脊柱结核与布氏杆菌性脊柱炎的MRI表现研究

目的探索脊柱结核与布氏杆菌性脊柱炎的磁共振(magnetic resonance image,MRI)表现差异。方法回顾性分析我院自2012年1月至2013年10月收治的10例脊柱结核与12例布氏杆菌性脊柱炎患者的临床资料,所有患者均经MRI扫描,对比分析其MRI表现差异。结果脊椎结核椎体破坏严重,常伴有明显的后凸畸形和多节段椎旁脓肿,甚至邻近器官结核。布氏杆菌性脊柱炎椎体破坏较轻,脓肿局限,一般只波及邻近椎体。结论根据典型的MRI的表现差异,可以区分典型的脊柱结核与布氏杆菌性脊柱炎。     

中西医结合治疗强直性脊柱炎临床护理体会

目的:探讨并且规范强直性脊柱炎在中西医结合治疗中的护理方法,以提高强直性脊柱炎的临床治疗的护理效果。方法:选取我院2010年至2013年住院接受中西医结合治疗的强直性脊柱炎的患者58例,对其临床资料进行回顾性分析,按住院先后随机分为两组,对照组29例进行一般常规护理,实验组29例在一般常规护理基础上进行专业化护理,评价进行专业化护理对提高强直性脊柱炎治疗效果的影响。结果:两组强直性脊柱炎患者接受护理后在疼痛、晨僵、脊柱活动度的缓解率等方面有显著差异,实验组临床治疗效果明显高于对照组,差异有统计学意义(P<0.05)。结论:针对性的专业化护理有助于提高强直性脊柱炎的治疗效果,改善患者的生活质量,值得临床推广。     

The role of the gut and microbes in the pathogenesis of spondyloarthritis

The intestinal microbiota is firmly implicated not only in the pathogenesis of inflammatory bowel disease (IBD) but increasingly also in the development of inflammation at extraintestinal tissue sites. Significant clinical, genetic, immunological, and microbiological overlap exists between IBD and spondyloarthritis (SpA), which indicates that pathophysiological mechanisms are shared between these diseases and may center on the intestinal microbiota. Recently, culture-independent techniques have enabled the microbiota in health and disease to be described in increasing detail. Moreover, functional studies have identified myriad host effector and regulatory pathways that shape or are shaped by this microbial community. We consider the complex relationship between SpA pathogenesis and gut microbes, with a discussion of how manipulation of the gut microbiota itself may be a promising future target for SpA therapy.     

Bone formation in axial spondyloarthritis

The success of targeted therapies directed against tumor necrosis factor for patients with spondyloarthritis has shifted the focus of physicians and scientists towards the prevention of structural damage to the involved structures, in particular the sacroiliac joints and the spine, to avoid loss of function and disability. Structural damage to the skeleton as witnessed by radiography mainly consists of new bone formation potentially progressively leading to spine or joint ankylosis. This important long-term outcome parameter has been difficult to study, not alone because the time window for change may be long but also because human tissues with direct translational relevance are rarely available. Data from rodent models have identified growth factor signaling pathways as relevant targets. Both human and animal studies have tried to understand the link between inflammation and new bone formation. At the current moment, most evidence points towards a strong link between both but with the question still lingering about the sequence of events, disease triggers, and the interdependence of both features of disease. New discoveries such as a masterswitch T cell population that carries the IL23 receptor and the analysis of auto-antibodies directed again noggin and sclerostin are contributing to innovative insights into the pathophysiology of disease. Long-term data with tumor necrosis factor (TNF) inhibitors also suggest that some window of opportunity may exist to inhibit structural disease progression. All these data provide support for a further critical analysis of the available datasets and boost research in the field. The introduction of novel disease definitions, in particular the characterization of non-radiographic axial spondyloarthritis patients, will likely be instrumental in our further understanding of structural damage.     

Adverse effects of TNF inhibitors in SpA: Are they different from RA?

Tumor necrosis factor (TNF) inhibitors were the first biologic drugs prescribed for the treatment of spondyloarthritis (SpA) and rheumatoid arthritis (RA). Although they provide significant improvement of signs and symptoms, TNF inhibitors need to be used frequently for a long period of time. The analysis of the follow-up of the largest national biologics registries has shown that the most important adverse effect of TNF inhibitors is infection, which is significantly higher than the non-biologic treatment group; reactivation of latent tuberculosis is three to four times more frequent in patients using monoclonal antibodies than soluble receptors. The only cancer site more frequent to be associated with TNF inhibitors in RA and SpA is the non-melanoma skin cancer. Paradoxical reactions do occur during anti-TNF treatment mainly in SpA, such as new manifestations or flares of acute uveitis, new onset of psoriasis, such as palmoplantar pustulosis, or new onset or flares of inflammatory bowel disease, which occurs especially during etanercept treatment.     

定量CT测量强直性脊柱炎患者髋臼骨密度

目的探讨定量CT（QCT）测量成年男性强直性脊柱炎（AS）患者髋臼骨密度（BMD）的价值,研究此类患者髋臼骨量变化。方法选取25例经临床确诊的成年男性AS患者为志愿者,年龄20-44岁,平均（28.6±7.1）岁。分别行双侧髋关节（50个）双能X线吸收仪（DXA）和QCT检查。按照全髋部DXA测定结果,将Z值≤-2.0S的27个髋关节设为试验组,Z值〉-2.0S的23个髋关节设为对照组,比较2组髋臼坐骨体、耻骨体和髂骨体BMD的差异。结果试验组耻骨体、坐骨体BMD值分别为（71.965±35.695）、（87.093±38.413）mg/cm^3,显著低于对照组的（110.526±62.466）、（121.883±39.380）mg/cm^3,差异有统计学意义（P〈0.05）,试验组髂骨体BMD（156.822±41.472）mg/cm^3与对照组（177.948±55.804）mg/cm^3差异无统计学意义（P〉0.05）;AS患者髋臼髂骨体BMD均显著高于坐骨体和耻骨体BMD（均P〈0.05）;AS患者坐骨体和耻骨体BMD差异无统计学意义（P〉0.05）。结论QCT可敏感地反映髋臼不同部位BMD变化。AS患者髋臼的坐骨体、耻骨体较髂骨体更易出现骨密度减低。