Disturbed Oesophageal Manometric Responses in Patients with Ankylosing Spondylitis and Pulmonary Aspergilloma

Two patients suffering from pulmonary aspergilloma and ankylosing spondylitis were found to have major disturbances of oesophageal function as demonstrated by measurements of oesophageal pressure. One patient suffered from dysphagia; a barium meal suggested the presence of a hiatus hernia. The other patient had no oesophageal symptoms; a barium swallow was normal. Manometry showed that in both subjects the gastrooesophageal sphincter failed to relax on swallowing and there was defective peristalsis in the oesophagus. It is postulated that these abnormalities predispose the subject to pulmonary complications which occasionally develop in ankylosing spondylitis.     

Relevance of Molecular Mimicry in the Mediation of Infectious Myocarditis

Heart disease, the leading cause of death in humans, is estimated to affect one in four American adults in some form. One predominant cause of heart failure in young adults is myocarditis, which can lead to the development of dilated cardiomyopathy, a major indication for heart transplantation. Environmental microbes, including viruses, bacteria, and fungi that are otherwise innocuous, have the potential to induce inflammatory heart disease. As the list is growing, it is critical to determine the mechanisms by which microbes can trigger heart autoimmunity and, importantly, to identify their target antigens. This is especially true as microbes showing structural similarities with the cardiac antigens can predispose to heart autoimmunity by generating cross-reactive immune responses. In this review, we discuss the relevance of molecular mimicry in the mediation of infectious myocarditis.     

Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis

The present study aimed to explore surgical treatments and assess the effects based on the features of cervical spine fracture in patients with ankylosing spondylitis (AS) and to summarize the experiences in perioperative management. Retrospective analysis was performed in 25 AS patients with cervical spine fracture treated in our hospital from January 2011 to December 2013. The patients were divided according to fracture segments, including 4 cases at C4 to C5, 8 cases at C5 to C6, and 13 cases at C6 to C7. Among them, 12 belonged to I type, 5 to II type, and 8 to III type based on the improved classification method for AS cervical spine fracture. The Subaxial Cervical Spine Injury Classification score for these patients was 7.2 ± 1.3, and the assessment of their neurological function states showed 6 patients (24%) were in American Spinal Injury Association (ASIA) A grade, 1 (4%) in ASIA B grade, 3 (12%) in ASIA C grade, 12 (48%) in ASIA D grade, and 3 (12%) in ASIA E grade. Surgical methods contained simple anterior approach alone, posterior approach alone, and combined posterior–anterior or anterior–posterior approach. The average duration of patients’ hospital stay was 38.6 ± 37.6, and the first surgical methods were as follows: anterior approach alone on 6 cases, posterior surgery alone on 9 cases, and combined posterior–anterior or anterior–posterior approach on 10 patients. The median segments of fixation and fusion were 4.1 ± 1.4 sections. Thirteen patients developed complications. During 2 to 36 months of postoperative follow-up, 1 patient died of respiratory failure caused by pulmonary infections 2 months after leaving hospital. At the end of the follow-up, bone graft fusion was achieved in the rest of patients, and obvious looseness or migration of internal fixation was not observed. In addition, the preoperative neurological injury in 12 patients (54.5%) was also alleviated in different levels. AS cervical spine fracture, an unstable fracture, should be treated with operation, and satisfactory effects will be achieved after the individualized surgical treatment according to the improved classification method for AS cervical spine fracture.     

Distribution of HLA-B*27 Alleles in Pa-tients with Ankylosing Spondylitis in Iran

Background: HLA-B*27 is strongly associated with ankylosing spondylitis (AS). It represents a family of alleles that differ among ethnic groups. Objective: The aim of this study was to determine the distribution of HLA-B*27 alleles in AS patients and healthy controls in Isfahan (Iran). Methods: Sixty AS patients and 430 healthy blood donors were selected. All subjects were HLA-B*27 positive by flow cytometry. HLAB* 27 subtypes were determined by PCR-SSP. Results: Forty patients (66.7%) and 17 controls (3.95%) were HLA-B*27 positive. Subtypes detected by PCR-SSP were B*2705, B*2702, B*2704 and B*2707. One patient was B*2702/B*2710. No significant difference was found in the distribution of these alleles between AS patients and controls. Conclusion: Although Caucasian subtypes are predominant among Iranians, this population is characterized by a combination of both specific Caucasian and Oriental subtypes. However such results should be interpreted carefully because of the small sample size in our investigation and definitive conclusion awaits more ethnicgroup studies.     

Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification

Purpose of Review

Pain, functional limitation, and spinal damage are the three main domains that have significant impact on various aspects of axial spondyloarthritis (axSpA).

Recent Findings

Several randomized controlled trials (RCTs) showed a beneficial effect of non-steroid ant-inflammatory drugs (NSAIDs) and biologic treatments on pain and function. The effect of available treatments on spinal damage is still of interest and is being studied.

Summary

In this article, we review the literature on radiographic progression in axSpA. We discuss the natural course of spinal progression, predictors of spinal damage, and the effect of lifestyle changes and medications on radiographic progression in axSpA.

     

Cardiovascular and Cerebrovascular Diseases in Ankylosing Spondylitis: Current Insights

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

Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.     

The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity

The purpose of this study was to investigate the reliability and validity of the Turkish version of the Bath Ankylosing Spondylitis (AS) Functional Index (BASFI). The Turkish version of the BASFI was obtained after a process of translation and back-translation. Eighty-one consecutive patients meeting the 1984 New York criteria for AS were enrolled. Patients were evaluated and requested to complete the questionnaire at days 1 and 2 and on a third occasion between days 15–90. Reliability, reproducibility, validity and sensitivity to change of the Turkish version of the index were assessed. Each score correlated closely with the index score, with coefficients between 0.727 and 0.844. Reliability analysis showed a Cronbachs alpha score of 0.926. Correlations were found between all items of the BASFI and Schobers test (r=–0.258 to –0.531, p<0.001–0.05), occiput-to-wall distance (r=0.284 and 0.589, p<0.001–0.05), and finger-to-floor distance (r=0.334 to 0.613, p<0.001–0.01). The total index score was correlated with the number of nocturnal awakenings (r=0.515, p<0.001), Schobers test (r=–0.444, p<0.001), finger-to-floor distance (r=0.567, p<0.001), occiput-to-wall distance (r=0.535, p<0.001), chest expansion (r=–0.403, p<0.001), and the Dougados articular index (r=0.371, p<0.01). A good correlation was found between day 0 and 1 BASFI indices (r=0.765–0.917, p<0.001), showing good reproducibility of the index. The Turkish version of the BASFI showed reliability, reproducibility, and validity, confirming its utility in the research of AS in Turkey. However, sensitivity to changes due to drug therapy and/or rehabilitation remains to be determined.     

Physical exercise in the treatment of Ankylosing Spondylitis: a systematic review

Physical exercise (PE) is a regular component in various disorders management, such as ankylosing spondilitis (AS). AS is a chronic and systematic rheumatic disorder without an effective treatment to restore the health. PE plays an important role on the prevention and management of the deformities related to AS. This review summarizes the randomized controlled trials that have examined the role of PE in AS patients' therapeutic process in order to promote an evidence based practise and to improve the AS patients care. Thirteen randomized controlled trials with a total of 1056 participants were identified in a Cochrane Central, Pubmed/ Medline and PEDro databases computer-based search. The quality assessment of the thirteen randomized controlled trial was 5,62 points in the PEDro scoring scale. Three trials assessed the effects induced by the addition of PE interventions to the medication program, three trials compared individualized home exercise with supervised group exercise, five trials compared alternative exercise programs (hydrotherapy and global posture reeducation) with traditional exercise programs usually recommended to treat AS patients, and two trials investigated the therapy effectiveness. The trials included in this review suggest that PE is a helpful therapy in the management of AS patients; PE should be performed in group under the physiotherapist supervision. New exercise-based approaches, hydrotherapy or global posture reeducation, offers promising results in the management of patients suffering AS.     

Assessment of Thoracolumbar Rotation in Ankylosing Spondylitis: A Simple Tape Method

Results of a ‘new’ method for thoracolumbar rotation by tape (TRPav), simple instrumental rotation (TRi), the modified Schober test and thoracolumbar flexion (ThFL) were correlalated with radiological changes in patients with ankylosing spondylitis (AS). TRPav showed a significant radiological correlation (Ls-r: 0.38; Th-r: 0.31), while the instrument method (TRi) did not; both the Schober test and ThFL, again, correlated fairly highly (Ls-r: 0.71, 0.62; Th-r: 0.49, 0.42). Both inter- and intratester reliability of the tests was good (Bland and Altman plots). Thoracolumbar rotation is one of the three principal levels of spinal motion and seems to be less affected by age. TRPav proved a valid and reliable method for measuring thoracolumbar rotation and clinically is a non-invasive, quick and easy complement to AS measurement methodologies. Received: 20 April 1998 / Accepted: 5 October 1998     

The Intersection of Age and Influenza Severity: Utility of Ferrets for Dissecting the Age-Dependent Immune Responses and Relevance to Age-Specific Vaccine Development

Many factors impact the host response to influenza virus infection and vaccination. Ferrets have been an indispensable reagent for influenza virus research for almost one hundred years. One of the most significant and well-known factors affecting human disease after infection is host age. Another significant factor is the virus, as strain-specific disease severity is well known. Studying age-related impacts on viral infection and vaccination outcomes requires an animal model that reflects both the physiological and immunological changes that occur with human aging, and sensitivity to differentially virulent influenza viruses. The ferret is uniquely susceptible to a plethora of influenza viruses impacting humans and has proven extremely useful in studying the clinical and immunological pictures of influenza virus infection. Moreover, ferrets developmentally have several of the age-related physiological changes that occur in humans throughout infancy, adulthood, old age, and pregnancy. In this review, we discuss ferret susceptibility to influenza viruses, summarize previous influenza studies using ferrets as models of age, and finally, highlight the application of ferret age models in the pursuit of prophylactic and therapeutic agents to address age-related influenza disease severity.     

Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS

The aim of this study was to adapt the Bath Ankylosing Spondylitis Functional Index (BASFI) to the Turkish population and investigate the reliability and the validity of the Turkish version. Seventy-six patients with ankylosing spondylitis (AS) were included in the study. The functional status of the patients was assessed by using the adapted Turkish version of the BASFI twice, at recruitment and 24 h later. For validity analysis, patients were also assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) evaluating disease activity, the Bath Ankylosing Spondylitis Global Score (BAS-G) indicating effect of the disease on patients well-being, physicians assessment of the disease activity and pain intensity. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI). Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels of the patients were also recorded. The lumbar region and the sacroiliac joints were assessed by Stoke Ankylosing Spondylitis Spine Score (SASSS) and the hip joints were assessed by Bath Ankylosing Spondylitis Radiology Index hip (BASRI-h). The internal consistency was 0.89 (Cronbachs alpha), which showed a high reliability for the Turkish version of the BASFI. Test-retest reliability was good, with a high intraclass correlation coefficient between the two time points (ICC=0.93). Significant correlations were detected between the BASFI and the BASDAI, BAS-G, doctors global assessment, and general pain intensity (r=0.62, p<0.001; r=0.47, p<0.001; r=0.55, p<0.001; r=0.47, p<0.001, respectively). The adaptation of the BASFI to the Turkish population was successful and it was found to be reliable and valid among Turkish patients. Thus, studies using the Turkish BASFI can be compared with international studies.     

A new dimension to outcome: application of the Bath Ankylosing Spondylitis Radiology Index

Our aim was to develop a reproducible and simple radiological scoring system for ankylosing spondylitis (AS) to use in cross sectional and prospective studies. Regarding validation of the BASRI (Bath Ankylosing Spondylitis Radiology Index), radiographs of 470 patients with AS were scored using the New York criteria for the sacroiliac joints. The lumbar and cervical spine, and hips were similarly graded 0-4. These scores were added together to give BASRI-t (total) and if the hips are excluded to give BASRI-s (spine). Radiographs of 188 patients were used to test reproducibility. Blinded radiographs of 89 non-AS patients were included randomly to assess disease specificity. Sensitivity to change was assessed using 177 radiographs from 40 patients. Regarding the cross sectional study, 2200 radiographs of 550 (104 F:446 M) patients were randomly selected and scored using BASRI. The frequency distribution of BASRI-t and BASRI-s were plotted using a probit plot. Inter and intraobservation showed between 73 and 82% and 73 and 88% complete agreement, with specificity of 0.78-0.89, suggesting scores are disease-specific. Sensitivity to change became apparent at 2 years (p<0.05). Scoring required 30 seconds to complete. BASRI-t was found to be normally distributed using a probit plot. The mean BASRI scores (total, spinal, hip) increased with disease duration. The correlation, however, was poor (r=0.293, 0.347, 0.263, respectively). Those with hip involvement had more severe spinal disease (p<0.0001). Men had more severe spinal disease than women (p<0.0001). We conclude BASRI is a reliable and rapid method to grade radiographic changes in AS. Using this scoring system it can be seen that AS is a slowly progressive disease with much individual variation. Hip patients have more severe spinal disease than those without hip involvement and men have more severe spinal disease than women.     

Angiotensin-Receptor Blockade Improves Inflammation and Endothelial Dysfunction in Ankylosing Spondylitis: ARB-AS Study

Cardiovascular (CV) disease is the leading cause of premature death in ankylosing spondylitis (AS). Atherosclerosis and AS share similar pathogenic mechanisms. The proven benefits of angiotensin-receptor blockers (ARBs) in atherosclerotic cardiovascular disease and their role in immune mediation provide strong rationale to investigate its impact with olmesartan on inflammation and endothelial dysfunction in AS. To investigate the effect of olmesartan on inflammation and endothelial dysfunction in AS. 40 AS patients were randomized to receive 24 weeks of treatment with olmesartan (10 mg/day, n  = 20) and placebo ( n  = 20) as an adjunct to existing stable antirheumatic drugs. Markers of endothelial function included the following: flow-mediated dilation (FMD) assessed by AngioDefender, endothelial progenitor cells (EPCs) estimated by flow cytometry, nitrite (nitric oxide surrogate), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and inflammatory measures including Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis functional index (BASFI); erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); proinflammatory cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor-α [TNF-α]) and marker of oxidative stress– thiobarbituric acid reactive substances (TBARS) estimated at baseline and after treatment. Health assessment questionnaire disability index (HAQDI), 36-item short form survey (SF-36), and systematic coronary risk evaluation (SCORE) were estimated using standard tools. FMD improved significantly in the olmesartan group (5.83 ± 0.31% to 7.68 ± 0.27%, p  ≤  0.05) as compared with placebo (5.89 ± 0.35% to 6.04 ± 0.32%, p  = 0.33). EPC population, nitrite, VCAM-1, and TBARS levels improved significantly in olmesartan group as compared with placebo ( p ≤ 0.05). Olmesartan significantly decreased ASDAS, BASDAI, BASFI, ESR, CRP, IL-6, TNF-α, and SCORE as compared with placebo. HAQDI and SF-36 (PH) scores improved significantly in olmesartan group as compared with placebo. Olmesartan reduces inflammatory disease activity, improves quality of life (QOL), and decreases CV risk demonstrating the immunomodulatory, vasculoprotective, and cardioprotective potential of this drug in AS.