Osteoclast-development patterns and their alterations across Ankylosing Spondylitis(AS)conditions are mysterious,making AS treatment difficult.Our study aims to clarify osteoclast-precursor(OCP)development patterns fr...Osteoclast-development patterns and their alterations across Ankylosing Spondylitis(AS)conditions are mysterious,making AS treatment difficult.Our study aims to clarify osteoclast-precursor(OCP)development patterns from monocytes and their variations under AS conditions.We performed single-cell transcriptomics in peripheral blood mononuclear cells(PBMCs)from healthy donors and AS patients in the early,aggravated and remission stages.After monocytic reclustering,OCP-development patterns and the alterations upon AS onset and different outcomes were revealed based on single-cell trajectory.The trajectories revealed two monocyte states with strong OCP features,and AS pathogenesis was characterized by their reduction.Ribosome synthesis was considered the essential function for the development towards OCP-featured states,and this function and its representative molecule,RPS17,showed a decreasing trend with AS onset and outcomes.Histology assessment showed that RPS17underexpression participated in AS inflammatory osteogenesis and ankylosing destruction.Conditional knockout of RPS17ameliorated ovariectomy-induced bone loss and enhanced osteoclastogenesis,and RPS17 overexpression improved the phenotype of AS-like mice.Importantly,local injection of RPS17-overexpressed monocytic OCPs markedly ameliorated the joint alterations of AS-like mice without promoting bone loss;this was associated with enhanced osteoclastogenesis adjacent to the articular surface and T-cell-suppressive property in monocytic OCPs.Overall,the evolution of monocytes towards OCP-lineage fate mainly depends on ribosome synthesis,and OCP-development disorder participates in AS lesions due to a reduction in RPS17-dependent ribosome synthesis.Notably,RPS17-overexpressed monocytic OCPs have translational potential in preventing and treating AS peripheral lesions.展开更多
BACKGROUND Ankylosing spondylitis(AS)is recognized as a long-term inflammatory disorder that leads to inflammation in the spine and joints,alongside abnormal bone growth.In previous studies,we reported that mesenchyma...BACKGROUND Ankylosing spondylitis(AS)is recognized as a long-term inflammatory disorder that leads to inflammation in the spine and joints,alongside abnormal bone growth.In previous studies,we reported that mesenchymal stem cells(MSCs)derived from individuals with AS demonstrated a remarkable inhibition in the formation of osteoclasts compared to those obtained from healthy donors.The mechanism through which MSCs from AS patients achieve this inhibition remains unclear.AIM To investigate the potential underlying mechanism by which MSCs from individuals with ankylosing spondylitis(AS-MSCs)inhibit osteoclastogenesis.METHODS We analysed fat mass and obesity-associated(FTO)protein levels in AS-MSCs and MSCs from healthy donors and investigated the effects and mechanism by which FTO in MSCs inhibits osteoclastogenesis by coculturing and measuring the levels of tartrate-resistant acid phosphatase,nuclear factor of activated T cells 1 and cathepsin K.RESULTS We found that FTO,an enzyme responsible for removing methyl groups from RNA,was more abundantly expressed in MSCs from AS patients than in those from healthy donors.Reducing FTO levels was shown to diminish the capacity of MSCs to inhibit osteoclast development.Further experimental results revealed that FTO affects the stability of the long non-coding RNA activated by DNA damage(NORAD)by altering its N6-methyladenosine methylation status.Deactivating NORAD in MSCs significantly increased osteoclast formation by affecting miR-4284,which could regulate the MSC-mediated inhibition of osteoclastogenesis reported in our previous research.CONCLUSION This study revealed elevated FTO levels in AS-MSCs and found that FTO regulated the ability of AS-MSCs to inhibit osteoclast formation through the long noncoding RNA NORAD/miR-4284 axis.展开更多
This study aims to explore the clinical and CT imaging features of brucellosis spondylitis(BS)and to strengthen the clinical cognition to reduce misdiagnosis and mistreatment.In this study,clinical and CT imaging data...This study aims to explore the clinical and CT imaging features of brucellosis spondylitis(BS)and to strengthen the clinical cognition to reduce misdiagnosis and mistreatment.In this study,clinical and CT imaging data of 106 patients with BS diagnosed in the Second Hospital of Hohhot and the Third Hospital of Baotou were collected from March 2023 to September 2024 and retrospectively analyzed by clinical manifestations,CT imaging,and disease regression.In 106 patients,58.5%had fever,98.1%had malaise,96.2%had excessive sweating,81.1%had lumbosacral pain,79.3%had limitation of limb movement,76.4%had constipation,and 6.6%had urinary retention.For imaging manifestations,the involvement of lumbar,thoracic and cervical vertebrae were 80.2%,16.9%and 1.9%,respectively.Lesions<1.0 cm,1.0–2.0 cm,2.0–3.0 cm,and>3.0 cm were found in 49.4%,29.6%,19.4%,and 1.6%,respectively.In 106 patients,CT showed round,irregular or worm-like areas of bone destruction,with coexisting osteophytes in 61.5%and no signs of dead bone or pedicle destruction.Interdiscal destruction,spinal canal abscess,ligament injury,and signs of lumbar major muscle compression were rare,accounting for 11.7%,6.6%,4.7%,and 3.8%,respectively.Regarding regression,106 patients with BS treated with antimicrobial therapy or antimicrobial+surgery had a good prognosis.In conclusion,BS has its own characteristics in clinical and imaging aspects and it is easy to distinguish from other common causes of spondylitis bone damage.展开更多
Brucellosis is a global public health issue that severely affects human health,Brucella melitensis is currently the predominant species in China.Brucella spondylitis is the primary cause of the debilitating and disabl...Brucellosis is a global public health issue that severely affects human health,Brucella melitensis is currently the predominant species in China.Brucella spondylitis is the primary cause of the debilitating and disabling complications[1].The lumbar vertebra was the most commonly affected site,followed by the thoracic,cervical,thoracolumbar,and lumbosacral segments,and back pain,fever,sweating,and fatigue were the most common symptoms[2].However,the diagnosis of Brucella spondylitis is challenging owing to its wide spectrum of clinical presentations,cross-reactions with other bacteria,and low strain isolation rate.Therefore,a timely and accurate diagnosis of spinal brucellosis is crucial for implementing an effective therapeutic plan and improving treatment outcomes.Droplet digital polymerase chain reaction(ddPCR)is widely used for low-abundance nucleic acid detection and is useful for diagnosing infectious diseases[3].Therefore,this study aimed to evaluate the ddPCR approach for the diagnosis of brucellosis with spondylitis to improve its clinical diagnostic capacity.展开更多
Ankylosing spondylitis(AS)is a chronic,progressive,systemic autoimmune disease characterised by spinal stiffness and ocular,cardiac,intestinal,and peripheral joint involvements.Genetics,infectious agents,and immune-me...Ankylosing spondylitis(AS)is a chronic,progressive,systemic autoimmune disease characterised by spinal stiffness and ocular,cardiac,intestinal,and peripheral joint involvements.Genetics,infectious agents,and immune-mediated inflammatory processes have all been hypothesized to contribute to AS pathogenesis,but the precise aetiology remains elusive.Recent studies have identified biological and cellular factors that correlate with the onset and progression of AS.This has provided avenues of research that may help elucidate disease mechanisms and lead to advances in therapeutic interventions.This study aimed to examine some of the findings from recent molecular studies,focusing on the molecular mechanism and associated factors such as interleukin-17,tumor necrosis factor-alpha,receptor activator of nuclear factor-kappa B/receptor activator of nuclear factor-kappa B ligand/osteoprotegerin pathway,and related micro-RNAs to gain insight into aberrant bone formation in AS and potential approaches to its prevention.This editorial also addresses the contribution of osteoclasts to bone pathology in AS.The author examined the molecular pathways governing osteoclast differentiation and activity,with particular emphasis on relevant cytokines and immune cell interactions.A comprehensive understanding of these mechanisms is essential for the development of targeted therapies to mitigate excessive bone resorption and pathological skeletal remodeling in AS.展开更多
Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on ...Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.展开更多
OBJECTIVE: To study changes in the nuclear factor-κB p65(NF-κB p65)-inducible nitric oxide synthase(i NOS)-nitric oxide(NO) signaling pathway and the effects of Xinfeng capsules(XFC) in patients with ankylosing spon...OBJECTIVE: To study changes in the nuclear factor-κB p65(NF-κB p65)-inducible nitric oxide synthase(i NOS)-nitric oxide(NO) signaling pathway and the effects of Xinfeng capsules(XFC) in patients with ankylosing spondylitis(AS)METHODS: One hundred twenty patients with AS were randomly divided into an XFC group and a Salazopyrin group. Sixty health subjects were included as a normal control group. In the two treatment groups, pulmonary functional parameters,forced vital capacity(FVC), forced expiratory volume in 1 second(FEV1), maximal voluntary ventilation(MVV), peak expiratory flow(PEF), forced expiratory flow at 25% of forced vital capacity(FEF25),forced expiratory flow at 50% of forced vital capacity(FEF50), and forced expiratory flow at 75% of forced vital capacity(FEF75) were determined. Enzyme linked immunosorbent assays were used for detection of the serum oxidative stress indexes,NF-κB p65, i NOS, NO, reactive oxygen species(ROS), reactive nitrogen species(RNS), malondialdehyde(MDA), superoxide dismutase(SOD), catalase(CAT), total antioxidative capacity(TAOC) and interleukin-4(IL-4), IL-10, IL-1β, and tumor necrosis factor-α(TNF-α) contents. Westergren's method was used for determination of erythrocyte sedimentation rate(ESR). High-sensitivity C-reactive protein(Hs-CRP) was detected with a 7060 full-automatic biochemical analyzer(Hitachi, Japan).RESULTS: The clinical therapeutic effect in the XFC group was significantly superior to that in the Salazopyrin group(P<0.01). Compared with the normal control group, FEV1, MVV, PEF, FEF50, FEF75, SOD, CAT,TAOC, IL-4, IL-10 were significantly lower, and NF-κB p65, i NOS, NO, ROS, RNS, MDA, IL-1β, TNF-α, ESR,and Hs-CRP significantly higher in patients with AS(P<0.01 or P<0.05). Compared with before treatment, FEV1, MVV, PEF, FEF50, FEF75, SOD, CAT, TAOC,IL-4, and IL-10 were significantly increased, and NF-κB p65, i NOS, NO, ROS, RNS, MDA, IL-1β, TNF-α,ESR, CRP, visual analog scales(VAS), Bath ankylosing spondylitis disease active index, Bath ankylosing spondylitis functional index, and Bath ankylosing spondylitis global index significantly decreased in the two treatment groups after treatment(P<0.01 or P<0.05), with significant differences between the XFC and Salazopyrin groups(P<0.01 or P<0.05). Spearman correlation analysis indicated that FEV1, MVV, PEF, FEF50, and FEF75 were positively correlated with SOD, CAT, TAOC, IL-4, and IL-10, and were negatively correlated with NF-κB p65, i NOS,NO, ROS, RNS, MDA, IL-1β, TNF-α, ESR, and CRP.CONCLUSION: Patients with AS have local pathologic changes in the spinal cord and other joints.They also have decreased pulmonary function,which is negatively correlated with the NF-κB-i NOS-NO signaling pathway, oxidative indexes, and inflammatory factors. XFC improves rigidity and pain in spinal joints and other symptoms, laboratory indexes, and pulmonary function. The mechanism is possibly related to inhibition of the NF-κB-i NOS-NO signaling pathway.展开更多
Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess th...Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.展开更多
Ankylosing spondylitis(AS)is chronic inflammatory arthritis with a progressive fusion of axial joints.Anti-inflammatory treatments such as anti-TNF-αantibody therapy suppress inflammation but do not effectively halt ...Ankylosing spondylitis(AS)is chronic inflammatory arthritis with a progressive fusion of axial joints.Anti-inflammatory treatments such as anti-TNF-αantibody therapy suppress inflammation but do not effectively halt the progression of spine fusion in AS patients.Here we report that the autoimmune inflammation of AS generates a microenvironment that promotes chondrogenesis in spine ligaments as the process of spine fusion.Chondrocyte differentiation was observed in the ligaments of patients with earlystage AS,and cartilage formation was followed by calcification.Moreover,a large number of giant osteoclasts were found in the inflammatory environment of ligaments and on bony surfaces of calcified cartilage.Resorption activity by these giant osteoclasts generated marrow with high levels of active TGF-β,which induced new bone formation in the ligaments.Notably,no Osterix+osteoprogenitors were found in osteoclast resorption areas,indicating uncoupled bone resorption and formation.Even at the late and maturation stages,the uncoupled osteoclast resorption in bony interspinous ligament activates TGF-βto induce the progression of ossification in AS patients.Osteoclast resorption of calcified cartilage-initiated ossification in the progression of AS is a similar pathologic process of acquired heterotopic ossification(HO).Our finding of cartilage formation in the ligaments of AS patients revealed that the pathogenesis of spinal fusion is a process of HO and explained why anti-inflammatory treatments do not slow ankylosing once there is new bone formation in spinal soft tissues.Thus,inhibition of HO formation,such as osteoclast activity,cartilage formation,or TGF-βactivity could be a potential therapy for AS.展开更多
Ankylosing spondylitis(AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, ca...Ankylosing spondylitis(AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.展开更多
Objective: To evaluate five drug treatment regimens in the treatment of Brucella spondylitis. Methods: Patients with clinical symptoms compatible and diagnostic test consistent with Brucella spondylitis were randomly ...Objective: To evaluate five drug treatment regimens in the treatment of Brucella spondylitis. Methods: Patients with clinical symptoms compatible and diagnostic test consistent with Brucella spondylitis were randomly assigned to five drug treatment regimens. Results: Combination therapy with doxycycline, rifampin and sulfamethoxazole for 56 consecutive days showed the highest cure rate of 20% after a single course and of 85% after a double course with affectivity rates of 55% and 95%. Cure rate and affectivity rate was significant better (P 0.05) than for patients receiving doxycycline, rifampin and streptomycin for the same period and regimens containing doxycycline were significant better than regimens without this drug. Conclusion: Combination therapy of doxycycline, rifampin and sulfamethoxazole for 8 weeks using one or two full courses should be recommended for Brucella spondylitis.展开更多
There is no radical cure for ankylosing spondylitis,a chronic inflammation in joint,till now.Tumor necrosis factor-alpha（TNF-α） inhibitors can block the cascade in inflammatory chain and improve clinical symptom.Am...There is no radical cure for ankylosing spondylitis,a chronic inflammation in joint,till now.Tumor necrosis factor-alpha（TNF-α） inhibitors can block the cascade in inflammatory chain and improve clinical symptom.Among these biological agents,three of them are marketed in China：etanercept,infliximab and adalimumab.Some of the research progresses between 2014 and 2016 are summarized including treatment application,side effects of drugs,and comprehensive research of TNF-α inhibitors.展开更多
Objective: To improve the clinical differential diagnosis level, the clinical manifestation of the brucellar spondylitis and the spine turberculosis were discussed in this paper. Method: The study was completed in the...Objective: To improve the clinical differential diagnosis level, the clinical manifestation of the brucellar spondylitis and the spine turberculosis were discussed in this paper. Method: The study was completed in the No. 1 Affiliated Hospital of Hebei North University in Zhangjiakou City, Hebei Province, China, from January 2001 to December 2013 by Analyzing the X-ray, CT scanning and MRI of 257 cases of the brucellar spondylitis retrospectively and comparing with the clinical imageology and pathology 332 cases of turberculosis of the spine diagnosed finally. Results: The brucellar spondylitis: The focuses usually locate in the lumbar vertebra and L4, 5 has the highest occurrence rate. The focuses are often small but multiple, and limited to the edge of the vertebra. Hyperostosis and osteoscterosis are usually found in the tissuses around the focuses. There are often new focuses in the newborn bones, and the destruction of intervertebral discs is usually slight. Hyperostosis and osteoscterosis might be found in the surfaces of the joints. The densites of the bones close to the focuses become high. There were less or no paravertebral abscesses but inflammational granuloma can be found frequently. Turberculosis of the spine: The focuses are usually located in the thoracic and lumbar vertebra, and are characterized by the destruction of the vertebra and the intervertebral discs, accompanied by the appearance of dead bones. In most cases, paravertebral abscesses and osteoporosis might be found. Conclusions: The specific manifestation of the clinical imageology can help to differentiate the brucelar spondylitis from the turberculosis of the spine.展开更多
The aim of this study was to assess sensitivity and responsiveness of power Doppler ultrasound （PDUS） in detecting enthesitis for ankylosing spondylitis （AS） patients compared to clinical examinations. Twenty AS p...The aim of this study was to assess sensitivity and responsiveness of power Doppler ultrasound （PDUS） in detecting enthesitis for ankylosing spondylitis （AS） patients compared to clinical examinations. Twenty AS patients initiating etanerceptunderwent clinical and PDUS examinations of six bilateral entheseal sites at baseline and after 1, 2 and 3 months of treatment. Clinical and PDUS examinations identified at least one entheseal lesion in nine （45%） and 19 （95%） patients, respectively. Furthermore, of 240 entheseal sites examined in these 20 patients, PDUS detected 123 entheseal lesions （51.3% of sites）, compared with only 47 entheseal lesions （19.6%） detected by clinical examination （P〈0.05）. The entheseal lesions found on PDUS were most commonly identified by calcification （33.3%）, tendon edema （29.2%）, abnormal blood flow （25.8%）, a thickened tendon （22.1%）, cortical irregularity （12.9%）, bony erosions （9.6%） and bursitis at the tendon insertion to the bone cortex （7.1%）. Improvements in clinical symptoms and laboratory parameters, and significant decreases in PDUS scores were observed following treatment with etanereept. Improvements in PDUS scores continued during follow-up in patients who entered remission following treatment. In conclusion, PDUS improves detection of structural and inflammatory abnormalities of the enthesis in AS compared to physical examination. In addition, PDUS may be useful inascertaining medications.展开更多
AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associate...AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated welt's. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35 +/- 12 (range 18-50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior wets was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.展开更多
Rational:Brucellosis is a globally prevalent zoonotic disease.Any part of the body can be affected by active brucellosis but osteoarticular involvement are the most common symptoms which was reported to vary from 10%t...Rational:Brucellosis is a globally prevalent zoonotic disease.Any part of the body can be affected by active brucellosis but osteoarticular involvement are the most common symptoms which was reported to vary from 10%to 85%.The spine is the most common site of brucellosis in the bones.However,noncontiguous brucellar spondylitis is rare,only few cases have been reported in the literature.Patient concerns:A 62-year-old woman with brucellar spondylitis presented with lower back pain and pain in the right lower extremity for six months.Diagnosis:Brucella agglutination test(1:320)and the result of polymerase chain reaction(PCR)confirmed the diagnosis of noncontiguous brucellar spondylitis.Intervention:During hospital stay,the women received intravenous treatment for brucellosis(A combination of doxycycline 200 mg/d,rifampicin 900 mg/d,levofloxacin 0.5 g/QD,and ceftriaxone 2 g/QD was administered for 1 week),The L4-S1 vertebral body was fixed by posterior lumbar debridement.Outcome:Six months after discharge,the follow-up radiographic images showed stable vertebral height and good lumbar stability.She complained no discomfort.Lessons:Multi-level involvement is an exceptional form of brucellar spondylitis.To the best of our knowledge,only few similar cases have been reported.PCR and bacterial culture is necessary for confirmed diagnosis.展开更多
AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT). METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53...AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT). METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53 males to 25 females who were followed up for 3.88 (1-22) years on average. neumonia and tuberculosis were excluded. In a detailed examination of lung HRCT findings, we investigated the presence of parenchymal micronodules,parenchymal bands, subpleural bands, interlobular and intralobular septal thickening, irregularity of interfaces,ground glass opacity, consolidation, mosaic pattern,bronchial wall thickening, bronchial dilatation, tracheal dilatation, pleural thickening, emphysema, thoracic cage asymmetry, honeycomb appearance, structural distortion, apical fibrosis and other additional findings.RESULTS: In detailed HRCT evaluations, lung parenchymal changes were found in 46 (59%) of all patients. We found parenchymal bands in 21 (27%) cases, interlobular septal thickening in 9 (12%), emphysema in 9 (12%), apical fibrosis in 8 (10%), ground-glass opacities in 7 (9%), parenchymal micronodules in 5 (6%), irregularity in interfaces in 3 (4%), bronchial dilatation in 3 (4%), mosaic pattern in 2 (3%), pleural thickening in 2 (3%), consolidation in 1 (1%), bronchial wall thick ening in 1 (1%) and a subpleural band in 1 (1%) case. Furthermore, we detected subsegmental atelectasis in 2 patients and a cavitary lesion in 1 patient. CONCLUSION: Our study had the highest number of AS cases of all previous studies in evaluating lung paren chymal changes. The rate of lung parenchymal changes was slightly lower than that reported in recent literature.展开更多
AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by im...AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.展开更多
BACKGROUND Ankylosing spondylitis(AS)frequently occurs in people aged 30-45 years,and its prevalence is generally believed to be between 0.1%and 1.4%globally.At present,the“gold standard”for diagnosis of AS requires...BACKGROUND Ankylosing spondylitis(AS)frequently occurs in people aged 30-45 years,and its prevalence is generally believed to be between 0.1%and 1.4%globally.At present,the“gold standard”for diagnosis of AS requires the provision of pelvic X-rays,which makes it more difficult to perform in population-based epidemiological studies.Therefore,the identification of serological indicators related to the diagnosis,treatment,and prognosis of AS patients is of great significance.AIM To analyze the therapeutic,diagnostic significance and prognostic value of dickkopf-related protein-1(DKK-1)and tumor necrosis factor-α(TNF-α)in AS.METHODS A total of 113 patients with active AS were selected as the research group,and 100 healthy subjects who underwent physical examination were selected as the control group.The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared.The diagnostic and predictive values of DKK-1 and TNF-α for AS were analyzed with ROC curves,and the factors influencing AS recurrence were analyzed with COX regression.RESULTS Before treatment,the research group showed lower DKK-1 levels but higher TNF-αlevels than the control group(both aP<0.05).In the research group,DKK-1 was up-regulated and TNF-αwas down-regulated after 12 wk of treatment(aP<0.05).The area under the curve,sensitivity and specificity of DKK-1 combined with TNF-αfor diagnosing AS were 0.934,82.30%and 97.00%,respectively.Before treatment,the area under the curve,cutoff value,sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825,68.42 pg/mL,73.68%and 80.00%,respectively,and those of TNF-αwere 0.863,32.79 ng/L,92.11%and 77.33%,respectively.DKK-1 and TNF-αlevels after treatment were closely related to the curative effect(aP<0.05).C-reactive protein,the Bath Ankylosing Spondylitis Disease Activity Index,DKK-1,and TNF-αwere risk factors for AS recurrence(aP<0.05).CONCLUSION DKK-1 and TNF-αare effective in the diagnosis and treatment of AS and are risk factors for its recurrence.In addition,DKK-1 may be a potential target for the diagnosis of AS.展开更多
Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Meth...Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Method 29 patients with active AS were selected to take GTT (1mg per kg) three times a day for one year. After that, its curative effect was evaluated. The serum level of sIL-2R of these patients was measured by sandwich ELISA method and was compared with that of normal subjects. Result The serum level of sIL-2R in active AS patients was obviously higher than that of the non-active AS patients. (P<0.01). The total effective rate of GTT on AS was 89.6%, while clinical relief rate 27.6%, obvious effective rate 44.8%, effective rate 17.2% and non-effective rate 10.4%. The patients’ serum level of sIL-2R after therapy was significantly lower than that before therapy except patients with no effect. (P<0.05). Conclusion GTT has positive curative effect on active AS patients and could cause obvious decrease of the serum level of sIL-2R. The serum level of sIL-2R can be used as an important index of activity of AS and as a guide of therapy.展开更多
基金supported by National Natural Science Foundation of China(82472473,81991510,81991511 and 81820108020)Major Scientific Research Project of Health in Fujian Province(20212D01003)+3 种基金Fujian Province Joint Fund Project for Science and Technology Innovation(2021Y9023,2023Y9601)China Postdoctoral Science Foundation(2022M710702)Fujian Provincial Natural Science Foundation Projects(2023J01177,2023J011209,2023J01172)Fujian Provincial Health Technology Project(2023GGA004)。
文摘Osteoclast-development patterns and their alterations across Ankylosing Spondylitis(AS)conditions are mysterious,making AS treatment difficult.Our study aims to clarify osteoclast-precursor(OCP)development patterns from monocytes and their variations under AS conditions.We performed single-cell transcriptomics in peripheral blood mononuclear cells(PBMCs)from healthy donors and AS patients in the early,aggravated and remission stages.After monocytic reclustering,OCP-development patterns and the alterations upon AS onset and different outcomes were revealed based on single-cell trajectory.The trajectories revealed two monocyte states with strong OCP features,and AS pathogenesis was characterized by their reduction.Ribosome synthesis was considered the essential function for the development towards OCP-featured states,and this function and its representative molecule,RPS17,showed a decreasing trend with AS onset and outcomes.Histology assessment showed that RPS17underexpression participated in AS inflammatory osteogenesis and ankylosing destruction.Conditional knockout of RPS17ameliorated ovariectomy-induced bone loss and enhanced osteoclastogenesis,and RPS17 overexpression improved the phenotype of AS-like mice.Importantly,local injection of RPS17-overexpressed monocytic OCPs markedly ameliorated the joint alterations of AS-like mice without promoting bone loss;this was associated with enhanced osteoclastogenesis adjacent to the articular surface and T-cell-suppressive property in monocytic OCPs.Overall,the evolution of monocytes towards OCP-lineage fate mainly depends on ribosome synthesis,and OCP-development disorder participates in AS lesions due to a reduction in RPS17-dependent ribosome synthesis.Notably,RPS17-overexpressed monocytic OCPs have translational potential in preventing and treating AS peripheral lesions.
基金Supported by Guangdong Provincial Clinical Research Center for Orthopedic Diseases,No.2023B110001the Excellent Medical Innovation Talent Program of the Eighth Affiliated Hospital of Sun Yat-sen University,No.YXYXCXRC202101+3 种基金the National Natural Science Foundation of China,No.82172349,No.82372372,No.22105229,No.32170708,No.82102530,No.82102541,No.82103098,No.82103909,No.82104182,No.82104350,No.82170427,No.82171291,No.82172215,No.82172385,and No.82302661Guangdong Natural Science Foundation,No.2023A1515010568 and No.2021A1515111057Shenzhen Science and Technology Program,No.JCYJ20220530144201004 and No.RCBS20210609104445097Futian Healthcare Research Project,No.FTWS2022022,No.FTWS2021013,No.FTWS2023072,and No.FTWS2022047.
文摘BACKGROUND Ankylosing spondylitis(AS)is recognized as a long-term inflammatory disorder that leads to inflammation in the spine and joints,alongside abnormal bone growth.In previous studies,we reported that mesenchymal stem cells(MSCs)derived from individuals with AS demonstrated a remarkable inhibition in the formation of osteoclasts compared to those obtained from healthy donors.The mechanism through which MSCs from AS patients achieve this inhibition remains unclear.AIM To investigate the potential underlying mechanism by which MSCs from individuals with ankylosing spondylitis(AS-MSCs)inhibit osteoclastogenesis.METHODS We analysed fat mass and obesity-associated(FTO)protein levels in AS-MSCs and MSCs from healthy donors and investigated the effects and mechanism by which FTO in MSCs inhibits osteoclastogenesis by coculturing and measuring the levels of tartrate-resistant acid phosphatase,nuclear factor of activated T cells 1 and cathepsin K.RESULTS We found that FTO,an enzyme responsible for removing methyl groups from RNA,was more abundantly expressed in MSCs from AS patients than in those from healthy donors.Reducing FTO levels was shown to diminish the capacity of MSCs to inhibit osteoclast development.Further experimental results revealed that FTO affects the stability of the long non-coding RNA activated by DNA damage(NORAD)by altering its N6-methyladenosine methylation status.Deactivating NORAD in MSCs significantly increased osteoclast formation by affecting miR-4284,which could regulate the MSC-mediated inhibition of osteoclastogenesis reported in our previous research.CONCLUSION This study revealed elevated FTO levels in AS-MSCs and found that FTO regulated the ability of AS-MSCs to inhibit osteoclast formation through the long noncoding RNA NORAD/miR-4284 axis.
文摘This study aims to explore the clinical and CT imaging features of brucellosis spondylitis(BS)and to strengthen the clinical cognition to reduce misdiagnosis and mistreatment.In this study,clinical and CT imaging data of 106 patients with BS diagnosed in the Second Hospital of Hohhot and the Third Hospital of Baotou were collected from March 2023 to September 2024 and retrospectively analyzed by clinical manifestations,CT imaging,and disease regression.In 106 patients,58.5%had fever,98.1%had malaise,96.2%had excessive sweating,81.1%had lumbosacral pain,79.3%had limitation of limb movement,76.4%had constipation,and 6.6%had urinary retention.For imaging manifestations,the involvement of lumbar,thoracic and cervical vertebrae were 80.2%,16.9%and 1.9%,respectively.Lesions<1.0 cm,1.0–2.0 cm,2.0–3.0 cm,and>3.0 cm were found in 49.4%,29.6%,19.4%,and 1.6%,respectively.In 106 patients,CT showed round,irregular or worm-like areas of bone destruction,with coexisting osteophytes in 61.5%and no signs of dead bone or pedicle destruction.Interdiscal destruction,spinal canal abscess,ligament injury,and signs of lumbar major muscle compression were rare,accounting for 11.7%,6.6%,4.7%,and 3.8%,respectively.Regarding regression,106 patients with BS treated with antimicrobial therapy or antimicrobial+surgery had a good prognosis.In conclusion,BS has its own characteristics in clinical and imaging aspects and it is easy to distinguish from other common causes of spondylitis bone damage.
基金supported by the Key Research and Development Projects of the Ningxia Hui Autonomous Region(Grant no.2022BEG03161)。
文摘Brucellosis is a global public health issue that severely affects human health,Brucella melitensis is currently the predominant species in China.Brucella spondylitis is the primary cause of the debilitating and disabling complications[1].The lumbar vertebra was the most commonly affected site,followed by the thoracic,cervical,thoracolumbar,and lumbosacral segments,and back pain,fever,sweating,and fatigue were the most common symptoms[2].However,the diagnosis of Brucella spondylitis is challenging owing to its wide spectrum of clinical presentations,cross-reactions with other bacteria,and low strain isolation rate.Therefore,a timely and accurate diagnosis of spinal brucellosis is crucial for implementing an effective therapeutic plan and improving treatment outcomes.Droplet digital polymerase chain reaction(ddPCR)is widely used for low-abundance nucleic acid detection and is useful for diagnosing infectious diseases[3].Therefore,this study aimed to evaluate the ddPCR approach for the diagnosis of brucellosis with spondylitis to improve its clinical diagnostic capacity.
基金Supported by 2024 Yeungnam University Research Grant.
文摘Ankylosing spondylitis(AS)is a chronic,progressive,systemic autoimmune disease characterised by spinal stiffness and ocular,cardiac,intestinal,and peripheral joint involvements.Genetics,infectious agents,and immune-mediated inflammatory processes have all been hypothesized to contribute to AS pathogenesis,but the precise aetiology remains elusive.Recent studies have identified biological and cellular factors that correlate with the onset and progression of AS.This has provided avenues of research that may help elucidate disease mechanisms and lead to advances in therapeutic interventions.This study aimed to examine some of the findings from recent molecular studies,focusing on the molecular mechanism and associated factors such as interleukin-17,tumor necrosis factor-alpha,receptor activator of nuclear factor-kappa B/receptor activator of nuclear factor-kappa B ligand/osteoprotegerin pathway,and related micro-RNAs to gain insight into aberrant bone formation in AS and potential approaches to its prevention.This editorial also addresses the contribution of osteoclasts to bone pathology in AS.The author examined the molecular pathways governing osteoclast differentiation and activity,with particular emphasis on relevant cytokines and immune cell interactions.A comprehensive understanding of these mechanisms is essential for the development of targeted therapies to mitigate excessive bone resorption and pathological skeletal remodeling in AS.
基金Scientific Research and Cultivation Plan project of Beijing Municipal Hospital(No.PZ2019018).
文摘Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.
基金the Twelfth Five-Year Support Project of the Ministry of Science and Technology for Clinical Studies Investigating Xin'an Medicine in the Treatment of Complicated Ascites Diseases(No.2012BAI26B02)Technology Planning Project of Anhui Science and Technology Department(No.11010402170)State Key Discipline Construction Project of TCM:Chinese Medical Arthralgia Syndrome Subject [No.(2009)30]
文摘OBJECTIVE: To study changes in the nuclear factor-κB p65(NF-κB p65)-inducible nitric oxide synthase(i NOS)-nitric oxide(NO) signaling pathway and the effects of Xinfeng capsules(XFC) in patients with ankylosing spondylitis(AS)METHODS: One hundred twenty patients with AS were randomly divided into an XFC group and a Salazopyrin group. Sixty health subjects were included as a normal control group. In the two treatment groups, pulmonary functional parameters,forced vital capacity(FVC), forced expiratory volume in 1 second(FEV1), maximal voluntary ventilation(MVV), peak expiratory flow(PEF), forced expiratory flow at 25% of forced vital capacity(FEF25),forced expiratory flow at 50% of forced vital capacity(FEF50), and forced expiratory flow at 75% of forced vital capacity(FEF75) were determined. Enzyme linked immunosorbent assays were used for detection of the serum oxidative stress indexes,NF-κB p65, i NOS, NO, reactive oxygen species(ROS), reactive nitrogen species(RNS), malondialdehyde(MDA), superoxide dismutase(SOD), catalase(CAT), total antioxidative capacity(TAOC) and interleukin-4(IL-4), IL-10, IL-1β, and tumor necrosis factor-α(TNF-α) contents. Westergren's method was used for determination of erythrocyte sedimentation rate(ESR). High-sensitivity C-reactive protein(Hs-CRP) was detected with a 7060 full-automatic biochemical analyzer(Hitachi, Japan).RESULTS: The clinical therapeutic effect in the XFC group was significantly superior to that in the Salazopyrin group(P<0.01). Compared with the normal control group, FEV1, MVV, PEF, FEF50, FEF75, SOD, CAT,TAOC, IL-4, IL-10 were significantly lower, and NF-κB p65, i NOS, NO, ROS, RNS, MDA, IL-1β, TNF-α, ESR,and Hs-CRP significantly higher in patients with AS(P<0.01 or P<0.05). Compared with before treatment, FEV1, MVV, PEF, FEF50, FEF75, SOD, CAT, TAOC,IL-4, and IL-10 were significantly increased, and NF-κB p65, i NOS, NO, ROS, RNS, MDA, IL-1β, TNF-α,ESR, CRP, visual analog scales(VAS), Bath ankylosing spondylitis disease active index, Bath ankylosing spondylitis functional index, and Bath ankylosing spondylitis global index significantly decreased in the two treatment groups after treatment(P<0.01 or P<0.05), with significant differences between the XFC and Salazopyrin groups(P<0.01 or P<0.05). Spearman correlation analysis indicated that FEV1, MVV, PEF, FEF50, and FEF75 were positively correlated with SOD, CAT, TAOC, IL-4, and IL-10, and were negatively correlated with NF-κB p65, i NOS,NO, ROS, RNS, MDA, IL-1β, TNF-α, ESR, and CRP.CONCLUSION: Patients with AS have local pathologic changes in the spinal cord and other joints.They also have decreased pulmonary function,which is negatively correlated with the NF-κB-i NOS-NO signaling pathway, oxidative indexes, and inflammatory factors. XFC improves rigidity and pain in spinal joints and other symptoms, laboratory indexes, and pulmonary function. The mechanism is possibly related to inhibition of the NF-κB-i NOS-NO signaling pathway.
基金funded by the National Natural Science Foundation of China (No. 81460259)
文摘Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.
文摘Ankylosing spondylitis(AS)is chronic inflammatory arthritis with a progressive fusion of axial joints.Anti-inflammatory treatments such as anti-TNF-αantibody therapy suppress inflammation but do not effectively halt the progression of spine fusion in AS patients.Here we report that the autoimmune inflammation of AS generates a microenvironment that promotes chondrogenesis in spine ligaments as the process of spine fusion.Chondrocyte differentiation was observed in the ligaments of patients with earlystage AS,and cartilage formation was followed by calcification.Moreover,a large number of giant osteoclasts were found in the inflammatory environment of ligaments and on bony surfaces of calcified cartilage.Resorption activity by these giant osteoclasts generated marrow with high levels of active TGF-β,which induced new bone formation in the ligaments.Notably,no Osterix+osteoprogenitors were found in osteoclast resorption areas,indicating uncoupled bone resorption and formation.Even at the late and maturation stages,the uncoupled osteoclast resorption in bony interspinous ligament activates TGF-βto induce the progression of ossification in AS patients.Osteoclast resorption of calcified cartilage-initiated ossification in the progression of AS is a similar pathologic process of acquired heterotopic ossification(HO).Our finding of cartilage formation in the ligaments of AS patients revealed that the pathogenesis of spinal fusion is a process of HO and explained why anti-inflammatory treatments do not slow ankylosing once there is new bone formation in spinal soft tissues.Thus,inhibition of HO formation,such as osteoclast activity,cartilage formation,or TGF-βactivity could be a potential therapy for AS.
文摘Ankylosing spondylitis(AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.
文摘Objective: To evaluate five drug treatment regimens in the treatment of Brucella spondylitis. Methods: Patients with clinical symptoms compatible and diagnostic test consistent with Brucella spondylitis were randomly assigned to five drug treatment regimens. Results: Combination therapy with doxycycline, rifampin and sulfamethoxazole for 56 consecutive days showed the highest cure rate of 20% after a single course and of 85% after a double course with affectivity rates of 55% and 95%. Cure rate and affectivity rate was significant better (P 0.05) than for patients receiving doxycycline, rifampin and streptomycin for the same period and regimens containing doxycycline were significant better than regimens without this drug. Conclusion: Combination therapy of doxycycline, rifampin and sulfamethoxazole for 8 weeks using one or two full courses should be recommended for Brucella spondylitis.
文摘There is no radical cure for ankylosing spondylitis,a chronic inflammation in joint,till now.Tumor necrosis factor-alpha（TNF-α） inhibitors can block the cascade in inflammatory chain and improve clinical symptom.Among these biological agents,three of them are marketed in China：etanercept,infliximab and adalimumab.Some of the research progresses between 2014 and 2016 are summarized including treatment application,side effects of drugs,and comprehensive research of TNF-α inhibitors.
文摘Objective: To improve the clinical differential diagnosis level, the clinical manifestation of the brucellar spondylitis and the spine turberculosis were discussed in this paper. Method: The study was completed in the No. 1 Affiliated Hospital of Hebei North University in Zhangjiakou City, Hebei Province, China, from January 2001 to December 2013 by Analyzing the X-ray, CT scanning and MRI of 257 cases of the brucellar spondylitis retrospectively and comparing with the clinical imageology and pathology 332 cases of turberculosis of the spine diagnosed finally. Results: The brucellar spondylitis: The focuses usually locate in the lumbar vertebra and L4, 5 has the highest occurrence rate. The focuses are often small but multiple, and limited to the edge of the vertebra. Hyperostosis and osteoscterosis are usually found in the tissuses around the focuses. There are often new focuses in the newborn bones, and the destruction of intervertebral discs is usually slight. Hyperostosis and osteoscterosis might be found in the surfaces of the joints. The densites of the bones close to the focuses become high. There were less or no paravertebral abscesses but inflammational granuloma can be found frequently. Turberculosis of the spine: The focuses are usually located in the thoracic and lumbar vertebra, and are characterized by the destruction of the vertebra and the intervertebral discs, accompanied by the appearance of dead bones. In most cases, paravertebral abscesses and osteoporosis might be found. Conclusions: The specific manifestation of the clinical imageology can help to differentiate the brucelar spondylitis from the turberculosis of the spine.
基金supported by the National Natural Science Foundation of China(No.81671608,81202350,81571586 and 81302559)Pfizer Competitive Grant(WS1620920)+5 种基金Jiangsu Six Talent Peaks Project(2015-WSN-074)Jiangsu 333 High Level Talents ProjectJiangsu Government Scholarship for Overseas StudiesJiangsu Health International Exchange Program sponsorshipNanjing Young Medical Talents ProjectNanjing Health Bureau Key Project(ZKX15018)
文摘The aim of this study was to assess sensitivity and responsiveness of power Doppler ultrasound （PDUS） in detecting enthesitis for ankylosing spondylitis （AS） patients compared to clinical examinations. Twenty AS patients initiating etanerceptunderwent clinical and PDUS examinations of six bilateral entheseal sites at baseline and after 1, 2 and 3 months of treatment. Clinical and PDUS examinations identified at least one entheseal lesion in nine （45%） and 19 （95%） patients, respectively. Furthermore, of 240 entheseal sites examined in these 20 patients, PDUS detected 123 entheseal lesions （51.3% of sites）, compared with only 47 entheseal lesions （19.6%） detected by clinical examination （P〈0.05）. The entheseal lesions found on PDUS were most commonly identified by calcification （33.3%）, tendon edema （29.2%）, abnormal blood flow （25.8%）, a thickened tendon （22.1%）, cortical irregularity （12.9%）, bony erosions （9.6%） and bursitis at the tendon insertion to the bone cortex （7.1%）. Improvements in clinical symptoms and laboratory parameters, and significant decreases in PDUS scores were observed following treatment with etanereept. Improvements in PDUS scores continued during follow-up in patients who entered remission following treatment. In conclusion, PDUS improves detection of structural and inflammatory abnormalities of the enthesis in AS compared to physical examination. In addition, PDUS may be useful inascertaining medications.
基金Supported by National Natural Science Foundation of China (No. 30400487)International Cooperation Project of Guangdong Province, China (No. 2004B50301002)"1135" Talent Doctor Foundation of Daping Hospital, China(2008-2012)
文摘AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated welt's. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35 +/- 12 (range 18-50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior wets was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.
基金funded by science foundation of Beijing Ditan Hospital Capital Medical University(No.DTQL201803)
文摘Rational:Brucellosis is a globally prevalent zoonotic disease.Any part of the body can be affected by active brucellosis but osteoarticular involvement are the most common symptoms which was reported to vary from 10%to 85%.The spine is the most common site of brucellosis in the bones.However,noncontiguous brucellar spondylitis is rare,only few cases have been reported in the literature.Patient concerns:A 62-year-old woman with brucellar spondylitis presented with lower back pain and pain in the right lower extremity for six months.Diagnosis:Brucella agglutination test(1:320)and the result of polymerase chain reaction(PCR)confirmed the diagnosis of noncontiguous brucellar spondylitis.Intervention:During hospital stay,the women received intravenous treatment for brucellosis(A combination of doxycycline 200 mg/d,rifampicin 900 mg/d,levofloxacin 0.5 g/QD,and ceftriaxone 2 g/QD was administered for 1 week),The L4-S1 vertebral body was fixed by posterior lumbar debridement.Outcome:Six months after discharge,the follow-up radiographic images showed stable vertebral height and good lumbar stability.She complained no discomfort.Lessons:Multi-level involvement is an exceptional form of brucellar spondylitis.To the best of our knowledge,only few similar cases have been reported.PCR and bacterial culture is necessary for confirmed diagnosis.
文摘AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT). METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53 males to 25 females who were followed up for 3.88 (1-22) years on average. neumonia and tuberculosis were excluded. In a detailed examination of lung HRCT findings, we investigated the presence of parenchymal micronodules,parenchymal bands, subpleural bands, interlobular and intralobular septal thickening, irregularity of interfaces,ground glass opacity, consolidation, mosaic pattern,bronchial wall thickening, bronchial dilatation, tracheal dilatation, pleural thickening, emphysema, thoracic cage asymmetry, honeycomb appearance, structural distortion, apical fibrosis and other additional findings.RESULTS: In detailed HRCT evaluations, lung parenchymal changes were found in 46 (59%) of all patients. We found parenchymal bands in 21 (27%) cases, interlobular septal thickening in 9 (12%), emphysema in 9 (12%), apical fibrosis in 8 (10%), ground-glass opacities in 7 (9%), parenchymal micronodules in 5 (6%), irregularity in interfaces in 3 (4%), bronchial dilatation in 3 (4%), mosaic pattern in 2 (3%), pleural thickening in 2 (3%), consolidation in 1 (1%), bronchial wall thick ening in 1 (1%) and a subpleural band in 1 (1%) case. Furthermore, we detected subsegmental atelectasis in 2 patients and a cavitary lesion in 1 patient. CONCLUSION: Our study had the highest number of AS cases of all previous studies in evaluating lung paren chymal changes. The rate of lung parenchymal changes was slightly lower than that reported in recent literature.
文摘AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.
文摘BACKGROUND Ankylosing spondylitis(AS)frequently occurs in people aged 30-45 years,and its prevalence is generally believed to be between 0.1%and 1.4%globally.At present,the“gold standard”for diagnosis of AS requires the provision of pelvic X-rays,which makes it more difficult to perform in population-based epidemiological studies.Therefore,the identification of serological indicators related to the diagnosis,treatment,and prognosis of AS patients is of great significance.AIM To analyze the therapeutic,diagnostic significance and prognostic value of dickkopf-related protein-1(DKK-1)and tumor necrosis factor-α(TNF-α)in AS.METHODS A total of 113 patients with active AS were selected as the research group,and 100 healthy subjects who underwent physical examination were selected as the control group.The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared.The diagnostic and predictive values of DKK-1 and TNF-α for AS were analyzed with ROC curves,and the factors influencing AS recurrence were analyzed with COX regression.RESULTS Before treatment,the research group showed lower DKK-1 levels but higher TNF-αlevels than the control group(both aP<0.05).In the research group,DKK-1 was up-regulated and TNF-αwas down-regulated after 12 wk of treatment(aP<0.05).The area under the curve,sensitivity and specificity of DKK-1 combined with TNF-αfor diagnosing AS were 0.934,82.30%and 97.00%,respectively.Before treatment,the area under the curve,cutoff value,sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825,68.42 pg/mL,73.68%and 80.00%,respectively,and those of TNF-αwere 0.863,32.79 ng/L,92.11%and 77.33%,respectively.DKK-1 and TNF-αlevels after treatment were closely related to the curative effect(aP<0.05).C-reactive protein,the Bath Ankylosing Spondylitis Disease Activity Index,DKK-1,and TNF-αwere risk factors for AS recurrence(aP<0.05).CONCLUSION DKK-1 and TNF-αare effective in the diagnosis and treatment of AS and are risk factors for its recurrence.In addition,DKK-1 may be a potential target for the diagnosis of AS.
文摘Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Method 29 patients with active AS were selected to take GTT (1mg per kg) three times a day for one year. After that, its curative effect was evaluated. The serum level of sIL-2R of these patients was measured by sandwich ELISA method and was compared with that of normal subjects. Result The serum level of sIL-2R in active AS patients was obviously higher than that of the non-active AS patients. (P<0.01). The total effective rate of GTT on AS was 89.6%, while clinical relief rate 27.6%, obvious effective rate 44.8%, effective rate 17.2% and non-effective rate 10.4%. The patients’ serum level of sIL-2R after therapy was significantly lower than that before therapy except patients with no effect. (P<0.05). Conclusion GTT has positive curative effect on active AS patients and could cause obvious decrease of the serum level of sIL-2R. The serum level of sIL-2R can be used as an important index of activity of AS and as a guide of therapy.
