Pulmonary involvement in ankylosing spondylitis

This is a prospective study analyzing 52 asymptomatic, consecutive patients with ankylosing spondylitis (AS), who submitted to a pulmonary investigation that included plain chest radiography, pulmonary function test (PFT), and thoracic high-resolution computed tomography (HRCT). The results were compared according to sex, race, dorsal spine involvement, thoracic diameter, smoking status, and HLA-B27. There were four patients (8%) with an altered plain chest radiograph. PFT presented a restrictive pattern in 52% of the patients. Thoracic HRCT showed abnormalities in 21 patients (40%), predominantly nonspecific linear parenchymal opacities (19%), lymphadenopathy (12%), emphysema (10%), bronchiectasis (8%), and pleural involvement (8%). Linear parenchymal opacities were associated with a smoking history (p=0.026) and dorsal spine involvement (p=0.032). HLA-B27 was not associated with any abnormality. A lower thoracic diameter was observed in patients with dorsal spine involvement (p=0.0001), restrictive pattern at PFT (p=0.023), and linear parenchymal opacities (p=0.015). The study concluded that nonspecific subclinical pulmonary involvement is frequent in AS.     

Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech Republic

The aim of the study was to evaluate factors that influence health status and work disability in patients with ankylosing spondylitis (AS) in the Czech Republic. Data were collected in a retrospective fashion directly from patients with AS using mailed questionnaires containing questions regarding sociodemographic characteristics of patients, the course of their disease, therapy, rehabilitation, quality of life, and ability to work. HAQ-DI (Health Assessment Questionnaire-Disability Index) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) were also included in the questionnaires; 1,008 questionnaires were suitable for further statistical analysis. The average age +/- SD of patients was 50.2 +/- 10.7 years, the average symptom duration was 23.0 +/- 11.6 years. Mean time from first symptoms to diagnosis was 9.1 years. Full disability had been awarded to 303 patients (30%) at some point of their disease. Twenty seven percent of patients reported receiving full disability pension for 10 or more years. Four hundred fifty six subjects (45%) were currently or had been previously receiving partial disability pension. Receiving disability pension was more frequent among men (64%) compared to women (56%) (P = 0.012), despite the fact that women had higher BASDAI (P < 0.001) and HAQ-DI (P = 0.004) scores. Patients with a family history of AS had higher BASDAI and HAQ-DI scores (P = 0.001 and P = 0.008, respectively) compared to patients without a family history of AS. BASDAI and HAQ-DI scores correlated with age and duration of illness, younger patients and those with shorter disease duration had lower values. Fifty eight percent of patients reported a BASDAI score >/=4 (current cutoff value for initiation of biological therapy), but only 1% of patients were treated by anti TNF alpha agents within the last year. Seven hundred ninety one patients underwent spa treatment in the previous year; 96% of them experienced improvement of their health condition.     

强直性脊柱炎患者肺部表现的高分辨CT特征及临床

目的研究强直性脊柱炎(anky losing spondy litis,A S)患者肺部高分辨CT(HRCT)表现及其临床特征。方法43例确诊A S患者分别进行肺HRCT、肺部X线平片、肺功能检查,并结合临床特征对比分析。结果43例A S患者中28例(65%)发现有肺HRCT异常,最常见的表现为非特异性间质改变20/43(46.5%),4例(9.3%)为间质性肺病(ILD),3例(7.0%)为上叶纤维化,每例患者可有1种以上病变表现。肺功能有16/43(23.3%)表现轻度限制性通气功能障碍,无DLCO下降。肺HRCT异常与不同病程、骶髂关节炎严重度、肺功能均无统计学相关。结论A S病人的肺部表现不少见,通过肺HRCT可以早期发现。     

Early-stage hip involvement in patients with ankylosing spondylitis: A Chinese study based on magnetic resonance imaging

Objectives: To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).

Methods: A cross-sectional retrospective study of 655 consecutive patients was performed. Patients with hip pain or limited hip function but lacking definitive evidence of hip involvement on radiography underwent hip MRI. Based on the results of the imaging tests, the patients were classified into three categories: (1) no hip involvement; (2) early-stage hip involvement according to MRI but not radiography; (3) advanced-stage hip involvement according to a Bath Ankylosing Spondylitis Radiology Index-hip score ≥2.

Results: One hundred and sixty-eight patients had early-stage hip involvement and 103 patients had advanced-stage hip involvement. Multivariate logistic regression analysis indicated that younger age at onset, worse BASMI score, and more active inflammation in the sacroiliac joints were associated with the occurrence of early-stage hip involvement.

Conclusion: Negative plain radiography results cannot be used to rule out hip involvement. MRI was superior to radiography for the detection of early-stage hip involvement. Susceptible AS patients with symptoms or risk factors for hip involvement should undergo hip MRI to test for lesions in the early stage.     

Risk factors for functional limitations in patients with long‐standing ankylosing spondylitis

Objective

To identify risk factors for functional limitations in patients with ankylosing spondylitis (AS) of at least 20 years' duration.

Methods

Patients with AS for ≥20 years were enrolled in the cross‐sectional component of the Prospective Study of Outcomes in AS. All patients had clinical evaluations and completed questionnaires on functional limitations and potential risk factors. Functional limitations were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI; score range 0–100, higher scores indicate more limitations) and the Health Assessment Questionnaire for the Spondylarthropathies (HAQS). Risk factors included demographic characteristics, duration of AS, smoking status, number of comorbid medical conditions, recalled level of recreational activity in teens and twenties, occupational physical activity throughout life (rated 1 = little, 2 = moderate, 3 = heavy, and weighted by the number of years in each job), and history of AS in a first‐degree relative.

Results

The 326 patients (74% men) had a mean ± SD age of 55.0 ± 10.7 years, a mean duration of AS symptoms of 31.7 ± 10.2 years, and a mean BASFI score of 40.7 ± 25.6. BASFI scores increased with higher lifetime occupational physical activity (r = 0.31; P < 0.0001), the number of comorbid conditions (r = 0.25; P < 0.0001), and the duration of AS (r = 0.12; P = 0.04). BASFI scores were higher among current smokers compared with former/nonsmokers (55.5 versus 38.9; P = 0.0002), and among nonwhites compared with whites (49.9 versus 39.3; P = 0.02). In multivariable analyses, lifetime occupational physical activity, current smoking, education level, number of comorbid conditions, and family history were significantly associated with BASFI scores. The same risk factors were associated with the HAQS.

Conclusion

Functional limitations in patients with AS for ≥20 years are greater among those with a history of more physically demanding jobs, more comorbid conditions, and among smokers, and are less severe among those with higher levels of education and a family history of AS.

     

Variables related to utility in patients with ankylosing spondylitis

The objective of this study was to identify variables associated to the utility of the health states in patients with ankylosing spondylitis (AS). A cross-sectional study was performed in a tertiary care centre. AS patients (New York modified criteria) were included. Demographic and disease-related variables were collected. The social tariffs of the EuroQol-5D (EQ-5D) were used to obtain utility values. Univariate and multivariate regression analyses were used in order to identify variables associated with utility. Seventy patients, 52 male (74.3%), with age (mean ± SD) 43.7 ± 9.1 years and disease duration 10.8 ± 8.1 years, were included. The mean utility was 0.5625 ± 0.3364. In the univariate analysis, patient global assessment, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) had a good correlation with the EQ-5D values (Pearson’s product moment correlation coefficient r > 0.6) whereas physician global assessment, patient pain assessment, and cervical rotation had a moderate correlation with the EQ-5D (0.6 > r > 0.4). Patients with significant comorbidity had lower utility values (0.3563 ± 0.068) than those without it (0.6796 ± 0.041, p = 0.0001). In the multivariate analysis, BASFI and BASDAI kept an independent association with utility and they explained a 62% of the variance of the utility values. In this study, physical function and disease activity, two outcomes with good responsiveness to the treatment, were the main determinants of the utility of the health states in AS patients.     

Cervical spine involvement in ankylosing spondylitis

Our objective was to study cervical spine involvement in a Moroccan population of ankylosing spondylitis (AS) patients and evaluate correlations with disease symptomatic and structural severity. Patients were prospectively enrolled for a 1-year period. Clinical, biological, and radiological data were collected. The risk of cervical spine involvement was estimated using the Kaplan–Maier method. Sixty-one patients were enrolled: 38 males (62.2%) and 23 females of mean (SD) age 35.1 years [11] (range 17–66). The mean disease duration was 10.6 years [7] (0.5–30). Forty-three patients (70.4%) had a history of neck pain. Radiological involvement was present in 33 cases (54%). The concordance between clinical and radiological involvement was statistically significant (κ=0.49; P<10^?6). The risk of cervical spine involvement with regard to disease duration showed that 19.6% of patients had radiological involvement after 5 years, 29.9% after 10 years, 45.1% after 15 years and 70.0% after 20 years. Comparison between patients with and without cervical spine radiological involvement showed no difference in age of onset or sex. There was statistical difference in symptomatic severity parameters (Schöber, chest expansion, BASMI, BASFI, BASDI, BASG) and structural severity parameters (lumbar syndesmophytes score, BASRI). Our study confirms the greater severity of AS in North African countries. Cervical spine involvement increases with age and disease duration in AS and is more frequent in symptomatic and structural severe forms of the disease.     

强直性脊柱炎骨质疏松30例临床分析

目的　研究强直性脊柱炎 (AS)骨质疏松的发生情况、相关因素及与骨代谢指标的关系。方法　 3 0例AS患者及对照组 2 0例 ,用双能X线吸收法 (DEXA)测定腰椎、股骨颈骨密度 (BMD) ,用酶联免疫法测定血清骨钙素 (BGP)、骨碱性磷酸酶 (BAP)及尿脱氧吡啶胶原交联 (D Pyr)。结果　AS早期腰椎及股骨颈BMD均较对照组低 ,而晚期椎体周围软组织骨化使腰椎BMD增加 ,但股骨颈BMD仍低于对照组。 3 0例AS中共有 6例骨质疏松 ,10例骨量减少。AS的股骨颈BMD与病程、ESR、CRP、X线分期呈负性相关 ,绝经前女性BMD变化不如男性明显 ,HLA B2 7阳性与阴性患者BMD无明显差异。AS骨质疏松组 ,骨形成的指标BGP、BAP与对照组无明显差异 ,骨吸收的指标D Pyr明显增高。结论　AS继发全身性骨质疏松并不少见 ,其发生与病程、疾病活动指标、疾病严重程度相关 ,AS骨质疏松主要与骨吸收增加有关。     

Cervical involvement in juvenile-onset ankylosing spondylitis with bone scintigraphy

Juvenile-onset ankylosing spondylitis is an unusual disorder which can present with either peripheral arthritis or more classic hip girdle and back symptoms. A 12-year-old child with this disease was admitted with walking disorder, cervical pain, restricted cervical motion, and right ankle swelling. Diffusely increased accumulation of radioactivity in the cervical spine, focally increased accumulation in bilateral sacroiliac joints, and diminished irregular uptake in thoracal spine were detected on technetium 99m methylene diphosphonate bone scintigraphy. As a result, this imaging technique may give important information for diagnosis and differential diagnosis in juvenile chronic arthritis.     

The absence of circulating immune complexes in patients with ankylosing spondylitis

Summary Sera from 50 patients with well-defined ankylosing spondylitis were examined for circulating immune complexes using both a C1q binding (fluid phase) assay and a Raji cell assay. No more than five of the patients assessed had circulating immune complexes by either one of these techniques and none were positive in both. This result is in contrast to the high prevalence in sera from unselected patients with rheumatoid arthritis and systemic lupus used as positive controls.     

强直性脊柱炎患者骨质疏松分析

目的 研究强直性脊柱炎（AS）患者骨质疏松的发生及其相关因素。分析骨质疏松与骨代谢指标的关系。方法 对30例AS患者用双能X线吸收法（DEXA）测定腰椎和股骨颈骨密度（BMD），用酶联免疫法测定血清骨钙素（BGP），骨碱性磷酸酶（BAP）及尿脱氧吡啶胶原交联（D-Pyr)。结果 AS早期腰椎及股骨颈BMD均较对照组低，而晚期椎体周围软组织骨化使腰椎BMD增加，但股骨颈BMD仍低于对照组，30例AS患者中，骨质疏松6例，骨量减少10例，AS的股骨颈BMD与病程，血沉（ESR），C-反应蛋白（CRP）和X线分期呈负相关，绝经前女性BMD的变化不如男性明显，HLA-B27阳性与阴性患者BMD无明显差异。AS骨质疏松组，骨形成的指标（BGP，BAP）与对照组比较，差异无显著性，骨吸收的指标（D-Pyr)明显增高。结论 AS继发全身性骨质疏松不少见，其发生与病程，疾病活动性和疾病严重程度相关，AS骨质疏松主要与骨吸收增加有关。     

Ochronotic spondyloarthropathy: spinal involvement resembling ankylosing spondylitis

Ochronotic spondyloarthropathy is a rare metabolic disease with the musculoskeletal manifestations of alkaptonuria. Ochronotic arthropathy patients may have spinal abnormalities similar to ankylosing spondylitis (AS). The proof of sacroiliac involvement or bamboo spine appearance is not sufficient either for diagnosis of ankylosing spondilitis or exclusion of ochronosis. In this report, the case of a 54-year-old woman having ochronosis, with clinically more recognizable axial arthropathy resembling AS, is presented, and the history, clinical presentation, diagnostic techniques, and distinctive diagnosis are reviewed.     

Plasma homocysteine status in patients with ankylosing spondylitis

Homocysteine (Hcy), a sulfur-containing amino acid, is eliminated through B vitamins-dependent pathways. Hyperhomocysteinemia has been found to be an independent risk factor for atherosclerotic cardiovascular, cerebrovascular, and peripheral vascular diseases. Recently, psoriasis, lupus, and rheumatoid arthritis were reported to be associated with hyperhomocysteinemia. This study was aimed to evaluate the changes of plasma Hcy level before and after sulfasalazine and MTX therapy in patients with ankylosing spondylitis (AS). One hundred and two patients with AS and ten normal controls were enrolled in the cross-sectional case-control study. Fasting plasma Hcy levels were determined by ELISA kits (IMX, Abbott). Hcy levels were compared to their Bath AS disease activity index (BASDAI) and the usage of sulfasalazine and/or MTX. Active disease was defined by BASDAI as more than 3 in a 10-cm scale with ESR >20 mm/h. For those patients with plasma Hcy ≥15 μmol/l, a perspective trial of daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg for 2 weeks were also tested for the efficacy. Plasma Hcy level increased significantly in AS patients under sulfasalazine (10.4±3.8 μmol/l, p<0.05), MTX (11.9±4.7, p<0.05) and sulfasalazine/MTX combination treatment (11.2±2.6, p<0.05) compared with normal controls (8.6±1.2 μmol/l) and AS patients without DMARD(9.4± 2.6μmol/l). No correlation between disease activity and plasma Hcy level was found. Daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg can lower Hcy level in 2 weeks (32.3±24.0 vs 15.6±11.1 μmol/l, p=0.007). Plasma homocysteine level did significantly increase in AS patients under sulfasalazine or MTX treatment. B-vitamins should be considered as a routine supplementation for patients who underwent sulfasalazine and/or MTX treatment. Further longitudinal studies are required to confirm the conclusions.     

Brazilian-Portuguese version of the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) in patients with ankylosing spondylitis: a translation,cross-cultural adaptation,and validation

To translate and cross-culturally adapt to the Brazilian-Portuguese language (BP), five items were added to Health Assessment Questionnaire (HAQ) to validate the resulting HAQ-S BP version for ankylosing spondylitis (AS). The items were translated into BP following translation and back-translation. To assess validity, 25 patients were evaluated using the HAQ, Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), and laboratory variables (erythrocyte sedimentation rate, C-reactive protein). One question required modification to adapt culturally to Brazilian conditions. The test–retest and interobserver correlation coefficients were 0.990 (p < 0.05) and 0.993 (p < 0.05), respectively. HAQ-S BP correlated to BASFI (r = 0.574; p < 0.05) and to HAQ (r = 0.963; p < 0.05), but not to BASDAI (r = 0.282), BASMI (r = 0.194), and laboratory variable. Individually, the fifth item referring to driving correlated highly to neck rotation (r = 0.900; p < 0.05), while the HAQ-S BP correlated to the neck rotation component (r = 0.303), but did not reach statistical significance. The HAQ-S BP version demonstrated adequate reproducibility, internal consistency and validity, confirming its utility in the research of AS in Brazil.     

Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms

Pulmonary involvement seen in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has been detected increasingly by using highly sensitive diagnostic techniques such as high-resolution computed tomography (HRCT). However, HRCT findings in healthy controls and the effects of smoking and drugs have not been well studied. The aim of this controlled study was to evaluate the relationships between disease-specific clinical, laboratory, HRCT and pulmonary function test (PFT) findings in 20 RA patients using methotrexate (MTX) and 20 AS patients using sulphasalazine who were non-smokers and exhibited asymptomatic respiratory signs. For this purpose, a total of 60 persons (40 patients and 20 healthy controls) were included in this study. A restrictive pattern on PFT was detected in four patients (20%) with AS, one patient with RA and one control (p<0.05). Fourteen patients (70%) with RA and ten patients (50%) with AS had positive HRCT findings. Only one patient (5%) in the control group had abnormal HRCT findings (p<0.05). Interstitial lung disease (ILD) was the most frequently seen HRCT finding in both the RA (35%) and AS (20%) groups. The chest expansion measurement, the score of the visual analogue scale (VAS) for pain and C-reactive protein (CRP) levels were statistically significantly better in patients with AS having normal HRCT than in those with abnormal findings (p<0.05). There was no correlation detected between HRCT and duration of disease, disease activity markers, functional indexes and PFT in patients with RA and AS. HRCT is a sensitive tool in detecting ILD in patients with RA and AS with no signs and symptoms of pulmonary involvement and may be an integral part of such work-up. However, future prospective studies are needed to better determine if HRCT is in fact a predictor of subsequent MTX toxicity.     

Serum homocysteine level in patients with ankylosing spondylitis

In this study serum homocystein (Hcy) level was measured and its relationship with disease activity criteria and treatment protocols was investigated in ankylosing spondylitis (AS) patients. Ninety-two AS patients and 58 healthy individuals were recruited. Erythrocyte sedimentation rate and serum C-reactive protein were determined. Bath AS disease activity index and Bath AS functional index were calculated. Serum Hcy levels >15 μmol/l were considered as hyperhomocysteinemia. The mean serum homocysteine levels were 14.40 and 12.60 μmol/l in patients with AS and the control group, respectively, and the difference between two groups was significant. While there was no significant difference between the sulfasalazine (SSZ) group with 14.25 μmol/l mean Hcy level and the methotrexate (MTX)/SSZ group with 16.05 μmol/l, there was a statistically significant difference between the Hcy levels of these two groups and Hcy level of 12.15 μmol/l of the non-steroidal anti-inflammatory drugs group, and 12.60 μmol/l Hcy level of the control group. Mean serum Hcy level was 13.65 μmol/l in patients with active AS and 14.60 μmol/l in patients with inactive AS, and there was no significant difference between the groups. In our study serum Hcy level was found to be significantly higher in patients with AS than in healthy control subjects. Especially for the AS patients receiving MTX and SSZ treatment without folic acid supplementation, addition of folic acid to their therapy may decrease the risk of cardiovascular disease which in turn decreases the mortality in these patients, but further prospective studies are needed for supporting these results.     

Serum hyaluronic acid levels in patients with ankylosing spondylitis

Our aim in this study was to investigate serum hyaluronic acid (HA) levels and the relationship between clinical parameters in ankylosing spondylitis (AS). Approximately 30 patients with AS and 30 healthy individuals were recruited in this study consecutively. Cross-sectional study was planned, and demographic, clinical, functional, radiological, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were assessed, respectively, with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short-Form 36 (SF-36). Mander Enthesis Index (MEI) was used for evaluation of enthesis involvement. We examined serum concentrations of HA (ng/ml) in patients with AS and controls. The mean ages of patients and control group were 38.3 (SD=10.8) and 42.7 (SD=10.6) years, respectively. The mean of serum HA levels in AS patients was 40.4 (SD=34.8) ng/ml and in controls was 24.9 (SD=20.2). There was significant difference of HA levels between two groups (p=0.04). Furthermore, there was a significant correlation between HA level and distance of hand-floor (r=0.444, p=0.014), modified lumbar Schober's (r= -0.413, p=0.023), distance of chin to chest (r=0.436, p=0.016), right sacroiliit grade (r=0.601, p<0.001), left sacroiliit grade (r=0.610, p<0.001), C reactive protein level (r=0.404, p=0.027), albumin (r= -0.464, p=0.010), C3 (p=0.449, p=0.013), and IgA levels (r=0.369, p=0.045). However, there was no significant correlation between HA levels with MEI, BASFI, BASDAI, and SF-36 (p >or= 0.05). Serum HA level was significantly higher in AS patients than controls. However, there was no significant correlation between serum HA level and disease-specific measures as BASFI and BASDAI; it had significant relation with spinal mobility limitation, sacroiliitis, and laboratory parameters related with acute inflammation. The serum HA level may be a potential biomarker of axial inflammation and disease severity in AS.     

强直性脊柱炎新的疾病活动性指数在中国患者中的应用价值研究

目的 验证新的强直性脊柱炎(AS)疾病活动性指数(ASDAS)在中国的AS患者中的辨别能力,评估其临床应用价值.方法 本研究共纳入AS患者129例,分别为参加依那西普临床试验的活动期AS患者(87例)和使用类克治疗的AS患者(42例).分别以4个ASDAS、毕氏AS疾病活动指数(BASDA1)及患者总体评价来评价患者的疾病活动性水平和治疗效果.计算标准化的均数差(SMD)分析指标的辨别能力,运用Pearson相关分析.两独立样本t检验与一元线性回归进行统计学处理.结果 无论是基线水平还是治疗6周后的变化程度,4个新的ASDAS均与患者总体评价(r=0.56～0.74)、红细胞沉降率(ESR)(r=0.50～0.80)及C反应蛋白(CRP)(r=0.50～0.69)有较好的相关性.4个ASDAS对AS患者的疾病活动性水平及治疗前后病情变化程度的辨别能力均优于BASDA1、患者总体评价、ESR和CRP.4个ASDAS之间差异无统计学意义.结论 新的ASDAS用于评价我国AS患者的疾病活动性和药物疗效有较高的辨别能力,值得临床推广和应用.