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

Clinical Rheumatology - To determine if obesity is associated with poorer patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA), we conducted a cross-sectional study...     

应用血清蛋白质指纹图谱筛选类风湿关节炎的血清标志物

目的 用表面增强激光解吸电离飞行时间质谱（SELDI—TOF—MS）和蛋白质芯片技术检测类风湿关节炎（RA）患者血清蛋白质指纹图谱，探讨基于人工神经网络的蛋白质指纹图谱模型对RA血清诊断标志物的筛选。方法 用H4蛋白芯片结合SELDI—TOF—MS测定了141例血清标本的蛋白质指纹图谱，其中RA90例，系统性红斑狼疮（SEE）20例，健康志愿者31名。将筛选出的血清蛋白质指纹图谱作为输入，建立人工神经网络预测模型，用随机抽取的93例标本（RA60例，SEE 13例，健康志愿者20名）作为训练组，进行训练与交叉验证，并用另外测试组48例（RA30例，SEE 7例，健康志愿者11名）的血清标本盲法验证该模型，同时与抗环瓜氨酸肽（抗CCP）抗体检测结果进行比较。结果 利用从训练组得出的基于人工神经网络的血清蛋白质指纹图谱模型，对测试组的48例未知血清进行预测．结果显示．对RA检测的敏感性为90％（27／30），特异性为90．9％（9／11），阳性率为90．2％（37／41），明显高于抗CCP抗体检测结果。结论血清蛋白质指纹图谱可有效筛选RA血清中特异性蛋白标志物，基于人工神经网络的血清蛋白质质谱模型较以往传统方法具有更高的敏感性和特异性。     

The role of the unfolded protein response in axial spondyloarthritis

Susceptibility to ankylosing spondylitis is highly genetic, with a heritability greater than 90 %. Presence of the HLA-B27 MHC class I allele remains the greatest genetic risk factor identified to date. Beyond its nominal role in antigen presentation, HLA-B27 displays interesting and possibly unique biochemical characteristics which may contribute to disease pathogenesis. During its biosynthesis in the endoplasmic reticulum (ER), HLA-B27 folds very slowly and misfolds, inducing ER stress. Herein, we describe a major outcome of ER stress, the unfolded protein response (UPR), as well as consequences of the UPR for inflammation and autophagy. The ability of the UPR to augment inflammatory cytokine production is particularly intriguing given the centrality of cytokines in spondyloarthritis. Evidence for the relevance of an HLA-B27-related UPR to spondyloarthritis pathogenesis in animal models and human subjects will be reviewed. As greater pharmacologic capacity to modulate ER stress becomes available, improved understanding of the role of the UPR in spondyloarthritis may yield new therapeutic targets.     

卒中后神经功能转归的神经内分泌标记物

卒中具有高发病率、高致残率和高死亡率等特点,严重威胁着人类生命和生活质量.研究证实,卒中发病后会出现神经内分泌功能紊乱并直接影响患者的转归,对病情和转归判断均具有重要价值,对临床治疗具有指导意义.文章对卒中后神经功能转归的神经内分泌标记物进行了综述.     

Sensitivity and specificity of magnetic resonance imaging for axial spondyloarthritis

Diagnosing spondyloarthritis (SpA) early in young patients with inflammatory back pain and normal findings on radiographs of the sacroiliac joints (SIJ) remains a challenge in routine practice. Magnetic resonance imaging (MRI) is regarded as the most sensitive imaging modality for detecting early SpA before the radiographic appearance of structural lesions. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least 1 clinical feature of SpA. A systematic and standardized evaluation of the SIJ in patients with SpA showed that MRI has much greater diagnostic utility than documented previously and allowed a data-driven definition of a positive MRI for SpA. Single MRI lesions suggestive of inflammation can be found in the SIJ and the spine in up to one quarter of healthy controls and young patients with mechanical back pain.     

The influence of age on clinical and patient-reported outcomes after cholecystectomy

Objective: To examine the relationship between the age of cholecystectomy patients and surgical complications, length of stay, symptom relief, and postdischarge functional status. Design: Patients’ medical records were reviewed and patients were sent a questionnaire three months after hospital discharge. Setting: Four university-affiliated teaching hospitals. Patients: 372 patients who had a primary operation of total cholecystectomy. Outcome measures: In-hospital complications, length of stay, patient satisfaction, symptom relief, and functional status after discharge. Results: Patients over the age of 60 years experienced a higher major postoperative complication rate than did younger patients (p<0.01), although the overall major complication rate was too low to determine whether factors other than age were important predictors. There was no age-related difference in minor postoperative complication rates. The older patients had a longer mean length of stay, even after statistical adjustment for covariates (p<0.05). The older patients reported similar levels of patient satisfaction, but reported recurrence of pre-operative abdominal pain less often than did the younger patients (OR=0.4, 95% CI=0.2, 0.7). There was no statistically significant difference between the older and younger patients in postoperative functioning, except for work performance. The younger patients reported improvement in postoperative work performance, while the older patients reported a decline (p < 0.01). Conclusions: Older cholecystectomy patients may experience more postoperative complications but report less recurrence of preoperative abdominal pain than do younger patients. The decline in work performance in older patients may indicate the need for a longer recuperation period. Supported in part by grants from the National Institute on Aging (AGO833101), the Robert Wood Johnson Foundation, and the John A. Hartford Foundation.     

Biologic disease-modifying anti-rheumatic drugs and patient-reported outcomes in axial SpA: a systematic review and a call for action

Clinical Rheumatology - This paper is to assess the efficacy of different biologic DMARDs (bDMARDs) on several patient-reported outcomes (PROs) in randomized controlled trials (RCT) in axial...     

Classification criteria for psoriatic arthritis and ankylosing spondylitis/axial spondyloarthritis

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.     

Imaging in the diagnosis and management of axial spondyloarthritis

Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing axial spondyloarthritis (SpA) when the pelvic radiograph is normal or equivocal. Subchodral bone marrow edema (BME) is the primary feature of early SpA, although structural changes, particularly erosions, may also be seen at an early stage. It is unclear whether incorporation of structural lesions enhances the classification performance of a positive MRI definition based on BME alone. Neither spinal imaging nor contrast-enhanced imaging are useful for routine diagnostic evaluation. Fat metaplasia is a key intermediary in the pathway from inflammation to ankylosis, although the histopathology remains to be determined. Both active and structural lesions can be reliably detected and quantified on MRI. Tumor necrosis factor inhibitor therapies ameliorate inflammation; however, it is unclear whether complete suppression of inflammation is necessary to prevent structural damage. Structural lesions on MRI require further validation using computed tomography and prospective follow-up to determine their prognostic significance.