whether immunosuppression is a risk factor for herpes encephalitis. Herein, we describe a rare case of herpes simplex virus (HSV) type 2 encephalitis in a patient treated with low-dose methotrexate for HLA-B27-associated spondyloarthritis. The patient was successfully treated with acyclovir but presented sequelae of encephalitis. Here we discuss the possible role of low-dose MTX therapy as a risk factor of neurological herpes reactivation and severe disease. The host-related and viral risk factors are also addressed.

  17. Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Herregods, N.; Leus, A.; Verstraete, K.; Jans, L. [Ghent University Hospital, Department of Radiology and Medical Imaging, Ghent (Belgium); Jaremko, J.L. [University of Alberta Hospital, Department of Radiology and Diagnostic Imaging, Edmonton, AB (Canada); Baraliakos, X. [Ruhr-University Bochum, Rheumazentrum Ruhrgebiet, Herne (Germany); Dehoorne, J. [Ghent University Hospital, Department of Pediatric Rheumatology, Ghent (Belgium)

    2015-11-15

    The aim of this study is to determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA). A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded. STIR and T1/Gd sequences had 100 % agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5 %) patients, 15 (83 %) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33 %, SP = 85 %) and T1/Gd synovial enhancement (SN = 36 %, SP = 92 %). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55 %, SP = 87 %, LR + =4.2; T1/Gd: SN = 55 %, SP = 92 %, LR + = 6.9). MRI without contrast administration is sufficient to identify bone marrow edema, capsulitis and retroarticular enthesitis as features of active sacroiliitis in juvenile spondyloarthritis. In selected cases when high STIR signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis. (orig.)

  18. Analysis and performance of various classification criteria sets in a Colombian cohort of patients with spondyloarthritis.

    Science.gov (United States)

    Bautista-Molano, Wilson; Landewé, Robert B M; Londoño, John; Romero-Sanchez, Consuelo; Valle-Oñate, Rafael; van der Heijde, Désirée

    2016-07-01

    The objective of this study was to investigate the performance of classification criteria sets (Assessment of SpondyloArthritis international Society (ASAS), European Spondylarthropathy Study Group (ESSG), and Amor) for spondyloarthritis (SpA) in a clinical practice cohort in Colombia and provide insight into how rheumatologists follow the diagnostic path in patients suspected of SpA. Patients with a rheumatologist's diagnosis of SpA were retrospectively classified according to three criteria sets. Classification rate was defined as the proportion of patients fulfilling a particular criterion. Characteristics of patients fulfilling and not fulfilling each criterion were compared. The ASAS criteria classified 81 % of all patients (n = 581) as having either axial SpA (44 %) or peripheral SpA (37 %), whereas a lower proportion met ESSG criteria (74 %) and Amor criteria (53 %). There was a high degree of overlap among the different criteria, and 42 % of the patients met all three criteria. Patients fulfilling all three criteria sets were older (36 vs. 30 years), had more SpA features (3 vs. 1 features), and more frequently had a current or past history of back pain (77 vs. 43 %), inflammatory back pain (47 vs. 13 %), enthesitis (67 vs. 26 %), and buttock pain (37 vs. 13 %) vs. those not fulfilling any criteria. HLA-B27, radiographs, and MRI-SI were performed in 77, 59, and 24 % of the patients, respectively. The ASAS criteria classified more patients as having SpA in this Colombian cohort when the rheumatologist's diagnosis is used as an external standard. Although physicians do not perform HLA-B27 or imaging in all patients, they do require these tests if the clinical symptoms fall short of confirming SpA and suspicion remains.

  19. BOWEL INVOLVEMENT IN PATIENTS WITH SPONDYLOARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. E. Karateev

    2015-01-01

    Full Text Available The pathogenetic  and clinical association between spondyloarthritis  (SpA and inflammatory bowel diseases (IBD is well known. Ulcerative colitis and Crohn's disease are more common  in patients with SpA than in general population. In turn, the involvement of the spine and peripheral joints is a typical systemic manifestation  of IBD. But at the same time at least half of patients with SpA have endoscopic and histological signs of chronic inflammation of the small and large intestine mucosa, which are unaccompanied by characteristic  clinical manifestations and cannot considered within a specific nosological entity. The importance  of this pathology has been unknown until the present time. Should asymptomatic  bowel inflammation be considered as a precursor of true IBD, which methods should be used to diagnose bowel involvement and how the presence of this pathology affects the choice of rational pharmacotherapy for SpA? This review analyzes the basic literature data concerning this problem.

  20. Occult spondyloarthritis in inflammatory bowel disease.

    Science.gov (United States)

    Bandinelli, Francesca; Manetti, Mirko; Ibba-Manneschi, Lidia

    2016-02-01

    Spondyloarthritis (SpA) is a frequent extra-intestinal manifestation in patients with inflammatory bowel disease (IBD), although its real diffusion is commonly considered underestimated. Abnormalities in the microbioma and genetic predisposition have been implicated in the link between bowel and joint inflammation. Otherwise, up to date, pathogenetic mechanisms are still largely unknown and the exact influence of the bowel activity on rheumatic manifestations is not clearly explained. Due to evidence-based results of clinical studies, the interest on clinically asymptomatic SpA in IBD patients increased in the last few years. Actually, occult enthesitis and sacroiliitis are discovered in high percentages of IBD patients by different imaging techniques, mainly enthesis ultrasound (US) and sacroiliac joint X-ray examinations. Several diagnostic approaches and biomarkers have been proposed in an attempt to correctly classify and diagnose clinically occult joint manifestations and to define clusters of risk for patient screening, although definitive results are still lacking. The correct recognition of occult SpA in IBD requires an integrated multidisciplinary approach in order to identify common diagnostic and therapeutic strategies. The use of inexpensive and rapid imaging techniques, such as US and X-ray, should be routinely included in daily clinical practice and trials to correctly evaluate occult SpA, thus preventing future disability and worsening of quality of life in IBD patients.

  1. Circulating levels of interleukin-6, vascular endothelial growth factor, YKL-40, matrix metalloproteinase-3, and total aggrecan in spondyloarthritis patients during 3 years of treatment with TNFα inhibitors

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Hetland, Merete Lund; Sørensen, Inge Juul;

    2010-01-01

    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) treate...

  2. Functional limitations due to foot involvement in spondyloarthritis

    Science.gov (United States)

    Ozaras, Nihal; Havan, Nuri; Poyraz, Emine; Rezvanı, Aylin; Aydın, Teoman

    2016-01-01

    [Purpose] Spondyloarthritis is a major inflammatory disease followed-up in the rheumatology clinics, foot involvement in spodyloarthritis is common. The functional states of patients with spondyloarthritis are usually evaluated globally. The aim of this study was to assess the foot involvement-related functional limitations in patients with spondyloarthritis. [Subjects and Methods] Patients with ankylosing spondylitis and psoriatic arthritis with foot pain more than 4 weeks who underwent anteroposterior and lateral feet radiography were enrolled into the study. A “clinical findings score” was calculated by assigning 1 point for every finding of swelling, redness, and tenderness. C-reactive protein and erythrocyte sedimentation rate were used as serum markers for disease activity. Foot radiograms were evaluated using the spondyloarthropathy tarsal radiographic index and the foot-related functional state of patients was determined by the Turkish version of the Foot and Ankle Outcome Score. [Results] There were no relationships between Foot and Ankle Outcome Score subscales and clinical findings score, serum markers, or radiologic score. Pain and symptoms subscale scores were result positively correlated with activity of daily living, sport and recreation, and quality of life subscale scores. [Conclusion] Pain and symptoms are the main determinants of foot-related functional limitations in spondyloarthritis. PMID:27512252

  3. 注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗前后中轴型脊柱关节炎患者血清白细胞介素-23水平和骶髂关节磁共振成像的变化%Change of serum interleukin-23 levels and sacroiliac joint magnetic resonance imaging before and after treatment with recombinant human tumor necrosis factor-α receptor Ⅱ IgG Fc fusion protein for injection in axial spondyloarthritis patients

    Institute of Scientific and Technical Information of China (English)

    苏培培; 米存东; 赵铖; 陈战瑞; 覃芳

    2015-01-01

    Objective We investigated interleukin (IL)-23 that might play a role in the pathogenesis of rheumatoid arthritis (RA) and whether it was correlated with disease activity and clinical manifestations in axial spondyloarthritis (SPA).In addition, the Spondyloarthritis Research Consortium of Canada (SPARCC) scores was used to examine whether recombinant human tumor necrosis factor-α receptor Ⅱ IgG Fc fusion protein for injection (rhTNFR:Fc) was effective for the reduction of magnetic resonance imaging (MRI)-proven sacroiliac joint (SIJ) inflammation.Methods The serum IL-23 levels of etanercept and conven-tional treatment groups were measured using enzyme-linked immunosorbent assay kits.At the same time, SIJ MRI SPARCC score levels were assessed by MRI, the change of clinical indicators of patients was observed.ANOVA, repeated measure data of ANOVA and Spearman's correlation analysis were used for statisical analysis.Results ① The basal serum IL-23 levels of the Etanercept group were (34.2±1.8) pg/ml and those of the conventional treatment group were (34.1 ±1.8) pg/ml (F=1 073.790, P=0.991), both were significantly higher than the healthy control group (18.1±0.8) pg/ml (P=0.005).After treatment, serum IL-23 levels of the rhTNFR: Fc treatment and conventional treatment group were (24.5 ±1.7) pg/ml and (25.2±1.7) pg/ml (F=232.488, P=0.242), (19.2±0.8) pg/ml and (21.6±1.3) pg/ml (F=114.135, P=0.025), (19.0±0.8) pg/ml and(19.4± 0.8) pg/ml (F=23.374, P=0.085) respectively.A significant decrease was observed in the two groups and the serum level of IL-23 of the rhTNFR:Fc group was lower than that of the conventional group at week 12.② SIJ MRI SPARCC scores of the rhTNFR:Fc group and the conventional drugs group were (20.1± 1.2) scores and(20.7±1.5) scores (F=2003.660, P=0.191), (12.5± 0.8) scores and (15.4±0.9) scores (F=1 680.430, P=0.004), (8.8±0.9) scores and (12.8± 0.9) scores (F=972.877, P=0.002), the scores of two group were significantly decreased

  4. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis

    OpenAIRE

    2009-01-01

    Targeted therapies that neutralize tumour necrosis factor are often able to control the signs and symptoms of spondyloarthritis. However, recent animal model data and clinical observations indicate that control of inflammation may not be sufficient to impede disease progression toward ankylosis in these patients. Bone morphogenetic proteins and WNTs (wingless-type like) are likely to play an important role in ankylosis and could be therapeutic targets. The relationship between inflammation an...

  5. Ankylosing spondyloarthritis in the rheumatology practice of Karelia

    Directory of Open Access Journals (Sweden)

    Irina Mikhailovna Marusenko

    2012-01-01

    Full Text Available The paper describes the pathological aspects of an inflammatory process in ankylosing spondyloarthritis (AS, the role of muscle spasm in maintaining the intensity of pain syndrome and stiffness, the need for the early diagnosis of AS, and the significance of the early use of nonster-oidal anti-inflammatory drugs in these patients. The results of clinical trials and the authorsX data demonstrate the high efficacy and good tolerance of nimesulide (nise in AS.

  6. Ankylosing spondyloarthritis in the rheumatology practice of Karelia

    Directory of Open Access Journals (Sweden)

    Irina Mikhailovna Marusenko

    2012-12-01

    Full Text Available The paper describes the pathological aspects of an inflammatory process in ankylosing spondyloarthritis (AS, the role of muscle spasm in maintaining the intensity of pain syndrome and stiffness, the need for the early diagnosis of AS, and the significance of the early use of nonster-oidal anti-inflammatory drugs in these patients. The results of clinical trials and the authorsX data demonstrate the high efficacy and good tolerance of nimesulide (nise in AS.

  7. Pathogenesis of ligaments ossification in spondyloarthritis: insights and doubts.

    Science.gov (United States)

    Neve, Anna; Maruotti, Nicola; Corrado, Addolorata; Cantatore, Francesco Paolo

    2017-05-01

    Despite intensive research in spondyloarthritis pathogenesis, some important questions still remain unanswered, particularly concerning enthesis new bone formation. Several evidences suggest that it prevalently occurs by endochondral ossification, however it remains to identify factors that can induce and influence its initiation and progression. Recent progress, achieved in animal models and in vitro and genetic association studies, has led us to hypothesize that several systemic factors (adipokines and gut hormones) and local factors (BMP and Wnt signaling) as well as angiogenesis and mechanical stress are involved. We critically review and summarize the available data and delineate the possible mechanisms involved in enthesis ossification, particularly at spinal ligament level. KEY MESSAGES Complete understanding of spondyloarthritis pathophysiology requires insights into inflammation, bone destruction and bone formation, which are all located in entheses and lead all together to ankylosis and functional disability. Several factors probably play a role in the pathogenesis of bone formation in entheses including not only cytokines but also several systemic factors such as adipokines and gut hormones, and local factors, such as BMP and Wnt signaling, as well as angiogenesis and mechanical stress. Data available about pathophysiology of new bone formation in spondyloarthritis are limited and often conflicting and future studies are needed to better delineate it and to develop new therapeutic approaches.

  8. Coexistence of osteopoikilosis with seronegative spondyloarthritis and spinal stenosis

    Science.gov (United States)

    Demir, Saliha Eroglu; Özaras, Nihal; Poyraz, Emine; Toprak, Hüseyin; Güler, Mustafa

    2015-01-01

    [Purpose] Osteopoikilosis is a rare hereditary bone disease that is usually asymptomatic. It is generally diagnosed incidentally on plain radiography. The coexistence of osteopoikilosis with seronegative spondyloarthritis or spinal stenosis is rarely reported. Here, we report the case of a 27-year-old male patient with osteopoikilosis, seronegative spondyloarthritis, and spinal stenosis. [Subject] A 27-year-old male patient with buttock pain and back pain radiating to the legs. [Methods] A plain anteroposterior radiograph of the pelvis revealed numerous round and oval sclerotic bone areas of varying size. Investigation of the knee joints showed similar findings, and the patient was diagnosed with osteopoikilosis. Lumbar magnetic resonance images showed spinal stenosis and degenerative changes in his lumbar facet joints. Magnetic resonance images of the sacroiliac joints showed bilateral involvement with narrowing of both sacroiliac joints, nodular multiple sclerotic foci, and contrast enhancement in both joint spaces and periarticular areas. HLA B-27 test was negative. [Results] The patient was diagnosed with osteopoikilosis, seronegative spondyloarthritis, and spinal stenosis. Treatment included asemetasin twice daily and exercise therapy. [Conclusion] Symptomatic patients with osteopoikilosis should be investigated for other possible coexisting medical conditions; this will shorten the times to diagnosis and treatment. PMID:26157277

  9. Increased IL-20 and IL-24 target osteoblasts and synovial monocytes in spondyloarthritis.

    Science.gov (United States)

    Kragstrup, Tue Wenzel; Andersen, Morten Nørgaard; Schiøttz-Christensen, Berit; Jurik, Anne Grethe; Hvid, Malene; Deleuran, Bent

    2017-04-02

    The pathogenesis of spondyloarthritis (SpA) involves activation of the innate immune system, inflammation and new bone formation. The two cytokines IL-20 and IL-24 have been shown to link innate immune activation and tissue homeostasis. We hypothesized that these two cytokines are secreted as part of activation of the innate immune system and affect bone homeostasis in SpA. IL-20 and IL-24 were measured in plasma from axial SpA patients (n=83). Peripheral SpA patients (n=16) were included for in vitro cell culture studies. The plasma IL-20 and IL-24 levels were increased in SpA patients compared with healthy controls (HCs) by 57% and 83%, respectively (both p<0.0001). The Toll like receptor 4 induced secretion of the two cytokines was greater in SpA peripheral blood mononuclear cells (PBMCs) compared with HC PBMCs. IL-20 and IL-24 increased the production of monocyte chemo attractant protein-1 by activated SpA synovial fluid monocytes, decreased the production of dickkopf-1 by SpA fibroblast-like synovial cells and induced mineralization in human osteoblasts. Taken together, our findings indicate disease-aggravating functions of IL-20 and IL-24 in SpA. This article is protected by copyright. All rights reserved.

  10. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis. Correlation with anatomy and histology

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    Hermann, K.G.A. [Charite Medical School, Campus Mitte, Berlin (Germany). Dept. of Radiology; Bollow, M. [Augusta Hospital, Bochum (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclear Medicine

    2014-03-15

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. (orig.)

  11. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology.

    Science.gov (United States)

    Hermann, K-G A; Bollow, M

    2014-03-01

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings.

  12. Prevalence of Peri-Implant Mucositis and Peri-Implantitis in Patients Treated with a Combination of Axial and Tilted Implants Supporting a Complete Fixed Denture

    Science.gov (United States)

    Cavalli, Nicolò; Taschieri, Silvio; Francetti, Luca

    2015-01-01

    Objectives. The aim of this retrospective study was to assess the incidence and prevalence of peri-implant mucositis and peri-implantitis in patients with a fixed full-arch prosthesis supported by two axial and two tilted implants. Materials and Methods. Sixty-nine patients were included in the study. Each patient received a fixed full-arch prosthesis supported by two mesial axial and two distal tilted implants to rehabilitate the upper arch, the lower arch, or both. Three hundred thirty-six implants for 84 restorations were delivered. Patients were scheduled for follow-up visits every 6 months in the first 2 years and yearly after. At each follow-up visit peri-implant mucositis and peri-implantitis were diagnosed if present. Results. The overall follow-up range was from 12 to 130 months (mean 63,2 months). Three patients presented peri-implantitis. The prevalence of peri-implant mucositis ranged between 0 and 7,14% of patients (5,06% of implants) while the prevalence of peri-implantitis varied from 0 to 4,55% of patients (3,81% of implants). Conclusions. The prevalence and incidence of peri-implant mucositis and peri-implantitis are lower than most of the studies in literature. Therefore this kind of rehabilitation could be considered a feasible option, on the condition of adopting a systematic hygienic protocol. PMID:26065029

  13. Prevalence of Peri-Implant Mucositis and Peri-Implantitis in Patients Treated with a Combination of Axial and Tilted Implants Supporting a Complete Fixed Denture

    Directory of Open Access Journals (Sweden)

    Nicolò Cavalli

    2015-01-01

    Full Text Available Objectives. The aim of this retrospective study was to assess the incidence and prevalence of peri-implant mucositis and peri-implantitis in patients with a fixed full-arch prosthesis supported by two axial and two tilted implants. Materials and Methods. Sixty-nine patients were included in the study. Each patient received a fixed full-arch prosthesis supported by two mesial axial and two distal tilted implants to rehabilitate the upper arch, the lower arch, or both. Three hundred thirty-six implants for 84 restorations were delivered. Patients were scheduled for follow-up visits every 6 months in the first 2 years and yearly after. At each follow-up visit peri-implant mucositis and peri-implantitis were diagnosed if present. Results. The overall follow-up range was from 12 to 130 months (mean 63,2 months. Three patients presented peri-implantitis. The prevalence of peri-implant mucositis ranged between 0 and 7,14% of patients (5,06% of implants while the prevalence of peri-implantitis varied from 0 to 4,55% of patients (3,81% of implants. Conclusions. The prevalence and incidence of peri-implant mucositis and peri-implantitis are lower than most of the studies in literature. Therefore this kind of rehabilitation could be considered a feasible option, on the condition of adopting a systematic hygienic protocol.

  14. Association of human leukocyte A, B, and DR antigens in Colombian patients with diagnosis of spondyloarthritis.

    Science.gov (United States)

    Santos, Ana M; Peña, Paola; Avila, Mabel; Briceño, Ignacio; Jaramillo, Carlos; Vargas-Alarcon, Gilberto; Rueda, Juan C; Saldarriaga, Eugenia-Lucia; Angarita, Jose-Ignacio; Martinez-Rodriguez, Nancy; Londono, John

    2017-04-01

    There is substantial evidence that non-B27 major histocompatibility complex (MHC) genes are associated with spondyloarthritis (SpA). Studies in Mexican and Tunisian populations demonstrated the association of SpA and human leukocyte antigen (HLA) B15. The purpose of this study was to evaluate the association of HLA-A, B, and DR antigens in a group of Colombian patients with a diagnosis of SpA. A total of 189 patients and 100 healthy subjects were included in the present study. All subjects underwent a complete characterization of HLA alleles A, B, and DR. Of the 189 studied patients, 35 were reactive arthritis (ReA), 87 were ankylosing spondylitis (AS), and 67 undifferentiated SpA (uSpA). According to the Assessment of Spondyloarthritis International Society (ASAS) criteria, 167 were axial SpA (axSpA) and 171 were peripheral SpA (pSpA). 63.8% were men, with a mean age of 35.9 ± 12.7 years. 40.7% (77/189) of patients were HLA-B27 positive of which 52.9% had AS and 42.5% axSpA. 23.2% (44/189) of patients were HLA-B15 positive: 23.8% were uSpA, 12.57% were axSpA, and 11.7% were pSpA. In addition, HLA-DRB1*01 was associated with AS (58.6%) and axSpA (42.5%). Also, HLA-DRB1*04 was present in 62 patients with AS (71.2%) and in 26 with axSpA (15.5%). In this population, we found a strong association between the presence of HLA-B27 and the diagnosis of axSpA and AS, but the HLA-B15 is also significantly associated with all subtypes of the disease, predominantly with pSpA. Additionally, HLA-DR1 and DR4 were associated in a cohort of patients with SpA from Colombia.

  15. Ocular involvement in patients with spondyloarthritis.

    Science.gov (United States)

    Bacchiega, Ana Beatriz Santos; Balbi, Gustavo Guimarães Moreira; Ochtrop, Manuella Lima Gomes; de Andrade, Francisco Assis; Levy, Roger Abramino; Baraliakos, Xenofon

    2017-03-18

    Ocular inflammatory diseases can present as isolated conditions but also as part of systemic inflammatory diseases. Anterior uveitis is closely related to SpA and shares the common genetic background of HLA-B27. Other ocular manifestations, such as episcleritis and scleritis, may also occur, although less frequently. Therefore, ocular involvement has been included as one of the important clinical features of SpA in the recently published classification criteria for axial and peripheral disease. However, there are a wide variety of aetiologies for ocular diseases and this must be considered in assessment of SpA.

  16. Atlantoaxial subluxation as an early manifestation in an adolescent with undifferentiated spondyloarthritis: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Jea Andrew

    2011-07-01

    Full Text Available Abstract Introduction Atlantoaxial instability has been described as a manifestation of ankylosing spondylitis (juvenile and adult onset, reactive arthritis, juvenile idiopathic arthritis, and rheumatoid arthritis; however, it has rarely been reported as an early manifestation of these disorders. We present this case report to increase awareness of the condition in the hope that earlier recognition of this disease may prevent further serious injury. Case presentation We report the case of a 17-year-old Hispanic adolescent woman who was initially diagnosed with undifferentiated spondyloarthritis due to peripheral arthritis, enthesitis, a positive human leukocyte antigen B27 result, and inflammatory spinal pain lasting two months. Our patient experienced persistent and worsening occipitocervical pain and signs of myelopathy three months after diagnosis; consequently, we found atlantoaxial instability along with cervical spine bone erosion and pannus formation. She was treated surgically with a C1-2 posterior instrumented fusion and at six weeks post-operatively was started on tumor necrosis factor α blockade. Her occipitocervical symptoms subsided following surgery and initiation of immunomodulation. Conclusions Our report serves to emphasize to pediatric and adult general practitioners, pediatricians, internists, family physicians, pediatric and adult rheumatologists and spine surgeons that atlantoaxial subluxation may be an early manifestation of spondyloarthritis, and that the condition is treatable by surgical intervention and immunomodulation.

  17. Does evaluation of the ligamentous compartment enhance diagnostic utility of sacroiliac joint MRI in axial spondyloarthritis?

    DEFF Research Database (Denmark)

    Weber, Ulrich; Maksymowych, Walter P; Chan, Stanley M

    2015-01-01

    compartment alone. METHODS: Two independent cohorts of 69 and 88 consecutive back pain patients ≤50 years were referred for suspected SpA (cohort A) or acute anterior uveitis plus back pain (cohort B). Patients were classified according to rheumatologist expert opinion based on clinical, radiographic...

  18. Head-to-toe whole-body MRI in psoriatic arthritis, axial spondyloarthritis and healthy subjects

    DEFF Research Database (Denmark)

    Poggenborg, René Panduro; Pedersen, Susanne Juhl; Eshed, Iris

    2015-01-01

    OBJECTIVES: By whole-body MRI (WBMRI), we aimed to examine the frequency and distribution of inflammatory and structural lesions in PsA patients, SpA patients and healthy subjects (HSs), to introduce global WBMRI inflammation/damage scores, and to assess WBMRI's reproducibility and correlation wi...

  19. Golimumab in radiographic and nonradiographic axial spondyloarthritis: a review of clinical trials [Corrigendum

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    Toussirot E

    2017-01-01

    Full Text Available Toussirot E, Vauchy C, Binda D, Michel F. Drug Des Devel Ther. 2016;10:2087–2094.On page 2089, a column heading in Table 1 was incorrectly presented. The last column heading was presented as “Golimumab 60 mg”, whereas this should have been presented as “Golimumab 100 mg” as shown below:Read the original article 

  20. Anti-IL17A in Axial Spondyloarthritis—Where Are We At?

    Science.gov (United States)

    Cheung, Peter P.

    2017-01-01

    Knowledge regarding the mechanisms of the IL17–IL23 pathway and its role in spondyloarthritis (SpA) has been pivotal to the development of IL-17 blockade in patients with axial SpA. Previously, only anti-TNF has proven to be clinically efficacious in patients with active disease, despite non-steroidal anti-inflammatory drugs and physiotherapy. However, up to 50% fail to achieve a clinically significant response. Secukinumab, a fully humanized monoclonal antibody targeting IL-17A, has recently been approved for use in patients with active ankylosing spondylitis. Clinical studies and current issues surrounding the use of secukinumab will be discussed. PMID:28149838

  1. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice.

    Science.gov (United States)

    Mandl, P; Navarro-Compán, V; Terslev, L; Aegerter, P; van der Heijde, D; D'Agostino, M A; Baraliakos, X; Pedersen, S J; Jurik, A G; Naredo, E; Schueller-Weidekamm, C; Weber, U; Wick, M C; Bakker, P A C; Filippucci, E; Conaghan, P G; Rudwaleit, M; Schett, G; Sieper, J; Tarp, S; Marzo-Ortega, H; Østergaard, M

    2015-07-01

    A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.

  2. Candida arthritis in a patient diagnosed with spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Remzi Çevik

    Full Text Available Abstract Candida arthritis is an unusual manifestation that usually affects the knees. A 35-year-old man presented with a 2-month history of pain and swelling in the right knee. Swelling persisted after anti-inflammatory treatment. Peripheric spondyloarthritis was considered, but methotrexate, sulfasalazine, and methylprednisolone did not reduce the swelling. Direct examination of synovial fluid and a culture were positive for Candida albicans. Intravenous and intra-articular amphotericin-B were administered. The arthritis regressed and a culture and direct staining showed negative results. Candida arthritis should be considered in patients with arthritis that is resistant to treatment and prolonged, even if risk factors are absent.

  3. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis.

    Science.gov (United States)

    Lories, Rik J U; Luyten, Frank P; de Vlam, Kurt

    2009-01-01

    Targeted therapies that neutralize tumour necrosis factor are often able to control the signs and symptoms of spondyloarthritis. However, recent animal model data and clinical observations indicate that control of inflammation may not be sufficient to impede disease progression toward ankylosis in these patients. Bone morphogenetic proteins and WNTs (wingless-type like) are likely to play an important role in ankylosis and could be therapeutic targets. The relationship between inflammation and new bone formation is still unclear. This review summarizes progress made in our understanding of ankylosis and offers an alternative view of the relationship between inflammation and ankylosis.

  4. Treatment challenges in axial spondylarthritis and future directions.

    Science.gov (United States)

    Sieper, Joachim

    2013-09-01

    Major progress has been made in recent years in the management of axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). Most predictors of response have been defined for TNF-blocker therapy, and new treatment strategies are being discussed about how to best reach remission and how to maintain remission. Other biologics besides TNF-blockers have been tested in AS but have so far failed. The IL-17/IL-23 cytokines currently seem to be the most interesting targets. Short-term TNF-blocker therapy does not inhibit radiographic progression but long-term might do so. NSAIDs have been proven to inhibit such progression, even after 2 years of treatment. The effect of a combined therapy of NSAIDs with TNF-blockers on the inhibition of new bone formation in AS patients is currently unknown.

  5. Danish recommendations on treatment of ankylosing spondylitis and spondyloarthritis based on multinational project initiative

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Madsen, Ole Rintek; Erlendsson, J.

    2008-01-01

    INTRODUCTION: The multinational initiative "3e Initiative in Rheumatology - Multi-national Recommendations for the Management of Ankylosing Spondylitis 2006-7" served the primary purpose of providing specific recommendations for the management of ankylosing spondylitis and spondyloarthritis...

  6. Undifferentiated spondyloarthritis following allogeneic stem cell transplantation

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    Espinoza Luis R

    2010-06-01

    Full Text Available Abstract Background Stem cell transplant has been utilized in the treatment of malignancies and rheumatic disease. Rheumatic disease may be transferred from the donor with active disease or may be developed in a recipient de novo as a late complication of SCT. Case Presentation We here report the rare case of a 26-year old male patient, who has been diagnosed with undifferentiated spondyloarthropathy after unique circumstance. The patient suffered from intermittent inflammatory back pain and peripheral joint swelling for several years and did not find relief through multiple emergency room visits at different medical facilities. After a thorough history and physical exam, it was noted that our patient had developed signs of axial disease along with dactylitis and overall that he had been insidiously developing an undifferentiated spondyloarthopathy after allogeneic stem cell transplantation. Conclusion Our observation supports the hypothesis that de novo rheumatic disease can develop after stem cell transplant for a variety of reasons. Thus, larger studies and awareness of this association are needed to delineate the exact underlying mechanism(s.

  7. STUDIES OF SPONDYLOARTHRITIS IN RUSSIA: FROM V.M. BEKHTEREV TO OUR DAYS

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    A. А. Godzenko

    2016-01-01

    Full Text Available The paper briefly describes the history of spondyloarthritis  studies from the works of the outstanding Russian neurologist V.M. Bekhterev up to the present time. Special emphasis is laid on the results of the representatives of the scientific school of Professor E.R. Agababova, an organizer of the first laboratory of spondyloarthritis  in Russia. The major areas of the investigations that are currently under way in Russia are shown.

  8. Safety of Etoricoxib, Celecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs in Ankylosing Spondylitis and Other Spondyloarthritis Patients

    DEFF Research Database (Denmark)

    Kristensen, L E; Jakobsen, A K; Askling, J

    2015-01-01

    OBJECTIVE: Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular, and cardio......OBJECTIVE: Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular...

  9. Light axial vector mesons

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    Chen, Kan; Liu, Xiang; Matsuki, Takayuki

    2015-01-01

    Inspired by the abundant experimental observation of axial vector states, we study whether the observed axial vector states can be categorized into the conventional axial vector meson family. In this paper we carry out analysis based on the mass spectra and two-body Okubo-Zweig-Iizuka-allowed decays. Besides testing the possible axial vector meson assignments, we also predict abundant information for their decays and the properties of some missing axial vector mesons, which are valuable to further experimental exploration of the observed and predicted axial vector mesons.

  10. MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

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    Stoll Matthew L

    2012-02-01

    Full Text Available Abstract Background Magnetic resonance enterography (MRE is an established tool to evaluate for changes associated with inflammatory bowel disease (IBD, but has not been studied in sub-clinical IBD. We sought to evaluate the use of MRE in children with spondyloarthritis (SpA, who are at risk of having sub-clinical gut inflammation. Methods Children with juvenile idiopathic arthritis (JIA with evidence of intestinal inflammation as evidence by an abnormal fecal calprotectin assay were offered MRE of their intestines. Flavored sports drink containing polyethylene glycol 3350 was used as oral contrast. Glucagon was used to arrest peristalsis. Patients were imaged in the prone position on a 1.5 T scanner. Heavily T2-weighted fat-suppressed coronal and axial images using breath-hold technique were obtained, followed by post-gadolinium fat-suppressed T1-weighted gradient echo images. Results We recruited five children with juvenile idiopathic arthritis (JIA; four had SpA, and one had poly-articular JIA. All five had evidence of intestinal inflammation based upon a positive fecal calprotectin assay and successfully completed the MRE. Three of the studies showed findings suggestive of IBD, including thickening and contrast uptake at the terminal ileum (TI in one child, contrast uptake of the distal ileum in another, and prominent vasa recta and mesenteric lymph nodes in the third. The child with evidence of inflammatory changes at the TI underwent colonoscopy, which revealed inflammatory bowel disease limited to the TI. Conclusions MRE can be used to evaluate for subclinical IBD in children with JIA. This protocol was safe and well-tolerated, and identified mild changes in three of the subjects.

  11. MODERN IDEA ON THE PATHOGENESIS OF SPONDYLOARTHRITIS: MOLECULAR MECHANISMS

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    E. L. Nasonov

    2015-01-01

    Full Text Available As of now, impaired immune homeostasis of the intestinal mucosa in genetically predisposed individuals is considered to be one of the major components in the pathogenesis of spondyloarthritis (SpA, which leads to systemic chronic inflammation. The results of recent studies may suggest that the interleukin-23/interleukin-17 (IL-23/IL-17 axis plays a leading role in the development of these diseases. The multifactorial components of the pathogenesis of SpA are characterized by not only the hyperproduction of IL-23, but also by the change in cell target susceptibility to this cytokine with aconcurrent increase in their number, resulting in the chronic autoinflammatory process that occurs via a wide spectrum of clinical manifestations of different types of SpA

  12. Role of stem cells in spondyloarthritis: Pathogenesis, treatment and complications.

    Science.gov (United States)

    Wong, Rebecca S Y

    2015-10-01

    Spondyloarthritis (SpA) is a family of interrelated inflammatory arthritis that includes ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, arthritis related to inflammatory bowel disease and undifferentiated SpA. The classification, epidemiology, pathogenesis and treatment of SpA have been extensively reviewed in the published literature. Reviews on the use of stem cells in various autoimmune diseases in general are also common. However, a review on the role of stem cells in SpA is currently lacking. This review focuses on the involvement of stem cells in the pathogenesis of SpA and the application of different types of stem cells in the treatment of SpA. It also addresses some of the complications which may arise as a result of the use of stem cells in the treatment of SpA.

  13. The -308 TNFα and the -174 IL-6 promoter polymorphisms associate with effective anti-TNFα treatment in seronegative spondyloarthritis.

    Science.gov (United States)

    Fabris, M; Quartuccio, L; Fabro, C; Sacco, S; Lombardi, S; Ramonda, R; Biasi, D; Punzi, D; Adami, S; Olivieri, I; Curcio, F; De Vita, S

    2016-06-01

    The genetic predisposition to a long-term efficacy of anti-tumor necrosis factor (TNF)α treatment in seronegative spondyloarthritis (SpA) was investigated by analysing the possible correlation between several single nucleotide gene polymorphisms and the retention rate of anti-TNFα therapies. We compared patients needing to switch the first anti-TNFα (Sw, No. 64) within at least 12 months of follow-up with patients not needing to switch (NSw, No. 123), observing at least 6 months of treatment to establish anti-TNFα failure, leading to treatment change. Response to treatment was evaluated by standardised criteria (BASDAI for axial involvement, DAS28-EULAR for peripheral involvement). The TNFα -308 A allele and the interleukin (IL)-6 -174GG homozygosis resulted as independent biomarkers predicting survival of the first anti-TNFα therapy in SpA patients (P=0.007, odds ratio (OR): 4.4, 95% confidence interval (CI)=1.5-13.1 and P=0.035, OR: 2.1, 95% CI=1.1-4.4). Also, the male gender (P=0.001, OR: 3.4, 95% CI=1.6-7.1) associated with the NSw phenotype, whereas no association was found either with the specific diagnosis or the predominant joint involvement.

  14. Demographic, clinical, laboratory and treatment characteristics of spondyloarthritis patients with and without acute anterior uveitis

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    Marcelo Gehlen

    Full Text Available CONTEXT AND OBJECTIVE: Acute anterior uveitis is a common extra-articular manifestation in spondyloarthritis patients. The aim of this study was to compare demographic, clinical, laboratory and treatment data among spondyloarthritis patients with and without acute anterior uveitis. DESIGN AND SETTING: This was a cross-sectional analytical study at the Rheumatology Outpatient Clinic of the Evangelical University Hospital, Curitiba, Brazil. METHODS: Spondyloarthritis patients with without acute anterior uveitis were compared regarding demographic data, spondyloarthritis subtype, peripheral arthritis, enthesitis, disease activity, functional index, physical examination, radiological involvement, HLA-B27 and treatment. RESULTS: Presence of acute anterior uveitis was not found to have any relationship with functional index, degree of radiological involvement, peripheral arthritis or enthesitis. Acute anterior uveitis showed a negative association with skin manifestations (P = 0.04 and a trend towards higher disease activity (P = 0.06. CONCLUSION: In the study sample, it could not be shown that AAU had any association with the functional and radiological prognoses. The patients with spondyloarthritis with and without acute anterior uveitis did not differ clinically except for a higher proportion of ankylosing spondylitis and smaller presence of skin involvement in those with uveitis.

  15. Early diagnosis of ankylosing spondylitis: assessment the criteria for axial spondyloarthritis, proposedby the International Working Group of the Assessment of SpondyloArthritis Society (ASAS

    Directory of Open Access Journals (Sweden)

    Anna Georgiyevna Bochkova

    2010-01-01

    Subjects and methods. The study enrolled patients aged 16 to 49 years who were consecutive visitors to the Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 2006-2008 for chronic (a history of at least 3 months, but not more than 3 years low back (LB and/or thoracic portion (TP pains without significant X-ray signs of sacroiliitis. In addition of pelvis X-ray study, goal-seeking collection of history data, and examination, sacroiliac joint (SJ magnetic resonance imaging (MRI (1,5 Tesla, Magnetom Symphony (Siemens was performed and HLA-B27 and erythrocyte sedimentation rate were determined in all the patients. X-ray and MRI of vertebral portions with pains being observed were, if needed, carried out. The diagnosis of axSPA was established in the detection of inflammatory LB and/or TP pains that met the criteria described by A. Calin et al., in the presence of MRI signs of sacroiliitis and/or spondylitis with no evidence for another interpretation of back pain. Pelvis X-ray films were assessed by two rheumatologists; MRI scans were estimated by a rheumatologist and a radiodiagnostician. The MRI diagnosis of sacroiliitis was made if there was one T2-FS medullary edema (ME area (on at least two consecutive slices or two areas or more (on at least one slice in the SJ subchondral or periarticular regions. The MRI diagnosis of spondylitis was established if there was one T2-FS ME area (on at least two consecutive slices or more (on at least one slice in the vertebral bodies or posterior vertebral structures. The ESSG criteria or the criteria proposed by B. Amor et al. were used for the diagnosis of undifferentiated SA. Results. Early axSPA was diagnosed in 39 patients (a study group. A control group consisted of other 39 patients with chronic LB and/or TP pain without MRI signs of sacroiliitis and spondylitis. The patients' median age in these groups was 25 and 23 years; the median duration of back pain was 12 and 20 months; HLA-B27 was detected in 94,9 and 43,6% of the patients, respectively. The sensitivity of the first variant of the ASAS criteria was 84,6% and its specificity was 100%. These of the second variant of the ASAS criteria were 94,9 and 84,7%, respectively. With the consecutive use of the first variant of the ASAS criteria for early SPA, then their second variant, their sensitivity was as high as 100%. LB pain only was observed in 76,9% of patients with axSPA, 20% of them having wandering pains in the buttocks. In the control patients, LB pain was also predominant (71,7%. The sensitivity and specificity of the criteria proposed by M. Rudwaleit et al. and the ASAS (J. Siper et al. were 89,7 and 85,7%; 89,7 and 100%, respectively. There were no statistical differences in the sensitivity of individual criteria. The specificity of the ASAS criteria was significantly higher than that of the criteria described by A. Calin (p=0,0000; double Fisher's test. Conclusion. With the consecutive use of the first variant of the ASAS criteria for early SPA, then their second variant, their sensitivity was as high as 100%. It is more preferential to use the criteria described by М. Rudwaleit et al. or the 2009 new criteria by the ASAS working group. The valuable symptom of inflammatory pain is wandering buttock pain, the specificity of which in patients with early axSPA was 100%.

  16. Validity of ankylosing spondylitis and undifferentiated spondyloarthritis diagnoses in the Swedish National Patient Register

    DEFF Research Database (Denmark)

    Lindström, U; Exarchou, S; Sigurdardottir, V

    2015-01-01

    OBJECTIVES: Epidemiological studies of spondyloarthritis (SpA), using ICD codes from the Swedish National Patient Register (NPR), offer unique possibilities but hinge upon an understanding of the validity of the codes. The aim of this study was to validate the ICD codes for ankylosing spondylitis...... (AS) and undifferentiated SpA (uSpA) in the NPR against the established classification criteria [modified New York (mNY), Assessment of SpondyloArthritis international Society (ASAS), Amor, and European Spondyloarthropathy Study Group (ESSG) criteria]. METHOD: All patients with an ICD-8/9/10 code...

  17. Baixa prevalência das manifestações extra-articulares renais, cardíacas, pulmonares e neurológicas nas espondiloartrites: análise do Registro Brasileiro de Espondiloartrites Low prevalence of renal, cardiac, pulmonary, and neurological extra-articular clinical manifestations in spondyloarthritis: analysis of the Brazilian Registry of Spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Carlos Ewerton Maia Rodrigues

    2012-06-01

    Full Text Available OBJETIVO: Descrever as manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas geralmente não relacionadas às espondiloartrites (EpA em uma grande coorte de pacientes brasileiros. MÉTODOS: Este estudo retrospectivo analisou 1.472 pacientes com o diagnóstico de EpA atendidos em 29 centros distribuídos pelas cinco principais regiões geográficas do Brasil, integrantes do Registro Brasileiro de Espondiloartrites. Todos os pacientes foram avaliados para a prevalência das principais manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas, divididas por diagnóstico [espondilite anquilosante (EA, artrite psoriásica (AP, artrite reativa (ARe, artrite associada a doença inflamatória intestinal (DII, EpA indiferenciada (EI e EpA juvenil] e por forma clínica (axial, periférica, mista e entesítica. RESULTADOS: Dentre os pacientes avaliados com EpA, 963 apresentavam EA, 271 AP, 49 ARe, 48 artrite associada a DII, 98 EI e 43 EpA juvenil. Acometimento cardíaco foi observado em 44 pacientes (3,0%, seguido por acometimento pulmonar em 19 (1,3%, renal em 17 (1,2% e neurológico em 13 pacientes (0,9%. A maioria dos casos de acometimento visceral ocorreu nos pacientes com EA ou AP e naqueles com forma clínica mista (axial e periférica e/ou predominantemente axial. CONCLUSÃO: As manifestações extra-articulares cardíacas, renais, pulmonares e neurológicas são muito pouco frequentes nas EpA, variando de 0,9%-3% nesta grande coorte brasileira, estando mais associadas a EA e AP.OBJECTIVE: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological, usually not related to spondyloarthritis (SpA, in a large cohort of Brazilian patients. MATERIALS AND METHODS: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian

  18. Mechanistic rationales for targeting interleukin-17A in spondyloarthritis.

    Science.gov (United States)

    Raychaudhuri, Siba P; Raychaudhuri, Smriti K

    2017-03-08

    The term spondyloarthritis (SpA) is used to describe a group of inflammatory autoimmune diseases, including ankylosing spondylitis and psoriatic arthritis, with common genetic risk factors and clinical features. SpA is clinically distinct from rheumatoid arthritis and typically affects the spine, sacroiliac joints, entheses, and, less commonly, peripheral joints. Although the pathogenesis of SpA is not fully understood, recent findings have identified the interleukin (IL)-17 pathway as a key mediator of disease pathogenesis. Clinical evidence for the efficacy of IL-17A inhibition by biologic agents was initially shown in patients with chronic plaque psoriasis, another autoimmune disease mediated by the IL-17 pathway. Subsequently, similar positive efficacy for inhibition of IL-17A was seen in patients with ankylosing spondylitis and psoriatic arthritis. Inhibition of IL-17A may also improve cardiovascular and metabolic comorbidities often found in patients with SpA because studies have linked these disorders to the IL-17 pathway. In this review, we will examine key preclinical studies that demonstrated the mechanistic role of IL-17A in the development SpA and discuss how these observations were translated into clinical practice.

  19. Spondyloarthritis: state of the art and future perspectives.

    Science.gov (United States)

    van der Heijde, Désirée; Maksymowych, Walter P

    2010-06-01

    Advances in the understanding of this group of arthritides over the past decade can be considered transformational from the perspective of basic mechanisms as well as clinical research focusing on the development of imaging technologies and a spectrum of standardised clinical outcomes that aim at a more comprehensive understanding of disease activity, functioning and disability, and prognosis. Prior to this decade, treatment was unsatisfactory and limited to physical modalities and non-steroidal anti-inflammatory agents, while diagnostic ascertainment primarily focused on clinical evaluation and plain radiography. Today, patients with spondyloarthritis (SpA) can look forward to earlier diagnosis and more effective treatment but significant challenges remain. This review will summarise the past decade's major accomplishments in the understanding of the basic mechanisms contributing to the development of SpA, outline those advances in clinical and imaging outcomes that have enabled major therapeutic advances and now permit a broader understanding of the early development of disease and its impact on patient well-being, and will describe new approaches to the development of diagnostic criteria that incorporate advances in imaging.

  20. Anti-TNFα agents and methotrexate in spondyloarthritis related uveitis in a Chinese population.

    Science.gov (United States)

    Lian, Fan; Zhou, Jun; Wei, Cui; Wang, Yu; Xu, Hanshi; Liang, Liuqin; Yang, Xiuyan

    2015-11-01

    This study seeks to evaluate the clinical characteristics of spondyloarthritis (SpA)-related uveitis in a cohort from South China and to assess the efficacy and safety of therapies based on TNF blockers. SpA patients with uveitis admitted to a south China hospital were enrolled. Demographic information, clinical characteristics, laboratory findings, intraocular inflammation, visual acuity, macular thickness, and treatments were documented. Of the 1,036 SpA patients reviewed, 182 had uveitis. Ankylosing spondylitis (AS) was the most common subtype. Unilateral uveitis was found in 51 cases (51/182, 28.0%), and unilateral alternating uveitis was found in 75 cases (75/182, 41.2%). Half of the cases were recurrent uveitis (52.2%), and acute onset was common (76.4%). The most serious complication was vision loss (0.5%). No significant difference in disease activity was found between the SpA patients with or without uveitis. Predominant improvements were found in cases treated with all three anti-TNFs (infliximab, adalimumab, and etanercept) and anti-TNFs plus methotrexate (MTX). Monotherapy of methotrexate was not adequate for inducing remission. Monotherapy of etanercept was not as effective as adalimumab and infliximab, mainly in the prevention of recurrence. No significant difference in effectiveness was found among the three anti-TNFs if MTX was added. Etanercept plus MTX were well tolerated. Infliximab and adalimumab were associated with more tuberculosis and/or hepatitis flares. Uveitis is common in SpA patients. Severe complications may develop in prolonged and intractable cases. Treatments based on anti-TNFs had good clinical response, and better safety documentation were observed in etanercept plus MTX compared to the other two anti-TNF monoclonal antibodies plus MTX.

  1. Education improves referral of patients suspected of having spondyloarthritis by general practitioners: a study with unannounced standardised patients in daily practice

    Science.gov (United States)

    van Onna, Marloes; Gorter, Simone; Maiburg, Bas; Waagenaar, Gerrie; van Tubergen, Astrid

    2015-01-01

    Objectives To evaluate the practice performance of general practitioners (GPs) and GP residents in recognising and referring patients suspected for having axial or peripheral spondyloarthritis (SpA), and to investigate the influence of education on this performance. Methods GP (residents) were visited in two rounds by standardised patients (SPs) simulating axial SpA, peripheral SpA or carpal tunnel syndrome (CTS) with in between an educational intervention on SpA for part of the participants. Participants were unaware of the nature of the medical problem and study purpose. CTS was included as diversionary tactic. The primary outcome was ≥40% improvement in (considering) referral of the SPs with SpA to the rheumatologist after education. Secondary outcomes included ordering additional diagnostic tests, correct recognition of SpA and identification of variables contributing to this. Results 68 participants (30 GPs and 38 GP residents) were included, of which 19 received education. The primary outcome was met. A significantly higher proportion of GP (residents) from the intervention group referred patients to the rheumatologist compared with the control group after education (change scores, axial SpA +71% vs +15% (p<0.01); peripheral SpA +48% vs 0% (p<0.001)). Participants who received education, more frequently correctly recognised SpA compared with controls (change scores, axial SpA +50% vs −5% (p<0.001); peripheral SpA +21% vs 0% (p=0.01). Conclusions Recognition and referral of patients suspected for having SpA by GP (residents) is low, but targeted education markedly improved this. This supports the development of educational initiatives to improve recognition of SpA and hence referral to a rheumatologist. PMID:26535152

  2. Undifferentiated seronegative spondyloarthritis with inflammatory bowel disease and a family history of psoriasis. Sicca syndrome

    OpenAIRE

    Norma Marigliano; Domenico Galasso

    2013-01-01

    Background: Seronegative spondyloarthritis is characterized by the presence of subcutaneous nodules, asymmetrical peripheral arthritis, sacroileitis with or without spondylitis, and rheumatoid-factor negativity. Other common clinical manifestations include oral ulcers, conjunctivitis, and cutaneous lesions such as psoriasis. Familial aggregation has also been described. According to the 1986 classification, corresponding clinical entities include ankylosing spondylitis, psoriatic arthritis, R...

  3. Acute Pancreatitis Occurring after Pamidronate Infusions in Two Patients with Spondyloarthritis

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    Éric Toussirot

    2013-01-01

    Full Text Available We report two cases of acute pancreatitis following the administration of pamidronate given as an anti-inflammatory agent for spondyloarthritis with a recurrence in one patient when the drug was reintroduced. The upper gastrointestinal toxicity of aminobisphosphonates is well known and this drug class could be added to the list of medications that are associated with the development of pancreatitis.

  4. Whole-body MRI of juvenile spondyloarthritis: protocols and pictorial review of characteristic patterns

    Energy Technology Data Exchange (ETDEWEB)

    Aquino, Michael R. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Tse, Shirley M.L.; Rachlis, Alisa C. [Hospital for Sick Children, Department of Rheumatology, Toronto (Canada); Gupta, Sumeet; Stimec, Jennifer [Hospital for Sick Children, Department of Radiology, Toronto (Canada)

    2015-05-01

    Spondyloarthritides are a group of inflammatory rheumatological diseases that cause arthritis with a predilection for spinal or sacroiliac involvement in addition to a high association with HLA-B27. Juvenile spondyloarthritis is distinct from adult spondyloarthritis and manifests more frequently as peripheral arthritis and enthesitis. Consequently juvenile spondyloarthritis is often referred to as enthesitis-related arthritis (ERA) subtype under the juvenile idiopathic arthritis (JIA) classification criteria. The American College of Rheumatology Treatment Recommendations for JIA, including ERA, are based on the following clinical parameters: current treatment, disease activity and the presence of poor prognostic features. The MRI features of juvenile spondyloarthritis include marrow edema, peri-enthesal soft-tissue swelling and edema, synovitis and joint or bursal fluid. Marrow edema is nonspecific and can be seen with other pathologies as well as in healthy subjects, and this is an important pitfall to consider. With further longitudinal study and validation, however, whole-body MRI with dedicated images of the more commonly affected areas such as the spine, sacroiliac joints, hips, knees, ankles and feet can serve as a more objective tool compared to clinical exam for early detection and monitoring of disease activity and ultimately direct therapeutic management. (orig.)

  5. Fears and beliefs in rheumatoid arthritis and spondyloarthritis: a qualitative study.

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    Francis Berenbaum

    Full Text Available To explore beliefs and apprehensions about disease and its treatment in patients with rheumatoid arthritis and spondyloarthritis.25 patients with rheumatoid arthritis and 25 with spondyloarthritis participated in semi-structured interviews about their disease and its treatment. The interviews were performed by trained interviewers in participants' homes. The interviews were recorded and the main themes identified by content analysis.Patients differentiated between the underlying cause of the disease, which was most frequently identified as a hereditary or individual predisposition. In patients with rheumatoid arthritis, the most frequently cited triggering factor for disease onset was a psychological factor or life-event, whereas patients with spondyloarthritis tended to focus more on an intrinsic vulnerability to disease. Stress and overexertion were considered important triggering factors for exacerbations, and relaxation techniques were frequently cited strategies to manage exacerbations. The unpredictability of the disease course was a common source of anxiety. Beliefs about the disease and apprehensions about the future tended to evolve over the course of the disease, as did treatment expectations.Patients with rheumatoid arthritis and spondyloarthritis hold a core set of beliefs and apprehensions that reflect their level of information about their disease and are not necessarily appropriate. The physician can initiate discussion of these beliefs in order to dispel misconceptions, align treatment expectations, provide reassurance to the patient and readjust disease management. Such a dialogue would help improve standards of care in these chronic and incapacitating diseases.

  6. The role of innate immune cells in tissue inflammation in spondyloarthritis

    NARCIS (Netherlands)

    Noordenbos, T.

    2017-01-01

    It is increasingly clear that the two most common forms of chronic inflammatory arthritis, rheumatoid arthritis and spondyloarthritis, have a distinct pathophysiology. Where failure of the acquired immune system is a major contributor for rheumatoid arthritis, this is not the case for spondyloarthri

  7. Increased Levels of IgG Antibodies against Human HSP60 in Patients with Spondyloarthritis

    DEFF Research Database (Denmark)

    Nielsen, Astrid Hjelholt; Carlsen, Thomas; Deleuran, Bent

    2013-01-01

    Introduction: Spondyloarthritis (SpA) comprises a heterogeneous group of inflammatory diseases, with strong association to human leukocyte antigen (HLA)-B27. SpA is suggested triggered by bacterial infection, and bacterial heat shock protein (HSP) seems to be a strong T cell antigen. Since...

  8. Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis

    Science.gov (United States)

    Cypers, H; Varkas, G; Beeckman, S; Debusschere, K; Vogl, T; Roth, J; Drennan, M B; Lavric, M; Foell, D; Cuvelier, C A; De Vos, M; Delanghe, J; Van den Bosch, F; Elewaut, D

    2016-01-01

    Introduction Microscopic bowel inflammation is present in up to 50% of patients with spondyloarthritis (SpA) and is associated with more severe disease. Currently no reliable biomarkers exist to identify patients at risk. Calprotectin is a sensitive marker of neutrophilic inflammation, measurable in serum and stool. Objectives To assess whether serum and faecal calprotectin in addition to C-reactive protein (CRP) can be used to identify patients with SpA at risk of microscopic bowel inflammation. Methods Serum calprotectin and CRP were measured in 125 patients with SpA. In 44 of these patients, faecal samples were available for calprotectin measurement. All 125 patients underwent an ileocolonoscopy to assess the presence of microscopic bowel inflammation. Results Microscopic bowel inflammation was present in 53 (42.4%) patients with SpA. Elevated serum calprotectin and CRP were independently associated with microscopic bowel inflammation. Faecal calprotectin was also significantly higher in patients with microscopic bowel inflammation. Patients with CRP and serum calprotectin elevated had a frequency of bowel inflammation of 64% vs 25% in patients with low levels of both. When either CRP or serum calprotectin was elevated, the risk was intermediate (40%) and measuring faecal calprotectin provided further differentiation. Hence we suggest a screening approach where initially serum calprotectin and CRP are assessed and, if necessary, faecal calprotectin. The model using this scenario provided an area under the ROC curve of 74.4% for detection of bowel inflammation. Conclusions Calprotectin measurements in stool and serum, in addition to CRP, may provide a promising strategy to identify patients with SpA at risk of bowel inflammation and could play a role in overall patient stratification. PMID:26698844

  9. Ankylosing spondylitis morbidity trends in Russia and Saturday spondyloarthritis schools

    Directory of Open Access Journals (Sweden)

    Shandor Fedorovich Erdes

    2013-01-01

    Full Text Available The countrywide detection and notification of ankylosing spondylitis (AS are not only late, but are frequently not even done not least due to the undertraining of physicians in this area. Objective: to define a role of special educational programs for physicians in improving the diagnosis and registration of AS on the basis of its morbidity analysis. Subjects and methods. Two levels of spondyloarthritis (SpA schools oriented to rheumatologists and other specialists were developed. Since late 2009, more than 40 schools have been arranged in different cities and towns of the country. The primary and overall morbidities of AS were studied using the data of the Ministry of Health of the Russian Federation from 2006 to 2011 inclusive: 2006-2008 were basic years (prior to SpA educational programs and 2009-2011 are educational years. Results. In the basic years, the overall and primary AS morbidities varied within ±10%. However, there was their growing tendency just in the first year of SpA schools (2009, which persisted in the following year (2010. By 2011, the total number of AS patients increased by 2.4 times as compared to 2008; the number of first diagnosed patients did by more than 4 times. Conclusion. In the past years, the primary and overall morbidity of AS rose drastically, which is likely to be associated with the improved diagnosis of the disease due to the optimization of a diagnostic process and to the introduction of new diagnostic and therapeutic techniques. Special SpA education programs implemented in different regions of the country, by attracting more physicians of various specialties, play a significant part in the introduction of early diagnosis of AS.

  10. Radiographic progression is associated with resolution of systemic inflammation in patients with axial spondylarthritis treated with tumor necrosis factor α inhibitors: A study of radiographic progression, inflammation on magnetic resonance imaging, and circulating biomarkers of inflammation

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Sørensen, Inge Juul; Lambert, Robert G W;

    2011-01-01

    metalloproteinase 3 [MMP-3], and cartilage oligomeric matrix protein [COMP]), and bone turnover (CTX-I and osteocalcin) to inflammation on magnetic resonance imaging (MRI) and radiographic progression in patients with axial spondylarthritis (SpA) beginning tumor necrosis factor a (TNFa) inhibitor therapy....

  11. Altered Axial Skeletal Development

    Science.gov (United States)

    The axial skeleton is routinely examined in standard developmental toxicity bioassays and has proven to be sensitive to a wide variety of chemical agents. Dysmorphogenesis in the skull, vertebral column and ribs has been described in both human populations and in laboratory anima...

  12. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Weber, Ulrich; Østergaard, Mikkel; Lambert, Robert G W

    2015-01-01

    . METHODS: Two independent cohorts A/B of 69/88 consecutive patients with back pain aged ≤50 years, with median symptom duration 1.3/10.0 years, were referred for suspected SpA (A) or acute anterior uveitis plus back pain (B). Patients were classified according to rheumatologist expert opinion based...

  13. Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort

    DEFF Research Database (Denmark)

    Sepriano, Alexandre; Landewé, Robert; van der Heijde, Désirée

    2016-01-01

    .0% and for the 'clinical arm'±'imaging arm' 96.0%, for the 'imaging arm only' 86.2% and for the 'imaging arm'+/-'clinical arm' 94.7%. A series of sensitivity analyses yielded similar results (range: 85.1-98.2%). CONCLUSIONS: The PPV of the axSpA and pSpA criteria to forecast an expert's diagnosis of 'SpA' after more than...

  14. Associations Between Spondyloarthritis Features and Magnetic Resonance Imaging Findings: A Cross-Sectional Analysis of 1,020 Patients With Persistent Low Back Pain

    DEFF Research Database (Denmark)

    Arnbak, Bodil; Grethe Jurik, Anne; Hørslev-Petersen, Kim

    2016-01-01

    OBJECTIVE: The Assessment of SpondyloArthritis international Society (ASAS) has previously published criteria for spondyloarthritis (SpA). In the Spines of Southern Denmark cohort, which included patients with persistent low back pain and an unknown proportion of patients with SpA, our objectives...

  15. Unsteady Flows in Axial Turbomachines

    Science.gov (United States)

    Marble, F. E.; Rannie, W. D.

    1957-01-01

    Of the various unsteady flows that occur in axial turbomachines certain asymmetric disturbances, of wave length large in comparison with blade spacing, have become understood to a certain extent. These disturbances divide themselves into two categories: self-induced oscillations and force disturbances. A special type of propagating stall appears as a self-induced disturbance; an asymmetric velocity profile introduced at the compressor inlet constitutes a forced disturbance. Both phenomena have been treated from a unified theoretical point of view in which the asymmetric disturbances are linearized and the blade characteristics are assumed quasi-steady. Experimental results are in essential agreement with this theory wherever the limitations of the theory are satisfied. For the self-induced disturbances and the more interesting examples of the forced disturbances, the dominant blade characteristic is the dependence of total pressure loss, rather than the turning angle, upon the local blade inlet angle.

  16. Seronegative spondyloarthritis and Darier’s disease: more than a casual association?

    Directory of Open Access Journals (Sweden)

    C. Cosso

    2013-05-01

    Full Text Available A 46-year old man, affected by Darier’s disease (DD, was seen because of right hand pain, later extended to shoulders and ankles. Physical examination showed swelling and tenderness of the wrist, metacarpophalangeal and metatarsophalangeal joints, of the right Achilles tendon’s enthesis and of the left knee, with psoriatic-like lesions of the scalp. A diagnosis of seronegative spondyloarthritis, supported by HLA-B27 positivity and by the magnetic resonance imaging fi nding of hand synovitis and unilateral sacro-iliitis, was made. The correlation between DD, spondyloarthritis and psoriasis has been already anecdotally reported. Further observations may clarify if this association is more than casual.

  17. Causality of Chlamydiae in Arthritis and Spondyloarthritis: a Plea for Increased Translational Research.

    Science.gov (United States)

    Zeidler, Henning; Hudson, Alan P

    2016-02-01

    Current molecular genetic understanding of the metabolically active persistent infection state of Chlamydia trachomatis and Chlamydia pneumoniae in the synovium in patients with arthritis and spondyloarthritis favors a causal relationship. Here, we examine how adequately the accepted criteria for that etiologic relationship are fulfilled, emphasizing the situation in which these microorganisms cannot be cultivated by standard or other means. We suggest that this unusual situation of causality by chlamydiae in rheumatic disease requires establishment of a consensus regarding microorganism-specific terminology as well as the development of new diagnostic and classification criteria. Recent studies demonstrate the value of molecular testing for diagnosis of reactive arthritis, undifferentiated spondyloarthritis, and undifferentiated arthritis caused by C. trachomatis and C. pneumoniae in clinical practice. Data regarding combination antibiotic therapy is consistent with the causative role of chlamydiae for these diseases. Observations of multiple intra-articular coinfections require more research to understand the implications and to respond to them.

  18. MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

    OpenAIRE

    Stoll Matthew L; Patel Ashish S; Punaro Marilynn; Dempsey-Robertson Molly

    2012-01-01

    Abstract Background Magnetic resonance enterography (MRE) is an established tool to evaluate for changes associated with inflammatory bowel disease (IBD), but has not been studied in sub-clinical IBD. We sought to evaluate the use of MRE in children with spondyloarthritis (SpA), who are at risk of having sub-clinical gut inflammation. Methods Children with juvenile idiopathic arthritis (JIA) with evidence of intestinal inflammation as evidence by an abnormal fecal calprotectin assay were offe...

  19. Spondylodiscitis as the only clinical manifestation of the onset of psoriatic spondyloarthritis

    Directory of Open Access Journals (Sweden)

    V. Bruzzese

    2011-06-01

    Full Text Available Psoriatic arthritis falls within the family of seronegative spondyloarthritis given that the involvement of the spine, whether in combination with peripheral arthritis or not, is one of the most common clinical fi ndings of the disease. Symptomatological polymorphism of the disease, however, still includes several clinical subsets ranging from peripheral arthritis, mono-, oligo- and polyarticular, to enthesitis and dactylitis, all the way to crippling arthritis. Despite the frequent

  20. Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in spondyloarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Jans, L.; Langenhove, C. van; Lambrecht, V.; Verstraete, K. [Ghent University Hospital, Department of Radiology and Medical Imaging, Gent (Belgium); Praet, L. van; Carron, P.; Elewaut, D.; Bosch, F.V. den [Ghent University Hospital, Department of Rheumatology, Gent (Belgium); Jaremko, J.L. [University of Alberta Hospital, Department of Radiology, Edmonton, Alberta (Canada)

    2014-04-15

    To determine the prevalence and diagnostic value of pelvic enthesitis on MRI of the sacroiliac (SI) joints in spondyloarthritis (SpA). A retrospective study in 444 patients aged 17-45 years old with MRI of the SI joints and with clinically suspected sacroiliitis was performed. Patients were classified as having SpA if they fulfilled the Assessment of Spondyloarthritis International Society (ASAS) criteria. Pelvic enthesitis on MRI was correlated with the final diagnosis. Sensitivity, specificity, positive and negative likelihood ratio (LR) and predictive values (PV) of pelvic enthesitis for the diagnosis of SpA were calculated. MRI showed pelvic enthesitis in 24.4 % of patients with SpA and in 7.1 % of patients without SpA. Presence of any enthesitis had sensitivity, specificity, LR+, LR-, PPV and NPV of 24.4 %, 92.9 %, 3.45, 0.81, 69.4 % and 65.2 % for the diagnosis of SpA, respectively. The most commonly affected entheses were the longitudinal ligament insertion (4.5 %), the retroarticular ligaments (4.1 %) and the pubic symphysis (4.1 %). The sites of enthesitis with the highest PPV for SpA were the iliac crest/wing (85.7 %) and the retroarticular ligaments (81.3 %). Nearly one fourth of SpA patients with suspected sacroiliitis showed pelvic enthesitis on MRI. Such pelvic enthesitis has a high specificity for the diagnosis of spondyloarthritis. (orig.)

  1. Progress in spondylarthritis immunopathogenesis of spondyloarthritis: which cells drive disease?

    OpenAIRE

    2009-01-01

    Spondyloarthritides, or SpA, form a cluster of chronic inflammatory diseases with the axial skeleton as the most typical disease localisation, although extra-articular manifestations such as intestinal inflammation may frequently occur during the course of the disease. This review summarises recent progress in our understanding of the immunopathogenesis of SpA with special emphasis on the cellular constituents considered to be responsible for the initiation and/or perpetuation of inflammation...

  2. Progression rate of ankylosing spondylitis in patients with undifferentiated spondyloarthritis

    Science.gov (United States)

    Xia, Qing; Fan, Dazhi; Yang, Xiao; Li, Xiaona; Zhang, Xu; Wang, Mengmeng; Xu, Shengqian; Pan, Faming

    2017-01-01

    Abstract Background: The idea that undifferentiated spondyloarthritis (uSpA) represents the early undifferentiated stage of ankylosing spondylitis (AS) and other well-defined SpA subtypes is well known. The gist of this study is to assess the rate estimate of patients with uSpA evolved to AS during long-term follow-up. Methods: A systematic search was implemented to identify pertinent articles. The primary outcome was the rate estimate that patients with uSpA fulfilling the diagnosis of AS according to the modified New York criteria during follow-up. The rate estimate and corresponding 95% confidence interval (95%CI) were pooled by the random-effects model in STATA 11.0 software. Meta-regression analyses were adopted to explore the sources of heterogeneity. The quality assessment was conducted by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Begg test and the Egger test were applied to assess publication bias. Results: Sixteen papers were finally included in this study after screening 1299 citations. The pooled rate of patients with uSpA progression to AS synthesized from the 16 papers was 0.323 (95%CI 0.257–0.389). Subgroup analysis based on the length of follow-up showed that the rate at the time-point of 5, 8, and 10 years follow-up was 0.220 (95%CI 0.110–0.330), 0.291 (95%CI 0.257–0.325), and 0.399 (95%CI 0.190–0.608), respectively; while the rate in Asia, Europe, and Latin America was 0.367 (95%CI 0.282–0.452), 0.228 (95%CI 0.066–0.390), and 0.269 (95%CI 0.209–0.329), respectively. Meta-regression analysis indicated that the length of follow-up alone accounts for 45.23% of the total heterogeneity. Nearly half of the papers scored fair quality and none publication bias was identified based on the Begg test and the Egger test. Further, line chart describes an obviously increased trend for the patients with uSpA fulfilling the diagnosis of AS over time. Conclusion: The

  3. Critical Axial Load

    Directory of Open Access Journals (Sweden)

    Walt Wells

    2008-01-01

    Full Text Available Our objective in this paper is to solve a second order differential equation for a long, simply supported column member subjected to a lateral axial load using Heun's numerical method. We will use the solution to find the critical load at which the column member will fail due to buckling. We will calculate this load using Euler's derived analytical approach for an exact solution, as well as Euler's Numerical Method. We will then compare the three calculated values to see how much they deviate from one another. During the critical load calculation, it will be necessary to calculate the moment of inertia for the column member.

  4. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score

    DEFF Research Database (Denmark)

    Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena

    2015-01-01

    OBJECTIVE: There is an unmet need for reliable assessment of structural progression in the sacroiliac joints (SIJ) of patients with spondyloarthritis (SpA), but radiography is unreliable and lacks responsiveness. We aimed to develop and validate a new scoring method for structural lesions based...... on magnetic resonance imaging (MRI), the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural Score (SSS). METHODS: The SSS method for assessment of structural lesions is based on T1-weighted spin echo MRI, validated lesion definitions, slice selection according to well-defined anatomical...

  5. Undifferentiated seronegative spondyloarthritis with inflammatory bowel disease and a family history of psoriasis. Sicca syndrome

    Directory of Open Access Journals (Sweden)

    Norma Marigliano

    2013-04-01

    Full Text Available Background: Seronegative spondyloarthritis is characterized by the presence of subcutaneous nodules, asymmetrical peripheral arthritis, sacroileitis with or without spondylitis, and rheumatoid-factor negativity. Other common clinical manifestations include oral ulcers, conjunctivitis, and cutaneous lesions such as psoriasis. Familial aggregation has also been described. According to the 1986 classification, corresponding clinical entities include ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, arthritis associated with inflammatory bowel disease (IBD, and undifferentiated spondyloarthritis. The disease is also frequently associated with the HLA B27 antigen. From the clinical point of view, there are often incomplete forms of spondyloarthritis, such as reactive arthritis triggered by asymptomatic infections, psoriatic arthritis without psoriasis itself, initial phases of specific forms of spondyloarthritis or the phase of ankylosing spondylitis characterized by sacroiliac lesions, and all forms that remain undifferentiated for long periods of time. Moreover, there are close relations between arthropathy and IBDs, such as Crohn’s disease, ulcerative colitis, and Whipple’s syndrome. Recently, microscopic inflammatory bowel lesions and psoriatic arthritis have been described. Case report: A 30-year-old man (HLA B27-negative who had been vaccinated against TBC and HBV presented with a 6-year history of recurrent episodes of predominantly left-sided sciatica. The pain was worse at night and during rest. He was suffering from bilateral sacroileitis without spondylitis. Three to five times a day, usually after eating, he passed watery feces containing mucous and small amounts of bright red blood. Colonoscopy revealed pancolitis with histological evidence of chronic inflammation interspersed with areas of acute inflammation, edema, hyperemia, and glandular distortion. One year later, the clinical manifestations and histological

  6. Successful infliximab therapy in a patient with comorbid spondyloarthritis, primary biliary cirrhosis and generalized morphea.

    Science.gov (United States)

    Resorlu, Hatice; Kılıc, Sevilay; Isık, Selda; Gokmen, Ferhat

    2017-02-23

    The patient in this report was diagnosed simultaneously with primary biliary cirrhosis (PBC), spondyloarthritis, and generalized morphea and was started on infliximab therapy. In addition to an improvement in clinical symptoms with this therapy, an improvement was also observed in laboratory parameters such as cholestatic enzymes, C-reactive protein, and erythrocyte sedimentation rate. Infliximab was well tolerated in this 56-year-old patient. However, further studies must be performed in order to clarify the therapeutic role of TNF-α blockers in, PBC and generalized morphea.

  7. Nefropatia por IgA nas espondiloartrites IgA nephropathy in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Daniela Castelo Azevedo

    2011-02-01

    Full Text Available Pacientes com espondiloartrites poderiam ser mais acometidos pela nefropatia por IgA do que a população geral, havendo, possivelmente, um mecanismo etiopatogênico comum. O seguinte artigo relaciona quatro casos que exemplificam essa possível associaçãoSpondyloarthritis patients can be more frequently affected by IgA nephropathy than the general population, and a common etiopathogenic mechanism can be involved. We report four cases that may exemplify that association

  8. Report from the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine organization 2012 workshop.

    Science.gov (United States)

    Bautista-Molano, Wilson; Toloza, Sergio; Gutiérrez, Marwin; Uribe, Carlos Vinicio Caballero; Pineda, Carlos; Londoño, John; Santos, Pedro; Jaimes, Diego; Diaz, Mario; Chalem, Phillipe; Villota, Orlando; Sierra, Rita; Puche, William; Salas, José; Yara, José; Hamilton, Gordon; Pardo, Carlos; Mercado, Beatriz; Valle-Oñate, Rafael

    2013-09-01

    The first annual meeting of the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine (LASSERIM) was held in Bogotá, Colombia, in September 2012 and was attended by key opinion leaders, researchers, and rheumatologists. The meeting included presentations and discussions from renowned speakers during 2 days and a coaching leadership exercise led by an expert in the field followed by an open forum. Two groups defined a priori discussed the establishment of a professional network and organization to be involved in the identification, assessment, and effective resolution of health care issues in Latin America.A broad spectrum of topics were discussed but focused on the following: pharmacoeconomics in general rheumatology, spondyloarthritis and chronic back pain, therapeutic interventions in rheumatoid arthritis, ultrasonography in spondyloarthritis, impact of social media in medicine and global trends in leadership, quality of life, and innovation. A special workshop on coaching in health care and coaching as a tool to implement LASSERIM goals was part of the 2-day conference.LASSERIM will be working in the future on education, research, and innovation in the field of rheumatology and immunology. A special focus will be on spondyloarthritis, by promoting research, open discussions, and by conducting carefully planned research studies to impact on the quality of life of patients and doctors from Latin American countries.

  9. Build Axial Gradient Field by Using Axial Magnetized Permanent Rings

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Axial magnetic field produced by an axial magnetized permanent ring was studied. For two permanent rings, if they are magnetized in the same directions, a nearly uniform axial field can be produced. If they are magnetized in opposite direction,an axial gradient magnetic field can be generated, with the field range changing from -B0 to B0. A permanent magnet with a high axial gradient field was fabricated, the measured results agree with the PANDIRA calculation very well. For wider usage,it is desirable for the field gradient to be changed. Some methods to produce the variable gradient field are presented. These kinds of axial gradient magnetic field can also be used as a beam focusing for linear accelerator if the periodic field can be produced along the beam trajectory. The axial magnetic field is something like a solenoid, large stray field will leak to the outside environment if no method is taken to control them. In this paper, one method is illustrated to shield off the outside leakage field.

  10. Dissipative Axial Inflation

    CERN Document Server

    Notari, Alessio

    2016-01-01

    We analyze in detail the background cosmological evolution of a scalar field coupled to a massless abelian gauge field through an axial term $\\frac{\\phi}{f_\\gamma} F \\tilde{F}$, such as in the case of an axion. Gauge fields in this case are known to experience tachyonic growth and therefore can backreact on the background as an effective dissipation into radiation energy density $\\rho_R$, which which can lead to inflation without the need of a flat potential. We analyze the system, for momenta $k$ smaller than the cutoff $f_\\gamma$, including numerically the backreaction. We consider the evolution from a given static initial condition and explicitly show that, if $f_\\gamma$ is smaller than the field excursion $\\phi_0$ by about a factor of at least ${\\cal O} (20)$, there is a friction effect which turns on before that the field can fall down and which can then lead to a very long stage of inflation with a generic potential. In addition we find superimposed oscillations, which would get imprinted on any kind of...

  11. Study of axial magnetic effect

    Energy Technology Data Exchange (ETDEWEB)

    Braguta, Victor [IHEP, Protvino, Moscow region, 142284 Russia ITEP, B. Cheremushkinskaya street 25, Moscow, 117218 (Russian Federation); School of Biomedicine, Far Eastern Federal University, Ajax 10 Building 25, Russian island, Vladivostok, 690922 (Russian Federation); Chernodub, M. N. [CNRS, Laboratoire de Mathématiques et Physique Théorique, Université François-Rabelais Tours, Fédération Denis Poisson, Parc de Grandmont, 37200 Tours, France Department of Physics and Astronomy, University of Gent, Krijgslaan 281, S9, B-9000 Gent (Belgium); School of Biomedicine, Far Eastern Federal University, Ajax 10 Building 25, Russian island, Vladivostok, 690922 (Russian Federation); Goy, V. A. [School of Natural Sciences, Far Eastern Federal University, Sukhanova street 8, Vladivostok, 690950 (Russian Federation); Landsteiner, K. [Instituto de Física Teórica UAM/CSIC, C/ Nicolás Cabrera 13-15, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid (Spain); Molochkov, A. V. [School of Biomedicine, Far Eastern Federal University, Ajax 10 Building 25, Russian island, Vladivostok, 690922 (Russian Federation); Ulybyshev, M. [ITEP, B. Cheremushkinskaya street 25, Moscow, 117218 Russia Institute for Theoretical Problems of Microphysics, Moscow State University, Moscow, 119899 (Russian Federation)

    2016-01-22

    The Axial Magnetic Effect manifests itself as an equilibrium energy flow of massless fermions induced by the axial (chiral) magnetic field. Here we study the Axial Magnetic Effect in the quenched SU(2) lattice gauge theory with massless overlap fermions at finite temperature. We numerically observe that in the low-temperature hadron phase the effect is absent due to the quark confinement. In the high-temperature deconfinement phase the energy flow is an increasing function of the temperature which reaches the predicted asymptotic T{sup 2} behavior at high temperatures. We find, however, that energy flow is about one order of magnitude lower compared to a theoretical prediction.

  12. Circulating levels of interleukin-6, vascular endothelial growth factor, YKL-40, matrix metalloproteinase-3, and total aggrecan in spondyloarthritis patients during 3 years of treatment with TNFα inhibitors

    DEFF Research Database (Denmark)

    Sørensen, Inge Juul; Ostergaard, Mikkel; Nielsen, Hans Jørgen;

    2010-01-01

    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......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......-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...

  13. Circulating levels of interleukin-6, vascular endothelial growth factor, YKL-40, matrix metalloproteinase-3, and total aggrecan in spondyloarthritis patients during 3 years of treatment with TNF alpha inhibitors

    DEFF Research Database (Denmark)

    Pedersen, S.J.; Hetland, M.L.; Sørensen, Inge Juul;

    2010-01-01

    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 (TNF alpha) 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 TNF alpha inhibitor therapy (infliximab, n = 38......Euro parts per thousand 0.001), whereas total aggrecan was lower (662 mu g/l (223-2,219) vs. 816 (399-2,190),p a parts per thousand currency signaEuro parts per thousand 0.001). Two weeks after first treatment, all biomarker levels changed towards normal levels (p a parts per thousand currency signa...

  14. Dissipative axial inflation

    Science.gov (United States)

    Notari, Alessio; Tywoniuk, Konrad

    2016-12-01

    We analyze in detail the background cosmological evolution of a scalar field coupled to a massless abelian gauge field through an axial term phi/fγ F ~F, such as in the case of an axion. Gauge fields in this case are known to experience tachyonic growth and therefore can backreact on the background as an effective dissipation into radiation energy density ρR, which can lead to inflation without the need of a flat potential. We analyze the system, for momenta k smaller than the cutoff fγ, including the backreaction numerically. We consider the evolution from a given static initial condition and explicitly show that, if fγ is smaller than the field excursion phi0 by about a factor of at least Script O (20), there is a friction effect which turns on before the field can fall down and which can then lead to a very long stage of inflation with a generic potential. In addition we find superimposed oscillations, which would get imprinted on any kind of perturbations, scalars and tensors. Such oscillations have a period of 4-5 efolds and an amplitude which is typically less than a few percent and decreases linearly with fγ. We also stress that the curvature perturbation on uniform density slices should be sensitive to slow-roll parameters related to ρR rather than dot phi2/2 and we discuss the existence of friction terms acting on the perturbations, although we postpone a calculation of the power spectrum and of non-gaussianity to future work and we simply define and compute suitable slow roll parameters. Finally we stress that this scenario may be realized in the axion case, if the coupling 1/fγ to U(1) (photons) is much larger than the coupling 1/fG to non-abelian gauge fields (gluons), since the latter sets the range of the potential and therefore the maximal allowed phi0~ fG.

  15. Selected issues in diagnostic imaging of spondyloarthritides: psoriatic arthritis and juvenile spondyloarthritis.

    Science.gov (United States)

    Sudoł-Szopińska, Iwona; Płaza, Mateusz; Pracoń, Grzegorz

    2016-01-01

    Spondyloarthritides (also known as spondyloarthropathies) are a group of rheumatic diseases that consists of diversified entities, i.e. ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis in the course of Crohn's disease and ulcerative colitis, and juvenile spondyloarthropathies. In the diagnostics of spondyloarthritides, plain radiography has played a crucial role for years due to its undisputed ability to show distinctive bony changes. Yet as those diseases often manifest themselves by soft tissue pathology and bone marrow inflammation, ultrasonography and magnetic resonance imaging are currently a subject of numerous studies in the quest for setting up diagnostic criteria, especially at early stages of inflammatory processes. In our review, we present an up-to-date insight into classifications, etiopathogenesis and imaging of psoriatic arthritis and juvenile spondyloarthritis.

  16. Efficacy of antibiotic therapy in urogenous reactive arthritis and peripheral variant of ankylosing spondyloarthritis

    Directory of Open Access Journals (Sweden)

    M M Urumova

    2003-01-01

    Full Text Available Objective. To study efficacy of antibiotics from two different groups - asitromycin/sumamed (macrolid and lomefloxacine/maxaquine (ftorquinolone in urogenous rheactive arthritis (URA and peripheral variant of ankylosing spondyloarthritis (PVAS with signs of urogenital Chlamidia inflammation. Material and methods. 86 pts were examined: 51 with URA (including Reiter’s disease - RD and 35 with PVAS. Diagnoses of URA, RD and PVAS were definite in all pts. 43 pts received sumamed in total dose of I5g, 43 - maxaquinum - 24g total. Treatment efficacy was assessed according to clinical and laboratory indices changes immediately after the end of treatment and then in 1 and 3 months. Results. Similar significant decrease of swollen and tender joint counf as well as laboratory activity indices accompanied by disappearance of urogenital inflammation signs was seen in URA and PVAS. Conclusion. Antibiotics administration for chlamidiosis is indicated in all cases of URA and PVAS with urogenital inflammation signs.

  17. Selected issues in diagnostic imaging of spondyloarthritides: psoriatic arthritis and juvenile spondyloarthritis

    Science.gov (United States)

    Płaza, Mateusz; Pracoń, Grzegorz

    2016-01-01

    Spondyloarthritides (also known as spondyloarthropathies) are a group of rheumatic diseases that consists of diversified entities, i.e. ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis in the course of Crohn’s disease and ulcerative colitis, and juvenile spondyloarthropathies. In the diagnostics of spondyloarthritides, plain radiography has played a crucial role for years due to its undisputed ability to show distinctive bony changes. Yet as those diseases often manifest themselves by soft tissue pathology and bone marrow inflammation, ultrasonography and magnetic resonance imaging are currently a subject of numerous studies in the quest for setting up diagnostic criteria, especially at early stages of inflammatory processes. In our review, we present an up-to-date insight into classifications, etiopathogenesis and imaging of psoriatic arthritis and juvenile spondyloarthritis. PMID:28115782

  18. Evoluation of the criteria for spondyloarthritis%脊柱关节炎分类标准的演变

    Institute of Scientific and Technical Information of China (English)

    杨金水; 张江林

    2014-01-01

    Spondyloarthritis is a group of interrelated diseases, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter’s syndrome, inlfammatory bowel disease arthritis, juvenile onset spondyloarthropathy and unclassified spondyloarthropathies. Ankylosing spondylitis is the original type of such diseases. They have something in common, such as family history, HLA-B27 related, clinical manifestations, sacroiliac joint, enthesis and ligament involved and so on. Although the pathogenesis of the disease is not yet clear, its criteria is gradually updated with the deepening of research on the disease. From Rome criteria to New York criteria for ankylosing spondylitis,we become more objective. From Amor and ESSG criteria to ASAS criteria for spondyloarthritis,we are more inclined to the early diagnosis and treatment of the disease to improve the prognosis. This paper reviews the evolution of criteria to analyze the discovery, awareness and research of the disease for early control and the improvement of the prognosis.

  19. Anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction injury: anatomic study%颈椎前路钢板并轴向螺钉固定治疗屈曲牵张型损伤的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    瞿东滨; 邹琳; 杨勇; 徐准; 程勇泉

    2012-01-01

    Objective To study the anatomical flexibility of anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction. Methods Fifty cases of digital lateral X-ray films from adult healthy volunteers aged 24-48 years, with mean 28 years, were measured directly in the JW-PACS picture system. Measuring parameters included vertebral body height, intervertebral disc height and disc depth. The line started from anteroinferior point of the inferior vertebrae to posterosuperior point of the superior vertebrae was drawn to mimic the axial screw fixation in the lateral film. The maximal screw length, screw cephalic inclination angle and the distance between screw and anterior vertebral margin at disc level was recorded. Simulated anterior cervical plating and axial screw fixation was carried out in one preserved human specimen under the guidance of C-arm X-ray fluoroscope. Results The maximal length of anterior cervical axial screw was (41.18+3.92 )mm, and the axial screw inclination angle (25.21±3.58)°. The suitable depth of interbody graft was more than (11.69±1.63)mm, but less than (17.09±1.50)mm of disc depth. Simulated procedure in the preserved specimen demonstrated that axial screw fixation could be successfully completed at C2/3, C3/4, C4/5, and C5/6 levels, but difficult be performed at C6/7 due to obstacle of sternum. Conclusions The flexibility of axial screw fixation plus anterior cervical plating is confirmed from this study for managing of cervical flexion-distraction injuries.%目的 提出一种联合颈椎前路钢板固定治疗屈曲牵张型颈椎损伤的新术式—颈椎轴向螺钉固定术,进行解剖学可行性研究.方法 随机调取50例正常成年志愿者的颈椎侧位片.年龄22~48岁,平均28岁.通过JW-PACS图像系统,测量C2~6椎体高度;C2/3~C5/6椎间盘高度以及椎间盘矢径;并模拟轴向螺钉固定,即下位椎体前下缘至上位椎体后上缘的连线,测量轴向螺钉最大

  20. Aberrant expression of shared master-key genes contributes to the immunopathogenesis in patients with juvenile spondyloarthritis.

    Directory of Open Access Journals (Sweden)

    Lovro Lamot

    Full Text Available Association of juvenile spondyloarthritis (jSpA with the HLA-B27 genotype is well established, but there is little knowledge of other genetic factors with a role in the development of the disease. To date, only a few studies have tried to find those associated genes by obtaining expression profiles, but with inconsistent results due to various patient selection criteria and methodology. The aim of the present study was to identify and confirm gene signatures and novel biomarkers in highly homogeneous cohorts of untreated and treated patients diagnosed with jSpA and other forms of juvenile idiopathic arthritis (JIA according to ILAR criteria. For the purposes of the research, total RNA was isolated from whole blood of 45 children with jSpA and known HLA genotype, 11 children with oligo- and polyarticular forms of JIA, as well as 12 age and sex matched control participants without diagnosis of inflammatory disease. DNA microarray gene expression was performed in 11 patients with jSpA and in four healthy controls, along with bioinformatical analysis of retrieved data. Carefully selected differentially expressed genes where analyzed by qRT-PCR in all participants of the study. Microarray results and bioinformatical analysis revealed 745 differentially expressed genes involved in various inflammatory processes, while qRT-PCR analysis of selected genes confirmed data universality and specificity of expression profiles in jSpA patients. The present study indicates that jSpA could be a polygenic disease with a possible malfunction in antigen recognition and activation of immunological response, migration of inflammatory cells and regulation of the immune system. Among genes involved in these processes TLR4, NLRP3, CXCR4 and PTPN12 showed almost consistent expression in study patients diagnosed with jSpA. Those genes and their products could therefore potentially be used as novel biomarkers, possibly predictive of disease prognosis and response to

  1. Influence of Immunogenicity on the Efficacy of Long-Term Treatment with TNF α Blockers in Rheumatoid Arthritis and Spondyloarthritis Patients

    Directory of Open Access Journals (Sweden)

    Inesa Arstikyte

    2015-01-01

    Full Text Available Objective. To analyze the clinical relevance of the levels of TNFα blockers and anti-drug antibodies (anti-drug Ab in patients with rheumatoid arthritis (RA and spondyloarthritis (SpA treated with adalimumab (ADA, etanercept (ETA, or infliximab (INF for a prolonged period of time. Methods. Clinical characteristics (disease activity, and adverse events, serum TNFα blockers, and anti-drug Ab levels were evaluated in 62 RA and 81 SpA patients treated with TNFα blockers for a median of 28 months. Results. Anti-ADA Ab were detected in 1 (4.0% and anti-INF Ab in 14 out of 57 (24.6% RA and SpA patients. Patient with anti-ADA Ab and 57.1% patients with anti-INF Ab were considered nonresponders to treatment. Anti-ETA Ab were not found in any of 61 ETA treated patients. Anti-ADA and anti-INF Ab levels differ between responders and nonresponders (P>0.05. Three (5.3% patients with high serum anti-INF Ab levels developed infusion related reactions. Patients with anti-INF Ab more often required changing to another biologic drug (OR 11.43 (95% CI 1.08–120.93 and treatment discontinuation (OR 9.28 (95% CI 1.64–52.52. Conclusion. Patients not responding to treatment had higher serum anti-ADA and anti-INF Ab concentrations. Anti-INF Ab formation is related to increased risk of infusion related reactions, changing to another biologic drug, and treatment discontinuation.

  2. Axial Current and Noether Charge

    CERN Document Server

    Mahato, Prasanta

    2012-01-01

    A decade ago, a Lagrangian density has been proposed by the author where only the local symmetries of the Lorentz subgroup of (A)ds group is retained. This formalism has been found to produce some results encompassing that of standard Einstein-Hilbert formalism. In the present article, the conserved axial vector matter currents, constructed in some earlier paper, have been found to be a result of Noether's theorem. PACS: 04.20.Fy, 04.20.Cv, 11.40.-q Keywords: Torsion, Axial Current, Noether's Theorem

  3. Relativistic RPA in axial symmetry

    CERN Document Server

    Arteaga, D Pena; 10.1103/PhysRevC.77.034317

    2009-01-01

    Covariant density functional theory, in the framework of self-consistent Relativistic Mean Field (RMF) and Relativistic Random Phase approximation (RPA), is for the first time applied to axially deformed nuclei. The fully self-consistent RMF+RRPA equations are posed for the case of axial symmetry and non-linear energy functionals, and solved with the help of a new parallel code. Formal properties of RPA theory are studied and special care is taken in order to validate the proper decoupling of spurious modes and their influence on the physical response. Sample applications to the magnetic and electric dipole transitions in $^{20}$Ne are presented and analyzed.

  4. Axial structure of the nucleon

    Energy Technology Data Exchange (ETDEWEB)

    Veronique Bernard; Latifa Elouadrhiri; Ulf-G Meissner

    2002-01-01

    We review the current status of experimental and theoretical understanding of the axial nucleon structure at low and moderate energies. Topics considered include (quasi)elastic (anti)neutrino-nucleon scattering, charged pion electroproduction off nucleons and ordinary as well as radiative muon capture on the proton.

  5. Thermophoresis of Axially Symmetric Bodies

    Science.gov (United States)

    2007-11-02

    Sweden Abstract. Thermophoresis of axially symmetric bodies is investigated to first order in the Knudsen-mimber, Kn. The study is made in the limit...derived. Asymptotic solutions are studied. INTRODUCTION Thermophoresis as a phenomenon has been known for a long time, and several authors have approached

  6. Optimization of axial blowers. Optimierung von Axial-Ventilatoren

    Energy Technology Data Exchange (ETDEWEB)

    Bolte, W.

    1992-08-01

    For the optimum possible design of axial blowers, trials are evaluated in the article, which are based on the grid profile examined by N. Scholz. The computation for the pressure number and the primary degree of efficiency are shown as well as the evaluation of the effect of the Reynolds and mach number on the degree of efficiency and determination of the secondary losses. In a final example, the dimensions of a blower are computed from the data determined during the trials. (orig.).

  7. View of the Axial Field Spectrometer

    CERN Multimedia

    1980-01-01

    The Axial Field Spectrometer, with the vertical uranium/scintillator calorimeter and the central drift chamber retracted for service. One coil of the Open Axial Field Magnet is just visible to the right.

  8. Development and validation of an MRI reference criterion for defining a positive SIJ MRI in spondyloarthritis

    DEFF Research Database (Denmark)

    Weber, Ulrich; Zubler, Veronika; Pedersen, Susanne J

    2012-01-01

    OBJECTIVE: To validate an MRI reference criterion for a positive SIJ MRI based on the level of confidence in classification of spondyloarthritis (SpA) by expert MRI readers. METHODS: Four readers assessed SIJ MRI in two inception cohorts (A/B) of 157 consecutive back pain patients ≤50 years...... (0=definitely not; 10=definite). The MRI reference criterion was pre-specified as the majority of readers recording a confidence of 8-10; absence of SpA required all readers to record Non-SpA (confidence 0-4). We calculated inter-reader reliability and agreement between MRI-based and clinical...... classification using kappa statistics. We estimated cut-off values for MRI lesions attaining specificity `0.90 for SpA. RESULTS: 76.4%/71.6% of subjects in cohorts A/B met the MRI criterion. Kappa values for inter-reader agreement were 0.76/0.80, and between MRI-based and clinical assessment 0.93/0.57. Using...

  9. Interobserver Agreement in Magnetic Resonance of the Sacroiliac Joints in Patients with Spondyloarthritis

    Science.gov (United States)

    Arias-Correal, Sofia; Vasquez, Andres Y.; Calvo, Enrique; Peña, Paola; Porras, Marlon; Angarita, Jose-Ignacio; Saldarriaga, Eugenia-Lucia; Santos, Ana M.

    2017-01-01

    Background. Clinical, laboratory, and radiologic parameters are used for diagnosis and classification of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is being increasingly used to detect early sacroiliitis. We decided to evaluate the interobserver agreement in MRI findings of SI joints of SpA patients between a local radiologist, a rheumatologist, and an expert radiologist in musculoskeletal diseases. Methods. 66 MRI images of the SI joints of patients with established diagnosis of SpA were evaluated. Agreement was expressed in Cohen's kappa. Results. Interobserver agreement between a local radiologist and an expert radiologist was fair (κ = 0.37). Only acute findings showed a moderate agreement (κ = 0.45), while chronic findings revealed 76.5% of disagreement (κ = 0.31). A fair agreement was observed in acute findings (κ = 0.38) as well as chronic findings (κ = 0.38) between a local radiologist and a rheumatologist. There was a substantial agreement between an expert radiologist and a rheumatologist (κ = 0.73). In acute findings, a 100% agreement was achieved. Also chronic and acute plus chronic findings showed high levels of agreement (κ = 0.73 and 0.62, resp.). Conclusions. Our study shows that rheumatologists may have similar MRI interpretations of SI joints in SpA patients as an expert radiologist. PMID:28286523

  10. Enthesitis of lumbar spinal ligaments in clinically suspected spondyloarthritis: value of gadolinium-enhanced MR images in comparison to STIR

    Energy Technology Data Exchange (ETDEWEB)

    Agten, Christoph A.; Zubler, Veronika; Rosskopf, Andrea B.; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Weiss, Bettina [Balgrist University Hospital, Rheumatology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2016-02-15

    To compare detection of spinal ligament enthesitis between gadolinium-enhanced fat-saturated T1-weighted gadolinium-enhanced fat-saturated T1-weighted (T1+Gd) and STIR sequences in patients with suspected spondyloarthritis. Sixty-eight patients (37 males, 42 ± 14 years) with a sacroiliac-joint (SIJ) and lumbar spine MRI for suspected spondyloarthritis were prospectively included. Sagittal T1+Gd and STIR images of the lumbar spine were assessed by two readers for enthesitis of interspinous/supraspinous ligaments, and for capsulitis of facet-joints between T12-S1. Patients' MRI were grouped according to ASAS (Assessment of SpondyloArthritis international Society) criteria in positive (group A) or negative (group B) SIJs. Enthesitis/capsulitis were compared between groups. Interreader agreement was assessed. Enthesitis/capsulitis per patient was statistically significantly more frequent with T1+Gd compared to STIR (p ≤ 0.007), except for interspinous ligaments for reader 1 (p = 0.455). Interspinous enthesitis, supraspinous enthesitis, and capsulitis were present with T1+Gd(STIR) in 64.7 %(72.1 %), 60.3 %(17.7 %), and 61.8 %(29.4 %) for reader 1, and 51.5 %(41.2 %), 45.6 %(7.4 %), and 91.2 %(45.5 %) for reader 2. There were 76.5 %(52/68) patients in group A and 23.5 %(16/68) in group B. Total number of enthesitis/capsulitis on T1+Gd was statistically significantly higher in group A than B (4.96 vs. 2.94, p = 0.026; 8.12 vs. 5.25, p = 0.041 for reader 1 and 2, respectively). Interreader agreement showed mixed results for interspinous/supraspinous/capsulitis but was higher on T1+Gd (ICC = 0.838/0.783/0.367; p ≤ 0.001) compared to STIR (ICC = 0.652/0.298/0.224; p ≤ 0.032). In patients with suspected spondyloarthritis, enthesitis/capsulitis in the lumbar spine are common findings and more frequently/reliably detected with T1+Gd than STIR. In patients with positive SIJ-MRI, the total number of enthesitis/capsulitis in T1+Gd was higher compared to patients with

  11. Clinical evaluation of FW-Ⅱ axial blood pump short-term assistance for treating acute left heart failure%FW-Ⅱ轴流泵短期辅助治疗急性左心衰初步临床评价

    Institute of Scientific and Technical Information of China (English)

    胡盛寿; 孙寒松; 李立环; 陈祖君; 石丽; 张岩; 陈海波

    2014-01-01

    目的 初步评价FW-Ⅱ轴流泵短期辅助治疗急性左心衰的安全性和有效性.方法 选择术后撤除体外循环困难的重症冠状动脉硬化性心脏病(冠心病)患者5例,经左心房牛颈静脉-肝素涂层管道-FW-Ⅱ轴流泵-肝素涂层管道-股动脉循环支持和卸负荷,观察围手术期血流动力学和心肌损伤标记物,对比分析不同转速下血浆vW因子含量和白细胞-血小板聚集体的表达.结果 FW-Ⅱ轴流泵辅助(24.0±2.6)h,最高流量3.2 L/min,辅助期间泵转速7 000~9000 r/min,流量1.9~3.0 L/min,均无机械故障发生.1例患者术后第7天死于多器官功能衰竭,其余4例均顺利出院,近期随访结果良好.置入FW-Ⅱ轴流泵前平均动脉压(MAP)为(50.29±6.98) mmHg(1 mmHg=0.133 kPa),心脏指数(CI)为(1.70±0.23) L·min-1 ·m-2,全身外周血管阻力(SVR)为(2009.86±129.46) dyn·s·cm-5;置入后8 000 r/min时MAP (65.43±6.90) mmHg,CI(2.53 ±0.27)L·min-1·m-2,SVR(1 578.14±356.70)dyn·s·cm-5,其中MAP和CI显著增加,SVR显著下降,P<0.01,差异均有统计学意义.置入前外周血中肌酸激酶同功酶(CK-MB)和肌钙蛋白Ⅰ(cTnI)含量为(147±20) IU/L和(12.6±5.7)μg/L,置入后12h时CK-MB和cTnI水平降至(66±11) IU/L和(8.4±3.8) μg/L,差异均有统计学意义,P<0.01.同7 000 r/min比较,vW因子含量在8 500 r/min时显著增加[(2.59 ±0.57) U/L对(1.26±0.43) U/L,P<0.01];血小板活化和白细胞-血小板聚集体数变化呈V形变化,其中8000 r/min时最低(15±3)%,7 000 r/min和9000 r/min时达最高值(33±3)%和(31±5)%.结论 FW-Ⅱ轴流泵短期辅助可有效促进急性左心衰后心脏功能复苏,8 000 r/min是最佳平衡转速.%Objective To evaluate the safety and efficacy of FW-Ⅱ axial blood pump short term assistance for treating acute heart failure.Methods We selected 5 patients who were difficult to remove cardiopulmonary bypass,and implanted FW-Ⅱ axial blood pump by left atrium-pump-femoral artery

  12. Comparison of performance of the Assessment of SpondyloArthritis International Society, the European Spondyloarthropathy Study Group and the modified New York criteria in a cohort of Chinese patients with spondyloarthritis.

    Science.gov (United States)

    Chung, Ho Yin; Lau, Chak Sing; Wu, Ka Pik; Wong, Woon Sing; MOK, Mo Yin

    2011-07-01

    Early diagnosis of spondyloarthritis (SpA) is essential as anti-tumor necrosis factor therapy can achieve significant symptomatic relief and control of disease activity. This study aims to compare the clinical characteristics, disease activity, and functional status of a Chinese cohort of SpA patients who were re-classified into ankylosing spondylitis (AS) patients fulfilling the modified New York (MNY) criteria, those with undifferentiated SpA (USpA) fulfilling the European Spondyloarthropathy Study Group (ESSG) classification criteria only (USpA/ESSG) and those who fulfill Assessment of SpondyloArthritis International Society (ASAS) only (USpA/ASAS). Disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), severity of morning stiffness, patient global assessment, and C-reactive protein. Functional status was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI), modified Schober index, and dimension of chest expansion. One hundred and twenty-eight patients with disease duration of 16.3 ± 10.4 years were recruited. Patients in USpA/ESSG and USpA/ASAS were significantly younger (p = 0.01), had shorter disease duration (p 3. BASFI correlated inversely with dimension of chest expansion and negatively modified Schober index in AS patients (p expansion or modified Schober index. Compared with established AS patients recognized by MNY criteria, patients fulfilling USpA defined by ESSG or ASAS criteria had earlier disease, as active disease and less irreversible functional deficit.

  13. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

    DEFF Research Database (Denmark)

    Rudwaleit, M; Jurik, A G; Hermann, K-G A

    2009-01-01

    be detected by MRI. At present, however, the exact place of structural damage lesions for diagnosis and classification is less clear, particularly if these findings are minor. The ASAS group formally approved these proposals by voting at the annual assembly. CONCLUSIONS: For the first time, MRI findings...

  14. Axial Vector $Z'$ and Anomaly Cancellation

    CERN Document Server

    Ismail, Ahmed; Tsao, Kuo-Hsing; Unwin, James

    2016-01-01

    Whilst the prospect of new $Z'$ gauge bosons with only axial couplings to the Standard Model (SM) fermions is widely discussed, examples of anomaly-free renormalisable models are lacking in the literature. We look to remedy this by constructing several motivated examples. Specifically, we consider axial vectors which couple universally to all SM fermions, as well as those which are generation-specific, leptophilic, and leptophobic. Anomaly cancellation typically requires the presence of new coloured and charged chiral fermions, and we argue that the masses of these new states must generally be comparable to that of the axial vector. Finally, an axial vector mediator could provide a portal between SM and hidden sector states, and we also consider the possibility that the axial vector couples to dark matter. If the dark matter relic density is set due to freeze-out via the axial vector, this strongly constrains the parameter space.

  15. Diabetes mellitus and the eye: axial length

    OpenAIRE

    Huntjens, B.; O’Donnell, C.

    2006-01-01

    Background and aims: The refractive error of the eye is dependent on its axial length. Refractive error is known to fluctuate significantly in poorly controlled diabetic patients. Recently it has been reported that human eyes fluctuate in axial length during the day. However, this change is not detectable in all subjects, suggesting physiological influences such as diet. The purpose of this study was to investigate fluctuations in axial length and blood glucose levels (BGLs) in diabetic patie...

  16. The Bench-to-Bedside Story of IL-17 and the Therapeutic Efficacy of its Targeting in Spondyloarthritis.

    Science.gov (United States)

    Smith, Judith A

    2016-06-01

    TNF-blocking biologics have revolutionized the care of patients with spondyloarthritis, a group of clinically overlapping conditions that includes ankylosing spondylitis and psoriatic arthritis. However, incomplete response rates speak to the need for alternative therapeutic approaches. Over the last decade, animal models, genetics, and translational studies have implicated the excessive production of a pro-inflammatory cytokine interleukin-17 (IL-17) along with another IL-17-promoting cytokine IL-23 in the pathogenesis of spondyloarthritis. Genome-wide studies identified disease associations with multiple genes regulating IL-23/IL-17 immune pathway activity. Direct examination of the patient blood and tissues revealed excessive IL-17 and IL-23 production by diverse cell types. Murine models both underscored the sufficiency of excess IL-23 in driving disease phenotype and predicted utility in IL-23/IL-17 pathway blockade. However, the clinical efficacy of agents such as secukinumab and ustekinumab, which block IL-17 and IL-23/IL-12 respectively, provided exciting proof of concept.

  17. Course of Magnetic Resonance Imaging-Detected Inflammation and Structural Lesions in the Sacroiliac Joints of Patients in the Randomized, Double-Blind, Placebo-Controlled Danish Multicenter Study of Adalimumab in Spondyloarthritis, as Assessed by the Berlin and Spondyloarthritis Research Consortium

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Poddubnyy, Denis; Sørensen, Inge J

    2016-01-01

    OBJECTIVE: To investigate changes in magnetic resonance imaging (MRI)-assessed inflammation and structural lesions in the sacroiliac (SI) joints during treatment with adalimumab versus placebo. METHODS: In a 48-week double-blind, placebo-controlled trial, 52 patients with spondyloarthritis were...... of the SI joints was performed at weeks 0, 12, 24, and 48, and the images were assessed independently in a blinded manner using the modified Berlin and the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scores for inflammation and structural lesions of the SI joints. RESULTS: At baseline, 56...

  18. System Study for Axial Vane Engine Technology

    Science.gov (United States)

    Badley, Patrick R.; Smith, Michael R.; Gould, Cedric O.

    2008-01-01

    The purpose of this engine feasibility study was to determine the benefits that can be achieved by incorporating positive displacement axial vane compression and expansion stages into high bypass turbofan engines. These positive-displacement stages would replace some or all of the conventional compressor and turbine stages in the turbine engine, but not the fan. The study considered combustion occurring internal to an axial vane component (i.e., Diesel engine replacing the standard turbine engine combustor, burner, and turbine); and external continuous flow combustion with an axial vane compressor and an axial vane turbine replacing conventional compressor and turbine systems.

  19. IgA-coated E. coli enriched in Crohn's disease spondyloarthritis promote TH17-dependent inflammation.

    Science.gov (United States)

    Viladomiu, Monica; Kivolowitz, Charles; Abdulhamid, Ahmed; Dogan, Belgin; Victorio, Daniel; Castellanos, Jim G; Woo, Viola; Teng, Fei; Tran, Nhan L; Sczesnak, Andrew; Chai, Christina; Kim, Myunghoo; Diehl, Gretchen E; Ajami, Nadim J; Petrosino, Joseph F; Zhou, Xi K; Schwartzman, Sergio; Mandl, Lisa A; Abramowitz, Meira; Jacob, Vinita; Bosworth, Brian; Steinlauf, Adam; Scherl, Ellen J; Wu, Hsin-Jung Joyce; Simpson, Kenneth W; Longman, Randy S

    2017-02-08

    Peripheral spondyloarthritis (SpA) is a common extraintestinal manifestation in patients with active inflammatory bowel disease (IBD) characterized by inflammatory enthesitis, dactylitis, or synovitis of nonaxial joints. However, a mechanistic understanding of the link between intestinal inflammation and SpA has yet to emerge. We evaluated and functionally characterized the fecal microbiome of IBD patients with or without peripheral SpA. Coupling the sorting of immunoglobulin A (IgA)-coated microbiota with 16S ribosomal RNA-based analysis (IgA-seq) revealed a selective enrichment in IgA-coated Escherichia coli in patients with Crohn's disease-associated SpA (CD-SpA) compared to CD alone. E. coli isolates from CD-SpA-derived IgA-coated bacteria were similar in genotype and phenotype to an adherent-invasive E. coli (AIEC) pathotype. In comparison to non-AIEC E. coli, colonization of germ-free mice with CD-SpA E. coli isolates induced T helper 17 cell (TH17) mucosal immunity, which required the virulence-associated metabolic enzyme propanediol dehydratase (pduC). Modeling the increase in mucosal and systemic TH17 immunity we observed in CD-SpA patients, colonization of interleukin-10-deficient or K/BxN mice with CD-SpA-derived E. coli lead to more severe colitis or inflammatory arthritis, respectively. Collectively, these data reveal the power of IgA-seq to identify immunoreactive resident pathosymbionts that link mucosal and systemic TH17-dependent inflammation and offer microbial and immunophenotype stratification of CD-SpA that may guide medical and biologic therapy.

  20. Extra-Articular Symptoms in Constellation with Selected Serum Cytokines and Disease Activity in Spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Hanna Przepiera-Będzak

    2016-01-01

    Full Text Available Objectives. In this study, we assessed the extra-articular symptoms in constellation with selected serum cytokines and disease activity in spondyloarthritis (SpA. Patients and Methods. We studied 287 SpA patients: 131 had AS, 110 had PsA, and 46 had SAPHO. We assessed extra-articular symptoms in all cases. In 191 SpA patients, we measured serum interleukin-6 (IL-6, interleukin-18 (IL-18, interleukin-23 (IL-23, endothelin-1 (ET-1, vascular endothelial growth factor (VEGF, and epidermal growth factor (EGF. Results. Patients with acute anterior uveitis (AAU had higher VAS (P=0.0008, BADSDAI (P=0.0001, ASDAS-ESR (P=0.04, CRP (P=0.006, IL-6 (P=0.02, and IL-18 (P=0.03 levels. Patients with inflammatory bowel disease (IBD had higher VAS (P=0.03, CRP (P=0.0009, and IL-6 (P=0.0003 levels. Patients with skin psoriasis had lower VAS (P=0.001 and BASDAI (P=0.00007 levels. Patients with psoriatic onycholysis had lower VAS (P=0.006, BASDAI (P=0.00001, and CRP (P=0.02 and higher IL-23 (P=0.04 levels. Patients with PPP had lower BASDAI (P=0.04 and higher ET-1 (P=0.001 levels. Conclusions. SpA patients with increased serum IL-18 and decreased serum ET-1 had an increased risk of extra-articular symptoms. In SpA patients, increased disease activity was associated with an increased risk of AAU and IBD and a decreased risk of skin psoriasis, psoriatic onycholysis, and PPP.

  1. MRI grading method for active and chronic spinal changes in spondyloarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Madsen, K.B. [Department of Radiology, Aarhus University Hospital, Aarhus Sygehus (Denmark); Jurik, A.G., E-mail: anne.jurik@aarhus.rm.d [Department of Radiology, Aarhus University Hospital, Aarhus Sygehus (Denmark)

    2010-01-15

    Aim: To describe a magnetic resonance imaging (MRI) grading method for both active and chronic spondyloarthritis (SpA) changes in the spine, to test its validity, and compare chronic MRI scores with findings obtained by radiography. Material and methods: A total of 91 patients (41 males; 50 females) with back pain fulfilling the European Spondylarthropathy Study Group (ESSG) criteria for SpA were examined using MRI and radiography of the spine. The mean age was 36.7 years (range 16-51 years) and symptom duration was between 3 and 27 years. The MRI images were assessed for signs of disease activity (bone marrow oedema at the vertebral plates and costo-vertebral joints) and chronic structural changes [syndesmophytes/vertebral fusion, erosion, and fatty marrow deposition (FMD)]. The interobserver agreement was analysed based on 37 examinations. Radiographs were assessed for the presence of shiny corners, vertebral squaring, syndesmophytes/fusion, and erosion. Results: The interobserver agreement for the assessed MRI abnormalities was acceptable, with kappa values between 0.62 and 0.77. A total of 56 patients had SpA-related spinal abnormalities as depicted using MRI. The total chronic MRI score was not significantly related to the radiographic score, mainly because syndesmophytes were difficult to detect by MRI and FMD was only visualized by MRI. However, FMD was significantly related to the total radiographic score and vertebral squaring. Conclusion: The described MRI grading method was reliable for assessing both disease activity and chronic changes. MRI is promising for estimating chronic changes, but cervical radiography may still be needed. FMD seems to be an important sign of chronicity.

  2. Sacroiliitis at diagnosis of juvenile spondyloarthritis assessed by radiography, magnetic resonance imaging, and clinical examination

    Science.gov (United States)

    Weiss, Pamela F; Xiao, Rui; Biko, David M; Chauvin, Nancy A

    2015-01-01

    Objective We evaluated the prevalence of sacroiliitis at diagnosis of juvenile spondyloarthritis (JSpA) and the accuracy of physical examination and back pain to detect sacroiliitis, using imaging as the reference standard. Methods We performed a prospective cross-sectional study of 40 children with newly diagnosed JSpA and 14 healthy controls. Subjects were assessed using physical examination, anteroposterior pelvic radiograph, and pelvic MRI. Differences in clinical features between those children with and without sacroiliitis were assessed by Fisher’s exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Accuracy of physical examination and back pain for detection of sacroiliitis was determined using MRI as the reference standard. Predicted probability of sacroiliitis was determined using exact multivariate logistic regression. Results Eight (20%) children with JSpA had active sacroiliitis. Of those subjects with active changes on MRI, 7/8 (88%) also had evidence of erosions or sclerosis. Five (13%) children with JSpA and 1 (7%) control had non-periarticular bone marrow edema. Of the subjects with active sacroiliitis only 3 (38%) reported a history of back pain or tenderness on palpation of the sacroiliac joints. The positive and negative predictive values of clinical exam features and back pain for detection of sacroiliitis were low. The estimated probability of having sacroiliitis was 0.84 (95% CI: 0.40–1.00) in HLA-B27+ patients with an elevated CRP. Conclusion Active sacroiliitis by MRI is common at diagnosis in JSpA and is frequently asymptomatic. Children who are HLA-B27+ and have elevated CRP levels have the highest probability of sacroiliitis. PMID:26212574

  3. The Emergence of Axial Parts

    Directory of Open Access Journals (Sweden)

    Peter Svenonius

    2007-01-01

    Full Text Available Many languages have specialized locative words or morphemes translating roughly into words like ‘front,’ ‘back,’ ‘top,’ ‘bottom,’ ‘side,’ and so on. Often, these words are used instead of more specialized adpositions to express spatial meanings corresponding to ‘behind,’ ‘above,’ and so on. I argue, on the basis of a cross-linguistic survey of such expressions, that in many cases they motivate a syntactic category which is distinct from both N and P, which I call AxPart for ‘Axial Part’; I show how the category relates to the words which instantiate it, and how the meaning of the construction is derived from the combination of P[lace] elements, AxParts, and the lexical material which expresses them.

  4. Melt Motion Due to Peltier Marking During Bridgman Crystal Growth with an Axial Magnetic Field

    Science.gov (United States)

    Sellers, C. C.; Walker, John S.; Szofran, Frank R.; Motakef, Shariar

    2000-01-01

    This paper treats a liquid-metal flow inside an electrically insulating cylinder with electrically conducting solids above and below the liquid region. There is a uniform axial magnetic field, and there is an electric current through the liquid and both solids. Since the lower liquid-solid interface is concave into the solid and since the liquid is a better electrical conductor than the adjacent solid, the electric current is locally concentrated near the centerline. The return to a uniform current distribution involves a radial electric current which interacts with the axial magnetic field to drive an azimuthal flow. The axial variation of the centrifugal force due to the azimuthal velocity drives a meridional circulation with radial and axial velocities. This problem models the effects of Peltier marking during the vertical Bridgman growth of semiconductor crystals with an externally applied magnetic field, where the meridional circulation due to the Peltier Current may produce important mixing in the molten semiconductor.

  5. Increased levels of IgG antibodies against human HSP60 in patients with spondyloarthritis.

    Directory of Open Access Journals (Sweden)

    Astrid Hjelholt

    Full Text Available Spondyloarthritis (SpA comprises a heterogeneous group of inflammatory diseases, with strong association to human leukocyte antigen (HLA-B27. A triggering bacterial infection has been considered as the cause of SpA, and bacterial heat shock protein (HSP seems to be a strong T cell antigen. Since bacterial and human HSP60, also named HSPD1, are highly homologous, cross-reactivity has been suggested in disease initiation. In this study, levels of antibodies against bacterial and human HSP60 were analysed in SpA patients and healthy controls, and the association between such antibodies and disease severity in relation to HLA-B27 was evaluated.Serum samples from 82 patients and 50 controls were analysed by enzyme-linked immunosorbent assay (ELISA for immunoglobulin (IgG1, IgG2, IgG3 and IgG4 antibodies against human HSP60 and HSP60 from Chlamydia trachomatis, Salmonella enteritidis and Campylobacter jejuni. Disease severity was assessed by the clinical scorings Bath Ankylosing Spondylitis Disease Activity Index (BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI and Bath Ankylosing Spondylitis Metrology Index (BASMI. Levels of IgG1 and IgG3 antibodies against human HSP60, but not antibodies against bacterial HSP60, were elevated in the SpA group compared with the control group. Association between IgG3 antibodies against human HSP60 and BASMI was shown in HLA-B27⁺ patients. Only weak correlation between antibodies against bacterial and human HSP60 was seen, and there was no indication of cross-reaction. These results suggest that antibodies against human HSP60 is associated with SpA, however, the theory that antibodies against human HSP60 is a specific part of the aetiology, through cross-reaction to bacterial HSP60, cannot be supported by results from this study. We suggest that the association between elevated levels of antibodies against human HSP60 and disease may reflect a general activation of the immune system and an increased

  6. Clinical uveitis evaluation and its value in the diagnosis of spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Alla Aleksandrovna Godzenko

    2011-01-01

    Full Text Available Objective: to estimate the value of clinical parameters of uveitis for the diagnosis of spondyloarthritis (SA. Subjects and methods. One hundred and five uveitis patients referred by ophthalmologists to the Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 2007–2009 were examined. X-ray study of the pelvis and lumbar spine, HLA-B27 test, and objective examination were performed in all the patients to detect inflammatory back pain, arthritis, and enthesitis. Results. The diagnosis of SA was verified in 60 patients: 24 had ankylosing spondylitis, 2 had reactive arthritis, and 38 had undifferentiat ed SA. The diagnosis of SA was discarded in 45 patients. Subsequent examination of these patients diagnosed BehНet's disease in 2 of them, sarcoidosis in 1, toxoplasmosis in 4, virus infection-associated uveitis in 8, Fuchs' syndrome in 1, and unspecified uveitis in 29. There was unilateral uveitis in 51 (85% of the 60 patients with SP and in 26 (58% of the 45 patients without SP (p = 0.0033; alternat ing eye lesion in 30 (50% of the 60 patients with SP and in 4 (8.9% of the 45 patients without SP (p = 0.00001; anterior uveitis in 57 (95% of the 60 patients with SP and in 32 of the 45 patients without SP (p = 0.0017; posterior uveitis in 6 (10% of the 60 patients with SP and in 20 (44% of the 45 patients without SP (p = 0.0001; panuveitis in 2 (3.3% of the 60 patients with SP and in 10 (22.2% of the 45 patients without SP (p = 0.0039, acute recurrent uveitis in 15 (33.3% of the 45 patients without SP and in 44 (73% of the 60 patients with SP (p = 0.0001. The age at onset was less than 30 years in 38 patients with SP and in 19 patients without SP (p = 0.04. Conclusion. The estimation of the location and course of uveitis is important in diagnosing SP that is probable in patients with acute anteri or unilateral uveitis with alternating eye lesion, which occurred before the age of 30 years.

  7. Axial force measurement for esophageal function testing

    Institute of Scientific and Technical Information of China (English)

    Flemming H Gravesen; Peter Funch-Jensen; Hans Gregersen; Asbjφrn Mohr Drewes

    2009-01-01

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  8. Axial force measurement for esophageal function testing.

    Science.gov (United States)

    Gravesen, Flemming H; Funch-Jensen, Peter; Gregersen, Hans; Drewes, Asbjørn Mohr

    2009-01-14

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  9. New Anomaly of the Axial-Vector Current

    Institute of Scientific and Technical Information of China (English)

    HE Han-Xin

    2001-01-01

    By computing the axial-vector current operator equation, we find the anomalous axial-vector curl equation besides the well-known anomalous axial-vector divergence equation (the Adler-Bell-Jackiw anomaly) and discuss its implication.``

  10. Treating Infertility

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Treating Infertility Home For Patients Search FAQs Treating Infertility Page ... Treating Infertility FAQ137, March 2015 PDF Format Treating Infertility Gynecologic Problems What is infertility? What treatment options ...

  11. LIVER FUNCTION CHANGES IN PATIENTS WITH SPONDYLOARTHRITIS TAKING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS OVER A LONG PERIOD: RESULTS OF A 10-YEAR PROGRESS PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2016-01-01

    Full Text Available Objective: to assess liver function changes in patients with spondyloarthritis (SpA taking NSAIDs regularly over a long period.Patients and methods. The data obtained during a 10-year PROGRESS prospective single-center cohort study of functional status, activity, and comorbidity (including gastrointestinal tract diseases in patients with SpA were analyzed. The data of 363 SpA patients receiving NSAIDs regularly over a long period and followed up for 10 years were also explored. The changes that had occurred over a decade in the liver enzyme levels, the number of discontinued NSAID treatments because of a persistent increase in liver enzyme levels, and the number of prescriptions of hepatoprotective agents were analyzed.Results. For 10 years, 18 patients with SpA discontinued their NSAID intake due to elevated liver enzyme levels (≥3 times greater than the reference value; during that time, the same increase in enzyme levels was observed in 2 healthy individuals (χ2 =1.39; p=0.2. In the patients with SpA as compared to the healthy individuals, the relative risk of abnormal liver function was 1.19 (95% CI, 1.009–1.405; odds ratio was 2.9 (95% CI, 0.65–12.95. There was no increased risk for discontinuation of some NSAIDs, including nimesulide (χ2 =0.03, p=0.85, the frequency of using hepatoprotective drugs was proved to be highest for diclofenac sodium, ibuprofen, nimesulide, and ketoprofen.Conclusion. The regular long-term (as long as 10 years use of NSAIDs to treat SpA is associated with treatment discontinuation because of elevated enzyme levels in every 10 patients. The maximum rate of discontinuation of NSAIDs due to a persistent increase in liver enzyme levels is observed 6–8 years after their regular use, so long-term NSAID therapy requires continuous monitoring of hepatic safety. The longterm intake of nimesulide, as compared with other NSAIDs, is shown to be unassociated with the higher rate of its discontinuation because of

  12. Gender differences among patients with primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease in an iberoamerican spondyloarthritis cohort

    OpenAIRE

    Landi, Margarita; Maldonado-Ficco, Hernán; Perez-Alamino, Rodolfo; Maldonado-Cocco, José A.; Citera, Gustavo; Arturi, Pablo; Percival D. Sampaio-Barros; Flores Alvarado, Diana E.; Burgos-Vargas, Rubén; Santos, Elena; Palleiro, Daniel; Gutiérrez,Miguel A; Vieyra-Sousa, Elsa; Pimentel-Santos, Fernando; Paira, Sergio O.

    2016-01-01

    Abstract The aim of the study was to compare clinical manifestations, disease activity, functional capacity, spinal mobility, and radiological findings between men and women from a multicenter, multiethnic Ibero-American cohort of patients with Spondyloarthritis (SpA). This observational cross-section study included 1264 consecutive SpA patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS). Demographic, clinical, and radiologic data were evaluated. Categorical ...

  13. Axial Super-resolution Evanescent Wave Tomography

    CERN Document Server

    Pendharker, Sarang; Newman, Ward; Ogg, Stephen; Nazemifard, Neda; Jacob, Zubin

    2016-01-01

    Optical tomographic reconstruction of a 3D nanoscale specimen is hindered by the axial diffraction limit, which is 2-3 times worse than the focal plane resolution. We propose and experimentally demonstrate an axial super-resolution evanescent wave tomography (AxSET) method that enables the use of regular evanescent wave microscopes like Total Internal Reflection Fluorescence Microscope (TIRF) beyond surface imaging, and achieve tomographic reconstruction with axial super-resolution. Our proposed method based on Fourier reconstruction achieves axial super-resolution by extracting information from multiple sets of three-dimensional fluorescence images when the sample is illuminated by an evanescent wave. We propose a procedure to extract super-resolution features from the incremental penetration of an evanescent wave and support our theory by 1D (along the optical axis) and 3D simulations. We validate our claims by experimentally demonstrating tomographic reconstruction of microtubules in HeLa cells with an axi...

  14. Axial thermal rotation of slender rods.

    Science.gov (United States)

    Li, Dichuan; Fakhri, Nikta; Pasquali, Matteo; Biswal, Sibani Lisa

    2011-05-06

    Axial rotational diffusion of rodlike polymers is important in processes such as microtubule filament sliding and flagella beating. By imaging the motion of small kinks along the backbone of chains of DNA-linked colloids, we produce a direct and systematic measurement of axial rotational diffusivity of rods both in bulk solution and near a wall. The measured diffusivities decrease linearly with the chain length, irrespective of the distance from a wall, in agreement with slender-body hydrodynamics theory. Moreover, the presence of small kinks does not affect the chain's axial diffusivity. Our system and measurements provide insights into fundamental axial diffusion processes of slender objects, which encompass a wide range of entities including biological filaments and linear polymer chains.

  15. Axial force measurement for esophageal function testing

    DEFF Research Database (Denmark)

    Gravesen, Flemming Holbæk; Funch-Jensen, Peter; Gregersen, Hans

    2009-01-01

    force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been...... force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external...... documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe...

  16. Numerical simulation of axial flow compressors.

    OpenAIRE

    Jesuino Takachi Tomita

    2002-01-01

    This work deals with the numerical simulation of axial flow compressors, from design to performance prediction. The stage performance prediction uses the meanline flow properties. Stage-stacking is used to analyse a multi-stage compressor. A computer program, written in FORTRAN, was developed and is able to design an axial flow compressor given air mass flow, total pressure ratio, overall efficiency and design speed. All geometrical data relevant to the compressor performance prediction is ca...

  17. Nonperturbative Aspects of Axial Vector Vertex

    Institute of Scientific and Technical Information of China (English)

    ZONG Hong-Shi; CHEN Xiang-Song; WANG Fan; CHANG Chao-Hsi; ZHAO En-Guang

    2002-01-01

    It is shown how the axial vector current of current quarks is related to that of constituent quarks within the framework of the global color symmetry model.Gluon dressing of the axial vector vertex and the quark self-energy functions are described by the inhomogeneous Bethe-Salpeter equation in the ladder approximation and the Schwinger Dyson equation in the rainbow approximation,respectively.

  18. Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast

    Energy Technology Data Exchange (ETDEWEB)

    Hodgson, R.J.; Emery, P. [University of Leeds, Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Grainger, A.J.; O' Connor, P.J.; Evans, R. [Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Coates, L.; Marzo-Ortega, H.; Helliwell, P.; McGonagle, D. [University of Leeds, Leeds Institute for Molecular Medicine, Leeds (United Kingdom); Robson, M.D. [University of Oxford, Oxford Centre for Clinical Magnetic Resonance Research, Oxford (United Kingdom)

    2011-06-15

    To compare conventional MRI, ultrashort echo time MRI and ultrasound for assessing the extent of tendon abnormalities in spondyloarthritis. 25 patients with spondyloarthritis and Achilles symptoms were studied with MRI and ultrasound. MR images of the Achilles tendon were acquired using T1-weighted spin echo, gradient echo and ultrashort echo time (UTE) sequences with echo times (TE) between 0.07 and 16 ms, before and after intravenous contrast medium. Greyscale and power Doppler ultrasound were also performed. The craniocaudal extent of imaging abnormalities measured by a consultant musculoskeletal radiologist was compared between the different techniques. Abnormalities were most extensive on spoiled gradient echo images with TE=2 ms. Contrast enhancement after intravenous gadolinium was greatest on the UTE images (TE=0.07 ms). Fewer abnormalities were demonstrated using unenhanced UTE. Abnormalities were more extensive on MRI than ultrasound. Contrast enhancement was more extensive than power Doppler signal. 3D spoiled gradient echo images with an echo time of 2 ms demonstrate more extensive tendon abnormalities than the other techniques in spondyloarthritis. Abnormalities of vascularity are best demonstrated on enhanced ultrashort echo time images. (orig.)

  19. Non-traumatic atlanto-axial subluxation: Grisel's syndrome. Two case reports.

    Science.gov (United States)

    Cekinmez, Melih; Tufan, Kadir; Sen, Orhan; Caner, Hakan

    2009-04-01

    Two 8-year-old boys presented with complaints of torticollis and pain on neck turning. Both patients had a history of throat infection. Radiography and computed tomography demonstrated atlanto-axial subluxation. The patients were treated under diagnoses of Grisel's syndrome, unilateral or bilateral subluxation of the atlas on the axis associated with infection in the head or neck. Both patients were treated conservatively with bed rest, muscle relaxants, non-steroid anti-inflammatory agents, and immobilization with a soft cervical collar and cervical halter traction. The torticollis had resolved and reduction of atlanto-axial subluxation was confirmed within 2 weeks in both patients. Early diagnosis of Grisel's syndrome with appropriate antibiotics and a cervical collar, with halter traction if necessary, can achieve good outcome. Surgical treatment for the reduction of atlanto-axial subluxation should be reserved for persistent or recurrent cases.

  20. Wave propagation in axially moving periodic strings

    Science.gov (United States)

    Sorokin, Vladislav S.; Thomsen, Jon Juel

    2017-04-01

    The paper deals with analytically studying transverse waves propagation in an axially moving string with periodically modulated cross section. The structure effectively models various relevant technological systems, e.g. belts, thread lines, band saws, etc., and, in particular, roller chain drives for diesel engines by capturing both their spatial periodicity and axial motion. The Method of Varying Amplitudes is employed in the analysis. It is shown that the compound wave traveling in the axially moving periodic string comprises many components with different frequencies and wavenumbers. This is in contrast to non-moving periodic structures, for which all components of the corresponding compound wave feature the same frequency. Due to this "multi-frequency" character of the wave motion, the conventional notion of frequency band-gaps appears to be not applicable for the moving periodic strings. Thus, for such structures, by frequency band-gaps it is proposed to understand frequency ranges in which the primary component of the compound wave attenuates. Such frequency band-gaps can be present for a moving periodic string, but only if its axial velocity is lower than the transverse wave speed, and, the higher the axial velocity, the narrower the frequency band-gaps. The revealed effects could be of potential importance for applications, e.g. they indicate that due to spatial inhomogeneity, oscillations of axially moving periodic chains always involve a multitude of frequencies.

  1. An Unbroken Axial Vector Current Conservation Law

    CERN Document Server

    Sharafiddinov, Rasulkhozha S

    2015-01-01

    The mass, energy and momentum of the neutrino of a true flavor have an axial-vector nature. As a consequence, the left-handed truly neutral neutrino in an axial-vector field of emission can be converted into a right-handed one and vice versa. This predicts the unidenticality of masses, energies and momenta of neutrinos of the different components. Recognizing such a difference in masses, energies, momenta and accepting that the left-handed axial-vector neutrino and the right-handed antineutrino of true neutrality refer to long-lived C-odd leptons, and the right-handed truly neutral neutrino and the left-handed axial-vector antineutrino are of short-lived fermions of C-oddity, we would write a new CP-even Dirac equation taking into account the flavor symmetrical axial-vector mass, energy and momentum matrices. Their presence explains the spontaneous mirror symmetry violation, confirming that an axial-vector current conservation law has never violated. They reflect the availability of a mirror Minkowski space i...

  2. In vitro pulsatility analysis of axial-flow and centrifugal-flow left ventricular assist devices.

    Science.gov (United States)

    Stanfield, J Ryan; Selzman, Craig H

    2013-03-01

    Recently, continuous-flow ventricular assist devices (CF-VADs) have supplanted older, pulsatile-flow pumps, for treating patients with advanced heart failure. Despite the excellent results of the newer generation devices, the effects of long-term loss of pulsatility remain unknown. The aim of this study is to compare the ability of both axial and centrifugal continuous-flow pumps to intrinsically modify pulsatility when placed under physiologically diverse conditions. Four VADs, two axial- and two centrifugal-flow, were evaluated on a mock circulatory flow system. Each VAD was operated at a constant impeller speed over three hypothetical cardiac conditions: normo-tensive, hypertensive, and hypotensive. Pulsatility index (PI) was compared for each device under each condition. Centrifugal-flow devices had a higher PI than that of axial-flow pumps. Under normo-tension, flow PI was 0.98 ± 0.03 and 1.50 ± 0.02 for the axial and centrifugal groups, respectively (p centrifugal pumps, respectively (p = 0.01). Under hypotension, PI was 0.73 ± 0.02 and 0.78 ± 0.02 for the axial and centrifugal groups, respectively (p = 0.13). All tested CF-VADs were capable of maintaining some pulsatile-flow when connected in parallel with our mock ventricle. We conclude that centrifugal-flow devices outperform the axial pumps from the basis of PI under tested conditions.

  3. MAGNETIC-RESONANCE IMAGING FOR EARLY DIAGNOSIS OF COXITIS IN PATIENTS WITH SPONDYLOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Anna Georgievna Bochkova

    2012-01-01

    Full Text Available Objective — to define more precisely the potential of magnetic-resonance imaging (MRI in the early diagnosis of coxitis in patients with spondyloarthritis (SpA. Material and methods. Hip (coxofemoral joint (HJ MRI (in T1 and T2Fat Sat; 1,5 T modes was performed in 60 patients with ankylosing spondilitis (AS and SpA: clinical signs of coxitis were present in 37 patients, while remaining 13 patients without coxitis were included into the control group while 10 healthy subjects without SpA made formed a healthy control group. The following parameters were monitored: pain intensity — by the numeric rating scale (NRS 0—10, distance between the ankles, radiographic changes (RCh by BASRI index, presence of intraar-ticular exudate by US-examination. Active coxitis was defined as pain (during active and/or passive movement and/or pain at rest in hip joint after exclusion of enthezitis-related pelvic or greater trochanteric pain. Results. Cases of AS and SpA aged younger than 20 y.o. predominated in the cohort patients with coxitis (55,2%. Bilateral coxitis was diagnosed in 81% patients. Median (Me of disease duration was 12 [25th; 75th percentiles — 1; 132] months. Pain intensity in hip joint measured by NRS was 3 [2; 5]. RC were not found (BASRI-hip=0 in 20 (29,8% affected joints, 47 joints met the criteria of I—III BASRI-hip stage. RCh were not present in patients without coxitis (BASRI-hip=1 in 9 (28,7% joints. The most prevalent inflammatory changes (ICh in patients with coxitis following MRI data were: exudation in the articular space >7 Ml (54%, bone marrow edema (BME in the acetabular region (39%, cysts of the acetabular roof (32%, capsule thickening (25,5%, BME of the femoral head (13,4%, cysts of the femoral head (10%. There was a significant correlation between pain intensity measured by NRS and prevalence of ICh (Spearman's rank correlation R=-0,29; t=-2,46; p=0,01. BME of the femoral head and/or of the acetabular roof were seen

  4. Growth-induced axial buckling of a slender elastic filament embedded in an isotropic elastic matrix

    KAUST Repository

    O'Keeffe, Stephen G.

    2013-11-01

    We investigate the problem of an axially loaded, isotropic, slender cylinder embedded in a soft, isotropic, outer elastic matrix. The cylinder undergoes uniform axial growth, whilst both the cylinder and the surrounding elastic matrix are confined between two rigid plates, so that this growth results in axial compression of the cylinder. We use two different modelling approaches to estimate the critical axial growth (that is, the amount of axial growth the cylinder is able to sustain before it buckles) and buckling wavelength of the cylinder. The first approach treats the filament and surrounding matrix as a single 3-dimensional elastic body undergoing large deformations, whilst the second approach treats the filament as a planar, elastic rod embedded in an infinite elastic foundation. By comparing the results of these two approaches, we obtain an estimate of the foundation modulus parameter, which characterises the strength of the foundation, in terms of the geometric and material properties of the system. © 2013 Elsevier Ltd. All rights reserved.

  5. Optimization of residual heat removal pump axial thrust and axial bearing

    Energy Technology Data Exchange (ETDEWEB)

    Schubert, F.

    1996-12-01

    The residual heat removal (RHR) pumps of German 1300 megawatt pressurized-water reactor (PWR) power plants are of the single stage end suction type with volute casing or with diffuser and forged circular casing. Due to the service conditions the pumps have to cover the full capacity range as well as a big variation in suction static pressure. This results in a big difference in the axial thrust that has to be borne by the axial bearing. Because these pumps are designed to operate without auxiliary systems (things that do not exist can not fail), they are equipped with antifriction bearings and sump oil lubrication. To minimize the heat production within the bearing casing, a number of PWR plants have pumps with combined axial/radial bearings of the ball type. Due to the fact that the maximum axial thrust caused by static pressure and hydrodynamic forces on the impeller is too big to be borne by that type of axial bearing, the impellers were designed to produce a hydrodynamic axial force that counteracts the static axial force. Thus, the resulting axial thrust may change direction when the static pressure varies.

  6. Axial super-resolution evanescent wave tomography

    Science.gov (United States)

    Pendharker, Sarang; Shende, Swapnali; Newman, Ward; Ogg, Stephen; Nazemifard, Neda; Jacob, Zubin

    2016-12-01

    Optical tomographic reconstruction of a 3D nanoscale specimen is hindered by the axial diffraction limit, which is 2-3 times worse than the focal plane resolution. We propose and experimentally demonstrate an axial super-resolution evanescent wave tomography (AxSET) method that enables the use of regular evanescent wave microscopes like Total Internal Reflection Fluorescence Microscope (TIRF) beyond surface imaging, and achieve tomographic reconstruction with axial super-resolution. Our proposed method based on Fourier reconstruction achieves axial super-resolution by extracting information from multiple sets of three-dimensional fluorescence images when the sample is illuminated by an evanescent wave. We propose a procedure to extract super-resolution features from the incremental penetration of an evanescent wave and support our theory by 1D (along the optical axis) and 3D simulations. We validate our claims by experimentally demonstrating tomographic reconstruction of microtubules in HeLa cells with an axial resolution of $\\sim$130 nm. Our method does not require any additional optical components or sample preparation. The proposed method can be combined with focal plane super-resolution techniques like STORM and can also be adapted for THz and microwave near-field tomography.

  7. Axial super-resolution evanescent wave tomography.

    Science.gov (United States)

    Pendharker, Sarang; Shende, Swapnali; Newman, Ward; Ogg, Stephen; Nazemifard, Neda; Jacob, Zubin

    2016-12-01

    Optical tomographic reconstruction of a three-dimensional (3D) nanoscale specimen is hindered by the axial diffraction limit, which is 2-3 times worse than the focal plane resolution. We propose and experimentally demonstrate an axial super-resolution evanescent wave tomography method that enables the use of regular evanescent wave microscopes like the total internal reflection fluorescence microscope beyond surface imaging and achieve a tomographic reconstruction with axial super-resolution. Our proposed method based on Fourier reconstruction achieves axial super-resolution by extracting information from multiple sets of 3D fluorescence images when the sample is illuminated by an evanescent wave. We propose a procedure to extract super-resolution features from the incremental penetration of an evanescent wave and support our theory by one-dimensional (along the optical axis) and 3D simulations. We validate our claims by experimentally demonstrating tomographic reconstruction of microtubules in HeLa cells with an axial resolution of ∼130  nm. Our method does not require any additional optical components or sample preparation. The proposed method can be combined with focal plane super-resolution techniques like stochastic optical reconstruction microscopy and can also be adapted for THz and microwave near-field tomography.

  8. Reducing axial mixing in flotation columns

    Energy Technology Data Exchange (ETDEWEB)

    Al Taweel, A.M.; Ramadan, A.M. [Technical Univ. of Nova Scotia, Halifax (Canada). Chemical Engineering Dept.; Moharam, M.R.; Hassan, T.A. [Al Azhar Univ., Cairo (Egypt); El Mofty, S.M. [Cairo Univ., Giza (Egypt)

    1995-10-01

    The axial mixing characteristics of a pilot-scale flotation column were investigated with the objective of identifying means to mitigate the extent of axial mixing that adversely affects its grade/recovery performance. A wide range of design and operating conditions wa investigated and the experimental results, obtained using the dynamic response method, were analyzed using three axial mixing models. The dynamic response of the column can best be described using the axial dispersion model. The results obtained suggest that the value of the axial dispersion coefficient, E{sub L}, can be significantly reduced by judicial selection of hydrodynamic conditions and/or the use of column inserts that suppress the onset of hydrodynamic instabilities inherent to the operation of conventional flotation columns. Up to 40% reduction in the value of E{sub L} was thus obtained by using spargers that produce more uniform bubble sizes, while up to 30% reductions were obtained by controlling the residual frother concentration. 33 refs., 7 figs.

  9. Management of early spondyloarthritis: from diagnosis to treatment in clinical practice

    OpenAIRE

    Moltó Revilla, Anna

    2015-01-01

    L'objectiu d'aquesta recerca era avaluar el diagnòstic i el tractament de les formes primerenques d‘espondiloartritis a la practica diària. Per això, hem inclòs en aquesta tesi tres articles que reflecteixen els tres punts claus de la nostra recerca. Primer, hem validat els criteris ASAS per a les espondiloartritis axials en la pràctica clínica, avaluant el seu rendiment per a la classificació dels pacients però també per al diagnòstic, comparant-los amb altres criteris d'espondiloartritis, i...

  10. Improving the lattice axial vector current

    Energy Technology Data Exchange (ETDEWEB)

    Horsley, R. [Edinburgh Univ. (United Kingdom). School of Physics and Astronomy; Nakamura, Y. [RIKEN Advanced Institute for Computational Science, Kobe (Japan); Perlt, H.; Schiller, A. [Leipzig Univ. (Germany). Inst. fuer Theoretische Physik; Rakow, P.E.L. [Liverpool Univ. (United Kingdom). Theoretical Physics Div.; Schierholz, G. [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Zanotti, J.M. [Adelaide Univ. (Australia). CSSM, Dept. of Physics

    2015-11-15

    For Wilson and clover fermions traditional formulations of the axial vector current do not respect the continuum Ward identity which relates the divergence of that current to the pseudoscalar density. Here we propose to use a point-split or one-link axial vector current whose divergence exactly satisfies a lattice Ward identity, involving the pseudoscalar density and a number of irrelevant operators. We check in one-loop lattice perturbation theory with SLiNC fermion and gauge plaquette action that this is indeed the case including order O(a) effects. Including these operators the axial Ward identity remains renormalisation invariant. First preliminary results of a nonperturbative check of the Ward identity are also presented.

  11. Axial flow positive displacement worm gas generator

    Science.gov (United States)

    Murrow, Kurt David (Inventor); Giffin, Rollin George (Inventor); Fakunle, Oladapo (Inventor)

    2010-01-01

    An axial flow positive displacement engine has an inlet axially spaced apart and upstream from an outlet. Inner and outer bodies have offset inner and outer axes extend from the inlet to the outlet through first, second, and third sections of a core assembly in serial downstream flow relationship. At least one of the bodies is rotatable about its axis. The inner and outer bodies have intermeshed inner and outer helical blades wound about the inner and outer axes respectively. The inner and outer helical blades extend radially outwardly and inwardly respectively. The helical blades have first, second, and third twist slopes in the first, second, and third sections respectively. The first twist slopes are less than the second twist slopes and the third twist slopes are less than the second twist slopes. A combustor section extends axially downstream through at least a portion of the second section.

  12. Axial symmetry and conformal Killing vectors

    CERN Document Server

    Mars, M; Mars, Marc; Senovilla, Jose M.M.

    1993-01-01

    Axisymmetric spacetimes with a conformal symmetry are studied and it is shown that, if there is no further conformal symmetry, the axial Killing vector and the conformal Killing vector must commute. As a direct consequence, in conformally stationary and axisymmetric spacetimes, no restriction is made by assuming that the axial symmetry and the conformal timelike symmetry commute. Furthermore, we prove that in axisymmetric spacetimes with another symmetry (such as stationary and axisymmetric or cylindrically symmetric spacetimes) and a conformal symmetry, the commutator of the axial Killing vector with the two others mush vanish or else the symmetry is larger than that originally considered. The results are completely general and do not depend on Einstein's equations or any particular matter content.

  13. Atlanto-axial infection after acupuncture.

    Science.gov (United States)

    Robinson, A; Lind, C R P; Smith, R J; Kodali, V

    2015-12-11

    A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.

  14. Improving the lattice axial vector current

    CERN Document Server

    Horsley, R; Perlt, H; Rakow, P E L; Schierholz, G; Schiller, A; Zanotti, J M

    2015-01-01

    For Wilson and clover fermions traditional formulations of the axial vector current do not respect the continuum Ward identity which relates the divergence of that current to the pseudoscalar density. Here we propose to use a point-split or one-link axial vector current whose divergence exactly satisfies a lattice Ward identity, involving the pseudoscalar density and a number of irrelevant operators. We check in one-loop lattice perturbation theory with SLiNC fermion and gauge plaquette action that this is indeed the case including order $O(a)$ effects. Including these operators the axial Ward identity remains renormalisation invariant. First preliminary results of a nonperturbative check of the Ward identity are also presented.

  15. Axial loaded MRI of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Saifuddin, A. E-mail: asaifuddin@aol.com; Blease, S.; MacSweeney, E

    2003-09-01

    Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

  16. Axial Nucleon form factors from lattice QCD

    CERN Document Server

    Alexandrou, C; Carbonell, J; Constantinou, M; Harraud, P A; Guichon, P; Jansen, K; Korzec, T; Papinutto, M

    2010-01-01

    We present results on the nucleon axial form factors within lattice QCD using two flavors of degenerate twisted mass fermions. Volume effects are examined using simulations at two volumes of spatial length $L=2.1$ fm and $L=2.8$ fm. Cut-off effects are investigated using three different values of the lattice spacings, namely $a=0.089$ fm, $a=0.070$ fm and $a=0.056$ fm. The nucleon axial charge is obtained in the continuum limit and chirally extrapolated to the physical pion mass enabling comparison with experiment.

  17. Optimization of Axial Intensity Point Spread Function

    Institute of Scientific and Technical Information of China (English)

    WANG Haifeng; GAN Fuxi; CHEN Zhongyu

    2001-01-01

    It is known that for the converged laser beam, the axial intensity distribution corresponds to a Gaussian curve, that is, the intensity on the focal plane is the peak intensity. When it defocuses, the intensity would decrease rapidly. In optical data storage, for instance, we expect the intensity within a certain distance to be almost equal. In this paper, we propose to use a pure phase superresolution apodizer to optimize the axial intensity distribution of the converged laser beam and at the same time improve the resolution. The intensity point spread function remains almost identical in a wide range within the focal depth.

  18. Investigations on Experimental Impellers for Axial Blowers

    Science.gov (United States)

    Encke, W.

    1947-01-01

    A selection of measurements obtained on experimental impellers for axial blowers will be reported. In addition to characteristic curves plotted for low and for high peripheral velocities, proportions and blade sections for six different blower models and remarks on the design of blowers will be presented.

  19. Excitation modes in non-axial nuclei

    Energy Technology Data Exchange (ETDEWEB)

    Leviatan, A.; Ginnochio, J.N.

    1990-01-01

    Excitation modes of non-axial quadrupole shapes are investigated in the framework of interacting boson models. Both {gamma}-unstable and {gamma}-rigid nuclear shapes are considered for systems with one type of boson as well as with proton-neutron bosons. 6 refs.

  20. Wave propagation in axially moving periodic strings

    DEFF Research Database (Denmark)

    Sorokin, Vladislav S.; Thomsen, Jon Juel

    2017-01-01

    The paper deals with analytically studying transverse waves propagation in an axially moving string with periodically modulated cross section. The structure effectively models various relevant technological systems, e.g. belts, thread lines, band saws, etc., and, in particular, roller chain drive...

  1. A study of casing treatment stall margin improvement phenomena. [for axial compressor rotor blade tips

    Science.gov (United States)

    Prince, D. C., Jr.; Wisler, D. C.; Hilvers, D. E.

    1975-01-01

    The results of a program of experimental and analytical research in casing treatments over axial compressor rotor blade tips are presented. Circumferential groove, axial-skewed slot and blade angle slot treatments were tested at low speeds. With the circumferential groove treatment the stalling flow was reduced 5.8% at negligible efficiency sacrifice. The axial-skewed slot treatment improved the stalling flow by 15.3%; 1.8 points in peak efficiency were sacrificed. The blade angle slot treatment improved the stalling flow by 15.0%; 1.4 points in peak efficiency were sacrificed. The favorable stalling flow situations correlated well with observations of higher-than-normal surface pressures on the rotor blade pressure surfaces in the tip region, and with increased maximum diffusions on the suction surfaces. Annulus wall pressure gradients, especially in the 50 to 75% chord region, are also increased and blade surface pressure loadings are shifted toward the trailing edge for treated configurations.

  2. On two transverse nonlinear models of axially moving beams

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Nonlinear models of transverse vibration of axially moving beams are computationally investigated. A partial-differential equation is derived from the governing equation of coupled planar motion by omit- ting its longitudinal terms. The model can be reduced to an integro-partial-differential equation by av- eraging the beam disturbed tension. Numerical schemes are respectively presented for the governing equations of coupled planar and the two governing equations of transverse motion via the finite dif- ference method and differential quadrature method under the fixed boundary and the simple support boundary. A steel beam and a copper beam are treated as examples to demonstrate the deviations of the solutions to the two transverse equations from the solution to the coupled equation. The numerical results indicate that the differences increase with the amplitude of vibration and the axial speed. Both models yield almost the same precision results for small amplitude vibration and the inte- gro-partial-differential equation gives better results for large amplitude vibration.

  3. On two transverse nonlinear models of axially moving beams

    Institute of Scientific and Technical Information of China (English)

    DING Hu; CHEN LiQun

    2009-01-01

    Nonlinear models of transverse vibration of axially moving beams are computationally investigated. A partial-differential equation is derived from the governing equation of coupled planar motion by omit-ting its longitudinal terms. The model can be reduced to an integro-partial-differential equation by av-eraging the beam disturbed tension. Numerical schemes are respectively presented for the governing equations of coupled planar and the two governing equations of transverse motion via the finite dif-ference method and differential quadrature method under the fixed boundary and the simple support boundary. A steel beam and a copper beam are treated as examples to demonstrate the deviations of the solutions to the two transverse equations from the solution to the coupled equation. The numerical results indicate that the differences increase with the amplitude of vibration and the axial speed. Both models yield almost the same precision results for small amplitude vibration and the inte-gro-partial-differential equation gives better results for large amplitude vibration.

  4. Differential mechanisms of de-regulated bone formation in rheumatoid arthritis and spondyloarthritis.

    Science.gov (United States)

    Goldring, Steven R

    2016-12-01

    The inflammatory arthropathies share in common their tendency to produce marked alterations in skeletal remodelling and architecture. This review will focus on RA and the seronegative spondyloarthopathies (SpA), which share common features with respect to their tendency to produce localized bone destruction at sites of articular and peri-articular inflammation. However, there are significant differences in the skeletal pathology in these conditions, which include the unique involvement of the axial skeleton and the presence of inflammation in the extra-articular entheses in SpA. There also are differences in the pattern of bone formation and repair associated with the articular and peri-articular inflammation. This review will highlight the molecular and cellular processes that are involved in the pathogenesis of the skeletal pathology in these two forms of inflammatory arthritis with specific focus on the pathogenic mechanisms underlying the differential patterns of bone formation and repair.

  5. Indirect and direct costs of treating patients with ankylosing spondylitis in the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Valderilio Feijó Azevedo

    2016-04-01

    Full Text Available ABSTRACT Introduction: Patients with Ankylosing Spondylitis (AS require a team approach from multiple professionals, various treatment modalities for continuous periods of time, and can lead to the loss of labour capacity in a young population. So, it is necessary to measure its socio-economic impact. Objectives: To describe the use of public resources to treat AS in a tertiary hospital after the use of biological medications was approved for treating spondyloarthritis in the Health Public System, establishing approximate values for the direct and indirect costs of treating this illness in Brazil. Material and methods: 93 patients selected from the ambulatory spondyloarthritis clinic at the Hospital de Clínicas of the Federal University of Paraná between September 2011 and September 2012 had their direct costs indirect treatment costs estimation. Results: 70 patients (75.28% were male and 23 (24.72% female. The mean age was 43.95 years. The disease duration was calculated based on the age of diagnosis and the mean was 8.92 years (standard deviation: 7.32; 63.44% were using anti-TNF drugs. Comparing male and female patients the mean BASDAI was 4.64 and 5.49 while the mean BASFI was 5.03 and 6.35 respectively. Conclusions: The Brazilian public health system's spending related to ankylosing spondylitis has increased in recent years. An important part of these costs is due to the introduction of new, more expensive health technologies, as in the case of nuclear magnetic resonance and, mainly, the incorporation of anti-TNF therapy into the therapeutic arsenal. The mean annual direct and indirect cost to the Brazilian public health system to treat a patient with ankylosing spondylitis, according to our findings, is US$ 23,183.56.

  6. Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort.

    Directory of Open Access Journals (Sweden)

    Gaetane Nocturne

    Full Text Available To investigate DKK-1 and SOST serum levels among patients with recent inflammatory back pain (IBP fulfilling ASAS criteria for SpA and associated factors.The DESIR cohort is a prospective, multicenter French cohort of 708 patients with early IBP (duration >3 months and <3 years suggestive of AxSpA. DKK-1 and SOST serum levels were assessed at baseline and were compared between the subgroup of patients fulfilling ASAS criteria for SpA (n = 486; 68.6% and 80 healthy controls.Mean SOST serum levels were lower in ASAS+ patients than healthy controls (49.21 ± 25.9 vs. 87.8 ± 26 pmol/L; p<0.0001. In multivariate analysis, age (p = 5.4 10-9, CRP level (p<0.0001 and serum DKK-1 level (p = 0.001 were associated with SOST level. Mean DKK-1 serum levels were higher in axial SpA patients than controls (30.03 ± 15.5 vs. 11.6 ± 4.2 pmol/L; p<0.0001. In multivariate analysis, DKK-1 serum levels were associated with male gender (p = 0.03, CRP level (p = 0.006, SOST serum level (p = 0.002 and presence of sacroiliitis on radiography (p = 0.05. Genetic association testing of 10 SNPs encompassing the DKK-1 locus failed to demonstrate a significant contribution of genetics to control of DKK-1 serum levels.DKK-1 serum levels were increased and SOST levels were decreased among a large cohort of patients with early axial SpA compared to healthy controls. DKK-1 serum levels were mostly associated with biological inflammation and SOST serum levels.

  7. Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort

    Science.gov (United States)

    Nocturne, Gaetane; Pavy, Stephan; Boudaoud, Saida; Seror, Raphaèle; Goupille, Philippe; Chanson, Philippe; van der Heijde, Désirée; van Gaalen, Floris; Berenbaum, Francis; Mariette, Xavier; Briot, Karine; Feydy, Antoine; Claudepierre, Pascal; Dieudé, Philippe; Nithitham, Joanne; Taylor, Kimberly E.; Criswell, Lindsey A.; Dougados, Maxime; Roux, Christian; Miceli-Richard, Corinne

    2015-01-01

    Objectives To investigate DKK-1 and SOST serum levels among patients with recent inflammatory back pain (IBP) fulfilling ASAS criteria for SpA and associated factors. Methods The DESIR cohort is a prospective, multicenter French cohort of 708 patients with early IBP (duration >3 months and <3 years) suggestive of AxSpA. DKK-1 and SOST serum levels were assessed at baseline and were compared between the subgroup of patients fulfilling ASAS criteria for SpA (n = 486; 68.6%) and 80 healthy controls. Results Mean SOST serum levels were lower in ASAS+ patients than healthy controls (49.21 ± 25.9 vs. 87.8 ± 26 pmol/L; p<0.0001). In multivariate analysis, age (p = 5.4 10−9), CRP level (p<0.0001) and serum DKK-1 level (p = 0.001) were associated with SOST level. Mean DKK-1 serum levels were higher in axial SpA patients than controls (30.03 ± 15.5 vs. 11.6 ± 4.2 pmol/L; p<0.0001). In multivariate analysis, DKK-1 serum levels were associated with male gender (p = 0.03), CRP level (p = 0.006), SOST serum level (p = 0.002) and presence of sacroiliitis on radiography (p = 0.05). Genetic association testing of 10 SNPs encompassing the DKK-1 locus failed to demonstrate a significant contribution of genetics to control of DKK-1 serum levels. Conclusions DKK-1 serum levels were increased and SOST levels were decreased among a large cohort of patients with early axial SpA compared to healthy controls. DKK-1 serum levels were mostly associated with biological inflammation and SOST serum levels. PMID:26313358

  8. TNF-α Promoter Polymorphisms Predict the Response to Etanercept More Powerfully than that to Infliximab/Adalimumab in Spondyloarthritis.

    Science.gov (United States)

    Liu, Jing; Dong, Zheng; Zhu, Qi; He, Dongyi; Ma, Yanyun; Du, Aiping; He, Fan; Zhao, Dongbao; Xu, Xia; Zhang, Hui; Jin, Li; Wang, Jiucun

    2016-08-31

    While previous studies have researched in association analyses between TNFα promoter polymorphisms and responses to TNF blockers in spondyloarthritis patients, their results were conflicting. Therefore, we aimed to determine whether TNFα promoter polymorphisms could predict response to TNF blockers and find the source of heterogeneity. Data were extracted and analyzed from published articles and combined with our unpublished data. We found that the greatest potential sources of heterogeneity in the results were gender ratio, disease type, continents, and TNF blockers. Then Stratification analysis showed that the TNFα -308 G allele and the -238 G allele predicted a good response to TNF blockers (OR = 2.64 [1.48-4.73]; 2.52 [1.46-4.37]). However, G alleles of TNFα -308 and -238 could predict the response to etanercept (OR = 4.02 [2.24-7.23]; 5.17 [2.29-11.67]) much more powerfully than the response to infiliximab/adalimumab (OR = 1.68 [1.02-2.78]; 1.28 [0.57-2.86]). TNFα -857 could not predict the response in either subgroup. Cumulative meta-analysis performed in ankylosing spondylitis patients presented the odds ratio decreased with stricter response criteria. In conclusion, TNFα -308 A/G and -238 A/G are more powerful to predict the response to Etanercept and it is dependent on the criteria of response.

  9. Anterior chest wall inflammation by whole body MRI in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study

    OpenAIRE

    2012-01-01

    Introduction Inflammatory involvement of the anterior chest wall (ACW) affects the quality of life of patients with spondyloarthritis (SpA), although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole-body (WB) MRI is an imaging method used to assess the ACW in addition to the sacroiliac joints and spine without inconvenience for patients. Our goals in this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA ...

  10. Impact of axial velocity and transmembrane pressure (TMP) on ARP filter performance

    Energy Technology Data Exchange (ETDEWEB)

    Poirier, M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Burket, P. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2016-02-29

    The Savannah River Site (SRS) is currently treating radioactive liquid waste with the Actinide Removal Process (ARP) and the Modular Caustic Side Solvent Extraction Unit (MCU). Recently, the low filter flux through the ARP of approximately 5 gallons per minute has limited the rate at which radioactive liquid waste can be treated. Salt Batch 6 had a lower processing rate and required frequent filter cleaning. Savannah River Remediation (SRR) has a desire to understand the causes of the low filter flux and to increase ARP/MCU throughput. One potential method for increasing filter flux is to adjust the axial velocity and transmembrane pressure (TMP). SRR requested SRNL to conduct bench-scale filter tests to evaluate the effects of axial velocity and transmembrane pressure on crossflow filter flux. The objective of the testing was to determine whether increasing the axial velocity at the ARP could produce a significant increase in filter flux. The authors conducted the tests by preparing slurries containing 6.6 M sodium Salt Batch 6 supernate and 2.5 g MST/L, processing the slurry through a bench-scale crossflow filter unit at varying axial velocity and TMP, and measuring filter flux as a function of time.

  11. Axial flow positive displacement worm compressor

    Science.gov (United States)

    Murrow, Kurt David (Inventor); Giffin, Rollin George (Inventor); Fakunle, Oladapo (Inventor)

    2010-01-01

    An axial flow positive displacement compressor has an inlet axially spaced apart and upstream from an outlet. Inner and outer bodies have offset inner and outer axes extend from the inlet to the outlet through first and second sections of a compressor assembly in serial downstream flow relationship. At least one of the bodies is rotatable about its axis. The inner and outer bodies have intermeshed inner and outer helical blades wound about the inner and outer axes respectively. The inner and outer helical blades extend radially outwardly and inwardly respectively. The helical blades have first and second twist slopes in the first and second sections respectively. The first twist slopes are less than the second twist slopes. An engine including the compressor has in downstream serial flow relationship from the compressor a combustor and a high pressure turbine drivingly connected to the compressor by a high pressure shaft.

  12. Direct optical nanoscopy with axially localized detection

    CERN Document Server

    Bourg, N; Dupuis, G; Barroca, T; Bon, P; Lécart, S; Fort, E; Lévêque-Fort, S

    2014-01-01

    Evanescent light excitation is widely used in super-resolution fluorescence microscopy to confine light and reduce background noise. Herein we propose a method of exploiting evanescent light in the context of emission. When a fluorophore is located in close proximity to a medium with a higher refractive index, its near-field component is converted into light that propagates beyond the critical angle. This so-called Supercritical Angle Fluorescence (SAF) can be captured using a hig-NA objective and used to determine the axial position of the fluorophore with nanometer precision. We introduce a new technique for 3D nanoscopy that combines direct STochastic Optical Reconstruction Microscopy (dSTORM) imaging with dedicated detection of SAF emission. We demonstrate that our approach of a Direct Optical Nanoscopy with Axially Localized Detection (DONALD) yields a typical isotropic 3D localization precision of 20 nm.

  13. Piping inspection carriage having axially displaceable sensor

    Science.gov (United States)

    Zollinger, William T.; Treanor, Richard C.

    1994-01-01

    A pipe inspection instrument carriage for use with a pipe crawler for performing internal inspections of piping surfaces. The carriage has a front leg assembly, a rear leg assembly and a central support connecting the two assemblies and for mounting an instrument arm having inspection instruments. The instrument arm has a y-arm mounted distally thereon for axially aligning the inspection instrumentation and a mounting block, a linear actuator and axial movement arm for extending the inspection instruments radially outward to operably position the inspection instruments on the piping interior. Also, the carriage has a rotation motor and gear assembly for rotating the central support and the front leg assembly with respect to the rear leg assembly so that the inspection instruments azimuthally scan the piping interior. The instrument carriage allows performance of all piping inspection operations with a minimum of moving parts, thus decreasing the likelihood of performance failure.

  14. Multimode interaction in axially excited cylindrical shells

    OpenAIRE

    2014-01-01

    Cylindrical shells exhibit a dense frequency spectrum, especially near the lowest frequency range. In addition, due to the circumferential symmetry, frequencies occur in pairs. So, in the vicinity of the lowest natural frequencies, several equal or nearly equal frequencies may occur, leading to a complex dynamic behavior. So, the aim of the present work is to investigate the dynamic behavior and stability of cylindrical shells under axial forcing with multiple equal or nearly equal natural fr...

  15. Axial flux permanent magnet brushless machines

    CERN Document Server

    Gieras, Jacek F; Kamper, Maarten J

    2008-01-01

    Axial Flux Permanent Magnet (AFPM) brushless machines are modern electrical machines with a lot of advantages over their conventional counterparts. They are being increasingly used in consumer electronics, public life, instrumentation and automation system, clinical engineering, industrial electromechanical drives, automobile manufacturing industry, electric and hybrid electric vehicles, marine vessels and toys. They are also used in more electric aircrafts and many other applications on larger scale. New applications have also emerged in distributed generation systems (wind turbine generators

  16. Consistent formulation of the spacelike axial gauge

    Energy Technology Data Exchange (ETDEWEB)

    Burnel, A.; Van der Rest-Jaspers, M.

    1983-12-15

    The usual formulation of the spacelike axial gauge is afflicted with the difficulty that the metric is indefinite while no ghost is involved. We solve this difficulty by introducing a ghost whose elimination is such that the metric becomes positive for physical states. The technique consists in the replacement of the gauge condition nxA = 0 by the weaker one partial/sub 0/nxAroughly-equal0.

  17. Direct optical nanoscopy with axially localized detection

    Science.gov (United States)

    Bourg, N.; Mayet, C.; Dupuis, G.; Barroca, T.; Bon, P.; Lécart, S.; Fort, E.; Lévêque-Fort, S.

    2015-09-01

    Evanescent light excitation is widely used in super-resolution fluorescence microscopy to confine light and reduce background noise. Here, we propose a method of exploiting evanescent light in the context of emission. When a fluorophore is located in close proximity to a medium with a higher refractive index, its near-field component is converted into light that propagates beyond the critical angle. This so-called supercritical-angle fluorescence can be captured using a high-numerical-aperture objective and used to determine the axial position of the fluorophore with nanometre precision. We introduce a new technique for three-dimensional nanoscopy that combines direct stochastic optical reconstruction microscopy (dSTORM) with dedicated detection of supercritical-angle fluorescence emission. We demonstrate that our approach of direct optical nanoscopy with axially localized detection (DONALD) typically yields an isotropic three-dimensional localization precision of 20 nm within an axial range of ∼150 nm above the coverslip.

  18. The clinical evaluation of anterior/posterior decompression in treating radiculopathy and axial symptoms caused by multilevel cervical spondylosis%多节段颈椎病前路与后路减压对神经根及轴性症状的疗效评估

    Institute of Scientific and Technical Information of China (English)

    王坤; 陈赞; 吴浩; 菅凤增

    2012-01-01

    Objective To evaluate the clinical outcomes about root and axial symptoms of multilevel cervical spondylosis operated via anterior or posterior approach.Methods We retrospectively,analyzed the JOA scores,JOA recovery rate,NDI,VAS and Nurick grades of 85 patients with multilevel cervical spondylosis who were divided into the anterior and posterior groups by method of different approach,then SPSS 17.0 was used to analyze the related status.Results The mean JOA scores of the anterior and posterior groups were,respectively,improved by 3.33 and 3.77 points,meanwhile,the corresponding JOA recovery rates were (62.79 ±41.12)% and (50.86 ±50.49)%,and no differences exist between the two groups.We used Median M (25%,75 % ) to describe Nurick grades,the pre - and post -operation M were ( 1,3,3 ),( 1,3,4) VS(0,0,2),(0,1,3)and there was no significant difference.However,in the aspects of NDI and VAS,via nonparametric test,the result showed the anterior group was superior.All surgery related complications occurred in the anterior group. Conclusions In the respect of releasing root/axial symptoms,the anterior approach was probably superior to the posterior group,but the complications related to surgery should be paid cautiously.%目的 评估多节段颈椎病前路与后路减压对神经根及轴性症状的疗效.方法 回顾性分析85例多节段颈椎病患者手术前后JOA评分及其改善率,NDI及VAS评分,Nurick分级.根据不同手术方式对85例患者分成前路及后路手术两组,并对手术疗效进行统计学分析.结果 前后路手术组JOA评分分别提升3.33分、3.77分,JOA改善率分别为(62.79±41.12)%、(50.86±50.49)%,两组间差异无统计学意义,P<0.05.Nurick分级采用中位数M(25%、75%)表示,前后路两组术前分别为(1、3、3)和(1、3、4),术后分别为(0、0、2)和(0、1、3),均比术前有改善,两组间差异无统计学意义.但在NDI、VAS评分方面,经非参数检验后,结果显示前

  19. Effects of Axial Non-uniform Tip Clearances on Aerodynamic Performance of a Transonic Axial Compressor

    Institute of Scientific and Technical Information of China (English)

    Hongwei MA; Baihe LI

    2008-01-01

    This paper presents a numerical investigation of effects of axial non-uniform tip clearances on the aerodynamic performance of a transonic axial compressor rotor (NASA Rotor 37). The three-dimensional steady flow field within the rotor passage was simulated with the datum tip clearance of 0.356 mm at the design wheel speed of 17188.7 rpm. The simulation results are well consistent with the measurement results, which verified the numeri-cal method. Then the three-dimensional steady flow field within the rotor passage was simulated respectively with different axial non-uniform tip clearances. The calculation results showed that optimal axial non-uniform tip clearances could improve the compressor performance, while the efficiency and the pressure ratio of the com-pressor were increased. The flow mechanism is that the axial non-uniform tip clearance can weaken the tip leak-age vortex, blow down low-energy fluids in boundary layers and reduce both flow blockage and tip loss.

  20. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resnance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. [Inst. of Radiology, Univ. Medical Centre, Ljubljana (Slovenia); Watt, I. [Dept. of Clinical Radiology, Bristol Royal Infirmary (United Kingdom); Rozman, B. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Kos-Golja, M. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Demsar, F. [Inst. Jozef Stefan, Ljubljana (Slovenia); Jarh, O. [Inst. Jozef Stefan, Ljubljana (Slovenia)

    1995-07-01

    A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter`s syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflamatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter`s syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular desease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration. (orig.)

  1. Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?

    Science.gov (United States)

    Moreau, Caroline; Baille, Guillaume; Delval, Arnaud; Tard, Céline; Perez, Thierry; Danel-Buhl, Nicolas; Seguy, David; Labreuche, Julien; Duhamel, Alain; Delliaux, Marie; Dujardin, Kathy; Defebvre, Luc

    2016-01-01

    Background Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients. Objectives To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD. Methods We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes. Results The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men). Conclusion Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders. PMID:27654040

  2. Toll-like receptor 2 and 4 induced interleukin-19 dampens immune reactions and associates inversely with spondyloarthritis disease activity.

    Science.gov (United States)

    Kragstrup, T W; Andersen, T; Holm, C; Schiøttz-Christensen, B; Jurik, A G; Hvid, M; Deleuran, B

    2015-05-01

    Spondyloarthritis (SpA) is a group of immune mediated inflammatory diseases affecting joints, gut, skin and entheses. The inflammatory process involves activation of Toll-like receptor (TLR)-2 and TLR-4 and production of cytokines and chemokines such as monocyte chemoattractant protein 1 (CCL2/MCP-1). This proinflammatory chemokine recruits monocytes to sites of inflammation and is central in the development of several immune-mediated inflammatory diseases. Interleukin (IL)-19 is a member of the IL-10 family of cytokines. IL-19-deficient mice are more susceptible to innate-mediated colitis and develop more severe inflammation in response to injury. In this work, we studied inducers of IL-19 production and effect of IL-19 on the production of CCL2/MCP-1 and proinflammatory cytokines in peripheral blood mononuclear cells (PBMCs) from healthy controls (HCs) and in PBMCs and synovial fluid mononuclear cells (SFMCs) from SpA patients. Further, we measured IL-19 in plasma from HCs and in plasma and synovial fluid from SpA patients. Constitutive IL-19 expression was present in both PBMCs and SFMCs and the secretion of IL-19 was increased by TLR-2 and TLR-4 ligands. Neutralizing IL-19 in HC PBMCs and SpA SFMCs resulted in increased production of CCL-2/MCP-1. IL-19 concentrations were decreased in synovial fluid compared with plasma and associated inversely with disease activity in SpA. SpA SFMCs produced less IL-19 in response to LPS compared with HC PBMCs. These findings indicate that IL-19 production is diminished in SpA. Taken together, impaired IL-19 control of the innate immune system might be involved in the pathogenesis of SpA.

  3. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany

    Directory of Open Access Journals (Sweden)

    Waller J

    2017-03-01

    Full Text Available John Waller,1 Emma Sullivan,1 James Piercy,1 Christopher M Black,2 Sumesh Kachroo2 1Adelphi Real World, Manchester, UK; 2Center for Observational and Real-World Evidence (CORE, Merck & Co., Inc., Kenilworth, NJ, USA Objectives: We examined rheumatologists’ motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. Methods: Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015–2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into “investigative”, “conservative” and “other” groups. Results: Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for <10% of all biologic therapy prescriptions, and >95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%–41%, potential side effects (26%–32% and potential long-term problems (19%–30%. Conclusion: Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and

  4. Validity and reliability of the Short Form 36 Health Surveys (SF-36) among patients with spondyloarthritis in Singapore.

    Science.gov (United States)

    Kwan, Yu Heng; Fong, Warren Weng Seng; Lui, Nai Lee; Yong, Si Ting; Cheung, Yin Bun; Malhotra, Rahul; Østbye, Truls; Thumboo, Julian

    2016-12-01

    The Short Form 36 Health Survey (SF-36) is a popular health-related quality of life (HrQoL) tool. However, few studies have assessed its psychometric properties in patients with spondyloarthritis (SpA). We therefore aimed to assess the reliability and validity of the SF-36 in patients with SpA in Singapore. Cross-sectional data from a registry of 196 SpA patients recruited from a dedicated tertiary referral clinic in Singapore from 2011 to 2014 was used. Analyses were guided by the COnsensus-based Standards for the selection of health Measurement INstruments framework. Internal consistency reliability was assessed using Cronbach's alpha. Construct validity was assessed through 33 a priori hypotheses by correlations of the eight subscales and two summary scores of SF-36 with other health outcomes. Known-group construct validity was assessed by comparison of the means of the subscales and summary scores of the SF-36 of SpA patients and the general population of Singapore using student's t tests. Among 196 patients (155 males (79.0 %), median (range) age: 36 (17-70), 166 Chinese (84.6 %)), SF-36 scales showed high internal consistency ranging from 0.88 to 0.90. Convergent construct validity was supported as shown by fulfillment of all hypotheses. Divergent construct validity was supported, as SF-36 MCS was not associated with PGA, pain and HAQ. Known-group construct validity showed SpA patients had lower scores of 3.8-12.5 when compared to the general population at p < 0.001. This study supports the SF-36 as a valid and reliable measure of HrQoL for use in patients with SpA at a single time point.

  5. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany

    Science.gov (United States)

    Waller, John; Sullivan, Emma; Piercy, James; Black, Christopher M; Kachroo, Sumesh

    2017-01-01

    Objectives We examined rheumatologists’ motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. Methods Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015–2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into “investigative”, “conservative” and “other” groups. Results Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for 95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%–41%), potential side effects (26%–32%) and potential long-term problems (19%–30%). Conclusion Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and physician communication. There remains a need for further research into nonclinical switching and the long-term impact of prescribing biosimilars. PMID:28331299

  6. Axial flow heat exchanger devices and methods for heat transfer using axial flow devices

    Energy Technology Data Exchange (ETDEWEB)

    Koplow, Jeffrey P.

    2016-02-16

    Systems and methods described herein are directed to rotary heat exchangers configured to transfer heat to a heat transfer medium flowing in substantially axial direction within the heat exchangers. Exemplary heat exchangers include a heat conducting structure which is configured to be in thermal contact with a thermal load or a thermal sink, and a heat transfer structure rotatably coupled to the heat conducting structure to form a gap region between the heat conducting structure and the heat transfer structure, the heat transfer structure being configured to rotate during operation of the device. In example devices heat may be transferred across the gap region from a heated axial flow of the heat transfer medium to a cool stationary heat conducting structure, or from a heated stationary conducting structure to a cool axial flow of the heat transfer medium.

  7. Aerodynamic Modelling and Optimization of Axial Fans

    DEFF Research Database (Denmark)

    Sørensen, Dan Nørtoft

    A numerically efficient mathematical model for the aerodynamics oflow speed axial fans of the arbitrary vortex flow type has been developed.The model is based on a blade-element principle, whereby therotor is divided into a number of annular streamtubes.For each of these streamtubes relations...... for velocity, pressure andradial position are derived from the conservationlaws for mass, tangential momentum and energy.The resulting system of equations is non-linear and, dueto mass conservation and pressure equilibrium far downstream of the rotor,strongly coupled.The equations are solved using the Newton...

  8. Single Band Helical Antenna in Axial Mode

    Directory of Open Access Journals (Sweden)

    Parminder Singh

    2012-11-01

    Full Text Available Helical antennas have been widely used in a various useful applications, due to their low weight and low profile conformability, easy and cheap realization.Radiation properties of this antenna are examined both theoretically and experimentally. In this paper, an attempt has been made to investigate new helical antenna structure for Applications. CST MWS Software is used for the simulation and design calculations of the helical antennas. The axial ratio, return loss, VSWR, Directivity, gain, radiation pattern is evaluated. Using CST MWS simulation software proposed antenna is designed/simulated and optimized. The antenna exhibits a single band from 0 GHz to 3 GHz for GPS and several satellite applications

  9. Tunable axial potentials for atom chip waveguides

    CERN Document Server

    Stickney, James A; Imhof, Eric; Kroese, Bethany R; Crow, Jonathon A R; Olson, Spencer E; Squires, Matthew B

    2014-01-01

    We present a method for generating algebraically precise magnetic potentials along the axis of a cold atom waveguide near the surface of an atom chip. With a single chip design consisting of several wire pairs, various axial potentials can be created, including double wells, triple wells, and pure harmonic traps with suppression of higher order terms. We characterize the error along a harmonic trap between the expected algebraic form and magnetic field simulations and find excel- lent agreement, particularly at small displacements from the trap center. Finally, we demonstrate experimental control over the bottom fields of an asymmetric double well potential.

  10. Cervical Spine Axial Rotation Goniometer Design

    Directory of Open Access Journals (Sweden)

    Emin Ulaş Erdem

    2012-06-01

    Full Text Available To evaluate the cervical spine rotation movement is quiet harder than other joints. Configuration and arrangement of current goniometers and devices is not always practic in clinics and some methods are quiet expensive. The cervical axial rotation goniometer designed by the authors is consists of five pieces (head apparatus, chair, goniometric platform, eye pads and camera. With this goniometer design a detailed evaluation of cervical spine range of motion can be obtained. Besides, measurement of "joint position sense" which is recently has rising interest in researches can be made practically with this goniometer.

  11. Aerodynamics of Advanced Axial-Flow Turbomachinery.

    Science.gov (United States)

    1980-11-30

    cementing in place short segments of lb ga. (1.2 mm I.D.) hypodermic tubing in drillud holes carefully aligned normal to the sidewall profile at the...PRESSURE I REFERENCE SCANPREF I I SYSTEM 0YTE NECKED- PRF NEEDLE VALVE PE PRRSSUE TRANSDUCER AMPLIF IER] POSITIONER TEMPERATURES I STO BE READ I...Compressors. U.S. NASA SP-36. 1965. 23. Hearsey, R. M. A Revised Computer Program for Axial Compressor Design Volume 1: Theory , Descriptions and User’s

  12. Composite Axial Flow Propulsor for Small Aircraft

    OpenAIRE

    2005-01-01

    This work focuses on the design of an axial flow ducted fan driven by a reciprocating engine. The solution minimizes the turbulization of the flow around the aircraft. The fan has a rotor - stator configuration. Due to the need for low weight of the fan, a carbon/epoxy composite material was chosen for the blades and the driving shaft.The fan is designed for optimal isentropic efficiency and free vortex flow. A stress analysis of the rotor blade was performed using the Finite Element  Method....

  13. Axial Tomography from Digitized Real Time Radiography

    Science.gov (United States)

    Zolnay, A. S.; McDonald, W. M.; Doupont, P. A.; McKinney, R. L.; Lee, M. M.

    1985-01-18

    Axial tomography from digitized real time radiographs provides a useful tool for industrial radiography and tomography. The components of this system are: x-ray source, image intensifier, video camera, video line extractor and digitizer, data storage and reconstruction computers. With this system it is possible to view a two dimensional x-ray image in real time at each angle of rotation and select the tomography plane of interest by choosing which video line to digitize. The digitization of a video line requires less than a second making data acquisition relatively short. Further improvements on this system are planned and initial results are reported.

  14. Treating Vomiting

    Science.gov (United States)

    ... hours. Your pediatrician usually won’t prescribe a drug to treat the vomiting, but some doctors will prescribe antinausea medications to children. If your child also has diarrhea, ask your pediatrician for instructions on giving liquids ...

  15. Treating Meningitis

    Science.gov (United States)

    ... David C. Spencer, MD Steven Karceski, MD Treating meningitis Steven Karceski, MD WHAT DID THE AUTHORS STUDY? ... study, “ Dexamethasone and long-term survival in bacterial meningitis, ” Dr. Fritz and his colleagues carefully evaluated 2 ...

  16. Investigation of multipactor breakdown in communication satellite microwave co-axial systems

    Indian Academy of Sciences (India)

    S K Nagesh; D Revannasiddiah; S V K Shastry

    2005-01-01

    Multipactor breakdown or multipactor discharge is a form of high frequency discharge that may occur in microwave components operating at very low pressures. Some RF components of multi-channel communication satellites have co-axial geometry and handle high RF power under near-vacuum conditions. The breakdown occurs due to secondary electron resonance, wherein electrons move back and forth in synchronism with the RF voltage across the gap between the inner and outer conductors of the co-axial structure. If the yield of secondary electrons from the walls of the co-axial structure is greater than unity, then the electron density increases with time and eventually leads to the breakdown. In this paper, the current due to the oscillating electrons in the co-axial geometry has been treated as a radially oriented Hertzian dipole. The electric field, due to this dipole, at any point in the coaxial structure, may then be determined by employing the dyadic Green’s function technique. This field has been compared with the field that would exist in the absence of multipactor.

  17. NUMERICAL INVESTIGATION OF PERFORMANCE OF AN AXIAL-FLOW PUMP WITH INDUCER

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The interaction of flow through the inducer and impeller of an axial-flow pump equipped with an inducer has significant effect on its performance. This article presents a recent numerical investigation on this topic. The studied pump has an inducer with 3 blades mounted on a conical hub and a 6-blade impeller. The blade angle of the impeller is adjustable to generate different relative circumferential angles between the inducer blade trailing edge and the impeller blade leading edge. A computational fluid dynamics code was used to investigate the flow characteristics and performance of the axial-flow pump. For turbulence closure, the RNG k-ε model was applied with an unstructured grid system. The rotor-stator interaction was treated with a Multiple Reference Frame (MRF) strategy. Computations were performed in different cases: 7 different relative circumferential angles (△θ) between the inducer blade trailing edge and the impeller blade leading edge, and 3 different axial gaps (G) between the inducer and the impeller. The variation of the hydraulic loss in the rotator was obtained by changing △θ. The numerical results show that the pressure generated is minimum in the case of (G=%3D), which indicates that the interference between inducer and impeller is strong if the axial gap is small. The pump performances were predicted and compared to the experimental measurements. Recommendations for future modifications and improvements to the pump design were also given.

  18. Single Rod Vibration in Axial Flow

    Science.gov (United States)

    Weichselbaum, Noah; Wang, Shengfu; Bardet, Philippe

    2013-11-01

    Fluid structure interaction of a single rod in axial flow is a coupled dynamical system present in many application including nuclear reactors, steam generators, and towed antenna arrays. Fluid-structure response can be quantified thanks to detailed experimental data where both structure and fluid responses are recorded. Such datum deepen understanding of the physics inherent to the system and provide high-dimensionality quantitative measurements to validate coupled structural and CFD codes with various level of complexity. In this work, single rods fixed on both ends in a concentric pipe, are subjected to an axial flow with Reynolds number based on hydraulic diameter of Re =4000. Rods of varying material stiffness and diameter are utilized in the experiment resulting in a range of dimensionless U between 0.5 and 1, where U = (ρA/EI)1/2uL. Experimental measurements of the velocity field around the rod are taken with PIV from time-resolved Nd:YLF laser and a high speed CMOS camera. Three-dimensional and temporal vibration and deflection of the rod is recorded with shadowgraphy utilizing two sets of pulsed high power LED and dedicated CMOS camera. Through integration of these two diagnostics, it is possible to reconstruct the full FSI domain providing unique validation data.

  19. Axial residual stresses in boron fibers

    Science.gov (United States)

    Behrendt, D. R.

    1978-01-01

    A method of measuring axial residual stresses in boron fibers is presented. With this method, the axial residual stress distribution as a function of radius is determined from the fiber surface to the core including the average residual stress in the core. Such measurements on boron on tungsten (B/W) fibers show that the residual stresses for 102, 142, 203, and 366 micron diam fibers are similar, being compressive at the surface and changing monotonically to a region of tensile stress within the boron. At approximately 25% of the original radius, the stress reaches a maximum tensile stress of about 860 MN sq m and then decreases to a compressive stress near the tungsten boride core. Data are presented for 203-micron diam B/W fibers that show annealing above 900 C reduces the residual stresses. A comparison between 102-micron diam B/W and boron on carbon (B/C) show that the residual stresses are similar in the outer regions of the fibers, but that large differences near and in the core are observed. Fracture of boron fibers is discussed.

  20. Study on the Axial Dispersion of Liquid in Column Flotation

    Institute of Scientific and Technical Information of China (English)

    周鵾; 曾爱武; 高长宝; 余国琮

    2003-01-01

    An experimental study on the axial dispersion of liquid was carried out in a 0.382-m-ID flotation column packed with different structured packings or free of packings. The correlations of axial Peclet numbers with the liquid and gas superficial Reynolds numbers were developed for various packings. Among the packings tested, it is found that in the column packed with 250Y or 350Y packings the axial dispersion is the lowest. The addition of frother can decrease the axial dispersion. By the simulation analysis of the one-dimension dispersion model of packed flotation column, it is found that small axial dispersion, high collection rate constant and low axial liquid velocity can increase the collection zone recovery.

  1. A technique to determine a desired preparation axial inclination.

    Science.gov (United States)

    Parker, M Harry; Ivanhoe, John R; Blalock, John S; Frazier, Kevin B; Plummer, Kevin D

    2003-10-01

    The guidelines recommended in the literature for the convergence angle of a crown preparation vary from 3 to 24 degrees. There is a lack of guidelines on techniques to achieve a specific axial inclination. The purpose of this article was to present a practical technique, with a diamond rotary cutting instrument of known axial inclination, to determine the diamond rotary cutting instrument angulations required to achieve the desired axial inclination of a preparation.

  2. Design and Test of a Transonic Axial Splittered Rotor

    Science.gov (United States)

    2015-06-15

    geometric rendering and analysis of a transonic axial compressor rotor with splitter blades. Predictive numerical simulations were conducted and...ANSYS-CFX) for the geometric rendering and analysis of a transonic axial compressor rotor with splitter blades. Predictive numerical simulations were...that uses commercial-off-the-shelf software ( MATLAB , SolidWorks, and ANSYS-CFX) for the geometric rendering and analysis of a transonic axial

  3. Rotordynamics of Turbine Labyrinth Seals with Rotor Axial Shifting

    OpenAIRE

    Jinxiang Xi; Rhode, David L.

    2006-01-01

    Rotors in high-performance steam turbines experience a significant axial shifting during starting and stopping processes due to thermal expansion, for example. This axial shifting could significantly alter the flow pattern and the flow-induced rotordynamic forces in labyrinth seals, which in turn, can considerably affect the rotor-seal system performance. This paper investigates the influence of the rotor axial shifting on leakage rate as well as rotordynamic forces in hi...

  4. Tricky Treats

    Centers for Disease Control (CDC) Podcasts

    2008-08-04

    The Eagle Books are a series of four books that are brought to life by wise animal characters - Mr. Eagle, Miss Rabbit, and Coyote - who engage Rain That Dances and his young friends in the joy of physical activity, eating healthy foods, and learning from their elders about health and diabetes prevention. Tricky Treats shows children the difference between healthy snacks and sweet treats.  Created: 8/4/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/5/2008.

  5. The ASAS Health Index (ASAS HI) - a new tool to assess the health status of patients with spondyloarthritis.

    Science.gov (United States)

    Kiltz, U; van der Heijde, D; Boonen, A; Braun, J

    2014-01-01

    Within the variable course of ankylosing spondylitis (AS), peripheral arthritis, enthesitis, and involvement of other organs can add to the burden of the disease. The primary complaints of patients with spondyloarthritis (SpA) are pain, stiffness, fatigue, and limitation in activities and social participation. Instruments currently available for the assessment of patients with SpA focus predominantly on specific aspects of health such as pain, disease activity, and physical function and measure specific concepts like physical function and health-related quality of life (HR-QoL). However, the overall picture of impairments, limitations and restrictions in activities or social participation of patients with AS is not adequately assessed in SpA-specific questionnaires. Most of the existing questionnaires are not conceptualised with regard to their underlying construct. The International classification of functioning, disability and health (ICF) Core Set for AS may serve as an appropriate model and underlying construct to develop a health index, since the whole range of functioning and disability of patients with AS is captured. Based on these assumptions, ASAS developed for patients with SpA an instrument assessing health as operationalised by the ICF. The questionnaire was developed by preparing an item pool, linkage of the items to the comprehensive ICF core set for AS and test of the item pool in two cross-sectional studies. The analysis of the questionnaire and the response scale were done with Rasch analysis. Emphasis was on optimal targeting, the capacity of items to differentiate between different levels of health, and optimal coverage of items to the spectrum of ICF categories, so that the final questionnaire could represent as much of the entire range of difficulty levels as possible. The ASAS HI is a linear composite measure and includes 17 items which cover most of the ICF core set. Preliminary validity has been confirmed in a field test in 4 English

  6. Energy Dissipation in Sandwich Structures During Axial Compression

    DEFF Research Database (Denmark)

    Urban, Jesper

    2002-01-01

    The purpose of this paper is to investigate the energy dissipation in sandwich structures during axial crushing. Axial crushing tests on six sandwich elements are described. The sandwich elements consist of a polyurethane core and E-glass/Polyester skin. The elements compare to full-scale structu......The purpose of this paper is to investigate the energy dissipation in sandwich structures during axial crushing. Axial crushing tests on six sandwich elements are described. The sandwich elements consist of a polyurethane core and E-glass/Polyester skin. The elements compare to full...

  7. Modular functional organisation of the axial locomotor system in salamanders.

    Science.gov (United States)

    Cabelguen, Jean-Marie; Charrier, Vanessa; Mathou, Alexia

    2014-02-01

    Most investigations on tetrapod locomotion have been concerned with limb movements. However, there is compelling evidence that the axial musculoskeletal system contributes to important functions during locomotion. Adult salamanders offer a remarkable opportunity to examine these functions because these amphibians use axial undulations to propel themselves in both aquatic and terrestrial environments. In this article, we review the currently available biological data on axial functions during various locomotor modes in salamanders. We also present data showing the modular organisation of the neural networks that generate axial synergies during locomotion. The functional implication of this modular organisation is discussed.

  8. Coinfection of Chlamydiae and other Bacteria in Reactive Arthritis and Spondyloarthritis: Need for Future Research

    Directory of Open Access Journals (Sweden)

    Henning Zeidler

    2016-08-01

    Full Text Available Reactive (inflammatory arthritis has been known for many years to follow genital infection with the intracellular bacterial pathogen Chlamydia trachomatis in some individuals. Recent studies from several groups have demonstrated that a related bacterium, the respiratory pathogen Chlamydia pneumoniae, can elicit a similar arthritis. Studies of these organisms, and of a set of gastrointestinal pathogens also associated with engendering inflammatory arthritis, have been relatively extensive. However, reports focusing on coinfections with these and/or other organisms, and the effects of such coinfections on the host immune and other systems, have been rare. In this article, we review the extant data regarding infections by multiple pathogens in the joint as they relate to engendering arthritis, and we suggest a number of research areas that must be given a high priority if we are to understand, and therefore to treat in an effective manner, such arthritides.

  9. Casimir Energy in the Axial Gauge

    CERN Document Server

    Esposito, G; Kirsten, K; Esposito, Giampiero; Kamenshchik, Alexander Yu.; Kirsten, Klaus

    2000-01-01

    The zero-point energy of a conducting spherical shell is studied by imposing the axial gauge via path-integral methods, with boundary conditions on the electromagnetic potential and ghost fields. The coupled modes are then found to be the temporal and longitudinal modes for the Maxwell field. The resulting system can be decoupled by studying a fourth-order differential equation with boundary conditions on longitudinal modes and their second derivatives. The exact solution of such equation is found by using a Green-function method, and is obtained from Bessel functions and definite integrals involving Bessel functions. Complete agreement with a previous path-integral analysis in the Lorenz gauge, and with Boyer's value, is proved in detail.

  10. The Axial Part Phrase in Japanese

    Directory of Open Access Journals (Sweden)

    Kaori Takamine

    2007-01-01

    Full Text Available In this paper, I investigate the categorial status of spatial terms in locative/directional expressions in Japanese. I will show that a certain class of spatial terms have a distinct categorial status from both regular postpositions and nouns. On one hand, syntactic diagnostics such as doubling, coordination by to, and co-occurrence with demonstratives indicate that these spatial terms belong to a nominal category rather than to a postpositional category. On the other hand, the fact that these spatial terms are modified by range modifiers indicates that they are more similar to regular postpositions than to nouns. On the basis of these diagnostics, I will argue that spatial terms in Japanese need to be assigned a new category Axial Part Phrase which is proposed by Svenonius 2006.

  11. Composite Axial Flow Propulsor for Small Aircraft

    Directory of Open Access Journals (Sweden)

    R. Poul

    2005-01-01

    Full Text Available This work focuses on the design of an axial flow ducted fan driven by a reciprocating engine. The solution minimizes the turbulization of the flow around the aircraft. The fan has a rotor - stator configuration. Due to the need for low weight of the fan, a carbon/epoxy composite material was chosen for the blades and the driving shaft.The fan is designed for optimal isentropic efficiency and free vortex flow. A stress analysis of the rotor blade was performed using the Finite Element  Method. The skin of the blade is calculated as a laminate and the foam core as a solid. A static and dynamic analysis were made. The RTM technology is compared with other technologies and is described in detail. 

  12. Aerodynamics of advanced axial-flow turbomachinery

    Science.gov (United States)

    Serovy, G. K.; Kavanagh, P.; Kiishi, T. H.

    1980-01-01

    A multi-task research program on aerodynamic problems in advanced axial-flow turbomachine configurations was carried out at Iowa State University. The elements of this program were intended to contribute directly to the improvement of compressor, fan, and turbine design methods. Experimental efforts in intra-passage flow pattern measurements, unsteady blade row interaction, and control of secondary flow are included, along with computational work on inviscid-viscous interaction blade passage flow techniques. This final report summarizes the results of this program and indicates directions which might be taken in following up these results in future work. In a separate task a study was made of existing turbomachinery research programs and facilities in universities located in the United States. Some potentially significant research topics are discussed which might be successfully attacked in the university atmosphere.

  13. Aerodynamic modelling and optimization of axial fans

    Energy Technology Data Exchange (ETDEWEB)

    Noertoft Soerensen, Dan

    1998-01-01

    A numerically efficient mathematical model for the aerodynamics of low speed axial fans of the arbitrary vortex flow type has been developed. The model is based on a blade-element principle, whereby the rotor is divided into a number of annular stream tubes. For each of these stream tubes relations for velocity, pressure and radial position are derived from the conservation laws for mass, tangential momentum and energy. The equations are solved using the Newton-Raphson methods, and solutions converged to machine accuracy are found at small computing costs. The model has been validated against published measurements on various fan configurations, comprising two rotor-only fan stages, a counter-rotating fan unit and a stator-rotor stator stage. Comparisons of local and integrated properties show that the computed results agree well with the measurements. Optimizations have been performed to maximize the mean value of fan efficiency in a design interval of flow rates, thus designing a fan which operates well over a range of different flow conditions. The optimization scheme was used to investigate the dependence of maximum efficiency on 1: the number of blades, 2: the width of the design interval and 3: the hub radius. The degree of freedom in the choice of design variable and constraints, combined with the design interval concept, provides a valuable design-tool for axial fans. To further investigate the use of design optimization, a model for the vortex shedding noise from the trailing edge of the blades has been incorporated into the optimization scheme. The noise emission from the blades was minimized in a flow rate design point. Optimizations were performed to investigate the dependence of the noise on 1: the number of blades, 2: a constraint imposed on efficiency and 3: the hub radius. The investigations showed, that a significant reduction of noise could be achieved, at the expense of a small reduction in fan efficiency. (EG) 66 refs.

  14. Structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis - definitions, assessment system, and reference image set

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Maksymowych, Walter P; Pedersen, Susanne J;

    2009-01-01

    are assessed at each vertebral endplate at all 23 spinal levels from C2/3 to L5/S1, whereas facet joint lesions are to be assessed by segmental level (cervical, thoracic, and lumbar). CONCLUSION: An anatomy-based set of definitions and an assessment system for structural lesions in the spine of patients......OBJECTIVE: There is no reliable and sensitive magnetic resonance imaging (MRI) assessment system for structural lesions in patients with spondyloarthritis (SpA). We sought to develop and illustrate a detailed anatomy-based set of MRI definitions and an assessment system for structural lesions...... in the spine of patients with SpA. METHODS: MRI definitions of different structural ("chronic") lesions at various anatomical locations in the spine, and an accompanying assessment system, were agreed by consensus within the Canada-Denmark MRI working group. Subsequently, a reference image set...

  15. Coexistence of osteopoikilosis with seronegative spondyloarthritis and Raynaud’s phenomenon: first case report with evaluation of the nailfold capillary bed and literature review

    Directory of Open Access Journals (Sweden)

    F. Ravera

    2012-12-01

    Full Text Available Osteopoikilosis (OPK is a rare autosomal dominant bone disorder characterized by numerous hyperostotic areas that tend to localize in periarticular osseous regions. It is usually asymptomatic and is often diagnosed incidentally during X-rays. OPK may be an isolated finding or associated with other pathologies, e.g. skin manifestations, rheumatic and/or skeletal disorders. We report a literature review and, for the first time, the coexistence of OPK with seronegative spondyloarthritis and Raynaud’s phenomenon in a 48-year old female. To the best of our knowledge, this is the first case of OPK studied by videocapillaroscopy, demonstrating the absence of specific microvascular abnormalities of nailfold capillaries.

  16. Case Study of CPT-based Design Methods for Axial Capacity of Driven Piles in Sand

    DEFF Research Database (Denmark)

    Thomassen, Kristina; Ibsen, Lars Bo; Andersen, Lars Vabbersgaard

    2012-01-01

    Today the design of onshore axially loaded driven piles in cohesionless soil is commonly made on basis of CPT-based methods because field investigations have shown strong correlation between the local shaft friction and the CPT cone resistance. However, the recommended design method for axially....... Thus, several CPT-based methods have been proposed for the design of offshore driven piles in cohesionless soil such as the UWA-05, ICP-05, and NGI-99 methods. This article treats a case study where the API-method as well as the UWA-05 and NGI-99 methods are compared using CPT-data from an offshore...... location with dense to very dense sand. The design of the piles in the jacket foundation shows that API-00 for both the tension and the compression loads predicted much longer piles than the CPT-based methods. Variation of the pile length and pile diameter shows that NGI-99 and UWA-05 predicts almost...

  17. Combined therapeutic approach: Inflammatory bowel diseases and peripheral or axial arthritis

    Institute of Scientific and Technical Information of China (English)

    Fabiola Atzeni; Sandro Ardizzone; Luca Bertani; Marco Antivalle; Alberto Batticciotto; Piercarlo Sarzi-Puttini

    2009-01-01

    Inflammatory bowel diseases (IBDs), particularly Crohn's disease(CD) and ulcerative colitis(UC), are associated with a variety of extra-intestinal manifestations (EIMs). About 36% of IBD patients have at least one EIM, which most frequently affect the joints,skin, eyes and the biliary tract. The EIMs associated with IBD have a negative impact on patients with UC and CD, and the resolution of most of them parallels that of the active IBD in terms of timing and required therapy; however, the clinical course of EIMs such as axial arthritis, pyoderma gangrenosum, uveitis, and primary sclerosing cholangitis is independent of IBD activity. The peripheral and axial arthritis associated with IBD have traditionally been treated with simple analgesics, non-steroidal anti-inflammatory drugs,steroids, sulfasalazine, methotrexate, local steroid injections and physiotherapy, but the introduction of biological response modifiers such as tumor necrosis factor-α blockers, has led to further improvements.

  18. Novel approach for determining the optimal axial preload of a simulating rotary table spindle system

    Institute of Scientific and Technical Information of China (English)

    SHAN Xiao-biao; XIE Tao; CHEN Wei-shan

    2007-01-01

    This paper presents a new theoretical model to determine the optimal axial preload ora spindle system, for challenging the traditional method which relies heavily on experience of engineers. The axial preloading stiffness was treated as the sum of the spindle modal stiffness and the framework elastic stiffness, based on a novel concept that magnitude of preloads can be controlled by measuring the resonant frequency of a spindle system. By employing an example of a certain type of aircraft simulating rotary table, the modal stiffness was measured on the Agilent 35670A Dynamic Signal Analyzer by experimental modal analysis. The equivalent elastic stiffness was simulated by both finite element analysis in ANSYS(R) and a curve fitting in MATLAB(R). Results showed that the static preloading stiffness of the spindle was 7.2125×107 N/m, and that the optimal preloading force was 120.0848 N. Practical application proved the feasibility of our method.

  19. Validation of Portuguese-translated computer touch-screen questionnaires in patients with rheumatoid arthritis and spondyloarthritis, compared with paper formats.

    Science.gov (United States)

    Cunha-Miranda, Luís; Santos, Helena; Miguel, Cláudia; Silva, Cândida; Barcelos, Filipe; Borges, Joana; Trinca, Ricardo; Vicente, Vera; Silva, Tiago

    2015-12-01

    The aim of this paper was to assess the validity and reliability of the touch-screen standard Portuguese version of the following patient-reported outcomes (PROs), compared with paper format, in patients with rheumatoid arthritis (RA) and spondyloarthritis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life scale (ASQoL), Short-Form 36 (SF-36), Health Assessment Questionnaire (HAQ) and visual analogue scales (VAS) measuring pain and burden of disease. Adult patients with RA and spondyloarthritis attending the Portuguese Institute of Rheumatology were recruited from March 2013 to January 2014. Patients filled the paper and touch-screen formats of the standard Portuguese versions of the PROs. Two groups of VAS were used, RA and psoriatic arthritis (Global VAS) and another specific for spondyloarthrites (Spa-VAS). Paper questionnaires were filled 15 min before touch-screen formats. Agreement between formats (validity) was assessed by intraclass correlation coefficient (ICC), while internal consistency of scales (reliability) was assessed by Cronbach's alpha. Overall, 134 patients were included with a mean age of 51 years, 74.6 % female and 57.5 % presenting RA. BASDAI, BASFI, HAQ and ASQoL showed high ICC between paper and touch-screen formats (0.977, 0.958, 0.974 and 0.940, respectively). ICC for Global VAS ranged from 0.906 to 0.921, while Spa-VAS ranged from 0.867 to 0.943. The mean ICC for all SF-36 domains was 0.889 (ICC for each domain ranged from 0.781 to 0.944). Touch-screen standard Portuguese formats of these PROs may be valid and reliable tools for PRO measurement in rheumatology.

  20. Case report: Physical therapy management of axial dystonia.

    Science.gov (United States)

    Voos, Mariana Callil; Oliveira, Tatiana de Paula; Piemonte, Maria Elisa Pimentel; Barbosa, Egberto Reis

    2014-01-01

    Few studies have described physical therapy approaches to provide functional independence and reduce pain in individuals with dystonia. This report describes the physical therapy treatment of a 46-year-old woman diagnosed with idiopathic segmental axial dystonia. For two years, the patient was treated with kinesiotherapy (active and resisted movements and stretching of neck and trunk muscles), abdominal taping (kinesiotaping techniques), functional training, and sensory tricks. She was assessed with parts I, II and III of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-I, TWSTRS-II and TWSTRS-III), Berg Balance Scale (BBS), Six-Minute Walk Test (6-MWT), and the motor domain of Functional Independence Measure (FIM-motor) before and after the two-year treatment and after the one year follow-up. Postural control and symmetry improved (TWSTRS-I: from 30 to 18), functional independence increased (TWSTRS-II: from 27 to 15; BBS: from 36 to 46; 6-MWT: from 0 to 480 meters (m); FIM-motor: from 59 to 81), and the pain diminished (TWSTRS-III: from 12 to 5). The functional improvement was retained after one year (TWSTRS-I: 14/35; TWRTRS-II: 12/30; TWRTRS-III: 5/20; BBS: 48/56; 6-MWT: 450 m; FIM-motor: 81/91). This program showed efficacy on providing a better control of the dystonic muscles and thus the doses of botulinum toxin needed to treat them could be reduced. Outcomes support the therapeutic strategies used to deal with this type of dystonia.

  1. Improved axial position detection in optical tweezers measurements

    DEFF Research Database (Denmark)

    Dreyer, Jakob Kisbye; Berg-Sørensen, Kirstine; Oddershede, Lene

    2004-01-01

    We investigate the axial position detection of a trapped microsphere in an optical trap by using a quadrant photodiode. By replacing the photodiode with a CCD camera, we obtain detailed information on the light scattered by the microsphere. The correlation of the interference pattern with the axial...

  2. Through flow analysis within axial flow turbomachinery blade rows

    Science.gov (United States)

    Girigoswami, H.

    1986-09-01

    Using Katsanis' Through Flow Code, inviscid flow through an axial flow compressor rotor blade as well as flow through inlet guide vanes are analyzed and the computed parameters such as meridional velocity distribution, axial velocity distribution along radial lines, and velocity distribution over blade surfaces are presented.

  3. Test Setup for Axially Loaded Piles in Sand

    DEFF Research Database (Denmark)

    Thomassen, Kristina

    The test setup for testing axially static and cyclic loaded piles in sand is described in the following. The purpose for the tests is to examine the tensile capacity of axially loaded piles in dense fully saturated sand. The pile dimensions are chosen to resemble full scale dimension of piles used...... in offshore pile foundations today....

  4. An Unbroken Axial-Vector Current Conservation Law

    Science.gov (United States)

    Sharafiddinov, Rasulkhozha S.

    2016-04-01

    The mass, energy and momentum of the neutrino of a true flavor have an axial-vector nature. As a consequence, the left-handed truly neutral neutrino in an axial-vector field of emission can be converted into a right-handed one and vice versa. This predicts the unidenticality of masses, energies and momenta of neutrinos of the different components. Recognizing such a difference in masses, energies, momenta and accepting that the left-handed axial-vector neutrino and the right-handed antineutrino of true neutrality refer to long-lived C-odd leptons, and the right-handed truly neutral neutrino and the left-handed axial-vector antineutrino are of short-lived fermions of C-oddity, we would write a new CP-even Dirac equation taking into account the flavor symmetrical axial-vector mass, energy and momentum matrices. Their presence explains the spontaneous mirror symmetry violation, confirming that an axial-vector current conservation law has never violated. They reflect the availability of a mirror Minkowski space in which a neutrino is characterized by left as well as by right space-time coordinates. Therefore, it is not surprising that whatever the main purposes experiments about a quasielastic axial-vector mass say in favor of an axial-vector mirror Minkowski space-time.

  5. A new approach to radial and axial gauges

    Science.gov (United States)

    Weigert, Heribert; Heinz, Ulrich

    1992-03-01

    We develop a new path integral formulation of QCD in radial and axial gauges. This formalism yields free propagators which are free of gauge poles. We find that radial gauges are ghost free. In axial gauges ghosts cannot generally be excluded from the formalism due to the need to fix the residual gauge freedom.

  6. On Stationary Axially Symmetric Solutions in Brans-Dicke Theory

    CERN Document Server

    Kirezli, Pınar

    2015-01-01

    Stationary axially symmetric Brans-Dicke-Maxwell solutions are re-examined in the framework of the Brans-Dicke theory. We see that, employing a particular parametrization of the standard axially symmetric metric simplifies the procedure of obtaining the Ernst equations for axially symmetric electro-vacuum space-times for this theory. This analysis also permit us to construct a two parameter extension in both Jordan and Einstein frames of an old solution generating technique frequently used to construct axially symmetric solutions for Brans-Dicke theory from a seed solution of General Relativity. As applications of this technique, several known and new solutions are constructed including a general axially symmetric BD-Maxwell solution of Plebanski-Demianski with vanishing cosmological constant, i.e. the Kinnersley solution and general magnetized Kerr-Newman type solutions. Some physical properties and circular motion of test particles for a particular subclass of Kinnersley solution, i.e. Kerr-Newman-NUT type ...

  7. Axial vibration analysis of nanocones based on nonlocal elasticity theory

    Institute of Scientific and Technical Information of China (English)

    Shu-Qi Guo; Shao-Pu Yang

    2012-01-01

    Carbon nanocones have quite fascinating electronic and structural properties,whose axial vibration is seldom investigated in previous studies.In this paper,based on a nonlocal elasticity theory,a nonuniform rod model is applied to investigate the small-scale effect and the nonuniform effect on axial vibration of nanocones.Using the modified Wentzel-Brillouin-Kramers (WBK) method,an asymptotic solution is obtained for the axial vibration of general nonuniform nanorods.Then,using similar procedure,the axial vibration of nanocones is analyzed for nonuniform parameters,mode number and nonlocal parameters.Explicit expressions are derived for mode frequencies of clamped-clamped and clamped-free boundary conditions.It is found that axial vibration frequencies are highly overestimated by the classical rod model because of ignorance of the effect of small length scale.

  8. Angular and axial deformities of the legs of children.

    Science.gov (United States)

    McDonough, M W

    1984-12-01

    Age is often a determining factor in establishing a treatment program for these axial and angular problems. As can be seen, the deformities of torsion are noticeable from early life. Any tibial torsion should be treated early, but an excessive medial range of motion in the infant leg with a corresponding adequate lateral range of motion of the limb may be cautiously observed. Medial femoral torsion is a normal early finding in the infant thigh. The problem becomes evident as the child matures without the corresponding reduction in femoral torsion, leading to a persistence of fetal or infantile alignment. The gait consequences are usually noticed at 4 to 8 years of age. The angular changes generally are a delayed finding noticed in stance. The bowleg may be associated with marked tibial torsion and picked up early but the Blount's patient has been traditionally definable at 2 years of age. Levin and Drennan may hasten the time of diagnosis with their radiographic criteria. Knock-knee is an alignment disturbance noticed during the early to mid-childhood years, age 4 to 8 years. The diagnosis is important, differentiating physiologic from torsion-related deformities, and treatment, if warranted, should not be delayed. Generally the earlier these problems are discovered, the more optimistic the prognosis. Since the pediatric limb is in a constant state of transition, there will be a perpetual argument as to the need or efficacy of various approaches to the problems of knock-knee and bowleg. If observation is the treatment of choice, the percentage of cases which go on to osteotomies and epiphyseal stapling will continue. For those with axial or angular deformities, degenerative arthritis of the knee may be forthcoming. Swanson, Greene, and Allis warned of problems becoming "unphysiologic." If we consider the epiphyseal malleability, not only to deformity but to correction, we can appreciate Lenoir's comment of "every day the problem goes untreated is a golden

  9. Axial Vibration Confinement in Nonhomogenous Rods

    Directory of Open Access Journals (Sweden)

    S. Choura

    2005-01-01

    Full Text Available A design methodology for the vibration confinement of axial vibrations in nonhomogenous rods is proposed. This is achieved by a proper selection of a set of spatially dependent functions characterizing the rod material and geometric properties. Conditions for selecting such properties are established by constructing positive Lyapunov functions whose derivative with respect to the space variable is negative. It is shown that varying the shape of the rod alone is sufficient to confine the vibratory motion. In such a case, the vibration confinement requires that the eigenfunctions be exponentially decaying functions of space, where the notion of spatial domain stability is introduced as a concept dual to that of the time domain stability. It is also shown that vibration confinement can be produced if the rod density and/or stiffness are varied with respect to the space variable while the cross-section area is kept constant. Several case studies, supporting the developed conditions imposed on the spatially dependent functions for vibration confinement in vibrating rods, are discussed. Because variation in the geometric and material properties might decrease the critical buckling loads, we also discuss the buckling problem.

  10. Nitinol stent design - understanding axial buckling.

    Science.gov (United States)

    McGrath, D J; O'Brien, B; Bruzzi, M; McHugh, P E

    2014-12-01

    Nitinol׳s superelastic properties permit self-expanding stents to be crimped without plastic deformation, but its nonlinear properties can contribute towards stent buckling. This study investigates the axial buckling of a prototype tracheobronchial nitinol stent design during crimping, with the objective of eliminating buckling from the design. To capture the stent buckling mechanism a computational model of a radial force test is simulated, where small geometric defects are introduced to remove symmetry and allow buckling to occur. With the buckling mechanism ascertained, a sensitivity study is carried out to examine the effect that the transitional plateau region of the nitinol loading curve has on stent stability. Results of this analysis are then used to redesign the stent and remove buckling. It is found that the transitional plateau region can have a significant effect on the stability of a stent during crimping, and by reducing the amount of transitional material within the stent hinges during loading the stability of a nitinol stent can be increased.

  11. Axially Symmetric Post-Newtonian Stellar Systems

    Directory of Open Access Journals (Sweden)

    Camilo Akímushkin

    2010-06-01

    Full Text Available We introduce a method to obtain self-consistent, axially symmetric disklike stellar models in the first post-Newtonian (1PN approximation. By using in the field equations of the 1PN approximation a distribution function (DF corresponding to a Newtonian model, two fundamental equations determining the 1PN corrections are obtained. The rotation curves of the corrected models differs from the classical ones and the corrections are clearly appreciable with values of the mass and radius of a typical galaxy. On the other hand, the relativistic mass correction can be ignored for all models. Resumen. Presentamos un método para obtener modelos estelares discoidales, axialmente simétricos, auto-consistentes en la primera aproximación post-Newtoniana (1PN. Usando en las ecuaciones de campo de la aproximación 1PN una función de distribución conocida (DF que corresponde a un modelo Newtoniano, se obtienen dos ecuaciones fundamentales para determinar las correcciones 1PN. Las curvas de rotación de los modelos corregidos difieren de las clásicas y las correcciones son claramente apreciables con los valores de la masa y el radio de una galaxia típica. Por otro lado, la corrección relativista de la masa se puede ignorar para todos los modelos.

  12. Multimode interaction in axially excited cylindrical shells

    Directory of Open Access Journals (Sweden)

    Silva F. M. A.

    2014-01-01

    Full Text Available Cylindrical shells exhibit a dense frequency spectrum, especially near the lowest frequency range. In addition, due to the circumferential symmetry, frequencies occur in pairs. So, in the vicinity of the lowest natural frequencies, several equal or nearly equal frequencies may occur, leading to a complex dynamic behavior. So, the aim of the present work is to investigate the dynamic behavior and stability of cylindrical shells under axial forcing with multiple equal or nearly equal natural frequencies. The shell is modelled using the Donnell nonlinear shallow shell theory and the discretized equations of motion are obtained by applying the Galerkin method. For this, a modal solution that takes into account the modal interaction among the relevant modes and the influence of their companion modes (modes with rotational symmetry, which satisfies the boundary and continuity conditions of the shell, is derived. Special attention is given to the 1:1:1:1 internal resonance (four interacting modes. Solving numerically the governing equations of motion and using several tools of nonlinear dynamics, a detailed parametric analysis is conducted to clarify the influence of the internal resonances on the bifurcations, stability boundaries, nonlinear vibration modes and basins of attraction of the structure.

  13. Computerized axial tomography in clinical pediatrics.

    Science.gov (United States)

    McCullough, D C; Kufta, C; Axelbaum, S P; Schellinger, D

    1977-02-01

    Computerized axial tomography (CAT), a noninvasive radiologie method, provides a new dimension in screening and diagnosis of intracranial pathology. Evaluation of 725 scans in infants and children demonstrates that CAT may be performed with negligible risk, although sedation and restraint are essential to the successful performance of studies in children under 6 years of age. CAT is the preferred initial diagnostic method in suspected hydrocephalls and is accurate in the detection and precise localization of brain tumors. The management of hydrocephalus and brain tumors has been significantly altered by the availability of CAT. Few invasive neuroradiologic procedures are required and pneumography is especially curtailed. Serial scanning is the best available method of monitoring ventricular alterations in hydrocephalus, tumor size during radiotherapy or chemotherapy, and postoperative recurrence of benign neoplasms. Complex intracranial anomalies are detectable with computerized tomography, but complete definition of pathology often requires angiography and air studies. Limited clinical experience in detecting neonatal intraventricular hemorrhage suggests that CAT will be a valuable tool for futlre investigations of that problem.

  14. Análisis de la fuerza axial en un transportador de sinfín // Analysis of axial force in a screw conveyor.

    Directory of Open Access Journals (Sweden)

    F. Aguilar Parés

    1999-01-01

    Full Text Available Durante el movimiento de un material en un transportador de sinfín surge una fuerza en dirección axial que influye en laselección de uno de los cojinetes de apoyo del equipo. En el artículo aparecen algunas soluciones constructivas que tienen encuentan la fuerza axial. Por otro lado se establece la relación entre la fuerza axial y el empuje axial y se precisa de quiendepende el sentido del empuje axial. Por último se propone un modelo matemático que relaciona la fuerza axial con la potenciarequerida por el equipo.Palabras claves: Transportador de sinf in, fuerza axial , empuje axial ._________________________________________________________________________AbstractDuring the movement of material in a screw conveyor surge a force in axial direction that influence in the selection of one ofthe equipment support bearings. Some constructive solutions appear in the article for considering the axial force. In the otherhand it is established the relation between axial force and axial thurst and it is precised whose direction thurst axial depend of.Finally it is proposed a mathematic model that relates the axial force with the power required by the equipment.Key words: Screw conveyor, axial force, axial thurst .

  15. Atlanto-axial dislocation complicating a type II odontoid fracture. Reduction and final fixation.

    Science.gov (United States)

    Riouallon, G; Pascal-Moussellard, H

    2014-05-01

    A case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture is reported. This is a rare case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture. Its management is discussed. A traumatic dislocation of atlanto-axial joint associated with an odontoid fracture remains a rare injury. No case of posterior dislocation has been reported so far in the literature with this type of management. The case is of a 25 year-old-man with a primary atlanto-axial posterolateral dislocation associated with a type II displaced odontoid fracture without any neurological complication. The patient underwent gentle traction during 24 hours with a halo frame. An incomplete reduction was achieved. Two days later, a complete reduction was obtained thanks to a preoperative manual traction maintained by a Mayfield (R) modified skull clamp. Anterior C1-C2 fixation was performed according to Vaccaro's technique. The patient wore a cervical collar and underwent physiotherapy during three months. To our best knowledge, this case represents the first traumatic atlanto-axial dislocation associated with an odontoid fracture which was treated through retropaharyngeal approach. This had been rendered possible thanks to the final reduction maneuver in extension.

  16. Case report 344: Tuberculous spondyilitis resulting in atlanto-axial dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Dowd, C.F.; Sartoris, D.J.; Resnick, D.; Haghighi, P.

    1986-01-01

    In summary, this case exhibits many of the typical features of atlanto-axial tuberculous spondylitis, including its presenting symptomatology and radiological manifestations. No other sites of tuberculous involvement were discovered on subsequent work-up in this patient. He was treated with traction and transoral debridement of soft tissues and bone, followed by anti-tuberculous chemotherapy for eight weeks and a posterior spinal fusion. The patient subsequently recovered full motor and sensory function and is currently undergoing rehabilitation therapy several months following surgery.

  17. Dynamic Analysis of Axial Magnetic Forces for DVD Spindle Motors

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The axial magnetic force, induced by the complicated flux linkage distribution from rotor magnet and stator slotted, is constructed by different relative heights and calculated by 3D finite element method (FEM) to analyze the dynamic characteristics for a DVD spindle motor. The axial magnetic force is designed to provide an axial stiffness and govern the natural frequency of the dynamic performance. According to the simulation results and experimental measurements, the dynamic behaviors are significantly improved with a variation of relative height of rotor magnet and stator slotted on a DVD spindle motor.

  18. The axial charges of the hidden-charm pentaquark states

    CERN Document Server

    Wang, Guang-Juan; Zhu, Shi-Lin

    2016-01-01

    With the chiral quark model, we have calculated the axial charges of the pentaquark states with $(I,I_3)=(\\frac{1}{2},\\frac{1}{2})$ and $J^{P}=\\frac{1}{2}^{\\pm},\\frac{3}{2}^{\\pm},\\frac{5}{2}^{\\pm}$. The $P_c$ states with the same $J^P$ quantum numbers but different color-spin-flavor configurations have very different axial charges, which encode important information on their underlying structures. For some of the $J^{P}=\\frac{3}{2}^{\\pm}$ or $\\frac{5}{2}^{\\pm}$ pentaquark states, their axial charges are much smaller than that of the proton.

  19. Tensile Property of Bi-axial Warp Knitted Structure

    Institute of Scientific and Technical Information of China (English)

    沈为

    2003-01-01

    The tensile property of bi-axial warp knitted fabrics is tested and compared with that of the plain weave fabric. The results show that there are obvious differences between the tensile property of a bi-axial warp knitted fabric and that of a plain weave fabric.The former can give fuller play to the property of a high modulus yarn than the latter. The tensile strength of a bi-axial warp knitted fabric is linear with the number of yarns in the direction of force.

  20. Gravitational waves from the axial perturbations of hyperon stars

    Institute of Scientific and Technical Information of China (English)

    Wen De-Hua; Yan Jing; Liu Xue-Mei

    2012-01-01

    The eigen-frequencies of the axial w-mode oscillations of hyperon stars are examined.It is shown that as the appearance of hyperons softens the equation of state of the super-density matter,the frequency of gravitational waves from the axial w-mode of hyperon star becomes smaller than that of a traditional neutron star at the same stellar mass.Moreover,the eigenfrequencies of hyperon stars also have scaling universality.It is shown that the EURO thirdgeneration gravitational-wave detector has the potential to detect the gravitational-wave signal emitted from the axial w-mode oscillations of a hyperon star.

  1. Osteolytic extra-axial sacral myxopapillary ependymoma

    Energy Technology Data Exchange (ETDEWEB)

    Biagini, R.; Demitri, S.; Orsini, U. [Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna (Italy); Bibiloni, J. [Medical Sciences Campus San Juan, University of Puerto Rico (Puerto Rico); Briccoli, A. [Istituto di Patologia Chirurgica, University of Modena (Italy); Bertoni, F. [Servizio di Anatomia Patologica, Istituto Ortopedico Rizzoli Bologna (Italy)

    1999-10-01

    The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

  2. Revealing atropisomer axial chirality in drug discovery.

    Science.gov (United States)

    LaPlante, Steven R; Edwards, Paul J; Fader, Lee D; Jakalian, Araz; Hucke, Oliver

    2011-03-07

    An often overlooked source of chirality is atropisomerism, which results from slow rotation along a bond axis due to steric hindrance and/or electronic factors. If undetected or not managed properly, this time-dependent chirality has the potential to lead to serious consequences, because atropisomers can be present as distinct enantiomers or diastereoisomers with their attendant different properties. Herein we introduce a strategy to reveal and classify compounds that have atropisomeric chirality. Energy barriers to axial rotation were calculated using quantum mechanics, from which predicted high barriers could be experimentally validated. A calculated rotational energy barrier of 20 kcal mol(-1) was established as a suitable threshold to distinguish between atropisomers and non-atropisomers with a prediction accuracy of 86%. This methodology was applied to subsets of drug databases in the course of which atropisomeric drugs were identified. In addition, some drugs were exposed that were not yet known to have this chiral attribute. The most valuable utility of this tool will be to predict atropisomerism along the drug discovery pathway. When used in concert with our compound classification scheme, decisions can be made during early discovery stages such as "hit-to-lead" and "lead optimization," to foresee and validate the presence of atropisomers and to exercise options of removing, further stabilizing, or rendering the chiral axis of interest more freely rotatable via SAR design, thereby decreasing this potential liability within a compound series. The strategy can also improve drug development plans, such as determining whether a drug or series should be developed as a racemic mixture or as an isolated single compound. Moreover, the work described herein can be extended to other chemical fields that require the assessment of potential chiral axes.

  3. Emergence and evolution of the name of non-radiological axial spondyloarthritis%放射学阴性中轴脊柱关节炎名称的出现与演变

    Institute of Scientific and Technical Information of China (English)

    王刚; 黄烽

    2014-01-01

    放射学阴性中轴脊柱关节炎这一概念的提出更加细分了脊柱关节炎,并在患者出现X线可见的骶髂关节结构变化之前为识别中轴型脊柱关节炎提供依据.非放射学中轴脊柱关节炎是由强直性脊柱炎、脊柱关节病、中轴型脊柱关节炎演变而来,本文对这些不同阶段的诊断分类标准的演变过程、制订疾病的治疗策略、判断疾病程度及预后作一综述.

  4. 中轴型脊柱关节炎患者脊柱MRI病变临床指标及相关性探讨%The analysis of MRI and clinical indicators in patients with Axial spondyloarthritis

    Institute of Scientific and Technical Information of China (English)

    尹立; 肖衡; 王立; 赵晨阳

    2016-01-01

    目的 探讨中轴型脊柱关节炎患者脊柱MRI病变和临床指标的相关性.方法 采用回顾性分析,选取我院于2014年9月~2015年6月收治的36例中轴型脊柱关节炎患者为研究对象,对患者Bath强直性脊柱炎活动指数(BASDAI)、Bath强直性脊柱炎功能指数调查表(BASFI)、Bath强直性脊柱炎计量指数(BASMI)、强直性脊柱炎疾病活动评分(ASDAS)进行统计,同时分析患者对疾病总体评价、夜间痛评分及腰背痛评分,检测患者血清HLA-B27、血沉及C反应蛋白,总结患者脊柱MRI表现,脊柱MRI病变和各临床指标的相关性.结果 36例中轴型脊柱关节炎患者中31例MRI显示异常,韧带骨赘4例、椎小关节炎2例、Andersson病灶12例及Romanus病灶30例,急性Romanus病灶、慢性Romanus病灶及总病变数目和BASMI呈正相关性(r=0.438,P=0.011;r=0.481,P=0.004;r=0.587,P=0.000);慢性Andersson病灶数目和BASF1、BASMI呈正相关性(r=0.387,P=0.022;r=0.422,P=0.015);总病变和BASDAI、夜间痛VAS评分、腰背痛VAS评分、患者对疾病总体VAS评价、ASDAS、ESR、CRP均无相关性(P>0.05).结论 中轴型脊柱关节炎患者脊柱MRI病变表现和BASDAI、夜间痛VAS评分、腰背痛VAS评分、患者对疾病总体VAS评价、ASDAS、ESR、CRP均无相关性(P>0.05),只与脊柱功能的急、慢性Romanus病灶及总病变数目和BASMI相关,能够为临床治疗提供指导.

  5. Adjunctive Treatment of Axial Undifferentiated Spondyloarthritis by Qiangji Recipe: a Clinical Study%强脊方辅助治疗中轴型未分化脊柱关节病的临床观察

    Institute of Scientific and Technical Information of China (English)

    何梦吟; 范伏元

    2015-01-01

    目的 通过4周开放性试验评价中药强脊方辅助治疗中轴型未分化脊柱关节病的疗效和安全性.方法 将符合纳入标准的54例中轴型未分化脊柱关节病肾虚督寒讧患者采用随机数字表法分为2组,对照组27例,口服塞来昔布胶囊0.2 g/次,2次/天;治疗组27例,在对照组用药基础上加服强脊方(组成:仙灵脾15g鹿角胶15g狗脊15g杜仲20 g 续断10 g 牛膝15 g骨碎补15 g 桑寄生20 g(蛰)虫10 g 全蝎5 g 独活10g 羌活10 g 王不留行10g 白芥子6g 甘草6 g,每日1剂,每日2次).疗程均为4周.两组分别于治疗前及治疗4周后对强直性脊柱炎活动指数(BASDAI)、强直性脊柱炎功能指数(BASFI)、强直性脊柱炎测量指数(BASMI)、全身痛和脊柱痛评分、患者和医生的总体评价、生活质量问卷(ASQoL)及血沉(ESR)、C反应蛋白(CRP)进行观察,并评价两组ASAS 20改善率.结果 共50例患者完成了试验观察,其中治疗组26例,对照组24例.与治疗前比较,两组BASDAI、BASFI、BAS-MI、ASQoL、ESR、CRP均有改善,两组治疗后组间比较,除BASMI指数和ESR两项指标外,强脊方治疗组疗效均优于对照组(P <0.05,P<0.01);治疗4周后达到ASAS 20的例数治疗组为20例(76.92%),对照组为12例(50.00%),差异有统计学意义(P<O.05).两组均无明显药物不良反应.结论 强脊方联合塞来昔布胶囊治疗中轴型未分化脊柱关节病患者疗效优于单用塞来昔布胶囊者.

  6. Evaluation of life quality of patients with axial spondyloarthritis and analysis of influencing factors%中轴型脊柱关节炎患者生存质量评估及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    陈玉铃; 李挺; 叶霜

    2015-01-01

    目的 评估中轴型脊柱关节炎(SpA)患者的生存质量,探讨影响中轴型SpA患者生存质量的人口学、炎症水平、疾病活动度、功能受损度等因素.方法 整群抽取213位中轴型SpA患者,采用SF12-v2量表评估患者的生存质量,分析影响生存质量因素.结果 与常模人群相比,中轴型SpA患者的生存质量显著下降(P<0.05).血沉正常组在SF12-v2各维度得分(除活力外)、生理总评分均较血沉升高组高(P<0.05);低疾病活动组[BathAS疾病活动性指数(BASDAI) <4、AS病情活动度评分(ASDAS) <2.1]的SF12-v2各维度得分(除活力外)、生理总评分、心理总评分均较高疾病活动组(BASDAI≥4、ASDAS≥2.1)高(P<0.05);功能状态较好组[BathAS疾病功能指数(BASFI) <5]的SF12-v2各维度得分(除活力外)、生理总评分、心理总评分均较功能状态较差组(BASFI≥5)高(P<0.05).SF-12v2各维度、生理总评分、心理总评分与ASDAS、BASFI均呈显著相关(P <0.05);SF-12v2各维度、生理总评分与血沉、C反应蛋白、BASDAI、BathAS疾病测量指数(BASMI)均呈显著相关(P<0.05).多元线性回归显示生理总评分与ASDAS、BASFI存在线性相关.结论 AS患者的生存质量明显低于常模人群,患者生存质量与炎症水平(血沉、C反应蛋白)、疾病的活动度(BASDAI、ASDAS)、功能受损度(BASFI、BASMI)明显相关.

  7. The Design Method of Axial Flow Runners Focusing on Axial Flow Velocity Uniformization and Its Application to an Ultra-Small Axial Flow Hydraulic Turbine

    Directory of Open Access Journals (Sweden)

    Yasuyuki Nishi

    2016-01-01

    Full Text Available We proposed a portable and ultra-small axial flow hydraulic turbine that can generate electric power comparatively easily using the low head of open channels such as existing pipe conduits or small rivers. In addition, we proposed a simple design method for axial flow runners in combination with the conventional one-dimensional design method and the design method of axial flow velocity uniformization, with the support of three-dimensional flow analysis. Applying our design method to the runner of an ultra-small axial flow hydraulic turbine, the performance and internal flow of the designed runner were investigated using CFD analysis and experiment (performance test and PIV measurement. As a result, the runners designed with our design method were significantly improved in turbine efficiency compared to the original runner. Specifically, in the experiment, a new design of the runner achieved a turbine efficiency of 0.768. This reason was that the axial component of absolute velocity of the new design of the runner was relatively uniform at the runner outlet in comparison with that of the original runner, and as a result, the negative rotational flow was improved. Thus, the validity of our design method has been verified.

  8. Structure and properties in the direction of the thickness of continuously rolled steel treated with SiCa and REM

    Science.gov (United States)

    Brodetskii, I. L.; Kharchevnikov, V. P.; Belov, B. F.; Poznyak, L. A.; Trotsan, A. I.

    1990-10-01

    In the zone of axial liquation of continuously cast thick hot-rolled steel 09G2S, treated in the process of pouring with SiCa and REM, ψ is more than 3 times, a 0.25 1.5 times to twice as large as these characteristics in the zone of axial liquation of steel from an ordinary melt.

  9. Radial breathing mode of carbon nanotubes subjected to axial pressure.

    Science.gov (United States)

    Lei, Xiao-Wen; Ni, Qing-Qing; Shi, Jin-Xing; Natsuki, Toshiaki

    2011-08-11

    In this paper, a theoretical analysis of the radial breathing mode (RBM) of carbon nanotubes (CNTs) subjected to axial pressure is presented based on an elastic continuum model. Single-walled carbon nanotubes (SWCNTs) are described as an individual elastic shell and double-walled carbon nanotubes (DWCNTs) are considered to be two shells coupled through the van der Waals force. The effects of axial pressure, wave numbers and nanotube diameter on the RBM frequency are investigated in detail. The validity of these theoretical results is confirmed through the comparison of the experiment, calculation and simulation. Our results show that the RBM frequency is linearly dependent on the axial pressure and is affected by the wave numbers. We concluded that RBM frequency can be used to characterize the axial pressure acting on both ends of a CNT.

  10. Time Domain Terahertz Axial Computed Tomography Non Destructive Evaluation Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to demonstrate key elements of feasibility for a high speed automated time domain terahertz computed axial tomography (TD-THz CT) non destructive...

  11. Time Domain Terahertz Axial Computed Tomography Non Destructive Evaluation Project

    Data.gov (United States)

    National Aeronautics and Space Administration — In this Phase 2 project, we propose to develop, construct, and deliver to NASA a computed axial tomography time-domain terahertz (CT TD-THz) non destructive...

  12. ANALYSIS OF PULSATILE BLOOD FLOW IN AXIALLY MOVING ARTERIES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    In order to study motional properties of pulsatile blood flow in axially moving arteries, the authors derived some expressions of the pulsatile blood flow from the basic equations of motion for blood and vascular walls, including an axial blood velocity equation, a flow rate equation and a wall shear stress equation, which described not only the overall axial movement of the arteries but also the elastic properties of the vascular walls, discussed the effects of the arterial wall elasticity on the wall shear stress in coronary arteries in terms of these expressions, and analyzed changes of motional properties of pulsatile blood flow between an elastic arterial tube model and a rigid tube model. The results proved the inference by J.E. Moore Jr. et al. (1994) that the axial movement of arteries be as important in determining coronary artery hemodynamics as the elastic property of the vascular wall.

  13. The geometrical theory of diffraction for axially symmetric reflectors

    DEFF Research Database (Denmark)

    Rusch, W.; Sørensen, O.

    1975-01-01

    The geometrical theory of diffraction (GTD) (cf. [1], for example) may be applied advantageously to many axially symmetric reflector antenna geometries. The material in this communication presents analytical, computational, and experimental results for commonly encountered reflector geometries...

  14. Axial Stringy System of the Kerr Spinning Particle

    CERN Document Server

    Burinskii, A

    2004-01-01

    The structure of classical spinning particle based on the Kerr-Newman black hole (BH) solution is investigated. For large angular momentum, $|a|>>m$, the BH horizons disappear exposing a naked ringlike source which is a circular relativistic string. It was shown recently that electromagnetic excitations of this string lead to the appearance of an extra axial stringy system which consists of two half-infinite strings of opposite chirality. In this paper we consider the relation of this stringy system to the Dirac equation. We also show that the axial strings are the Witten superconducting strings and describe their structure by the Higgs field model where the Higgs condensate is used to regularize axial singularity. We argue that this axial stringy system may play the role of a classical carrier of the wave function.

  15. Open-Axial-Field Magnet at ISR intersection I8

    CERN Multimedia

    1979-01-01

    This axial field spectrometer left the central collision region unobstructed in order to ease analysis of secondary particles emitted at large angle. The ISR circulating beams were passing through a hole in the magnet poles.

  16. Axial mesodermal dysplasia complex: a new case with parental consanguinity.

    Science.gov (United States)

    Mota, C R; Azevedo, M; Rocha, G; Manuela, F; Coelho, R; Lima, M R

    2000-01-01

    A female is described with axial mesodermal dysplasia complex (AMDC) born to a consanguineous couple. This is thought to be the first description of a patient with AMDC born to consanguineous parents.

  17. Axial Anomaly in Lattice Abelian Gauge Theory in Arbitrary Dimensions

    CERN Document Server

    Fujiwara, T; Wu, K; Fujiwara, Takanori; Suzuki, Hiroshi; Wu, Ke

    1999-01-01

    Axial anomaly of lattice abelian gauge theory in hyper-cubic regular lattice in arbitrary even dimensions is investigated by applying the method of exterior differential calculus. The topological invariance, gauge invariance and locality of the axial anomaly determine the explicit form of the topological part. The anomaly is obtained up to a multiplicative constant for finite lattice spacing and can be interpreted as the Chern character of the abelian lattice gauge theory.

  18. Axially astigmatic surfaces: different types and their properties

    Science.gov (United States)

    Malacara-Doblado, Daniel; Malacara-Hernandez, Daniel; Garcia-Marquez, Jorge L.

    1996-12-01

    Axially astigmatic surfaces have different curvatures in orthogonal diameters. Toroidal and spherocylindrical optical surfaces are two mathematically different special cases of axially astigmatic surfaces as noted by Menchaca and Malacara (1986), but they are almost identical in the vicinity of the optical axis. The different between these two surfaces increases when the distance to the optical axis increases. We study the general properties of astigmatic surfaces and some special interesting cases.

  19. Testing of Axially Loaded Bucket Foundation with Applied Overburden Pressure

    DEFF Research Database (Denmark)

    Vaitkunaite, Evelina; Ibsen, Lars Bo; Nielsen, Benjaminn Nordahl

    This report analyses laboratory testing data performed with a bucket foundation model subjected to axial loading. The examinations were conducted at the Geotechnical laboratory of Aalborg University. The report aims at showing and discussing the results of the static and cyclic axial loading tests...... on the bucket foundation model. Finally, a cyclic loading interaction diagram is given that can be applied for a full-scale bucket foundation design....

  20. Watson's theorem and the $N\\Delta(1232)$ axial transition

    CERN Document Server

    Alvarez-Ruso, L; Nieves, J; Vacas, M J Vicente

    2016-01-01

    We present a new determination of the $N\\Delta$ axial form factors from neutrino induced pion production data. For this purpose, the model of Hernandez et al., Phys. Rev. D76, 033005 (2007) is improved by partially restoring unitarity. This is accomplished by imposing Watson's theorem on the dominant vector and axial multipoles. As a consequence, a larger $C_5^A(0)$, in good agreement with the prediction from the off-diagonal Goldberger-Treiman relation, is now obtained.

  1. Method to Measure Tone of Axial and Proximal Muscle

    OpenAIRE

    2011-01-01

    The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs1, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the ...

  2. Axially symmetric volume constrained anisotropic mean curvature flow

    CERN Document Server

    Palmer, Bennett

    2011-01-01

    We study the long time existence theory for a non local flow associated to a free boundary problem for a trapped non liquid drop. The drop has free boundary components on two horizontal plates and its free energy is anisotropic and axially symmetric. For axially symmetric initial surfaces with sufficiently large volume, we show that the flow exists for all time. Numerical simulations of the curvature flow are presented.

  3. Aerodynamics and combustion of axial swirlers

    Science.gov (United States)

    Fu, Yongqiang

    A multipoint lean direct injection (LDI) concept was introduced recently in non-premixed combustion to obtain both low NOx emissions and good combustion stability. In this concept, a key feature is the injection of finely atomized fuel into the high-swirling airflow at the combustor dome that provides a homogenous, lean fuel-air mixture. In order to achieve the fine atomization and mixing of the fuel and air quickly and uniformly, a good swirler design should be studied. The focus of this dissertation is to investigate the aerodynamics and combustion of the swirling flow field in a multipoint Lean Direct Injector combustor. A helical axial-vaned swirler with a short internal convergent-divergent venturi was used. Swirlers with various vane angles and fuel nozzle insertion lengths have been designed. Three non-dimensional parameter effects on non-reacting, swirling flow field were studied: swirler number, confinement ratio and Reynolds number. Spray and combustion characteristics on the single swirler were studied to understand the mechanism of fuel-air mixing in this special configuration. Multi-swirler interactions were studied by measuring the confined flow field of a multipoint swirler array with different configurations. Two different swirler arrangements were investigated experimentally, which include a co-swirling array and a counter-swirling array. In order to increase the range of stability of multipoint LDI combustors, an improved design were also conducted. The results show that the degree of swirl and the level of confinement have a clear impact on the mean and turbulent flow fields. The swirling flow fields may also change significantly with the addition of a variety of simulated fuel nozzle insertion lengths. The swirler with short insertion has the stronger swirling flow as compared with the long insertion swirler. Reynolds numbers, with range of current study, will not alter mean and turbulent properties of generated flows. The reaction of the spray

  4. Slow axial drift in three-dimensional granular tumbler flow

    Science.gov (United States)

    Zaman, Zafir; D'Ortona, Umberto; Umbanhowar, Paul B.; Ottino, Julio M.; Lueptow, Richard M.

    2013-07-01

    Models of monodisperse particle flow in partially filled three-dimensional tumblers often assume that flow along the axis of rotation is negligible. We test this assumption, for spherical and double cone tumblers, using experiments and discrete element method simulations. Cross sections through the particle bed of a spherical tumbler show that, after a few rotations, a colored band of particles initially perpendicular to the axis of rotation deforms: particles near the surface drift toward the pole, while particles deeper in the flowing layer drift toward the equator. Tracking of mm-sized surface particles in tumblers with diameters of 8-14 cm shows particle axial displacements of one to two particle diameters, corresponding to axial drift that is 1-3% of the tumbler diameter, per pass through the flowing layer. The surface axial drift in both double cone and spherical tumblers is zero at the equator, increases moving away from the equator, and then decreases near the poles. Comparing results for the two tumbler geometries shows that wall slope causes axial drift, while drift speed increases with equatorial diameter. The dependence of axial drift on axial position for each tumbler geometry is similar when both are normalized by their respective maximum values.

  5. Axial scanning in confocal microscopy employing adaptive lenses (CAL).

    Science.gov (United States)

    Koukourakis, Nektarios; Finkeldey, Markus; Stürmer, Moritz; Leithold, Christoph; Gerhardt, Nils C; Hofmann, Martin R; Wallrabe, Ulrike; Czarske, Jürgen W; Fischer, Andreas

    2014-03-10

    In this paper we analyze the capability of adaptive lenses to replace mechanical axial scanning in confocal microscopy. The adaptive approach promises to achieve high scan rates in a rather simple implementation. This may open up new applications in biomedical imaging or surface analysis in micro- and nanoelectronics, where currently the axial scan rates and the flexibility at the scan process are the limiting factors. The results show that fast and adaptive axial scanning is possible using electrically tunable lenses but the performance degrades during the scan. This is due to defocus and spherical aberrations introduced to the system by tuning of the adaptive lens. These detune the observation plane away from the best focus which strongly deteriorates the axial resolution by a factor of ~2.4. Introducing balancing aberrations allows addressing these influences. The presented approach is based on the employment of a second adaptive lens, located in the detection path. It enables shifting the observation plane back to the best focus position and thus creating axial scans with homogeneous axial resolution. We present simulated and experimental proof-of-principle results.

  6. Reactive control of subsonic axial fan noise in a duct.

    Science.gov (United States)

    Liu, Y; Choy, Y S; Huang, L; Cheng, L

    2014-10-01

    Suppressing the ducted fan noise at low frequencies without varying the flow capacity is still a technical challenge. This study examines a conceived device consisting of two tensioned membranes backed with cavities housing the axial fan for suppression of the sound radiation from the axial fan directly. The noise suppression is achieved by destructive interference between the sound fields from the axial fan of a dipole nature and sound radiation from the membrane via vibroacoustics coupling. A two-dimensional model with the flow effect is presented which allows the performance of the device to be explored analytically. The air flow influences the symmetrical behavior and excites the odd in vacuo mode response of the membrane due to kinematic coupling. Such an asymmetrical effect can be compromised with off-center alignment of the axial fan. Tension plays an important role to sustain the performance to revoke the deformation of the membrane during the axial fan operation. With the design of four appropriately tensioned membranes covered by a cylindrical cavity, the first and second blade passage frequencies of the axial fan can be reduced by at least 20 dB. The satisfactory agreement between experiment and theory demonstrates that its feasibility is practical.

  7. Axial blanket for 16NGF Angra 1 fuel type

    Energy Technology Data Exchange (ETDEWEB)

    Sadde, Luciano Martins; Faria, Eduardo Fernandes [Industrias Nucleares do Brasil (INB), Resende, RJ (Brazil)]. E-mails: sadde@inb.gov.br; faria@inb.gov.br; Sang-Keun You [Korea Nuclear Fuel Co. Ltd. (KNFC), Taejon (Korea, Republic of)]. E-mail: skyou@knfc.co.kr

    2007-07-01

    Angra-1, Kori-2 and Krsko are nuclear power plants with the same design. However, the fuel assemblies have some differences in design due to the countries strategies and the differences in the fabrication process. The 16NGF (16x16 Next Generation Fuel) was developed by INB, KNFC and Westinghouse in order to be used in these three nuclear power plants and the 'Axial Blanket' is one of the new features for the 16NGF design. The main purpose of the Axial Blanket Optimization study is to determine which axial blanket enrichment and length would provide the better fuel cycle cost benefit. All of the calculations were performed using Gadolinium as Burnable Absorber and solid pellets type for Axial Blanket. The results indicate 1.8 w/o U235 enrichment and 8 inches length as the best option of Axial Blanket from the fuel cycle cost benefit standpoint. The economy is about 1.8%. The difference in the reload cost in the range between 1.5 and 2.6 w/o U235 enrichment and for the 6 and 8 inches length is not so significant. Due that, from the Fq limit standpoint and also for longer cycle length requirements, a higher axial blanket enrichment (2.6 w/o) and shorter length (6 inches) is recommended. (author)

  8. Axial design of nuclear fuel using path relinking; Diseno axial de combustible nuclear utilizando path relinking

    Energy Technology Data Exchange (ETDEWEB)

    Castillo, A.; Torres, M.; Ortiz, J. J.; Perusquia, R.; Hernandez, J. L.; Montes, J. L. [ININ, 52750 La Marquesa, Estado de Mexico (Mexico)]. e-mail: jacm@nuclear.inin.mx

    2008-07-01

    In the present work the preliminary results were obtained with the zoctli system whose purpose is the axial design of assembly of nuclear fuel under certain considerations. For the mentioned design well-know cells were already used and that they have been proven in diverse cycles of operation in the nuclear power plant of Laguna Verde. The design contemplates fuels assemblies of 10x10 and with 2 water channels. The assembly was distributed in 6 axial zones according to its structure. In order to take to end the optimization is was used the well-known technique like Path relinking and to find the group of previous solutions required by this technique uses the technical Taboo search. In order to work with Path relinking, 5 trajectories was taken in to account from a set of 5 previous solutions generated with theTaboo search, the update of the group of solutions is carried out in dynamic form. In the case of the Taboo search it was used a list of variable size, it was implement an aspiration approach, it was used the vector of frequencies and due to the cost of the evaluation of the objective function, only it was review 5% of the vicinity. For the objective function was considered the limit thermal, the axial profile of power, the effective multiplication factor and the margin of having turned off in cold. In order to prove the design system, it was used a balance cycle with a value of reference of 0.9928 for the effective multiplication factor that is equivalent to a produced energy of 10896 MWd/TU at the end of operation to full power. The designed assemblies were placed both in one of lots different from fresh assemblies on which it counts the referred cycle. At the end one a comparison with the results obtained with other techniques and under similar conditions is made. The results obtained until the moment show an appropriate performance of the system. It is possible to indicate that a small inconvenient is the amount of consumed resources of calculation during

  9. Juvenile Spondyloarthritis: An Overview

    Science.gov (United States)

    ... Have Spondylitis? Treatment Information Medications Exercise & Posture Diet & Nutrition Medication & Diet Dietary Supplements Changing Your Diet The London AS / Low Starch Diet Complementary Treatments Possible Complications Iritis or Anterior Uveitis Fatigue in Spondylitis Pain in ...

  10. Macrophage polarization in spondyloarthritis

    OpenAIRE

    Ambăruş, C.A.

    2012-01-01

    Er zijn verschillen tussen macrofagen (grote mononucleaire cellen) die buiten het lichaam zijn gekweekt en macrofagen in het gewricht van de mens. Dat concludeert Carmen Ambarus. Ook blijken macrofagen een veel complexere functie hebben dan voorheen werd gedacht. Dit is belangrijk om het ontstaan van chronische gewrichtsziekte spondyloartritis beter te begrijpen en betere behandelingen te ontwikkelen. Spondyloartritis is na reumatoïde artritis de meest voorkomende vorm van chronische gewricht...

  11. Macrophage polarization in spondyloarthritis

    NARCIS (Netherlands)

    Ambăruş, C.A.

    2012-01-01

    Er zijn verschillen tussen macrofagen (grote mononucleaire cellen) die buiten het lichaam zijn gekweekt en macrofagen in het gewricht van de mens. Dat concludeert Carmen Ambarus. Ook blijken macrofagen een veel complexere functie hebben dan voorheen werd gedacht. Dit is belangrijk om het ontstaan va

  12. Spondyloarthritis: A Gouty Display

    OpenAIRE

    Gongidi, Preetam; Gough-Fibkins, Shawn

    2010-01-01

    Gout is a systemic, metabolic disease that typically affects the peripheral joints. We describe an unusual presentation of gout affecting the facet joints and costovertebral joints in the thoracic and lumbar spine. A 54-year old man presents to the emergency department with increasing swelling and pain at the left elbow for one week and difficulty ambulating. The imaging work-up included plain radiographs of the left elbow, left wrist, and chest with subsequent admission for possible septic a...

  13. Magnetic resonance imaging of the sacroiliac joints in patients with suspected spondyloarthritis. Comparison of turbo spin-echo and gradient-echo sequences for the detection of structural alterations; MRT-Bildgebung der Sakroiliakalgelenke bei Verdacht auf Spondyloarthritis. Vergleich von Turbospinecho- und Gradientenechosequenzen zum Nachweis struktureller Veraenderungen

    Energy Technology Data Exchange (ETDEWEB)

    Dornia, C.; Hoffstetter, P. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik; Asklepios Klinikum, Bad Abbach (Germany). Inst. fuer Roentgendiagnostik; Fleck, M. [Universitaetsklinikum Regensburg (Germany). Klinik fuer Innere Medizin I; Asklepios Klinikum, Bad Abbach (Germany). Klinik fuer Rheumatologie und Klinische Immunologie; Hartung, W. [Asklepios Klinikum, Bad Abbach (Germany). Klinik fuer Rheumatologie und Klinische Immunologie; Niessen, C.; Stroszczynski, C. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik

    2015-02-15

    Magnetic resonance imaging (MRI) is the method of choice for the evaluation of spondyloarthritis (SpA). According to the guidelines of the Assessment of Spondyloarthritis International Society (ASAS) and Outcome Measures in Rheumatology (OMERACT), MRI findings in SpA of the spine and the sacroiliac joints (SIJ) are classified as inflammatory and structural alterations. Modern gradient-echo sequences (GRE) are recommended for optimized detection of structural alterations of the SIJ. We assess the benefit of GRE in the detection of structural alterations of the SIJ in comparison to conventional turbo spin-echo sequences (TSE). Retrospective study of 114 patients who received MRI of the SIJ for the evaluation of SpA. Structural alterations of the SIJ were assessed by two blinded readers separately for T1 TSE and T2{sup *} GRE. The findings were classified according to a previously published chronicity score separately for both sides and sequences. Interobserver reliability was calculated with Cohen's Kappa, and the significance of findings was assessed with the Wilcoxon test. P-values < 0.05 were required for statistical significance. 68 of 114 (60%) patients showed SpA-typical findings of the SIJ. The average chronicity score for GRE (score 3.3) was significantly higher than for TSE (score 2.6), p=0.001. The Kappa-values for the interobserver reliability were 0.86-0.90 without any statistically significant differences between both sides and sequences. Both T1 TSE and T2{sup *} GRE showed a high interobserver reliability in the detection of structural alterations in patients with SpA. However, T2{sup *} GRE detected significantly more structural alterations than T1 TSE and should be an integral part of a modern MRI protocol for the diagnostic workup of patients with suspected SpA.

  14. Microwave Radiation Effect on Axial Fluid Permeability in False Heartwood of Beech (Fagus sylvatica L.

    Directory of Open Access Journals (Sweden)

    Vojtěch Koiš

    2016-10-01

    Full Text Available This study evaluated the effect of microwave radiation on the fluid permeability and compression strength parallel to the grain of beech false heartwood. European beech (Fagus sylvatica L. was selected, and samples of false heartwood with dimensions of 30×20×20 mm3 were used. The microwave treatment was carried out in a laboratory device at a frequency of 2.45 GHz. The testing samples were divided into three groups (untreated, treated at 20-s intervals, and treated at 30-s intervals. The permeability was measured in the axial direction using distilled water. The coefficient of specific permeability was calculated using Darcy’s law. The results showed that the coefficient of specific permeability increased by up to 159% in comparison with untreated samples. The compression strength parallel to the grain decreased by up to 15%.

  15. Clinical and laboratory characteristics of 112 rare cases misdiagnosed as spondyloarthritis%脊柱关节炎误诊112例临床和实验室特征

    Institute of Scientific and Technical Information of China (English)

    赵楚楚; 叶华; 陈适; 栗占国

    2016-01-01

    目的 回顾分析被误诊为SpA的病例,探讨误诊原因,以期减少临床误诊.方法 收集2004年1月至2014年4月于我院就诊前曾误诊为SpA,并检索1998年1月至2014年10月中文文献报道的误诊病例,依照2009年中轴SpA标准及2011年外周SpA标准进行分析.结果 共112例符合本研究入选条件.被误诊为SpA的疾病主要有感染性疾病27例(24.1%),遗传和代谢性疾病47例(42.0%),肿瘤25例(22.3%),骨关节疾病13例(11.6%).被误诊患者的临床表现多不典型,其中102例患者(91.1%)不具备炎性腰背痛特点,有23例(20.5%)患者伴随发热,HLA-B27阳性者仅占20.4%(21/103).29例行骶髂关节X线检查患者中,11例提示有关节面模糊、关节间隙变窄或骨质破坏.4例最终依靠骶髂关节磁共振检查确诊.仅19.8%(18/91)以腰背痛为主要表现的患者符合2009年国际脊柱关节炎协会中轴型SpA分类标准,33.3%(2/6)以外周关节炎为主要表现的患者符合外周型SpA分类标准.结论 对于非典型炎性下腰痛的患者,尤其伴有发热等表现,应考虑到肿瘤、感染以及遗传和代谢性骨病等疾病.HLA-B27阳性有助于诊断SpA,但并非特异指标.对X线表现不确切者,应及早行骶髂关节CT或磁共振检查.多数误诊病例不符合分类标准.%Objective To reduce the misdiagnosis rate of spondyloarthritis (SPA) by reviewing the rare cases misdiagnosed as SpA.Methods Cases misdiaguosed as SpA were collected from our hospital from January 2004 to April 2014.Reported cases among Chinese journals from January 1998 to October,2014 were also collected.According to the Assessment of Spondylo Arthritis international Society (ASAS) axial SpA criteria (2009) and peripheral SpA criteria (2011),the diagnostic accordance rate was studied.Results There were 112 cases within the objective scope,out of which,27 cases (24.1%) were infectious diseases,47 cases (42.0%) were heredity and metabolic diseases,25

  16. Investigation of axial power gradients near a control rod tip

    Energy Technology Data Exchange (ETDEWEB)

    Loberg, John, E-mail: John.Loberg@fysast.uu.se [Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, Box 525, SE-75120 Uppsala (Sweden); Osterlund, Michael, E-mail: Michael.Osterlund@fysast.uu.se [Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, Box 525, SE-75120 Uppsala (Sweden); Bejmer, Klaes-Hakan, E-mail: Klaes-Hakan.Bejmer@vattenfall.com [Vattenfall Nuclear Fuel AB, Jaemtlandsgatan 99, 162 60 Vaellingby, Stockholm (Sweden); Blomgren, Jan, E-mail: Jan.Blomgren@vattenfall.com [Vattenfall Nuclear Fuel AB, Jaemtlandsgatan 99, 162 60 Vaellingby, Stockholm (Sweden); Kierkegaard, Jesper, E-mail: Jesper.Kierkegaar@vattenfall.com [Vattenfall Nuclear Fuel AB, Jaemtlandsgatan 99, 162 60 Vaellingby, Stockholm (Sweden)

    2011-07-15

    Highlights: > Pin power gradients near BWR control rod tips have been investigated. > A control rod tip is modeled in MCNP and compared to simplified 2D/3D geometry. > Small nodes increases pin power gradients; standard nodes underestimates gradients. > The MCNP results are validated against axial gamma scan of a controlled fuel pin. - Abstract: Control rod withdrawal in BWRs induces large power steps in the adjacent fuel assemblies. This paper investigates how well a 2D/3D method, e.g., CASMO5/SIMULATE5 computes axial pin power gradients adjacent to an asymmetrical control-rod tip in a BWR. The ability to predict pin power gradients accurately is important for safety considerations whereas large powers steps induced by control rod withdrawal can cause Pellet Cladding Interaction. The computation of axial pin power gradients axially around a control rod tip is a challenging task for any nodal code. On top of that, asymmetrical control rod handles are present in some BWR designs. The lattice code CASMO requires diagonal symmetry of all control rod parts. This introduces an error in computed pin power gradients that has been evaluated by Monte Carlo calculations. The results show that CASMO5/SIMULATE5, despite the asymmetrical control rod handle, is able to predict the axial pin power gradient within 1%/cm for axial nodal sizes of 15-3.68 cm. However, a nodal size of 3.68 cm still causes underestimations of pin power gradients compared with 1 cm nodes. Furthermore, if conventional node sizes are used, {approx}15 cm, pin power gradients can be underestimated by over 50% compared with 1 cm nodes. The detailed axial pin power profiles from MCNP are corroborated by measured gamma scan data on fuel rods irradiated adjacent to control rods.

  17. Axial length as a risk factor to branch retinal vein occlusion

    NARCIS (Netherlands)

    Timmerman, EA; deLavalette, VWR; vandenBrom, HJB

    1997-01-01

    Purpose: To determine whether axial length is a factor in branch retinal vein occlusion. Methods: Axial length measurements in a group of 24 patients with a unilateral branch retinal Vein occlusion were compared with the axial length measurements in a control group. axial length measurements were ta

  18. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Arnbak, Bodil; Jensen, Tue S.; Manniche, Claus [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Egund, Niels; Zejden, Anna [Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark); Hoerslev-Petersen, Kim [University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); King Christian 10th Hospital for Rheumatic Diseases, Graasten, Graasten (Denmark); Jurik, Anne G. [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark)

    2016-04-15

    To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients. (orig.)

  19. Reduced Appendicular Lean Body Mass, Muscle Strength, and Size of Type II Muscle Fibers in Patients with Spondyloarthritis versus Healthy Controls: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Kristine Røren Nordén

    2016-01-01

    Full Text Available Introduction. The purpose of this study was to investigate body composition, muscle function, and muscle morphology in patients with spondyloarthritis (SpA. Methods. Ten male SpA patients (mean ± SD age 39±4.1 years were compared with ten healthy controls matched for sex, age, body mass index, and self-reported level of physical exercise. Body composition was measured by dual energy X-ray absorptiometry. Musculus quadriceps femoris (QF strength was assessed by maximal isometric contractions prior to test of muscular endurance. Magnetic resonance imaging of QF was used to measure muscle size and calculate specific muscle strength. Percutaneous needle biopsy samples were taken from m. vastus lateralis. Results. SpA patients presented with significantly lower appendicular lean body mass (LBM (p=0.02, but there was no difference in bone mineral density, fat mass, or total LBM. Absolute QF strength was significantly lower in SpA patients (p=0.03 with a parallel trend for specific strength (p=0.08. Biopsy samples from the SpA patients revealed significantly smaller cross-sectional area (CSA of type II muscle fibers (p=0.04, but no difference in CSA type I fibers. Conclusions. Results indicate that the presence of SpA disease is associated with reduced appendicular LBM, muscle strength, and type II fiber CSA.

  20. Axially symmetric pseudo-Newtonian hydrodynamics code

    CERN Document Server

    Kim, Jinho; Choptuik, Matthew William; Lee, Hyung Mok

    2012-01-01

    We develop a numerical hydrodynamics code using a pseudo-Newtonian formulation that uses the weak field approximation for the geometry, and a generalized source term for the Poisson equation that takes into account relativistic effects. The code was designed to treat moderately relativistic systems such as rapidly rotating neutron stars. The hydrodynamic equations are solved using a finite volume method with High Resolution Shock Capturing (HRSC) techniques. We implement several different slope limiters for second order reconstruction schemes and also investigate higher order reconstructions. We use the method of lines (MoL) to convert the mixed spatial-time partial differential equations into ordinary differential equations (ODEs) that depend only on time. These ODEs are solved using 2nd and 3rd order Runge-Kutta methods. The Poisson equation for the gravitational potential is solved with a multigrid method. In order to confirm the validity of our code, we carry out four different tests including one and two...

  1. Development and Testing of an Axial Halbach Magnetic Bearing

    Science.gov (United States)

    Eichenberg, Dennis J.; Gallo, Christopher A.; Thompson, William K.

    2006-01-01

    The NASA Glenn Research Center has developed and tested a revolutionary Axial Halbach Magnetic Bearing. The objective of this work is to develop a viable non-contact magnetic thrust bearing utilizing Halbach arrays for all-electric flight, and many other applications. This concept will help to reduce harmful emissions, reduce the Nation s dependence on fossil fuels and mitigate many of the concerns and limitations encountered in conventional axial bearings such as bearing wear, leaks, seals and friction loss. The Axial Halbach Magnetic Bearing is inherently stable and requires no active feedback control system or superconductivity as required in many magnetic bearing designs. The Axial Halbach Magnetic Bearing is useful for very high speed applications including turbines, instrumentation, medical systems, computer memory systems, and space power systems such as flywheels. Magnetic fields suspend and support a rotor assembly within a stator. Advanced technologies developed for particle accelerators, and currently under development for maglev trains and rocket launchers, served as the basis for this application. Experimental hardware was successfully designed and developed to validate the basic principles and analyses. The report concludes that the implementation of Axial Halbach Magnetic Bearings can provide significant improvements in rotational system performance and reliability.

  2. Design and Simulation of Axial Flow Maglev Blood Pump

    Directory of Open Access Journals (Sweden)

    Huachun Wu

    2011-03-01

    Full Text Available The axial flow maglev blood pump (AFMBP has become a global research focus and emphasis for artificial ventricular assist device, which has no mechanical contact, mechanical friction, compact structure and light weight, can effectively solve thrombus and hemolysis. Magnetic suspension and impeller is two of the important parts in the axial flow maglev blood pump, and their structure largely determines the blood pump performance. The research adopts electromagnetic and fluid finite element analysis, and puts forward a method to design the magnetic suspension and impeller of axial flow blood pump, which tacks into account the small volume of axial blood pump. The magnetic bearing’s characteristics are evaluated by electromagnetic finite element analysis. The Blades have been designed by calculating aerofoil bone line, and make simulation analysis for different thicken ways of blade by Fluent software, and make a conclusion that the blade thickened with certain rules has better characteristics in the same conditions. The results will provide some guidance for design of axial flow maglev blood pump, and establish theoretical basis for application of the implantable artificial heart pump.

  3. Light Weakly Coupled Axial Forces: Models, Constraints, and Projections

    CERN Document Server

    Kahn, Yonatan; Mishra-Sharma, Siddharth; Tait, Tim M P

    2016-01-01

    We investigate the landscape of constraints on MeV-GeV scale, hidden U(1) forces with nonzero axial-vector couplings to Standard Model fermions. While the purely vector-coupled dark photon, which may arise from kinetic mixing, is a well-motivated scenario, several MeV-scale anomalies motivate a theory with axial couplings which can be UV-completed consistent with Standard Model gauge invariance. Moreover, existing constraints on dark photons depend on products of various combinations of axial and vector couplings, making it difficult to isolate the effects of axial couplings for particular flavors of SM fermions. We present a representative renormalizable, UV-complete model of a dark photon with adjustable axial and vector couplings, discuss its general features, and show how some UV constraints may be relaxed in a model with nonrenormalizable Yukawa couplings at the expense of fine-tuning. We survey the existing parameter space and the projected reach of planned experiments, briefly commenting on the relevan...

  4. Amphiregulin Antibody and Reduction of Axial Elongation in Experimental Myopia

    Directory of Open Access Journals (Sweden)

    Wen Jun Jiang

    2017-03-01

    Full Text Available To examine the mechanism of ocular axial elongation in myopia, guinea pigs (age: 2–3 weeks which either underwent unilateral or bilateral lens-induced myopization (group 1 or which were primarily myopic at baseline (group 2 received unilateral intraocular injections of amphiregulin antibody (doses: 5, 10, or 15 μg three times in intervals of 9 days. A third group of emmetropic guinea pigs got intraocular unilateral injections of amphiregulin (doses: 0.25, 0.50 or 1.00 ng, respectively. In each group, the contralateral eyes received intraocular injections of Ringer's solution. In intra-animal inter-eye comparison and intra-eye follow-up comparison in groups 1 and 2, the study eyes as compared to the contralateral eyes showed a dose-dependent reduction in axial elongation. In group 3, study eyes and control eyes did not differ significantly in axial elongation. Immunohistochemistry revealed amphiregulin labelling at the retinal pigment epithelium in eyes with lens-induced myopization and Ringer's solution injection, but not in eyes with amphiregulin antibody injection. Intraocular injections of amphiregulin-antibody led to a reduction of lens-induced axial myopic elongation and of the physiological eye enlargement in young guinea pigs. In contrast, intraocularly injected amphiregulin in a dose of ≤1 ng did not show a significant effect. Amphiregulin may be one of several essential molecular factors for axial elongation.

  5. Axial clamp for nuclear reactor head penetration conoseal joints

    Energy Technology Data Exchange (ETDEWEB)

    Hackley, T.A.

    1987-03-31

    A method is described for forming a sealed coupling between two bodies, each body presenting an annular abutment surface. The respective bodies are arranged so that their respective annular abutment surfaces are axially adjacent one another, defining a space therebetween, wherein a deformable gasket is disposed within the space. The method comprises: providing one of the bodies with an annular projection; providing the other body with threads for receiving an annular locknut which can be tightened to bear against the annular projection of the one body; applying an external axial forced to the bodies for compressing the abutment surfaces together against the gasket to form a seal between the bodies; immobilizing the bodies relative to one another while the external force is being applied to the bodies by hand-tightening an annular locknut via the threads of the other body until the locknut abuts the annular projection of the one body, substantially preventing relative axial movement between the bodies when the external axial force is withdrawn; and withdrawing the external axial force applied to the bodies, leaving the two bodies coupled together via the seal.

  6. An Axial-Vector Photon in a Mirror World

    Science.gov (United States)

    Sharafiddinov, Rasulkhozha S.

    2016-03-01

    The unity of symmetry laws emphasizes, in the case of a mirror CP-even Dirac Lagrangian, the ideas of the left- and right-handed axial-vector photons referring to long- and short-lived bosons of true neutrality, respectively. Such a difference in lifetimes expresses the unidenticality of masses, energies and momenta of axial-vector photons of the different components. They define the unified field theory equation of C-odd particles with an integral spin. Together with a new equation of a theory of truly neutral particles with the half-integral spin, the latter reflects the availability in their nature of the second type of the local axial-vector gauge transformation responsible for origination in the Lagrangian of C-oddity of an interaction Newton component giving an axial-vector mass to all the interacting particles and fields. The mirror axial-vector mass, energy and momentum operators constitute a CP-invariant equation of quantum mechanics, confirming that each of them can individually influence on matter field. Thereby, findings suggest at the level of the mass-charge structure of gauge invariance a new equation for the C-noninvariant Lagrangian.

  7. Light Weakly Coupled Axial Forces: Models, Constraints, and Projections

    Energy Technology Data Exchange (ETDEWEB)

    Kahn, Yonatan [Princeton U.; Krnjaic, Gordan [Fermilab; Mishra-Sharma, Siddharth [Princeton U.; Tait, Tim P. [UC, Irvine

    2016-09-28

    We investigate the landscape of constraints on MeV-GeV scale, hidden U(1) forces with nonzero axial-vector couplings to Standard Model fermions. While the purely vector-coupled dark photon, which may arise from kinetic mixing, is a well-motivated scenario, several MeV-scale anomalies motivate a theory with axial couplings which can be UV-completed consistent with Standard Model gauge invariance. Moreover, existing constraints on dark photons depend on products of various combinations of axial and vector couplings, making it difficult to isolate the effects of axial couplings for particular flavors of SM fermions. We present a representative renormalizable, UV-complete model of a dark photon with adjustable axial and vector couplings, discuss its general features, and show how some UV constraints may be relaxed in a model with nonrenormalizable Yukawa couplings at the expense of fine-tuning. We survey the existing parameter space and the projected reach of planned experiments, briefly commenting on the relevance of the allowed parameter space to low-energy anomalies in pi^0 and 8-Be* decay.

  8. Method to measure tone of axial and proximal muscle.

    Science.gov (United States)

    Gurfinkel, Victor S; Cacciatore, Timothy W; Cordo, Paul J; Horak, Fay B

    2011-12-14

    The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body's relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention.

  9. An Axial Vector Photon in a Mirror World

    CERN Document Server

    Sharafiddinov, Rasulkhozha S

    2015-01-01

    The unity of symmetry laws emphasizes, in the case of a mirror CP-even Dirac Lagrangian, the ideas of the left- and right-handed axial-vector photons referring to long- and short-lived bosons of true neutrality, respectively. Such a difference in lifetimes expresses the unidenticality of masses, energies and momenta of axial-vector photons of the different components. They define the unified field theory equation of C-odd particles with an integral spin. Together with a new equation of a theory of truly neutral particles with the half-integral spin, the latter reflects the availability in their nature of the second type of the local axial-vector gauge transformation responsible for origination in the Lagrangian of C-oddity of an interaction Newton component giving an axial-vector mass to all the interacting particles and fields. The mirror axial-vector mass, energy and momentum operators constitute a CP-invariant equation of quantum mechanics, confirming that each of them can individually influence on matter ...

  10. Dynamic Behavior of Axially Functionally Graded Pipes Conveying Fluid

    Directory of Open Access Journals (Sweden)

    Chen An

    2017-01-01

    Full Text Available Dynamic behavior of axially functionally graded (FG pipes conveying fluid was investigated numerically by using the generalized integral transform technique (GITT. The transverse vibration equation was integral transformed into a coupled system of second-order differential equations in the temporal variable. The Mathematica’s built-in function, NDSolve, was employed to numerically solve the resulting transformed ODE system. Excellent convergence of the proposed eigenfunction expansions was demonstrated for calculating the transverse displacement at various points of axially FG pipes conveying fluid. The proposed approach was verified by comparing the obtained results with the available solutions reported in the literature. Moreover, parametric studies were performed to analyze the effects of Young’s modulus variation, material distribution, and flow velocity on the dynamic behavior of axially FG pipes conveying fluid.

  11. Liquid Axial Mixing in Packed Tower at Elevated Pressure

    Institute of Scientific and Technical Information of China (English)

    唐忠利; 张鹏; 等

    2003-01-01

    Liquid phase axial mixing was measured with the tracer technique in a packed column with inner diameter of 0.15m,in which the structured packing,Mellapak 350Y,was installed.Tap water as the liquid phase flowed down through the column and stagnant gas was at elevated pressure ranging from atmospheric to 2.0MPa.The model parameters of Bo andθwere estimated with the least square method in the time domain.As liquid flow rate was increased,the liquid axial mixing decreased.under our experimental conditions,the effect of pressure on Bo number on single liquid phase was negligible,and eddy diffusion was believed to be the primary cause of axial mixing in liquid phase.

  12. Unsteady cooperative flow type in the axial compressor

    Institute of Scientific and Technical Information of China (English)

    ZHENG Xinqian; ZHOU Sheng; HOU Anping; XIONG Jinsong

    2005-01-01

    For increasing the performance of the axial compressor, a method for realizing unsteady cooperative flow type is proposed in this paper as a critical objective in the new generation of the axial compressor design system. Unsteady excitations were utilized to trigger the transformation from the unsteady natural flow pattern into the unsteady cooperative flow pattern, resulting in increment of aerodynamic performances of axial compressor. Numerical simulations show that distinct positive effect can be obtained for the 2D cascade in a wide range of subsonic working conditions. No positive effect can be observed under the 2D supersonic working conditions and unsteady excitations have little influence on the flow field space-time structure. However, positive effect can be obtained under the 3D transsonic working conditions. In addition, engineering applications of unsteady cooperative flow type are discussed.

  13. Investigation of Aluminum-Copper Tube Hydroforming with Axial Feeding

    Science.gov (United States)

    Parto D., M.; Seyedkashi, S. M. H.; Liaghat, Gh.; Naeini, H. Moslemi; Panahizadeh R., V.

    2011-01-01

    Hydroforming of a two-layered Aluminum-Copper tube is investigated numerically and experimentally. Pressure is applied through a nonlinear path along with symmetrical axial feeding. ABAQUS/Explicit commercial code is used for finite element simulation of the process. ASTM C11000 Copper alloy is used as inner layer and ASTM AA1050A Aluminum alloy is used as outer layer. The simulation results show that the part can be successfully formed under internal pressure of 40 MPa with 8 mm axial displacement. Stress distributions on both inner and outer tubes are compared and maximum thinning on their wall is also discussed. Different friction conditions are applied on the process using different coefficients of friction and their effects are investigated on thinning percentage of inner and outer tubes and also on axial feeding. It is observed that finite element results are in good agreement with experimental results.

  14. Numerical analysis of cavitation within slanted axial-flow pump

    Institute of Scientific and Technical Information of China (English)

    张睿; 陈红勋

    2013-01-01

    In this paper, the cavitating flow within a slanted axial-flow pump is numerically researched. The hydraulic and cavitation performance of the slanted axial-flow pump under different operation conditions are estimated. Compared with the experimental hydraulic performance curves, the numerical results show that the filter-based model is better than the standard k-e model to predict the parameters of hydraulic performance. In cavitation simulation, compared with the experimental results, the proposed numerical method has good predicting ability. Under different cavitation conditions, the internal cavitating flow fields within slanted axial-flow pump are investigated. Compared with flow visualization results, the major internal flow features can be effectively grasped. In order to explore the origin of the cavitation performance breakdown, the Boundary Vorticity Flux (BVF) is introduced to diagnose the cavitating flow fields. The analysis results indicate that the cavitation performance drop is relevant to the instability of cavitating flow on the blade suction surface.

  15. Bistability between equatorial and axial dipoles during magnetic field reversals

    CERN Document Server

    Gissinger, Christophe; Schrinner, Martin; Dormy, Emmanuel

    2012-01-01

    Numerical simulations of the geodynamo in presence of an heterogeneous heating are presented. We study the dynamics and the structure of the magnetic field when the equatorial symmetry of the flow is broken. If the symmetry breaking is sufficiently strong, the m = 0 axial dipolar field is replaced by an hemispherical magnetic field, dominated by an oscillating m = 1 magnetic field. Moreover, for moderate symmetry breaking, a bistability between the axial and the equatorial dipole is observed. In this bistable regime, the axial magnetic field exhibits chaotic switches of its polarity, involving the equatorial dipole during the transition period. This new scenario for magnetic field reversals is discussed within the framework of the Earth's dynamo.

  16. Bistability between equatorial and axial dipoles during magnetic field reversals.

    Science.gov (United States)

    Gissinger, Christophe; Petitdemange, Ludovic; Schrinner, Martin; Dormy, Emmanuel

    2012-06-08

    Numerical simulations of the geodynamo in the presence of heterogeneous heating are presented. We study the dynamics and the structure of the magnetic field when the equatorial symmetry of the flow is broken. If the symmetry breaking is sufficiently strong, the m=0 axial dipolar field is replaced by a hemispherical magnetic field, dominated by an oscillating m=1 magnetic field. Moreover, for moderate symmetry breaking, a bistability between the axial and the equatorial dipole is observed. In this bistable regime, the axial magnetic field exhibits chaotic switches of its polarity, involving the equatorial dipole during the transition period. This new scenario for magnetic field reversals is discussed within the framework of Earth's dynamo.

  17. Regional brain axial and radial diffusivity changes during development.

    Science.gov (United States)

    Kumar, Rajesh; Nguyen, Haidang D; Macey, Paul M; Woo, Mary A; Harper, Ronald M

    2012-02-01

    The developing human brain shows rapid myelination and axonal changes during childhood, adolescence, and early adulthood, requiring successive evaluations to determine normative values for potential pathological assessment. Fiber characteristics can be examined by axial and radial diffusivity procedures, which measure water diffusion parallel and perpendicular to axons and show primarily axonal status and myelin changes, respectively. Such measures are lacking from widespread sites for the developing brain. Diffusion tensor imaging data were acquired from 30 healthy subjects (age 17.7 ± 4.6 years, range 8-24 years, body mass index 21.5 ± 4.5 kg/m(2), 18 males) using a 3.0-Tesla MRI scanner. Diffusion tensors were calculated, principal eigenvalues determined, and axial and radial diffusivity maps calculated and normalized to a common space. A set of regions of interest was outlined from widespread brain areas within rostral, thalamic, hypothalamic, cerebellar, and pontine regions, and average diffusivity values were calculated using normalized diffusivity maps and these regions of interest masks. Age-related changes were assessed with Pearson's correlations, and gender differences evaluated with Student's t-tests. Axial and radial diffusivity values declined with age in the majority of brain areas, except for midhippocampus, where axial diffusivity values correlated positively with age. Gender differences emerged within putamen, thalamic, hypothalamic, cerebellar, limbic, temporal, and other cortical sites. Documentation of normal axial and radial diffusivity values will help assess disease-related tissue changes. Axial and radial diffusivities change with age,with fiber structure and organization differing between sexes in several brain areas. The findings may underlie gender-based functional characteristics, and mandate partitioning age- and gender-related changes during developmental brain pathology evaluation.

  18. The axial topographic high at intermediate and fast spreading ridges

    Science.gov (United States)

    Carbotte, Suzanne M.; MacDonald, Ken C.

    1994-12-01

    An axial topographic high is commonly observed at both fast spreading ridges and some segments of intermediate spreading ridges. At fast rates the axial high is primarily created by the buoyancy of hot rock and magma beneath the rise. As newly formed crust is transported off axis, little vestige of an axial high is observed on the ridge flanks. In contrast, at intermediate rates, a significant component of the positive topography may be a volcanic construction, preserved on the ridge flanks as abyssal hills, which are slit axial volcanoes. We suggest this difference in the nature of the axial high reflects a lithosphere strong enough to support construction of a volcanic crestal ridge at intermediate spreading rates, but only rarely at fast rates. Relict overlap ridges, found within the discordant zones left by overlapping spreading centers, is one class of ridge-flank topography which appears to have a significant volcanic constructional component even at fast spreading ridges. Unlike topography away from these discontinuities, the relief and shape of overlapping spreading centers is preserved as relict ridge tips are rafted onto the ridge flanks. Reduced magma supply at these discontinuities may give rise to an axial lithosphere strong enough to support volcanic construction of overlap ridges. Low axial lithospheric strength may also account for the lack of normal faults within the innermost 1-2 km of fast, and some intermediate, spreading ridges. With a thin/weak brittle layer at the ridge crest, tensile failure will predominate and few normal faults will form. Depths to the axial magma chamber reflector observed in multi-channel seismic data limit the thickness of the brittel layer on axis to less than 1-2 km for much of the East Pacific Rise (EPR). This depth is comparable to depths over which tensile failure within the oceanic crust will predominate, estimated from the Griffith criteria for fracture initiation (approx. 0.5-1.5 km). As the brittle layer

  19. Recent Results on High-Pressure Axial Blowers

    Science.gov (United States)

    Eckert, B.

    1947-01-01

    Considerable progress has, in recent times, been attained in the development of the high-pressure axial blower by well-planned research. The efforts are directed toward improving the efficiencies, which are already high for the axial blower, and in particular the delivery pressure heads. For high pressures multistage arrangements are used. Of fundamental importance is the careful design of all structural parts of the blower that are subject to the effects of the flow. In the present report, several recent results and experiences are reported, which are based on results of German engine research.

  20. The seismic design of axial blower using Ansys

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hyung Bin; Kim, Kang Sung; Heo, Jin Wook; Chung, Jin Tai [Hanyang Univ., Seoul (Korea, Republic of)

    2001-07-01

    The seismic design for an axial blower is the procedure in which the Required Response Spectrum(RRS) is computed by using the Floor Response Spectrum(FRS). The seismic design is very important to reduce severe damages from an earthquake; therefore, the seismic design has been a great concern in engineering society. In this study, after finite element modeling is established by using Ansys, the modal data are obtained such as the natural frequencies, the participation factor, and so on. With these data, the RRS is acquired by a numerical approach. The seismic safety of the axial blower is evaluated.

  1. Fermion decoupling and the axial anomaly on the lattice

    CERN Document Server

    Banerjee, H; De, Asit K.

    1999-01-01

    By an explicit calculation of the continuum limit of the triangle graph amplitude in lattice QED we show that in the axial Ward identity the ABJ anomaly exactly cancels the pseudoscalar density term in the limit of infinite fermion mass $m$. The result, a reflection of decoupling of the heavy fermion, provides a convenient framework for computing the flavor-singlet or U(1) axial anomaly in non-Abelian gauge theories on lattice. Our calculations on the lattice are performed using Wilson fermions but the results are general.

  2. Vector and Axial Currents in Wilson Chiral Perturbation Theory

    CERN Document Server

    Aoki, Sinya; Sharpe, Stephen R

    2009-01-01

    We reconsider the construction of the vector and axial-vector currents in Wilson Chiral Perturbation Theory (WChPT), the low-energy effective theory for lattice QCD with Wilson fermions. We discuss in detail the finite renormalization of the currents that has to be taken into account in order to properly match the currents. We explicitly show that imposing the chiral Ward identities on the currents does, in general, affect the axial-vector current at O(a). As an application of our results we compute the pion decay constant to one loop in the two flavor theory. Our result differs from previously published ones.

  3. Self-collimated axial jets from thin accretion disks

    CERN Document Server

    Tirabassi, Giulio; Carlevaro, Nakia; Benini, Riccardo

    2012-01-01

    We show how an appropriate stationary crystalline structure of the magnetic field can induce a partial fragmentation of the accretion disk, generating an axial jet composed of hot rising plasma twisted in a funnel-like structure by the rotation of the system. The most important feature of the obtained jet is its high degree of collimation, naturally arising from the condition for its existence. The presence of non-zero dissipative effects allows the plasma ejection throughout the axial jet and the predicted values of the accretion rate are in agreement with observations.

  4. An effective theory for QCD with an axial chemical potential

    CERN Document Server

    Andrianov, Alexander A; Espriu, Domenec; Planells, Xumeu

    2013-01-01

    We consider the low energy realization of QCD in terms of meson fields when an axial chemical potential is present; a situation that may be relevant in heavy ion collisions. We shall demonstrate that the presence of an axial charge constitutes an explicit source of parity breaking. The eigenstates of strong interactions do not have a definite parity and interactions that would otherwise be forbidden compete with the familiar ones. In this work, we first focus on scalars and pseudoscalars that are described by a generalized linear sigma model; and next, we give some hints on how the Vector Meson Dominance model describes the vector sector.

  5. Instability of Meridional Axial System in f(R) Gravity

    CERN Document Server

    Sharif, M

    2015-01-01

    We analyze dynamical instability of non-static reflection axial stellar structure by taking into account generalized Euler's equation in metric $f(R)$ gravity. Such an equation is obtained by contracting Bianchi identities of usual anisotropic and effective stress-energy tensors, which after using radial perturbation technique gives modified collapse equation. In the realm of $R+\\epsilon R^n$ gravity model, we investigate instability constraints at Newtonian and post-Newtonian approximations. We find that instability of meridional axial self-gravitating system depends upon static profile of structure coefficients while $f(R)$ extra curvature terms induce stability to the evolving celestial body.

  6. Spectral analysis in thin tubes with axial heterogeneities

    KAUST Repository

    Ferreira, Rita

    2015-01-01

    In this paper, we present the 3D-1D asymptotic analysis of the Dirichlet spectral problem associated with an elliptic operator with axial periodic heterogeneities. We extend to the 3D-1D case previous 3D-2D results (see [10]) and we analyze the special case where the scale of thickness is much smaller than the scale of the heterogeneities and the planar coefficient has a unique global minimum in the periodic cell. These results are of great relevance in the comprehension of the wave propagation in nanowires showing axial heterogeneities (see [17]).

  7. Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series

    Directory of Open Access Journals (Sweden)

    Miller Larry E

    2011-09-01

    Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL. Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management

  8. Nuclear spin dependent atomic parity violation, nuclear anapole moments, and the hadronic axial neutral current

    Energy Technology Data Exchange (ETDEWEB)

    Bouchiat, C.; Piketty, C.A. (Ecole Normale Superieure, 75 - Paris (France). Lab. de Physique Theorique)

    1991-01-01

    Left-right symmetries in atomic transitions, depending upon the nuclear spin, could be a source of information on the neutral hadronic axial current. We show that the relevant electroweak parameter can be extracted from experiment by measuring hyperfine component ratios which do not involve the knowledge of the atomic wave function. In the standard electroweak model, the parity violating electron-nucleus interaction associated with the hadronic axial neutral current is accidently suppressed and, as a consequence, dominated by the electron interaction with the nuclear anapole moment, which describes the effect of the parity violating nuclear forces on the nucleus electromagnetic current. One of our objectives was to identify the various physical mechanisms which determine the size of the nuclear anapole moments. As an important step, we have established a simple relation between the anapole moment and the nuclear spin magnetization. From this relation it follows that the computation of the anapole moment can be reduced to that of one-body operators. The basic tool is a unitary transformation W which eliminates the one-body parity violating potential from the nuclear hamiltonian. A particular attention was paid to nuclear correlation effects. They are treated semi-empirically in the independent pair approximation. The nuclear anapole moments of {sup 85}Rb, {sup 133}Cs, and {sup 209}Bi have been evaluated for three sets of parity violating meson-nucleon coupling constants, taking into account configuration mixing effects in a semi-empirical way. We suggest a possible strategy to disentangle the axial neutral current from the anapole moment contribution. (orig.).

  9. Dynamic response of the occipito-atlanto-axial (C0-C1-C2) complex in right axial rotation.

    Science.gov (United States)

    Chang, H; Gilbertson, L G; Goel, V K; Winterbottom, J M; Clark, C R; Patwardhan, A

    1992-05-01

    The torque-angular deformation in right axial rotation until failure of the ligamentous occipito-atlanto-axial complex subjected to variable loading rate (dynamic) axial torque was characterized using a biaxial MTS system. A special fixture and gear box that permitted right axial rotation of the specimen until failure without imposing any additional constraints were used to obtain the data. The specimens were divided into three groups and tested until failure at three different dynamic loading rates: 50, 100, and 400 degrees/s. A previous study by the authors provided data for quasi-static (4 degrees/s) loading conditions. The torque versus rotation curves can be divided into two straight regions and two transition zones. The plots clearly indicated that at loading rates higher than 4 degrees/s, the specimens became stiffer in the region of steadily increasing resistance prior to failure. The increase in stiffness was maximum at 100 degrees/s. The stiffness decreased somewhat at 400 degrees/s in comparison with 100 degrees/s, but this decrease was not significant. The resulting torque-right axial rotation curves were also examined to estimate the magnitude of maximum resistance (torque) and the corresponding angular rotation value. The average maximum resistance torque increased from 13.6 Nm at 4 degrees/s to 27.8 Nm at 100 degrees/s. The corresponding right angular rotation data (65-78 degrees), however, did not show any significant variation with loading rate. Posttest dissection of the specimens indicated that the type of injury observed was related to the rate of axial loading imposed on a specimen during testing.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Multi-axial mechanical stimulation of tissue engineered cartilage: Review

    Directory of Open Access Journals (Sweden)

    S D Waldman

    2007-04-01

    Full Text Available The development of tissue engineered cartilage is a promising new approach for the repair of damaged or diseased tissue. Since it has proven difficult to generate cartilaginous tissue with properties similar to that of native articular cartilage, several studies have used mechanical stimuli as a means to improve the quantity and quality of the developed tissue. In this study, we have investigated the effect of multi-axial loading applied during in vitro tissue formation to better reflect the physiological forces that chondrocytes are subjected to in vivo. Dynamic combined compression-shear stimulation (5% compression and 5% shear strain amplitudes increased both collagen and proteoglycan synthesis (76 ± 8% and 73 ± 5%, respectively over the static (unstimulated controls. When this multi-axial loading condition was applied to the chondrocyte cultures over a four week period, there were significant improvements in both extracellular matrix (ECM accumulation and the mechanical properties of the in vitro-formed tissue (3-fold increase in compressive modulus and 1.75-fold increase in shear modulus. Stimulated tissues were also significantly thinner than the static controls (19% reduction suggesting that there was a degree of ECM consolidation as a result of long-term multi-axial loading. This study demonstrated that stimulation by multi-axial forces can improve the quality of the in vitro-formed tissue, but additional studies are required to further optimize the conditions to favour improved biochemical and mechanical properties of the developed tissue.

  11. Optimal design of multi-conditions for axial flow pump

    Science.gov (United States)

    Shi, L. J.; Tang, F. P.; Liu, C.; Xie, R. S.; Zhang, W. P.

    2016-11-01

    Passage components of the pump device will have a negative flow state when axial pump run off the design condition. Combined with model tests of axial flow pump, this paper use numerical simulation and numerical optimization techniques, and change geometric design parameters of the impeller to optimal design of multi conditions for Axial Flow Pump, in order to improve the efficiency of non-design conditions, broad the high efficient district and reduce operating cost. The results show that, efficiency curve of optimized significantly wider than the initial one without optimization. The efficiency of low flow working point increased by about 2.6%, the designed working point increased by about 0.5%, and the high flow working point increased the most, about 7.4%. The change range of head is small, so all working point can meet the operational requirements. That will greatly reduce operating costs and shorten the period of optimal design. This paper adopted the CFD simulation as the subject analysis, combined with experiment study, instead of artificial way of optimization design with experience, which proves the reliability and efficiency of the optimization design of multi-operation conditions of axial-flow pump device.

  12. FINITE ELEMENT ANALYSIS OF AXIAL FEED BAR ROLLING

    Institute of Scientific and Technical Information of China (English)

    C.G. Xu; G.H. Liu; G.S. Ren; Z. Shen; C.P. Ma; W. W. Ren

    2007-01-01

    A flexible technique of hot working of bars by axial feed rolling was introduced. The processdeformation, strain field, stress field, and temperature field of the parts are analyzed by finite elementmethod (FEM)-simulation software DEFORM-3D. The material flow rule and tool load have beeninvestigated.

  13. 3-D Simulation of Vertical-Axial Tidal Current Turbine

    Directory of Open Access Journals (Sweden)

    Zhiyang Zhang

    2016-12-01

    Full Text Available Vertical-axial tidal current turbine is the key for the energy converter, which has the advantages of simple structure, adaptability to flow and uncomplex convection device. It has become the hot point for research and application recently. At present, the study on the hydrodynamic performance of vertical-axial tidal current turbine is almost on 2-D numerical simulation, without the consideration of 3-D effect. CFD (Computational Fluid Dynamics method and blade optimal control technique are used to improve accuracy in the prediction of tidal current turbine hydrodynamic performance. Numerical simulation of vertical-axial tidal current turbine is validated. Fixed and variable deflection angle turbine are comparatively studied to analysis the influence of 3-D effect and the character of fluid field and pressure field. The method, put the plate on the end of blade, of reduce the energy loss caused by 3-D effect is proposed. The 3-D CFD numerical model of vertical-axial tidal current turbine hydrodynamic performance in this study may provide theoretical, methodical and technical reference for the optimal design of turbine.

  14. On aspects of vibration of axially moving continua

    NARCIS (Netherlands)

    Hageraats-Ponomareva, S.

    2009-01-01

    In axially moving structures like conveyor belt systems, magnetic tapes, and so on, vibrations occur due to the presence of different kinds of imperfections in the systems. For these structures internal resonances can lead to severe vibrations. Resonance free conveyor belt systems can be constructed

  15. Dynamic Behaviors of Axially Moving Viscoelastic Plate with Varying Thicknessn

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yinfeng; WANG Zhongmin

    2009-01-01

    Structural components of varying thickness draw increasing attention these days due to economy and light-weight considerations. In view of the absence of research in vibration analysis of viscoelastic plate with varying thickness, this study devotes to investigate the dynamic behaviors of axially moving viscoelastic plate with varying thickness. Based on the thin plate theory and the two-dimensional viscoelastic differential constitutive relation, the differential equation of motion of the axially moving viscoelastic rectangular plate is derived, the plate constituted by Kelvin-Voigt model has linearly varying thickness in the y-direction. The dimensionless complex frequencies of axially moving viscoelastic plate with four edges simply supported are calculated by the differential quadrature method, curves of real parts and imaginary parts of the first three-order dimensionless complex frequencies versus dimensionless moving speed are obtained, the effects of the aspect ratio, thickness ratio, the dimensionless moving speed and delay time on the dynamic behaviors of the axially moving viscoelastic rectangular plate with varying thickness are analyzed. When other parameters keep constant, with the decrease of thickness ratio, the real parts of the first three-order natural frequencies decrease, and the critical divergence speeds of various modes decrease too, moreover, whether the delay time is large or small, the frequencies are all complex numbers.

  16. View of the Axial Field Spectrometer (R807)

    CERN Multimedia

    1980-01-01

    In this view of the Axial Field Spectrometer at I8, the vertical uranium/scintillator hadron calorimeter (just left of centre) is retracted to give access to the cylindrical central drift chamber. The yellow iron structure served as a filter to identify muons, with MWPCs and the array of Cherenkov counters to the right.

  17. Axially and spherically symmetric solitons in warm plasma

    CERN Document Server

    Dvornikov, Maxim

    2010-01-01

    We study the existence of stable axially and spherically symmetric plasma structures on the basis of the new nonlinear Schrodinger equation (NLSE) accounting for nonlocal electron nonlinearities. The numerical solutions of NLSE having the form of spatial solitions are obtained and their stability is analyzed. We discuss the possible application of the obtained results to the theoretical description of natural plasmoids in the atmosphere.

  18. An axially symmetric solution of metric-affine gravity

    CERN Document Server

    Vlachynsky, E J; Obukhov, Yu N; Hehl, F W

    1996-01-01

    We present an exact stationary {\\it axially symmetric} vacuum solution of metric-affine gravity (MAG) which generalises the recently reported spherically symmetric solution. Besides the metric, it carries nonmetricity and torsion as post-Riemannian geometrical structures. The parameters of the solution are interpreted as mass and angular momentum and as dilation, shear and spin charges.

  19. Further comment on pion electroproduction and the axial form factor

    CERN Document Server

    Bernard, V; Meißner, Ulf G; Mei{\\ss}ner, Ulf-G.

    2001-01-01

    We show that a recent claim (H.Haberzettl, Phys. Rev. Lett. 85 (2000) 3576) that one cannot extract the nucleon weak axial form factor G_A (t) from charged pion threshold electroproduction is incorrect. Thus previous calculations remain valid and threshold charged pion electroproduction experiments can indeed be used to determine G_A (t), and they should certainly be pursued.

  20. The cause of axial rotation of the scoliotic spine

    NARCIS (Netherlands)

    Lemmers, L.G.; Sanders, M.M.; Cool, J.C.; Grootenboer, H.J.

    1991-01-01

    To explain the cause of axial rotation in a scoliotic vertebral column, the influence of the gravitation force on a spine with a C-scoliosis has been investigated by means of a mechanical model. In this model the gravitation force takes hold of the three-dimensionally curved vertebral column eccentr