Clinical profile of ankylosing spondylitis patients in Togo

Aim of the workTo determine the clinical characteristics of ankylosing spondylitis (AS) in rheumatology wards in Togo. Patients and methods: The medical records of AS patients in four rheumatology wards in Togo were recorded from January 2000 to December 2019. Results: The study included 37 AS cases out of 35,304 rheumatic diseases patients’ files that were investigated over the preceding 20 years; accounting for 0.1% of hospital cases. Male predominance was noticed with a M:F ratio of 4.3. The mean age at disease onset was 29.6 ± 10.3 years and the mean duration of the symptoms was 9.5 ± 9.2 years. The clinical findings were dominated by spinal pain (91.9%). The main peripheral joints involvements were knees (48.6%) and ankles (35.1%) and the most frequent extra-articular features were ocular with conjunctivitis (13.5%) and uveitis (8.1%) respectively. Plain radiographs of the spine revealed syndesmophytes (45.9%) with bony ankylosis and bamboo spine (21.6%); and that of the pelvis showed sacroiliitis in 89.2%. The human leucocytic antigen (HLA B27) was positive in four cases. Non-steroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine were the most commonly used drugs, respectively in 89.2% and 67.6% of patients. One patient was receiving biologic therapy. Conclusion: Ankylosing spondylitis is relatively rare in Togo. There is no particularity in the clinical features or imaging and laboratory findings. The diagnostic delay reflects the importance of the plain radiograph structural changes. NSAIDs and disease modifying anti-rheumatic drugs (DMARDs) are the cornerstone of the treatment due to their accessibility in Togo.     

基于TCA循环关键酶测定研究督灸治疗早期强直性脊柱炎患者关节活动度的疗效及机制＊

目的 基于TCA循环（三羧酸循环，tricarboxylic acid cycle）关键酶测定研究督灸治疗早期强直性脊柱炎（AS）肾虚督寒证患者关节活动度的疗效及生物学机制。方法 110例早期AS肾虚督寒证患者随机分为观察组和对照组，各55例。对照组口服甲氨蝶呤+洛索洛芬钠，观察组在对照组治疗基础上给予督灸，疗程均为12周。观察治疗前后患者的病情活动指数（bath ankylosing spondylitis disease activity index，BASDAI）、功能指数（bath ankylosing spondylitis fundation index，BASFI）、活动度衡量指数（bath ankylosing measure index activity index，BASMI）、总和指数（bath ankylosing spondylitis patient slobal，BAS-G）、指-地距、枕-墙距、胸廓活动度、Schober试验水平和早期AS肾虚督寒证中医辨证（肾虚督寒证）评分；检测血清炎症因子肿瘤坏死因子-α（TNF-α）、白细胞介素-18（IL-18）、血沉（ESR）和C-反应蛋白（CRP）含量；检测TCA循环关键酶柠檬酸合成酶（citrate synthase，CS）、异柠檬酸脱氢酶（isocitrate dehydrogenase，IDH）及α-酮戊二酸脱氢酶（α-ketoglutarate dehydrogenase，α-KGDHC）的水平；比较治疗12周患者的临床疗效及随访6个月复发率。结果 临床研究过程脱落6例。观察组总有效率96.2%，明显高于观察组的82.4%（P<0.05）；观察组随访6个月复发率5.7%，明显低于对照组的21.6%（P<0.05）。治疗12周后，观察组患者BASDAI、BASFI、BASMI、BAS-G、指-地距、枕-墙距和肾虚督寒证评分较对照组明显下降（P<0.05），胸廓活动度和Schober试验较对照组明显升高（P<0.05）；观察组患者TNF-α、IL-18、ESR、CRP、CS和IDH水平较对照组明显下降（P<0.05），α-KGDHC水平较对照组明显升高（P<0.05）。结论 督灸可以有效改善早期AS肾虚督寒证患者的临床症状，复发率低，值得临床推广应用。     

Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications

Purpose: To investigate clinical features, visual prognosis, and ocular complications in patients with ankylosing spondylitis (AS)-associated anterior uveitis (AU).

Methods: Data of 211 eyes of 145 patients with AU associated with AS were reviewed retrospectively.

Results: Mean follow-up time was 6.31 ± 6.33 years. Men were younger than women at AS diagnosis (p = 0.035). The mean number of uveitis flares was highest during the first quarter of the year and lowest during the third quarter (p = 0.017). Immunosuppressive agent use was higher in women than men (p = 0.052). Ocular complications developed in 120 eyes (56.9%), and the complication rate was 0.146/eye year. Males developed cystoid macular edema more frequently than females (p = 0.05). Glaucoma was observed more often in early-onset disease (age at AS onset <45 years) than late-onset disease (p = 0.028).

Conclusions: Visual prognosis of AU in patients with AS was good, although more than half of the eyes developed ocular complications (56.9%).     

Positive HLA‐B27 and sacroiliitis is not always spondyloarthritis

A 36‐year‐old man was treated for several years with multiple agents for ankylosing spondylitis based on positive human leukocyte antigen‐B27 and sacroiliitis. He was also diagnosed with osteoporosis and hypophosphatemia. Over these years, from being an avid runner, he became dependent on a walker for ambulation. The lack of treatment response and the low phosphorus were clues that eventually led to a diagnosis of tumor‐induced osteomalacia. This case discusses the importance of not solely relying on genetic markers and sacroiliitis for diagnosing ankylosing spondylitis as other conditions can cause similar presentations.     

Perspectiva de género en epidemiología clínica. Aprendiendo con el caso de las espondiloartritis

ObjectiveTo illustrate some gender challenges and contributions which are more frequent in research and health care through a chronic disease such as spondyloarthritis.MethodUsing two of the main identified gender biases in research and health care (de-contextualization of diseases, especially in women, and problem definition and knowledge production in women's health), a cross-sectional study was used with 96 men and 54 women with spondyloarthritis of the Rheumatology Department of the Alicante University General Hospital, whose sources of information were semi-structured patient interviews and clinical records.ResultsWe show how the gender perspective can contribute to contextualise the differences by sex of functional alterations and other social and health indicators, and highlight inequalities in the socioeconomic repercussions between patients of both sexes. It can contribute towards re-conceptualizing diseases, especially of women, specifying the profile of differential diagnosis according to sex, and provide knowledge about methodological challenges related to diagnostic tests.ConclusionsAchieving scientific and professional excellence in health care is also a gender issue. Analysing from a gender perspective the history of the diseases, how their diagnosis criteria were established and the normality and abnormality cut-off points, especially identified diseases of men, such as spondyloarthritis, is a priority to re-conceptualize medicine; as well as providing information on how the gender norms and values of the context interact with the lives of those who suffer these diseases.     

浅论强直性脊柱炎归于肝

强直性脊柱炎是一种起病较缓慢而隐匿的风湿免疫系统疾病,具有病程长、难治愈和临床误诊率高等特点,可影响患者正常生活和工作,严重者可致骨质疏松及骨折,甚至可致残。本文主要从肝藏血主筋、肝肾同源理论辨证论治强直性脊柱炎,通过运用肝藏血主筋、肝肾同源理论对其病因病机的演变及临床治疗进一步研究,为临床中强直性脊柱炎的治疗提供理论依据。     

Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features

Background

The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes.

The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis

Fibromyalgia (FM) is one of the most common conditions that rheumatologists encounter. It is characterised by chronic widespread pain, fatigue, sleep disturbances and impaired cognition. The prevalence of comorbid FM among populations with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are considerably higher than among the general population, with pooled prevalence estimates of 18–24% in RA, 14–16% in axSpA and 18% in PsA. Prevalence estimates should be interpreted with care as the criteria for FM have not been validated for use in patients with inflammatory arthritis. Comorbid FM appears to affect assessment of disease severity in these conditions, particularly patient-reported outcome measures, and may influence response to treatment. There is a need for better identification, classification and management of FM in the context of inflammatory rheumatic diseases.