Spinal mobility and its impact in Moroccan patients with ankylosing spondylitis

The main objective of this cross-sectional study was to assess spinal mobility and its relationship with disease-related parameters of activity, severity, and quality of life in Moroccan patients with ankylosing spondylitis (AS). One hundred patients with AS according to New York Classification criteria were recruited. Chest expansion, Schober index, occiput-to-wall distance, and the combined index of Bath Ankylosing Spondylitis Metrology Index (BASMI) were used to assess spinal mobility. Assessment criteria included the evaluation of disease activity (Bath Ankylosing Spondylitis Disease Activity index), functional status (Bath Ankylosing Spondylitis Functional Index), and radiographic damage (Bath Ankylosing Spondylitis Radiologic Index).The short form-36 (SF-36) generic instrument was used to assess health-related quality of life. The mean age of patients was 38?±?13?years. There were 67% of males in our data. Our patients had moderate disease activity, severe functional disability, and important radiological damage. The mean value of occiput-to-wall distance was 4?±?6.2?cm, chest expansion was 3.4?±?1.2?cm, Schober index was 2.7?±?1.2?cm, and BASMI was 4?±?3. Impaired spinal mobility, corresponding to higher scores of BASMI, had good statistically significant correlations with prolonged disease duration, severe functional disability (BASFI), important radiological damage (BASRI) and with the deterioration of most domains of SF-36 (p?相似文献   

International spondyloarthritis interobserver reliability exercise--the INSPIRE study: I. Assessment of spinal measures

OBJECTIVE: To determine whether the axial measures used in primary ankylosing spondylitis (AS) were reproducible for both AS and psoriatic arthritis (PsA) with axial disease. METHODS: A group of 20 rheumatologists from 11 countries with expertise in spondyloarthritis (SpA) met for a combined physical examination exercise to assess 10 patients with PsA with axial involvement (9 men, 1 woman, mean age 52 yrs, mean disease duration 17 yrs) and 9 AS patients (7 men, 2 women, mean age 38 yrs, mean disease duration 16 yrs). A modified Latin-square design was used. Measures included were occiput to wall, tragus to wall, cervical rotation, chest expansion, lateral spinal bending, modified Schober, and hip mobility. Data were analyzed using intraclass correlation coefficients (ICC) adjusted for order of measurements. RESULTS: The majority of the variance was contributed by the patients. There was no order effect. Observer effect was noted especially for chest expansion for both AS and PsA patients, and for the modified Schober in PsA. The ICC demonstrated very good to excellent agreement for most measures for both AS and PsA. Chest expansion provided only moderate agreement for AS and PsA. CONCLUSION: Overall, measures of spinal mobility used in primary AS perform well with respect to interobserver reliability, and are equally reproducible when applied to PsA patients with axial involvement. Thus, these measures should now be evaluated in therapeutic trials of patients with PsA to determine sensitivity to change and concordance with other measures of structural damage.     

Effect of physiotherapy on spinal mobility in ankylosing spondylitis.

The efficacy of intensive inpatient physiotherapy was retrospectively analysed in 505 adult patients with ankylosing spondylitis (AS). Eight different measures of thoracic and spinal mobility were collected from the patients' medical records. Recovery in terms of the following measures was 7 to 37% when results after rehabilitation were compared to those taken before: thoracolumbar flexibility (TLF) 15%, the Schober test 12.4%, occiput to wall distance (OWD) 30.8%, cervical rotation 22.6%, chin to chest distance (CCD) 21.7%, finger to floor distance (FFD) 36.6%, chest expansion (CE) 31.3%, vital capacity (VC) 7.4%. Changes in all measures were statistically significant (p less than 0.001). OWD, CE and FFD showed greatest improvement. The average increase in CE was about 1 cm in both sexes and the average increase in VC200 ml in men and 270 ml in women, which indicates improvement in ventilatory capacity. Mobility in the majority of patients improved, though in 2 to 8% range of motion (ROM) deteriorated during the course.     

Quality of life in patients with ankylosing spondylitis: relationships with spinal mobility, disease activity and functional status

The aim of this study was to evaluate quality of life (QOL) in patients with ankylosing spondylitis (AS) and to determine the relationships between QOL and clinical variables including spinal mobility, disease activity and functional status. Forty-eight adult patients who fulfilled the modified New York criteria for AS were included in the study. After detailed physical examination, disease-specific instruments: the Bath ankylosing spondylitis disease activity index (BASDAI) and the Bath ankylosing spondylitis functional index (BASFI) were applied. QOL was assessed using short form-36 (SF-36). The mean age of the patients was 37.0 ± 9.7 years and the mean duration of symptoms was 11.7 ± 8.4 years. Most affected domains of SF-36 were bodily pain, vitality, and physical role, respectively. No significant correlations were found between SF-36 subgroup scores and chest expansion, wall–tragus distance, chin–sternum distance, and floor–finger tip distance. Only modified Schober correlated with two SF-36 domains: physical role and bodily pain. BASDAI and BASFI scores had significant negative correlations with all SF-36 domains except for general health. Identification of QOL in patients with AS is very important in evaluation of illness-related sufferings and development of new management strategies.     

Juvenile onset ankylosing spondylitis (JAS) has less severe spinal disease course than adult onset ankylosing spondylitis (AAS): clinical comparison between JAS and AAS in Korea

OBJECTIVE: To assess the frequency of juvenile onset ankylosing spondylitis (JAS) in Korean patients with AS and to differentiate the clinical characteristics of JAS from adult onset ankylosing spondylitis (AAS). METHODS: We studied 98 consecutive patients with AS who visited the rheumatology clinic of a tertiary referral center and compared clinical and radiographic features of JAS (n = 41) with those of AAS (n = 57). RESULTS: Median age at onset in JAS was 14 years (range 7-16) and in AAS 22 years (range 17-38) (p < 0.01). Patients with JAS at presentation showed fewer spinal symptoms and more frequent peripheral joint symptoms than those with AAS (41.5% vs 80.7% and 73.2% vs 36.8%, respectively; p < 0.01). Current cervical spine disease was more frequent in AAS (66.7% vs 43.9%; p = 0.02) and current knee disease in JAS (26.8% vs 8.8%; p = 0.02). Patients with JAS showed a shorter tragus-wall distance (mean +/- SD 10.6 +/- 1.7 vs 13.1 +/- 6.9 cm; p < 0.01), more mobility on the modified Schober test (5.7 +/- 2.0 vs 4.0 +/- 2.6 cm; p < 0.01) and chest expansion (4.4 +/- 1.7 vs 3.2 +/- 1.8 cm; p < 0.01), and a better forced vital capacity (75.1 +/- 14.1% vs 82.1 +/- 16.1% of predicted value; p = 0.03) than those with AAS. Totally ankylosed sacroiliitis and spinal syndesmophyte on radiographs were less frequent in JAS patients than in AAS (19.5% vs 47.4% and 17.1% vs 54.4%, respectively; p < 0.01). CONCLUSION: The frequency of JAS (41.3%) among Koreans was higher than that reported for Caucasians. General joint involvement pattern at disease onset in JAS was similar to previous reports. Our data suggest that clinically and radiographically JAS has a less severe spinal disease course than AAS.     

Association of cigarette smoking with Chinese ankylosing spondylitis patients in Taiwan: a poor disease outcome in systemic inflammation, functional ability, and physical mobility

We investigated the association between smoking and the disease activity, functional ability, physical mobility, and systemic inflammation in Chinese ankylosing spondylitis (AS) patients. Seventy five male Chinese AS patients in Taiwan were enrolled in the cross-sectional study. These patients fulfilled the 1984 modified New York criteria. Patients completed the questionnaires, containing the demographic data, disease activity, functional ability (BASFI), and patient’s global assessment. Meanwhile, physical examinations were performed to determine the patient’s physical mobility. Acute-phase reactants, erythrocyte sedimentation rate (ESR), and C-reactive protein levels were also measured in the AS patients. Smoking habits with smoking duration and smoking intensity (pack–years of smoking) were recorded. Among these physical mobility parameters, modified Schober’s index (p?<?0.001), cervical rotation (p?=?0.034), later lumbar flexion (p?=?0.002), chest expansion (p?=?0.016), and occiput-to-wall distances (p?=?0.003) were significantly impaired in smoking AS patients (n?=?35) as compared to non-smoking (n?=?40). Systemic inflammation parameter, ESR was significantly higher in smoking AS patients than non-smoking (p?=?0.03). The odds ratio of advanced modified Schober’s index, lateral lumbar flexion, fingertip-to-floor distance, chest expansion, and occiput-to-wall were significantly elevated in smoking AS patients as compared to non-smoking. Moreover, the smoking intensity correlated significantly with BASFI (r?=?0.481, p?=?0.005), cervical rotation (r?=??0.401, p?=?0.031), fingertip-to-floor distance (r?=?0.485, p?=?0.004), and occiput-to-wall distance (r?=?0.473, p?=?0.005) in the 35 smoking AS patients. The cigarette smokers in the Chinese AS patients have increased systemic inflammation and poor physical mobility. In addition, the higher smoking intensity in the AS smokers is associated with poor disease outcome, including functional ability and physical mobility. Thus, it is quite important for the physician to emphasize the association of smoking with poor disease prognosis in AS, and patients should be strongly recommended to avoid smoking cigarette.     

Evaluation of ankylosing spondylitis spinal mobility measurements in the assessment of spinal involvement in psoriatic arthritis

Objective

To determine the clinical usefulness of spinal mobility measurements used for ankylosing spondylitis (AS) to assess spinal involvement in patients with psoriatic arthritis (PsA).

Methods

We assessed 100 patients with PsA and 103 patients with AS. Patients were classified as having axial PsA if they had grade 2 or higher unilateral sacroiliitis in the presence of spinal symptoms. All PsA patients, without taking the degree of joint involvement into consideration, were evaluated using several measurements for AS. Spinal measurements were compared with axial and peripheral forms of PsA, and the ability of the techniques to discriminate between the 2 forms of PsA was analyzed using the Mann‐Whitney U test and the area under the receiver operating characteristic (ROC) curve. A logistic regression model was used to determine the best measurements for evaluating axial PsA. Finally, the results of measurements for axial PsA were compared with those for AS.

Results

Of the 100 PsA patients, 46 met the classification criteria for axial PsA, which presented more severe spinal measurement assessments compared with peripheral PsA. Modified Schober test, lumbar side flexion, chest expansion, and cervical rotation measurements performed best under the ROC curve. Modified Schober test, lumbar side flexion, and cervical rotation were the more suitable measurements for assessing axial PsA. There were only minor differences between axial PsA and AS.

Conclusion

The spinal measurements used to evaluate AS performed well to assess spinal involvement in PsA. These measurements, notably the modified Schober test, lumbar side flexion, and cervical rotation, should be used in daily clinical practice to assess PsA patients with spinal involvement.     

Efficacy of sacroiliac corticosteroid injections in patients with inflammatory spondyloarthropathy: results of a 6 month controlled study

OBJECTIVE: To evaluate changes in articular symptoms, spinal mobility, and global function over 6 months after intraarticular injections of long acting corticosteroid into the sacroiliac (SI) joints of patients with inflammatory low back pain (ILBP). METHODS: Nineteen patients with symptoms of ILBP were studied. Thirteen (68%) had radiographic evidence of sacroiliitis. The remaining 6 patients (32%) had normal imaging studies and thus were considered to have mechanical low back pain. All patients received bilateral SI joint injections of triamcinolone hexacetonide (40 mg/joint) under computer tomographic guidance. Outcome variables included the duration of low back morning stiffness, back pain (by visual analog scale, McGill Pain Questionnaire), spinal mobility (chest expansion, Schober test, 10 cm segments test, finger-fibula distance), and self-report health status (SF-36). RESULTS: Both groups of patients showed a transient improvement in stiffness and pain, spinal mobility, and general health status that was most pronounced at 1-3 months after intraarticular therapy. This did not reach statistical significance (p > 0.05) and by 6 months, followup all outcome variables had reverted to pretherapy levels in both groups. CONCLUSION: These preliminary observations suggest that SI corticosteroid injections are ineffective in the management of patients with inflammatory spondyloarthropathy.     

Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis

OBJECTIVE: It is a well-known fact that pulmonary function is altered in ankylosing spondylitis (AS) mainly due to the restriction of chest wall movements. The objective of this study was to investigate whether alterations in pulmonary function affected exercise capacity. METHODS: Twenty male patients with definite AS and 20 age-matched healthy male controls were recruited for the study. All subjects were assessed for functional status by BASFI and physical activity level. Measurement of chest expansion and lumbar spinal flexion by the modified Schober method were performed. Pulmonary function tests and exercise testing on a treadmill using the Bruce protocol were performed. RESULTS: The physical activity level was similar in both groups. In the AS group the mean BASFI score suggested good functional capacity, while chest expansion and modified Schober measurements were significantly lower and pulmonary function tests revealed restrictive lung disease. The results of the exercise tolerance test were similar in both groups except for the rate of perceived exertion. CONCLUSION: This study demonstrated that exercise capacity in AS patients is not influenced by the limitation of chest wall movements, probably due to the maintenance of moderate physical activity along with an active life style.     

Treatment of ankylosing spondylitis with biologics and targeted physical therapy

Objective

Biologics are highly effective in ankylosing spondylitis (AS). In this self-controlled study, we assessed the additive value of complex physiotherapy in decreasing chest pain and tenderness and improving respiratory function in AS patients treated with tumor necrosis factor α (TNF-α) inhibitors.

Patients and methods

The trial consisted of 2 parts. In study I, clinical data of AS patients with (n?=?55) or without biological therapy (n?=?20) were retrospectively analyzed and compared. Anthropometrical data, duration since diagnosis and patient assessment of disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. In study II, 10 voluntary patients (6 men and 4 women, age 52.4?±?13.6 years) with definite AS and receiving anti-TNF therapy were recruited. It was a prospective, non-randomized physiotherapeutic trial. BASFI (Bath Ankylosing Spondylitis Functional Index), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), modified Schober Index, occiput-to-wall distance, and fingertip-to-floor distance were evaluated. Forced vital capacity, forced 1-s expiratory volume, peak expiratory flow, and maximum voluntary ventilation were recorded. Furthermore, typical tender points were recorded. A targeted physiotherapy program was conducted twice a week for 12 weeks and all above parameters were recorded at baseline and after 12 weeks.

Results

Differences in patient assessment of disease activity (p?=?0.019) and pain intensity (p?=?0.017) were found in study I. Pain and tenderness of the thoracic spine were observed in both groups. Back pain without biologic therapy was slightly higher than other group. In study II, we found that patient assessment of disease activity and pain intensity significantly improved after the physical therapy program (p?=?0.002 and p?<?0.001). BASFI and BASDAI increased after treatment (p?=?0.004 and p?<?0.001). The finger-to-floor distance, chest expansion, and modified Schober index increased (p?=?0.008, p?<?0.001, and p?=?0.031, respectively). The respiratory functional parameters showed a tendency towards improvement.

Conclusion

AS patients already receiving biological therapy may benefit from additional targeted physiotherapy. Physical therapy may be of important additive value in AS patients being treated with biological. The exercise program presented here showed an improvement in functional parameters as well as spine and chest mobility, thereby enhancing the favorable effects of biological therapy.     

Measurements of spinal mobility in the sagittal plane: new skin contraction technique compared with established methods

A new skin contraction (10 cm segment) method for measuring segmental and "total" spinal movement in the sagittal plane is described and compared with the modified Schober test, finger-floor distance and goniometry. Three consecutive 10 cm segments are marked out along the spine from the lumbosacral junction with the patient in full flexion. The amount of contraction occurring within each segment is measured after maximal spinal extension. Skin contraction correlated significantly with comparable measurements by other methods. Interobserver variation was not significant. Mean patient measurement time (+/- SD) was 124 +/- 59 seconds. The 10 cm segment method was found to be more sensitive than other available clinical techniques for detecting loss of spinal mobility in ankylosing spondylitis.     

Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis

OBJECTIVE: To correlate measures of spinal mobility used in the assessment of spondyloarthritis with radiographic severity, and to compare ankylosing spondylitis (AS) and psoriatic spondylitis (Ps-Sp) in this clinical-radiographic correlation. METHODS: As part of the International SPondyloarthritis Interobserver Reliability Exercise (INSPIRE) study, 20 spondyloarthropathy (SpA) experts met for an examination exercise assessing 19 patients with SpA -- 10 with Ps-Sp (9 men, mean age 52 yrs, mean disease duration 17 yrs) and 9 with AS (7 men, mean age 38 yrs, mean disease duration 16 yrs). Spearman correlation with bias correction was used to correlate median values of the spinal measurements obtained in the INSPIRE study with modified Stoke AS spinal score (mSASSS) and Bath AS Radiology Index-spine (BASRI-s) scores calculated by consensus of 2 assessors. RESULTS: The 2 radiographic measures performed comparably in relation to clinimetrics in the SpA group as a whole. There was very good correlation between mSASSS and the occiput-to-wall distance, tragus-to-wall distance, modified Schober, and lateral spinal flexion in the entire group (rs > 0.64, p < 0.05 for each measure). There was also good correlation between mSASSS and cervical rotation and chest expansion (rs = 0.58 and 0.54, p <0.05, respectively). The clinical-radiographic correlations were comparable in the AS and Ps-Sp, except for cervical rotation, which correlated better with mSASSS in Ps-Sp than in AS. CONCLUSION: Our study documents the structure-function correlations in axial SpA and provides evidence supporting application of radiographic and clinical measures used in AS to studies of Ps-Sp.     

No effect of taurine on platelet aggregation in men with a predisposition to type 2 diabetes mellitus

Abbreviations

ADP–denosine diphosphate; BMI–body mass index; FFA–free fatty acids; FFM–fat-free mass; IGT–impaired glucose tolerance; OGTT–oral glucose tolerance test; PPP–platelet-poor plasma; PRP–platelet-rich plasma; T2DM–type 2 diabetes mellitus; TG–triglyceride.

Contributed equally to this study.

Any diet therapy that potentially could affect platelet function would also influence the initiation of atherosclerotic plaque formation which is an important complication of diabetes mellitus eventually resulting in myocardial infarction and stroke. Blood platelets are rich in taurine, and it has been shown that taurine inhibits platelet aggregation in healthy subjects. The purpose was to examine the effect of taurine supplementation on platelet aggregation in high-risk subjects with a positive family history of T2DM. Twenty healthy men were included in a double-blinded, randomized, crossover study, receiving daily supplementation of 1.5?g taurine or placebo for two 8-week periods. Subjects were overweight and first-degree relatives of T2DM patients. At the end of each treatment, fasting blood samples for assessment of platelet aggregation was drawn. Platelet aggregation was induced by ADP. Plasma taurine concentration was significantly greater after taurine intervention compared to placebo (131.4?±?61.7 vs. 38.9?±?6.7?µmol/l, P?<?0.0001). There was no difference in the threshold level for complete platelet aggregation induced by ADP in vivo between placebo and taurine intervention (placebo 3.86?±?2.21 vs. taurine 3.86?±?3.25?µmol/l). Supplementation with 1.5?g of taurine for 8 weeks had no effect on platelet aggregation in overweight prediabetic men.     

Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis

Pulmonary function is altered in ankylosing spondylitis (AS) owing mainly to the restriction of chest wall involvement (limited chest expansion). The objective of this study was to investigate the relationship between chest expansion, respiratory muscle strength (MIP, MEP) maximum voluntary ventilation (MVV), and BASFI score in patients with AS. Twenty-three male patients with definite AS and 21 age-matched healthy male controls were recruited for the study. Patients with AS were assessed for functional status by BASFI. Measurement of chest expansion and lumbar spinal flexion (modified Schober) method was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth-pressure meter (MPM). Body mass index (kg/m²) was recorded in all individuals. Chest expansion and modified Schober measurement were significantly lower in AS patients (p<0.05). Pulmonary function tests revealed restrictive lung disease. The mean BASFI score suggested good functional capacity in the AS group. The respiratory muscle strength and MVV were also lower in AS (p<0.05). The chest expansion was correlated with MIP and MEP values (r=0.491; p=0.02, r=0.436; p=0.05). Chest expansion was also correlated negatively with disease duration (r=–0.502; p=0.03). In addition, there was no correlation between chest expansion and BASFI score (r=–0.076; p=0.773). This study demonstrates that functional status (BASFI) is not influenced by the limitation of chest wall movement. It may be as a result of the maintenance of moderate physical activity during active life in patients with AS.Abbreviations AS Ankylosing spondylitis - FEF Forced expiratory flow rate - FEV₁ Forced expiratory volume during the first second - FVC Forced vital capacity - MPM Mouth-pressure meter - MVV Maximum voluntary ventilation - VC Vital capacity     

Normal growth hormone secretion in growth hormone insufficient children retested after completion of linear growth

OBJECTIVE The recognition of the syndrome of adult GH deficiency suggests that young GH deficient adults, deprived of GH replacement at completion of linear growth, may suffer effects of GH deficiency. We assessed GH reserve in young adults previously diagnosed as having idiopathic GH insufficiency, who were treated with hGH replacement (14 IU/m²/week) in childhood. DESIGN Eight patients (7 males, 1 female) diagnosed as having GH insufficiency by insulin tolerance test (ITT) in childhood (ages 8.5–15.6 years) were retested by ITT at completion of linear growth (ages 15.1–19.6 years), 3 months after discontinuation of hGH therapy. MEASUREMENTS GH reserve was measured during ITT at diagnosis and at retesting. Height velocity (HV) and HV SDS were calculated before and during GH therapy. RESULTS At diagnosis, the mean peak GH response to ITT was 10.5 ± 2.0 mU/l (range 7.7–13.6). At retesting, mean GH was 52.4 ± 33.2 mU/l (range 10.4–100), 7/8 subjects having peak GH levels greater than 15 mU/l. During hGH therapy mean HV increased from 4.0 ± 1.5 cm/year at diagnosis to 7.3 ± 1.9 cm/year during the 1st year (P = 0.004) and 6.9 ± 2.3 cm/year during the 2nd year (P = 0.02). Mean HVSDS increased from ?1.6 ± 2.1 at diagnosis to 3.1 ± 2.9 during the 1st year (P = 0.004) and 2.2 ± 4.2 during the 2nd year (P = 0.05, NS) of treatment. CONCLUSIONS Seven out of 8 children diagnosed as having idiopathic GH insufficiency had normal GH secretion at completion of linear growth. Children with GH insufficiency cannot be assumed to become GH deficient adults and should not continue on GH therapy into adult life without reinvestigation. All who were GH insufficient children should be retested at completion of linear growth to identify those who are truly GH insufficient adults and may benefit from replacement therapy.     

Clinical Assessment of Spinal Mobility Measurements in Ankylosing Spondylitis: A Compact Set for Follow-up and Trials?

Different spinal ranges of motion (ROM) were measured and the results of 17 repeated tests correlated with spinal radiological changes in 52 male patients with ankylosing spondylitis (AS). Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus – wall and occiput – wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Cervical rotation (CRm, CRt) and flexion (CFLm) correlated only with cervical changes, and thoracolumbar rotation as assessed by instrument (TRi) correlated only weakly with lumbar changes, while chin–chest distance (CCD) and chest expansion (CE) showed no correlation. Inter- and intratester reliability was good in all tests (the intraclass correlation coefficients ranged from 0.84 to 0.98). Three new tape methods for measuring thoracolumbar and cervical rotations and cervical lateral flexion also proved to be valid and reliable, as did the Schober-S1 modification. We conclude that the thoracolumbar segment (Schober), whole (ThFL) and lateral (LFL) flexions and rotation (TR), and chest expansion (CE) (after careful standardisation) together with cervical rotation (CR), extension (CExt) and/or lateral flexion (CLFL) comprise the set of mobility tests for the follow-up and assessment of disease progression in AS. On the other hand, cervical (forward) flexion (CFL), chin–chest distance (CCD) and an instrument method for thoracolumbar rotation (TRi) are not approaches to be recommended. Received: 3 May 1999 / Accepted: 7 September 1999     

Interleukin-6 serum concentration in ankylosing spondylitis: a reliable predictor of disease progression in the subsequent year?

The aim of the present study was to evaluate whether in ankylosing spondylitis (AS), interleukin-6 (IL-6) is a reliable predictor of changes in mobility in the subsequent year. Of 261 AS patients who had been enrolled in a previous study, 128 returned for treatment at our health centre after 1 year (±3 months). The variables for mobility after 1 year (II) were compared with the findings of the previous year (I). Differences in parameters for mobility were related to the serum concentration of IL-6 in the previous year. Relation between serum concentration of IL-6 and difference (II–I) in occiput-to-wall distance (Spearman's rank correlation coefficient r _s, P value) was 0.02, 0.82; chin–chest distance −0.09, 0.31; cervical rotation −0.08, 0.39; chest expansion 0.05, 0.54; finger–floor distance −0.02, 0.84; Ott sign (flexibility of the thoracic spine) −0.11, 0.22; Schober sign 0.01, 0.94. After 1 year there was a significant improvement in cervical rotation in patients with low IL-6 serum concentration (lower quartile), but not in those with high levels of IL-6 (upper quartile). No further difference was seen between patients with high or low levels of IL-6. The present data suggest that the serum concentration of IL-6 does not allow a prediction of disease progression in the subsequent year. Received: 15 September 1999 / Accepted: 20 January 2000     

Reliability and Validity of the Turkish Eating Assessment Tool (T-EAT-10)

The purpose of this study was to test the reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10) among patients with swallowing disorders. One hundred and five patients completed the T-EAT-10 and Functional Oral Intake Scale (FOIS). The internal consistency, test–retest reliability, and criterion validity of T-EAT-10 were investigated. The internal consistency was assessed using Cronbach’s alpha. Intraclass correlation coefficient (ICC) value with 95 % confidence intervals was calculated for test–retest reliability. The criterion validity of the T-EAT-10 was determined by assessing the correlation between T-EAT-10 and FOIS. All the patients in the study completed the T-EAT-10 without assistance. The mean time to complete the instrument was 1.8 ± 0.9 min. The internal consistency of the T-EAT-10 was found to be high with 0.90 Cronbach’s alpha for test and 0.91 Cronbach’s alpha for retest reproducibility. No difference between the test and retest scores of the T-EAT-10 was found (p = 0.14). A negative, moderate correlation between T-EAT-10 and FOIS was detected (r = ?0.365, p < 0.001). The T-EAT-10 is a reliable and valid symptom-specific outcome tool for dysphagia in adult Turkish patients. It can be used in clinical practice and research.     

Acromegalic axial arthropathy: a clinical case-control study

Arthropathy is the major cause of morbidity in acromegaly. To feature the spinal involvement, 54 patients with active acromegaly (27 men, 27 women; age range, 21-69 yr) and 54 sex-, age-, and body mass index-matched healthy controls were enrolled in this observational analytical prospective case-control study. A questionnaire to describe onset, duration, and severity of articular symptoms; rheumatological examination, including vertebral and chest mobility, Schober test, thorax expansion, and axial radiological study; and IGF-I, GH, insulin, and glucose level measurement (baseline and after an oral glucose tolerance test) was used to investigate the prevalence of arthropathy and correlate these findings with hormonal parameters. Axial arthropathy was found in 28 patients (52%) and 12 controls (22%; chi(2) = 8.9; P = 0.003). In detail, spinal mobility was reduced in 30 patients (56%) and 10 controls (18%; chi(2) = 14.3; P < 0.0001), thoracic cage was involved in six patients (11%), alterations of spinal profile were observed in 37 patients (68%) and 15 controls (28%; chi(2) = 16.3; P < 0.0001), and increased L2 vertebra diameters were observed in 34 patients (63%) and none of the controls (chi(2) = 46.7; P < 0.0001). Narrowing and widening of L2-L3 disk space were found in 20 (37%) and seven (13%) patients, respectively. Features of diffuse idiopathic skeletal hyperostosis (DISH) were found in 11 patients (20%) and none of the controls (chi(2) = 10.1; P < 0.001). Disease duration was correlated with vertebral body height (P = 0.001) or intervertebral space height (P = 0.02), and lumbar mobility with thorax expansion (P = 0.004); DISH severity was correlated with basal (P = 0.04) and peak (P = 0.01) glucose levels after glucose load. In conclusion, chronic GH and IGF-I excess typically affects the axial skeleton with development of severe alterations of spine morphology and function until features of DISH occur. An early diagnosis of acromegaly is mandatory to reduce the severity of spine abnormalities as they were significantly higher in patients with longer disease duration.     

Validation of a new objective index to measure spinal mobility: the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI)

Spinal mobility measures are subject to high variability and subjectivity. Automated motion capture allows an objective and quantitative measure of mobility with high levels of precision. To validate the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI), an index measure of spinal mobility, based on automated motion capture, validation studies included the following: (1) validity, tested by correlation—Pearson’s r—between the UCOASMI and the mobility index Bath Ankylosing Spondylitis Metrology Index (BASMI), and a measure of structural damage, the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS); (2) reliability, with internal consistency tested by Cronbach’s alpha, test–retest by intraclass correlation coefficient (ICC) after 2 weeks, and error measurement, by variation coefficient (VC) and smallest detectable difference (SDD); and (3) responsiveness, by effect size (ES) in a clinical trial of anti-TNF. Patients for the different studies all had ankylosing spondylitis. Validity studies show correlation between the BASMI (r = 0.881) and the mSASSS (r = 0.780). Reliability studies show an internal consistency of Cronbach’s α = 0.894, intra-observer ICC = 0.996, test–retest ICC = 0.996, and a measurement error of VC = 2.80 % and SDD = 0.25 points. Responsiveness showed an ES after 24 weeks of treatment of 0.48. In all studies, the UCOASMI’s performance was better than that of the BASMI. The UCOASMI is a validated index to measure spinal mobility with better metric properties than previous indices.