Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax ...Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax SPA and it has a well-known safety profile over a longer duration. Recently, many IL-17i and JAKi were approved for the treatment of nr-ax SPA;however, data comparing IL1-7i and JAKi in terms of efficacy and safety is lacking. This systematized review aimed to compare the existing efficacy and safety data of JAKi vs IL-17i in the treatment of patients with nr-ax SPA. Methods: A systematic literature search was performed using relevant keywords in many databases. According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, 2020), relevant articles were included and evaluated in this review. Efficacy and safety data were collected, analyzed and compared through week 52. The first check was done by the end of week 14 and week 16 for upadacitinib and IL-17i respectively. Results: Data from four RCTs evaluating upadacitinib, secukinumab, ixekizumab, and bimekizumab comprising 1425 patients were analyzed. Overall, a comparable efficacy and safety profile were observed across different treatment arms through week 52;however, non-significant variations were encountered in some outcome measures. The primary endpoint among these RCTs (ASAS40 response rate) was met and it was higher in patients treated with bimekizumab 160 mg sc Q 4 weeks in TNFi non responders (48%) and lowest in ixekizumab 80 mg sc Q 4 weeks treated patients, (35%) (p Conclusion: The above-mentioned three IL-17i and the only one JAKi demonstrated comparable safety and efficacy profiles with some minor variations. A head-to-head trial comparing the effectiveness and safety characteristics of JAKi vs IL-17i may be needed in patients with active nr-ax SpA.展开更多
Introduction: Spondyloarthritis (SpA) comprises a group of chronic inflammatory rheumatic diseases characterized by predominant axial involvement. These include ankylosing spondylitis (AS), reactive arthritis (ReA), p...Introduction: Spondyloarthritis (SpA) comprises a group of chronic inflammatory rheumatic diseases characterized by predominant axial involvement. These include ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel diseases (IBD), SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), juvenile spondyloarthritis (JSPA), and undifferentiated SpA. Their exact cause is unknown but is believed to stem from a combination of factors. The first familial forms were described by de Blécourt et al. in 1961. The objective was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of familial forms of SpA and in particular, to prove the severity of the disease in family members compared to index cases in the rheumatology department of the Aristide Le Dantec University Hospital in Dakar. Methodology: This was a prospective, cross-sectional and descriptive study with an analytical aim on patients with the familial form of spondyloarthritis defined by the existence of at least one other family member with SpA outside the propositus, collected within the Aristide Le Dantec rheumatology department in Dakar over a period of 10 years between January 2012 and December 2021. There were two phases of study, the first of which consisted of collecting index cases with miserly SpA and the second of which consisted of family screening after consent. The data analysed were epidemiological, clinical, paraclinical, therapeutic and evolving. Results: Out of 100 families of 1905 members, 667 SpA patients included, i.e. a prevalence of 35%, including 225 (33.73%) men and 412 women (61.17%), i.e. a ratio of 1.8. The mean age at diagnosis among relatives was 26.3 years (range 13 and 80 years), 47.14 years among the propositus, in whom the mean age at onset was 36.26 years and that of relatives 49.9 years in the first degree, 15 years in the second degree and 1 year in the third degree. The time to diagnosis was 11.20 years in the first degree, 2.5 years in the second degree, 1 year in the third degree and 10.88 years in the case of the proposes. The number of marriages in families was 420 of which 116 were consanguineous (consanguinity rate 27.62%), 19% among the propositus. HLA-B27 positive in 92% of the proposers and 33.43% in the families;70% of the propositus had an inflammatory syndrome and 17.54% in the families;87% of sacroilliitis in the propositus and 5.54% in the families. Clinical forms were dominated by undifferentiated SpA (338 cases) and APS (295 cases). The average BASFI was 3.23 on D0;2.59 in the 3rd month and 1 in the 6th month for the propositus versus 2.55 at D0;1.86 at the 3rd month and 1.55 in the 6th month in the families. Average BASDAI was 3.92 at D0;3.12 at the 3rd month and 2.07 at the 6th month in the propositus and 3 at D0;2.21 at the 3rd month and 1 at the 6th month in the families. Autoimmune associated conditions were 18 cases, degenerative 24 cases, autoinflammatory 2 metabolic cases 18 cases. They all received: NSAIDs, methotrexate, salazopyrine (11 cases) and anti-TNF-α (1 case). The evolution was generally favourable. Conclusion: SpA is on the rise in Senegalese hospitals, frequent in young people, SPA and undifferentiated SpA are the most frequent, management is essentially based on conventional care, and the disease is less severe in family members than index cases.展开更多
AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis(SpA) particularly those studies using dual X-ray absorptiometry(DXA) methods. METHODS: This literature review examin...AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis(SpA) particularly those studies using dual X-ray absorptiometry(DXA) methods. METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis(AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineraldensity, osteoporosis(OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with Sp A were eligible. Each article was reviewed and the key elements were noted.RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axS pA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with Sp A varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.CONCLUSION: Bone loss may be determined in patients with ax Sp A at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation(bone marrow edema) at the vertebral colon.展开更多
Objectives:To explore the relationship between Vitamin D levels and pain and disease activity in patients with newly diagnosed axial spondyloarthritis(axSpA).Methods:A convenience sample of 131 newly diagnosed axSpA p...Objectives:To explore the relationship between Vitamin D levels and pain and disease activity in patients with newly diagnosed axial spondyloarthritis(axSpA).Methods:A convenience sample of 131 newly diagnosed axSpA patients and 60 healthy controls was recruited from July 2016 to December 2018.Serum 25-hydroxyvitamin D[25(OH)D]was measured to assess vitamin D levels.Disease activity was assessed by objective indicators[Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),the Bath Ankylosing Spondylitis Metrology Index(BASMI)],patientreported questionnaires[the Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),and the Bath Ankylosing Spondylitis Functional Index(BASFI)].Pain intensity and interference were also assessed.Results:Vitamin D insufficiency[serum 25(OH)D levels<50 nmol/L]was found in 46(35.1%)and 25(43.3%)of the axSpA patients and the healthy controls,respectively.Female patients had higher risk(0R:4.928;95%CI:1.921-12.642)for vitamin D insufficiency than male patients.Vitamin D was positively correlated with CRP,ESR level,the BASFI,and the BASMI.Logistic regression showed that vitamin D levels were not associated with pain,or disease activity in the newly diagnosed axSpA patients.Gender was the only predictive variable for vitamin D levels.Conclusions:Vitamin D insufficiency was prevalent in both newly diagnosed axSpA patients and healthy controls.There was no association between vitamin D and pain and disease activity in the newly diagnosed axSpA patients.Monitoring vitamin D levels is important and early intervention for vitamin D insufficiency is needed,especially in female patients.展开更多
AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was ev...AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes(PROs) of the HRQo L questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor(TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests:(1) Ankylosing Spondylitis Disease Activity ScoreC-Reactive Protein(ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index(BASDAI), Bath Ankylosing Spondylitis Functional Index(BASFI) and Bath Ankylosing Spondylitis Metrology Index(BASMI) for articular activity;(2) Inflammatory Bowel Disease Questionnaire(IBDQ), Crohn's Disease Activity Index(CDAI) and partial Mayo(p Mayo) score for gastrointestinal symptoms and activity; and(3) Health Assessment Questionnaire(HAQ), Patient Global Assessment(PGA) and Short Form-36 health survey(SF-36) questionnaires for PROs of the HRQo L.RESULTS Integrated evaluation and management of the patients affected by ES, carried out simultaneously by a gastroenterologist and a rheumatologist, allowed clinicians to choose the optimal therapeutic strategy. In a cohort of 30 ES patients affected by active articular and gastrointestinal disease, or axial active articular inflammation, Ada led to fast and sustained improvement of both articular and gastrointestinal disease activities. In fact, all the clinimetric evaluation tests exploring articular or gastrointestinal activity, as well as all the HRQo L scores, showed a significant improvement having been achieved at the earliest(6-mo) assessment. This important clinical improvement was maintained at the 12-mo follow-up. Importantly, global and gastrointestinal quality of life significantly correlated with articular disease activity, providing evidence to support that the integrated evaluation is the best option to manage patients with ES.CONCLUSION Ada treatment, upon multidisciplinary(gastrorheumatologic) evaluation, significantly improves both articular and gastrointestinal inflammation, thereby improving the HRQo L in patients affected by ES.展开更多
Although the development of the 2009 Sp A classification criteria by Assessment of Spondylo Arthritis international Society（ASAS） represents an important step towards a better definition of the early disease stage p...Although the development of the 2009 Sp A classification criteria by Assessment of Spondylo Arthritis international Society（ASAS） represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis（ax Sp A）, the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including Sp A. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having ax Sp A in central China. The results showed that clinical manifestations of ax Sp A could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from ax Sp A according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.展开更多
MULTIPLE myeloma （MM） is a hematologicmalignancy of differentiated plasma cells thataccumulate and proliferate in the bonemarrow. MM patients often develop bonedisease that results in severe bone pain, osteolytic le...MULTIPLE myeloma （MM） is a hematologicmalignancy of differentiated plasma cells thataccumulate and proliferate in the bonemarrow. MM patients often develop bonedisease that results in severe bone pain, osteolytic lesions,and pathologic fractures,1 presenting with unexplainedbackache or bone pain in the long bones, ribs, skull, orpelvis.2 However, the low backache mimicking spondyloarthritisin MM is uncommon during clinical practice. Spondyloarthritis isa chronic systemic inflammatory disorder of the axialskeleton, mainly affecting the sacroiliac joint and spinecausing low backache.3 Here we report a patient with MMwhich was initially misdiagnosed and treated asspondyloarthritis.展开更多
BACKGROUND Cervical disc arthroplasty(CDA)is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility.However,the CDA postoperative period is impacted by osteolysis...BACKGROUND Cervical disc arthroplasty(CDA)is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility.However,the CDA postoperative period is impacted by osteolysis,subsidence,metallosis,or heterotopic ossification(HO).We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.CASE SUMMARY A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc(HIVD).After four years,cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels.The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression.Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist.A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.CONCLUSION Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.展开更多
Within the concept of axial spondyloarthritis(ax Sp A), relevant differences between men and women have been described for patients with the radiographic disease form [ankylosing spondylitis(AS)]. The subjective perce...Within the concept of axial spondyloarthritis(ax Sp A), relevant differences between men and women have been described for patients with the radiographic disease form [ankylosing spondylitis(AS)]. The subjective perception of disease activity(spinal and peripheral pain, fatigue, morning stiffness) has been shown to be higher in female than in male patients. Moreover, women experience more functional limitations and a lower quality of life, despite lower degrees of radiographic spinal damage. Peripheral clinical involvement(arthritis and enthesitis) is, additionally, more predominant in women. On the other hand, a higher level of objective signs of inflammation(C-reactive protein, erythrocyte sedimentation rate, magnetic resonance imaging of sacroiliac joints and spine) has been reported in men. Whether these differences might explain the better response to treatment with anti-tumor necrosis factor agents observed in male patients remains unclear. The underlying causes of the discrepancies are still unknown and genetic, environmental, cultural and/or societal factors may be involved. While AS is still more prevalent in men in a ratio of 2-3:1, the prevalence of males and females in patients with ax Sp A without radiographic sacroiliac damage is similar. Gender differences in this subgroup of patients have not been adequately addressed, and are particularly needed to further validate the Assessment of Spondylo Arthritis international Society classification criteria.展开更多
Inflammatory rheumatological diseases like rheumatoid arthritis (RA) and ankylosing spondylitis/Spondyloarthritis (AS/SpA), have been treated with NSAIDs (non steroidal anti-inflammatory drugs), corticosteroids, and D...Inflammatory rheumatological diseases like rheumatoid arthritis (RA) and ankylosing spondylitis/Spondyloarthritis (AS/SpA), have been treated with NSAIDs (non steroidal anti-inflammatory drugs), corticosteroids, and DMARDs (disease modifying anti-rheumatic drugs).These have been only partially effective for the management of symptoms, since they are rarely associated with the complete control of disease and rarely slow down radiological damage. Several cytokines have been implicated in the pathogenesis of the inflammation and tumor necrosis factor (TNF) is the most important. The last decade and a half has seen advances in the form of “anti-TNF” therapies for RA and AS/SpA patients which target and neutralize the TNF cytokines, and thus reduce the disease activity. Two anti-TNF therapies have been used in India for treating DMARD resistant RA and AS/SpA for the last 13 years;Infliximab and Etanercept respectively. This paper is a description of the clinical outcomes and unmet needs/toxicities associated with the treatment of RA and AS/SpA with anti-TNF therapies (Infliximab, Etanercept), at a single rheumatology center (tertiary care, super-specialty hospital, Indraprastha Apollo Hospitals, New Delhi) in north India.展开更多
<span style="font-family:Verdana;"><strong>Objective:</strong> Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of...<span style="font-family:Verdana;"><strong>Objective:</strong> Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of the spondyloarthritis family. In black Africa, the prevalence of SpA associated with IBD is not clearly established. Thus the objective of our study was to describe the clinical and radiological characteristics of spondyloarthritis associated with IBD. <strong>Patients and Method:</strong> We carried out a prospective study in the rheumatology department of CHU Ignace Deen between January and December 2019. The diagnosis of SpA was based on clinical and biological arguments in accordance with the criteria of Amor and ASAS. <strong>Results:</strong> Fifteen observations of spondyloarthritis associated with IBD were collected in patients mean age 52 years with extremes of 32 and 65 years. 9 (53.33%) were female. Ten patients had Crohn’s disease (CD) and 5 had ulcerative colitis (UC). The mean number of pushes was 2.5 ± 1.2. The average diagnostic time was 46 months. Sacroiliitis was present in 73.3% of cases and the mean mSASSS score at diagnosis was 32.11/72. In total, corticosteroids were used in 9 (60%) of patients, NSAIDs in 26.6% while DMARDs salazopyrine and methotrexate in 33.3% and 20% of patients, respectively. <strong>Conclusion:</strong> The MICI and SpA association is undoubtedly underestimated in our regions. Better collaboration between rheumatologists and gastroenterologists could facilitate diagnosis and improve care.</span>展开更多
Objectives: This study aimed to evaluate the fatigue in patients with undifferentiated spondyloarthritis [USpA], and its relationship with disease-specific variables, spinal mobility measures and healthy related quali...Objectives: This study aimed to evaluate the fatigue in patients with undifferentiated spondyloarthritis [USpA], and its relationship with disease-specific variables, spinal mobility measures and healthy related quality of life [HRQOL]. Methods: Eighty patients with USpA and forty healthy subjects were included in this study. The multidimensional assessment of fatigue [MAF] and the generic instrument Short Form 36 [SF 36] were used in patient and control groups to assess fatigue and [HRQOL]. Fatigue was also assessed with the Bath ankylosing spondylitis disease activity index [BASDAI] fatigue item. The evaluation included the activity of the disease [BASDAI], functional status [Bath ankylosing spondylitis functional index], and visual analog scale [VAS] of axial and joint pain. Demographics and disease-related data were obtained. Results: Patients with USpA had higher scores in MAF total and in all MAF subgroup scales than controls. All SF-36 subgroups scores were also found to be significantly lower in patients. Severe fatigue experienced 60% in patients. MAF total scores were found to be significantly correlated with morning stiffness, BASDAI, Bath ankylosing spondylitis functional index (BASFI), BASDAI fatigue, VAS-axial, and SF-36 subgroups scores in patients [p < 0.05]. Conclusions: The patients with USpA defined significantly more fatigue and lower HRQOL when compared with healthy persons. MAF was found to be related with the clinical and functional status and health-related quality of life of patients with USpA.展开更多
Late onset peripheral spondyloarthritis is a particular clinical form of spondyloarthritis, occurring at the age of 50 years or older. Hashimoto’s thyroiditis (HT) is the most frequent autoimmune thyroid disorder res...Late onset peripheral spondyloarthritis is a particular clinical form of spondyloarthritis, occurring at the age of 50 years or older. Hashimoto’s thyroiditis (HT) is the most frequent autoimmune thyroid disorder responsible for considerable morbidity. HT is well known to be associated with many systemic autoimmune, it is less clear whether a similar association may also be present for spondyloarthritis. Here, we report a case of late onset peripheral spondyloarthritis in a 62-year-old African woman with a 12-year history of Hashimoto’s thyroiditis, a previously undescribed association in the literature. The diagnosis of Late onset peripheral spondyloarthritis was made according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for peripheral spondyloarthritis (presence of arthritis, enthesitis and Human Leukocyte Antigen B27). She was treated with methotrexate and celebid. After 6 months of treatment, the evolution was favourable with an overall improvement in her symptomatology and quality of life. The coexistence of late onset peripheral spondyloarthritis and Hashimoto’s thyroiditis may be related to the presence of a genetic background predisposing to both diseases.展开更多
The hallmarks of spondyloarthritis(SpA)are type 3 immunity-driven inflammation and new bone formation(NBF).Macrophage migration inhibitory factor(MIF)was found to be a key driver of the pathogenesis of SpA by amplifyi...The hallmarks of spondyloarthritis(SpA)are type 3 immunity-driven inflammation and new bone formation(NBF).Macrophage migration inhibitory factor(MIF)was found to be a key driver of the pathogenesis of SpA by amplifying type 3 immunity,yet MIF-interacting molecules and networks remain elusive.Herein,we identified hypoxia-inducible factor-1 alpha(HIF1A)as an interacting partner molecule of MIF that drives SpA pathologies,including inflammation and NBF.HIF1A expression was increased in the joint tissues and synovial fluid of SpA patients and curdlan-injected SKG(curdlan-SKG)mice compared to the respective controls.Under hypoxic conditions in which HIF1A was stabilized,human and mouse neutrophils exhibited substantially increased expression of MIF and IL-23,an upstream type 3 immunity-related cytokine.Similar to MIF,systemic overexpression of IL-23 induced SpA pathology in SKG mice,while the injection of a HIF1A-selective inhibitor(PX-478)into curdlan-SKG mice prevented or attenuated SpA pathology,as indicated by a marked reduction in the expression of MIF and IL-23.Furthermore,genetic deletion of MIF or HIF1A inhibition with PX-478 in IL-23-overexpressing SKG mice did not induce evident arthritis or NBF,despite the presence of psoriasis-like dermatitis and blepharitis.We also found that MIF-and IL-23-expressing neutrophils infiltrated areas of the NBF in curdlan-SKG mice.These neutrophils potentially increased chondrogenesis and cell proliferation via the upregulation of STAT3 in periosteal cells and ligamental cells during endochondral ossification.Together,these results provide supporting evidence for an MIF/HIF1A regulatory network,and inhibition of HIF1A may be a novel therapeutic approach for SpA by suppressing type 3 immunity-mediated inflammation and NBF.展开更多
BACKGROUND Prevalence of the main rheumatic diseases in the Republic of Sakha(Yakutia)[RS(Y)],one of the regions of the Russian Federation,differs from the other regions of the Russian Federation due to its ethnic and...BACKGROUND Prevalence of the main rheumatic diseases in the Republic of Sakha(Yakutia)[RS(Y)],one of the regions of the Russian Federation,differs from the other regions of the Russian Federation due to its ethnic and geographic features.Knowledge regarding the prevalence and structure of juvenile idiopathic arthritis(JIA)allows us to shape the work of the pediatric rheumatology service in the region correctly,and optimize the healthcare system and the need for medica-tions.AIM To describe the epidemiological,demographic,clinical,and laboratory characteristics of children with JIA in the RS(Y)and evaluate the main outcomes.METHODS This retrospective cohort study assessed all the data from the medical histories of the patients(n=225)diagnosed with JIA(2016-2023)in the Cardiorheumatology Department of the M.E.Nikolaev National Center of Medicine.Pearson'sχ²test,Fisher's exact test,Mann–Whitney and Kruskal-Wallis tests were used for statistical analyses.RESULTS The ethnic prevalence of JIA is higher in Sakha than in Russian children at 110.1 per 100000 children and 69.4 per 100000 children,respectively.The prevalence of JIA among boys and girls in Sakha was similar,unlike in Russians,where the number of girls predominated.The JIA categories were as follows:(1)Systemic arthritis:3.5%;(2)Oligoarthritis(persistent and extended):33.8%;(3)Rheumatoid factor(RF)(+)polyarthritis:0.9%;(4)RF(-)polyarthritis:14.7%;(5)Enthesitis-related arthritis(ERA):44%;and(6)Psoriatic arthritis:3.1%.Prevalence of the ERA category was 4.4 times higher in Sakha children,but the prevalence of systemic arthritis was 2.9 times lower compared to Russians(P=0.0005).The frequency of uveitis was 10.2%,and the frequency of human leukocyte antigen(HLA)B27 was 39.6%in JIA children.Biologic treatment was received by 40.4%of JIA children and 45.3%achieved remission.CONCLUSION Higher JIA prevalence,male and ERA predominance,related to a higher frequency of HLA B27 are typical in RS(Y).These data might improve the pediatric rheumatology health service.展开更多
Background: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by ...Background: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto odds ratio (OR) for infections in biologics-treated patientsvs. placebo patients. The risk of bias on the included RCTs was assessed by using the Cochrane Risk of Bias Tool.Results: In total, 62 studies were included in this meta-analysis. Overall, the risk of infection (Peto OR: 1.16, 95% confidence interval [CI]: 1.07-1.26,P < 0.001), serious infection (Peto OR: 1.65, 95% CI: 1.26-2.17,P < 0.001), upper respiratory tract infection (URTI) (Peto OR: 1.17, 95% CI: 1.04-1.32,P = 0.008), nasopharyngitis (Peto OR: 1.25, 95% CI: 1.10-1.42,P < 0.001), andCandida infection (Peto OR: 2.64, 95% CI: 1.48-4.71,P = 0.001) were increased in SpA patients treated with biologics compared with placebo. Sensitivity analysis based on biologics classes was conducted, and results demonstrated that compared with placebo, there was a higher risk of infection for tumor necrosis factor (TNF)-α inhibitors (Peto OR: 1.38, 95% CI: 1.13-1.68,P = 0.001) and interleukin (IL)-17 inhibitors (Peto OR: 1.55, 95% CI: 1.08-2.22,P = 0.018) in axial SpA, and for Janus kinase inhibitors in peripheral SpA (Peto OR: 1.39, 95% CI: 1.14-1.69,P = 0.001);higher risk of serious infection for IL-17 inhibitors in peripheral SpA (Peto OR: 3.46, 95% CI: 1.26-9.55,P = 0.016) and axial SpA (Peto OR: 2.01, 95% CI: 1.38-2.91,P < 0.001);higher risk of URTI for TNF-α inhibitors in axial SpA (Peto OR: 1.37, 95% CI: 1.05-1.78,P= 0.019), and for apremilast in peripheral SpA (Peto OR: 1.60, 95% CI: 1.08-2.36,P = 0.018);higher risk of nasopharyngitis for TNF-α inhibitors in axial SpA (Peto OR: 1.41, 95% CI: 1.05-1.90,P = 0.022) and peripheral SpA (Peto OR: 1.49, 95% CI: 1.09-2.05,P = 0.013), and for IL-17 inhibitors in axial SpA (Peto OR: 1.35, 95% CI: 1.01-1.82,P = 0.044);higher risk of herpes zoster for Janus kinase inhibitors in peripheral SpA (Peto OR: 2.18, 95% CI: 1.03-4.62,P = 0.043);higher risk ofCandida infection for IL-17 inhibitors in peripheral SpA (Peto OR: 2.52, 95% CI: 1.31-4.84,P= 0.006).Conclusions: This meta-analysis shows that biological therapy in patients with SpA may increase the risk of infections, including serious infections, URTI, nasopharyngitis, andCandida infection, which should be paid attention to in our clinical practice.展开更多
Background:Despite therapeutic advances,treatment of patients with axial spondyloarthritis(axSpA)continue to pose as a challenge as many do not respond well to conventional Western medications,such as nonsteroidal ant...Background:Despite therapeutic advances,treatment of patients with axial spondyloarthritis(axSpA)continue to pose as a challenge as many do not respond well to conventional Western medications,such as nonsteroidal anti-inflammatory drugs(NSAIDs)and biologic diseasemodifying antirheumatic drugs(bDMARDs).Hence,acupuncture is a possible alternative.Some studies found electroacupuncture to be better than manual acupuncture,though no trials have been conducted in patients with axSpA.This clinical trial aims to evaluate the clinical efficacy,safety,and cost-effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA.Methods/Design:This randomized controlled trial will recruit 100 patients diagnosed with axSpA,who have active disease despite NSAIDs and bDMARDs.Eligible patients will be randomized to receive either electroacupuncture or manual acupuncture in a 1:1 ratio.All participants will receive standard rheumatologic care in addition to 20 acupuncture sessions.The mean difference in Bath Ankylosing Spondylitis Disease Activity Index score between the 2 groups over 12 weeks will serve as the primary outcome.Secondary outcomes include improvements in other clinical,quality of life,and economic outcomes over 24 weeks.All adverse events will be recorded.Discussion:Results from this trial may provide evidence regarding the clinical effectiveness,safety,and cost-effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA,and guide implementation into clinical practice.Limitations of this trial include the lack of patient blinding,use of a repeated measures design,and possible variation in acupuncture technique amongst the various Traditional Chinese Medicine practitioners.展开更多
Our understanding of psoriatic arthritis has evolved as new knowledge of the disease has emerged. However, the exact prevalence of psoriatic arthritis is unknown, and its pathogenesis has not been fully elucidated. Ge...Our understanding of psoriatic arthritis has evolved as new knowledge of the disease has emerged. However, the exact prevalence of psoriatic arthritis is unknown, and its pathogenesis has not been fully elucidated. Genetic, environmental, and immunologic factors have all been implicated in disease development. Early diagnosis and treatment have become primary objectives in clinical rheumatology. Psoriatic arthritis not only causes functional impairment, but also increases mortality risk of patients. The advent of new therapeutic agents capable of arresting the progression of joint damage is expected. However, early psoriatic arthritis assessment remains limited. The objectives of this article are to outline the epidemiology, diagnosis, and treatment of psoriatic arthritis and to suggest a paradigm for identifying early psoriatic arthritis patients.展开更多
Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseas...Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseases. Bone is a target in many inflammatory rheumatic diseases. In recent years, the survival of patients with rheumatic diseases has increased markedly and the relationship between rheumatic diseases and osteoporosis(OP) has become more prominent. OP and related fragility fractures increase the morbidity and mortality of rheumatic disease. The cause of OP in rheumatic diseases is complex. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Osteoimmunology, a crosstalk between inflammatory and bone cells, provides some insight into the pathogenesis of bone loss in systematic inflammatory diseases. The aim of this article is to review different risk factors in rheumatic diseases. Several factors play a role, such as chronic inflammation, immunological factors, traditional factors, metabolism and drug factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Attention should be paid to bone loss in rheumatic disease. Optimal treatment of the underlying rheumatic disease is the first step towards prevention of OP and fractures. Apart from that, a healthy lifestyle is important as well as calcium and vitamin D supplementation. Bisphosphonates or denosumab might be necessary for patients with a low T score.展开更多
Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the la...Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.展开更多
文摘Background: Non-radiographic axial spondyloarthritis is a progressive and disabling inflammatory disease affecting young adults, with limited treatment options. TNFi are more efficacious than JAKi and IL1-7i in nr-ax SPA and it has a well-known safety profile over a longer duration. Recently, many IL-17i and JAKi were approved for the treatment of nr-ax SPA;however, data comparing IL1-7i and JAKi in terms of efficacy and safety is lacking. This systematized review aimed to compare the existing efficacy and safety data of JAKi vs IL-17i in the treatment of patients with nr-ax SPA. Methods: A systematic literature search was performed using relevant keywords in many databases. According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, 2020), relevant articles were included and evaluated in this review. Efficacy and safety data were collected, analyzed and compared through week 52. The first check was done by the end of week 14 and week 16 for upadacitinib and IL-17i respectively. Results: Data from four RCTs evaluating upadacitinib, secukinumab, ixekizumab, and bimekizumab comprising 1425 patients were analyzed. Overall, a comparable efficacy and safety profile were observed across different treatment arms through week 52;however, non-significant variations were encountered in some outcome measures. The primary endpoint among these RCTs (ASAS40 response rate) was met and it was higher in patients treated with bimekizumab 160 mg sc Q 4 weeks in TNFi non responders (48%) and lowest in ixekizumab 80 mg sc Q 4 weeks treated patients, (35%) (p Conclusion: The above-mentioned three IL-17i and the only one JAKi demonstrated comparable safety and efficacy profiles with some minor variations. A head-to-head trial comparing the effectiveness and safety characteristics of JAKi vs IL-17i may be needed in patients with active nr-ax SpA.
文摘Introduction: Spondyloarthritis (SpA) comprises a group of chronic inflammatory rheumatic diseases characterized by predominant axial involvement. These include ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel diseases (IBD), SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), juvenile spondyloarthritis (JSPA), and undifferentiated SpA. Their exact cause is unknown but is believed to stem from a combination of factors. The first familial forms were described by de Blécourt et al. in 1961. The objective was to evaluate the epidemiological, clinical, therapeutic and evolutionary aspects of familial forms of SpA and in particular, to prove the severity of the disease in family members compared to index cases in the rheumatology department of the Aristide Le Dantec University Hospital in Dakar. Methodology: This was a prospective, cross-sectional and descriptive study with an analytical aim on patients with the familial form of spondyloarthritis defined by the existence of at least one other family member with SpA outside the propositus, collected within the Aristide Le Dantec rheumatology department in Dakar over a period of 10 years between January 2012 and December 2021. There were two phases of study, the first of which consisted of collecting index cases with miserly SpA and the second of which consisted of family screening after consent. The data analysed were epidemiological, clinical, paraclinical, therapeutic and evolving. Results: Out of 100 families of 1905 members, 667 SpA patients included, i.e. a prevalence of 35%, including 225 (33.73%) men and 412 women (61.17%), i.e. a ratio of 1.8. The mean age at diagnosis among relatives was 26.3 years (range 13 and 80 years), 47.14 years among the propositus, in whom the mean age at onset was 36.26 years and that of relatives 49.9 years in the first degree, 15 years in the second degree and 1 year in the third degree. The time to diagnosis was 11.20 years in the first degree, 2.5 years in the second degree, 1 year in the third degree and 10.88 years in the case of the proposes. The number of marriages in families was 420 of which 116 were consanguineous (consanguinity rate 27.62%), 19% among the propositus. HLA-B27 positive in 92% of the proposers and 33.43% in the families;70% of the propositus had an inflammatory syndrome and 17.54% in the families;87% of sacroilliitis in the propositus and 5.54% in the families. Clinical forms were dominated by undifferentiated SpA (338 cases) and APS (295 cases). The average BASFI was 3.23 on D0;2.59 in the 3rd month and 1 in the 6th month for the propositus versus 2.55 at D0;1.86 at the 3rd month and 1.55 in the 6th month in the families. Average BASDAI was 3.92 at D0;3.12 at the 3rd month and 2.07 at the 6th month in the propositus and 3 at D0;2.21 at the 3rd month and 1 at the 6th month in the families. Autoimmune associated conditions were 18 cases, degenerative 24 cases, autoinflammatory 2 metabolic cases 18 cases. They all received: NSAIDs, methotrexate, salazopyrine (11 cases) and anti-TNF-α (1 case). The evolution was generally favourable. Conclusion: SpA is on the rise in Senegalese hospitals, frequent in young people, SPA and undifferentiated SpA are the most frequent, management is essentially based on conventional care, and the disease is less severe in family members than index cases.
文摘AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis(SpA) particularly those studies using dual X-ray absorptiometry(DXA) methods. METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis(AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineraldensity, osteoporosis(OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with Sp A were eligible. Each article was reviewed and the key elements were noted.RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axS pA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with Sp A varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.CONCLUSION: Bone loss may be determined in patients with ax Sp A at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation(bone marrow edema) at the vertebral colon.
文摘Objectives:To explore the relationship between Vitamin D levels and pain and disease activity in patients with newly diagnosed axial spondyloarthritis(axSpA).Methods:A convenience sample of 131 newly diagnosed axSpA patients and 60 healthy controls was recruited from July 2016 to December 2018.Serum 25-hydroxyvitamin D[25(OH)D]was measured to assess vitamin D levels.Disease activity was assessed by objective indicators[Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),the Bath Ankylosing Spondylitis Metrology Index(BASMI)],patientreported questionnaires[the Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),and the Bath Ankylosing Spondylitis Functional Index(BASFI)].Pain intensity and interference were also assessed.Results:Vitamin D insufficiency[serum 25(OH)D levels<50 nmol/L]was found in 46(35.1%)and 25(43.3%)of the axSpA patients and the healthy controls,respectively.Female patients had higher risk(0R:4.928;95%CI:1.921-12.642)for vitamin D insufficiency than male patients.Vitamin D was positively correlated with CRP,ESR level,the BASFI,and the BASMI.Logistic regression showed that vitamin D levels were not associated with pain,or disease activity in the newly diagnosed axSpA patients.Gender was the only predictive variable for vitamin D levels.Conclusions:Vitamin D insufficiency was prevalent in both newly diagnosed axSpA patients and healthy controls.There was no association between vitamin D and pain and disease activity in the newly diagnosed axSpA patients.Monitoring vitamin D levels is important and early intervention for vitamin D insufficiency is needed,especially in female patients.
文摘AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes(PROs) of the HRQo L questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor(TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests:(1) Ankylosing Spondylitis Disease Activity ScoreC-Reactive Protein(ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index(BASDAI), Bath Ankylosing Spondylitis Functional Index(BASFI) and Bath Ankylosing Spondylitis Metrology Index(BASMI) for articular activity;(2) Inflammatory Bowel Disease Questionnaire(IBDQ), Crohn's Disease Activity Index(CDAI) and partial Mayo(p Mayo) score for gastrointestinal symptoms and activity; and(3) Health Assessment Questionnaire(HAQ), Patient Global Assessment(PGA) and Short Form-36 health survey(SF-36) questionnaires for PROs of the HRQo L.RESULTS Integrated evaluation and management of the patients affected by ES, carried out simultaneously by a gastroenterologist and a rheumatologist, allowed clinicians to choose the optimal therapeutic strategy. In a cohort of 30 ES patients affected by active articular and gastrointestinal disease, or axial active articular inflammation, Ada led to fast and sustained improvement of both articular and gastrointestinal disease activities. In fact, all the clinimetric evaluation tests exploring articular or gastrointestinal activity, as well as all the HRQo L scores, showed a significant improvement having been achieved at the earliest(6-mo) assessment. This important clinical improvement was maintained at the 12-mo follow-up. Importantly, global and gastrointestinal quality of life significantly correlated with articular disease activity, providing evidence to support that the integrated evaluation is the best option to manage patients with ES.CONCLUSION Ada treatment, upon multidisciplinary(gastrorheumatologic) evaluation, significantly improves both articular and gastrointestinal inflammation, thereby improving the HRQo L in patients affected by ES.
文摘Although the development of the 2009 Sp A classification criteria by Assessment of Spondylo Arthritis international Society（ASAS） represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis（ax Sp A）, the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including Sp A. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having ax Sp A in central China. The results showed that clinical manifestations of ax Sp A could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from ax Sp A according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.
文摘MULTIPLE myeloma （MM） is a hematologicmalignancy of differentiated plasma cells thataccumulate and proliferate in the bonemarrow. MM patients often develop bonedisease that results in severe bone pain, osteolytic lesions,and pathologic fractures,1 presenting with unexplainedbackache or bone pain in the long bones, ribs, skull, orpelvis.2 However, the low backache mimicking spondyloarthritisin MM is uncommon during clinical practice. Spondyloarthritis isa chronic systemic inflammatory disorder of the axialskeleton, mainly affecting the sacroiliac joint and spinecausing low backache.3 Here we report a patient with MMwhich was initially misdiagnosed and treated asspondyloarthritis.
文摘BACKGROUND Cervical disc arthroplasty(CDA)is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility.However,the CDA postoperative period is impacted by osteolysis,subsidence,metallosis,or heterotopic ossification(HO).We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.CASE SUMMARY A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc(HIVD).After four years,cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels.The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression.Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist.A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.CONCLUSION Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.
文摘Within the concept of axial spondyloarthritis(ax Sp A), relevant differences between men and women have been described for patients with the radiographic disease form [ankylosing spondylitis(AS)]. The subjective perception of disease activity(spinal and peripheral pain, fatigue, morning stiffness) has been shown to be higher in female than in male patients. Moreover, women experience more functional limitations and a lower quality of life, despite lower degrees of radiographic spinal damage. Peripheral clinical involvement(arthritis and enthesitis) is, additionally, more predominant in women. On the other hand, a higher level of objective signs of inflammation(C-reactive protein, erythrocyte sedimentation rate, magnetic resonance imaging of sacroiliac joints and spine) has been reported in men. Whether these differences might explain the better response to treatment with anti-tumor necrosis factor agents observed in male patients remains unclear. The underlying causes of the discrepancies are still unknown and genetic, environmental, cultural and/or societal factors may be involved. While AS is still more prevalent in men in a ratio of 2-3:1, the prevalence of males and females in patients with ax Sp A without radiographic sacroiliac damage is similar. Gender differences in this subgroup of patients have not been adequately addressed, and are particularly needed to further validate the Assessment of Spondylo Arthritis international Society classification criteria.
文摘Inflammatory rheumatological diseases like rheumatoid arthritis (RA) and ankylosing spondylitis/Spondyloarthritis (AS/SpA), have been treated with NSAIDs (non steroidal anti-inflammatory drugs), corticosteroids, and DMARDs (disease modifying anti-rheumatic drugs).These have been only partially effective for the management of symptoms, since they are rarely associated with the complete control of disease and rarely slow down radiological damage. Several cytokines have been implicated in the pathogenesis of the inflammation and tumor necrosis factor (TNF) is the most important. The last decade and a half has seen advances in the form of “anti-TNF” therapies for RA and AS/SpA patients which target and neutralize the TNF cytokines, and thus reduce the disease activity. Two anti-TNF therapies have been used in India for treating DMARD resistant RA and AS/SpA for the last 13 years;Infliximab and Etanercept respectively. This paper is a description of the clinical outcomes and unmet needs/toxicities associated with the treatment of RA and AS/SpA with anti-TNF therapies (Infliximab, Etanercept), at a single rheumatology center (tertiary care, super-specialty hospital, Indraprastha Apollo Hospitals, New Delhi) in north India.
文摘<span style="font-family:Verdana;"><strong>Objective:</strong> Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of the spondyloarthritis family. In black Africa, the prevalence of SpA associated with IBD is not clearly established. Thus the objective of our study was to describe the clinical and radiological characteristics of spondyloarthritis associated with IBD. <strong>Patients and Method:</strong> We carried out a prospective study in the rheumatology department of CHU Ignace Deen between January and December 2019. The diagnosis of SpA was based on clinical and biological arguments in accordance with the criteria of Amor and ASAS. <strong>Results:</strong> Fifteen observations of spondyloarthritis associated with IBD were collected in patients mean age 52 years with extremes of 32 and 65 years. 9 (53.33%) were female. Ten patients had Crohn’s disease (CD) and 5 had ulcerative colitis (UC). The mean number of pushes was 2.5 ± 1.2. The average diagnostic time was 46 months. Sacroiliitis was present in 73.3% of cases and the mean mSASSS score at diagnosis was 32.11/72. In total, corticosteroids were used in 9 (60%) of patients, NSAIDs in 26.6% while DMARDs salazopyrine and methotrexate in 33.3% and 20% of patients, respectively. <strong>Conclusion:</strong> The MICI and SpA association is undoubtedly underestimated in our regions. Better collaboration between rheumatologists and gastroenterologists could facilitate diagnosis and improve care.</span>
文摘Objectives: This study aimed to evaluate the fatigue in patients with undifferentiated spondyloarthritis [USpA], and its relationship with disease-specific variables, spinal mobility measures and healthy related quality of life [HRQOL]. Methods: Eighty patients with USpA and forty healthy subjects were included in this study. The multidimensional assessment of fatigue [MAF] and the generic instrument Short Form 36 [SF 36] were used in patient and control groups to assess fatigue and [HRQOL]. Fatigue was also assessed with the Bath ankylosing spondylitis disease activity index [BASDAI] fatigue item. The evaluation included the activity of the disease [BASDAI], functional status [Bath ankylosing spondylitis functional index], and visual analog scale [VAS] of axial and joint pain. Demographics and disease-related data were obtained. Results: Patients with USpA had higher scores in MAF total and in all MAF subgroup scales than controls. All SF-36 subgroups scores were also found to be significantly lower in patients. Severe fatigue experienced 60% in patients. MAF total scores were found to be significantly correlated with morning stiffness, BASDAI, Bath ankylosing spondylitis functional index (BASFI), BASDAI fatigue, VAS-axial, and SF-36 subgroups scores in patients [p < 0.05]. Conclusions: The patients with USpA defined significantly more fatigue and lower HRQOL when compared with healthy persons. MAF was found to be related with the clinical and functional status and health-related quality of life of patients with USpA.
文摘Late onset peripheral spondyloarthritis is a particular clinical form of spondyloarthritis, occurring at the age of 50 years or older. Hashimoto’s thyroiditis (HT) is the most frequent autoimmune thyroid disorder responsible for considerable morbidity. HT is well known to be associated with many systemic autoimmune, it is less clear whether a similar association may also be present for spondyloarthritis. Here, we report a case of late onset peripheral spondyloarthritis in a 62-year-old African woman with a 12-year history of Hashimoto’s thyroiditis, a previously undescribed association in the literature. The diagnosis of Late onset peripheral spondyloarthritis was made according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for peripheral spondyloarthritis (presence of arthritis, enthesitis and Human Leukocyte Antigen B27). She was treated with methotrexate and celebid. After 6 months of treatment, the evolution was favourable with an overall improvement in her symptomatology and quality of life. The coexistence of late onset peripheral spondyloarthritis and Hashimoto’s thyroiditis may be related to the presence of a genetic background predisposing to both diseases.
基金supported by grants to NH from the Canadian Institute of Health Research(CIHR)and Arthritis Society(Canada)AN is a recipient of a CIHR fellowship,Spondyloarthritis Research and Treatment Network(SPARTAN)fellowship,Spondyloarthritis Research Consortium of Canada(SPARCC)fellowship,Edward Christie Stevens fellowship+5 种基金S.Fenwick Research fellowship,and Krembil Research Institute fellowship(Canada)IJ was supported in part by funding from the Natural Sciences Research Council(NSERC#203475)Canada Foundation for Innovation(CFI#225404,#30865)Ontario Research Fund(RDI#34876,RE010-020)IBM and Ian Lawson van Toch Fund.THK was supported by funding from the National Research Foundation(NRF)of Korea(NRF-2021R1A6A1A03038899)the Korea Healthy Industry Development Institute(HI23C0661).
文摘The hallmarks of spondyloarthritis(SpA)are type 3 immunity-driven inflammation and new bone formation(NBF).Macrophage migration inhibitory factor(MIF)was found to be a key driver of the pathogenesis of SpA by amplifying type 3 immunity,yet MIF-interacting molecules and networks remain elusive.Herein,we identified hypoxia-inducible factor-1 alpha(HIF1A)as an interacting partner molecule of MIF that drives SpA pathologies,including inflammation and NBF.HIF1A expression was increased in the joint tissues and synovial fluid of SpA patients and curdlan-injected SKG(curdlan-SKG)mice compared to the respective controls.Under hypoxic conditions in which HIF1A was stabilized,human and mouse neutrophils exhibited substantially increased expression of MIF and IL-23,an upstream type 3 immunity-related cytokine.Similar to MIF,systemic overexpression of IL-23 induced SpA pathology in SKG mice,while the injection of a HIF1A-selective inhibitor(PX-478)into curdlan-SKG mice prevented or attenuated SpA pathology,as indicated by a marked reduction in the expression of MIF and IL-23.Furthermore,genetic deletion of MIF or HIF1A inhibition with PX-478 in IL-23-overexpressing SKG mice did not induce evident arthritis or NBF,despite the presence of psoriasis-like dermatitis and blepharitis.We also found that MIF-and IL-23-expressing neutrophils infiltrated areas of the NBF in curdlan-SKG mice.These neutrophils potentially increased chondrogenesis and cell proliferation via the upregulation of STAT3 in periosteal cells and ligamental cells during endochondral ossification.Together,these results provide supporting evidence for an MIF/HIF1A regulatory network,and inhibition of HIF1A may be a novel therapeutic approach for SpA by suppressing type 3 immunity-mediated inflammation and NBF.
文摘BACKGROUND Prevalence of the main rheumatic diseases in the Republic of Sakha(Yakutia)[RS(Y)],one of the regions of the Russian Federation,differs from the other regions of the Russian Federation due to its ethnic and geographic features.Knowledge regarding the prevalence and structure of juvenile idiopathic arthritis(JIA)allows us to shape the work of the pediatric rheumatology service in the region correctly,and optimize the healthcare system and the need for medica-tions.AIM To describe the epidemiological,demographic,clinical,and laboratory characteristics of children with JIA in the RS(Y)and evaluate the main outcomes.METHODS This retrospective cohort study assessed all the data from the medical histories of the patients(n=225)diagnosed with JIA(2016-2023)in the Cardiorheumatology Department of the M.E.Nikolaev National Center of Medicine.Pearson'sχ²test,Fisher's exact test,Mann–Whitney and Kruskal-Wallis tests were used for statistical analyses.RESULTS The ethnic prevalence of JIA is higher in Sakha than in Russian children at 110.1 per 100000 children and 69.4 per 100000 children,respectively.The prevalence of JIA among boys and girls in Sakha was similar,unlike in Russians,where the number of girls predominated.The JIA categories were as follows:(1)Systemic arthritis:3.5%;(2)Oligoarthritis(persistent and extended):33.8%;(3)Rheumatoid factor(RF)(+)polyarthritis:0.9%;(4)RF(-)polyarthritis:14.7%;(5)Enthesitis-related arthritis(ERA):44%;and(6)Psoriatic arthritis:3.1%.Prevalence of the ERA category was 4.4 times higher in Sakha children,but the prevalence of systemic arthritis was 2.9 times lower compared to Russians(P=0.0005).The frequency of uveitis was 10.2%,and the frequency of human leukocyte antigen(HLA)B27 was 39.6%in JIA children.Biologic treatment was received by 40.4%of JIA children and 45.3%achieved remission.CONCLUSION Higher JIA prevalence,male and ERA predominance,related to a higher frequency of HLA B27 are typical in RS(Y).These data might improve the pediatric rheumatology health service.
文摘Background: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto odds ratio (OR) for infections in biologics-treated patientsvs. placebo patients. The risk of bias on the included RCTs was assessed by using the Cochrane Risk of Bias Tool.Results: In total, 62 studies were included in this meta-analysis. Overall, the risk of infection (Peto OR: 1.16, 95% confidence interval [CI]: 1.07-1.26,P < 0.001), serious infection (Peto OR: 1.65, 95% CI: 1.26-2.17,P < 0.001), upper respiratory tract infection (URTI) (Peto OR: 1.17, 95% CI: 1.04-1.32,P = 0.008), nasopharyngitis (Peto OR: 1.25, 95% CI: 1.10-1.42,P < 0.001), andCandida infection (Peto OR: 2.64, 95% CI: 1.48-4.71,P = 0.001) were increased in SpA patients treated with biologics compared with placebo. Sensitivity analysis based on biologics classes was conducted, and results demonstrated that compared with placebo, there was a higher risk of infection for tumor necrosis factor (TNF)-α inhibitors (Peto OR: 1.38, 95% CI: 1.13-1.68,P = 0.001) and interleukin (IL)-17 inhibitors (Peto OR: 1.55, 95% CI: 1.08-2.22,P = 0.018) in axial SpA, and for Janus kinase inhibitors in peripheral SpA (Peto OR: 1.39, 95% CI: 1.14-1.69,P = 0.001);higher risk of serious infection for IL-17 inhibitors in peripheral SpA (Peto OR: 3.46, 95% CI: 1.26-9.55,P = 0.016) and axial SpA (Peto OR: 2.01, 95% CI: 1.38-2.91,P < 0.001);higher risk of URTI for TNF-α inhibitors in axial SpA (Peto OR: 1.37, 95% CI: 1.05-1.78,P= 0.019), and for apremilast in peripheral SpA (Peto OR: 1.60, 95% CI: 1.08-2.36,P = 0.018);higher risk of nasopharyngitis for TNF-α inhibitors in axial SpA (Peto OR: 1.41, 95% CI: 1.05-1.90,P = 0.022) and peripheral SpA (Peto OR: 1.49, 95% CI: 1.09-2.05,P = 0.013), and for IL-17 inhibitors in axial SpA (Peto OR: 1.35, 95% CI: 1.01-1.82,P = 0.044);higher risk of herpes zoster for Janus kinase inhibitors in peripheral SpA (Peto OR: 2.18, 95% CI: 1.03-4.62,P = 0.043);higher risk ofCandida infection for IL-17 inhibitors in peripheral SpA (Peto OR: 2.52, 95% CI: 1.31-4.84,P= 0.006).Conclusions: This meta-analysis shows that biological therapy in patients with SpA may increase the risk of infections, including serious infections, URTI, nasopharyngitis, andCandida infection, which should be paid attention to in our clinical practice.
基金Reverie Rheumatology Research Fund,Spondyloarthritis:Excelling in Research for best Outcomes(SPERO)。
文摘Background:Despite therapeutic advances,treatment of patients with axial spondyloarthritis(axSpA)continue to pose as a challenge as many do not respond well to conventional Western medications,such as nonsteroidal anti-inflammatory drugs(NSAIDs)and biologic diseasemodifying antirheumatic drugs(bDMARDs).Hence,acupuncture is a possible alternative.Some studies found electroacupuncture to be better than manual acupuncture,though no trials have been conducted in patients with axSpA.This clinical trial aims to evaluate the clinical efficacy,safety,and cost-effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA.Methods/Design:This randomized controlled trial will recruit 100 patients diagnosed with axSpA,who have active disease despite NSAIDs and bDMARDs.Eligible patients will be randomized to receive either electroacupuncture or manual acupuncture in a 1:1 ratio.All participants will receive standard rheumatologic care in addition to 20 acupuncture sessions.The mean difference in Bath Ankylosing Spondylitis Disease Activity Index score between the 2 groups over 12 weeks will serve as the primary outcome.Secondary outcomes include improvements in other clinical,quality of life,and economic outcomes over 24 weeks.All adverse events will be recorded.Discussion:Results from this trial may provide evidence regarding the clinical effectiveness,safety,and cost-effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA,and guide implementation into clinical practice.Limitations of this trial include the lack of patient blinding,use of a repeated measures design,and possible variation in acupuncture technique amongst the various Traditional Chinese Medicine practitioners.
文摘Our understanding of psoriatic arthritis has evolved as new knowledge of the disease has emerged. However, the exact prevalence of psoriatic arthritis is unknown, and its pathogenesis has not been fully elucidated. Genetic, environmental, and immunologic factors have all been implicated in disease development. Early diagnosis and treatment have become primary objectives in clinical rheumatology. Psoriatic arthritis not only causes functional impairment, but also increases mortality risk of patients. The advent of new therapeutic agents capable of arresting the progression of joint damage is expected. However, early psoriatic arthritis assessment remains limited. The objectives of this article are to outline the epidemiology, diagnosis, and treatment of psoriatic arthritis and to suggest a paradigm for identifying early psoriatic arthritis patients.
文摘Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseases. Bone is a target in many inflammatory rheumatic diseases. In recent years, the survival of patients with rheumatic diseases has increased markedly and the relationship between rheumatic diseases and osteoporosis(OP) has become more prominent. OP and related fragility fractures increase the morbidity and mortality of rheumatic disease. The cause of OP in rheumatic diseases is complex. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Osteoimmunology, a crosstalk between inflammatory and bone cells, provides some insight into the pathogenesis of bone loss in systematic inflammatory diseases. The aim of this article is to review different risk factors in rheumatic diseases. Several factors play a role, such as chronic inflammation, immunological factors, traditional factors, metabolism and drug factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Attention should be paid to bone loss in rheumatic disease. Optimal treatment of the underlying rheumatic disease is the first step towards prevention of OP and fractures. Apart from that, a healthy lifestyle is important as well as calcium and vitamin D supplementation. Bisphosphonates or denosumab might be necessary for patients with a low T score.
文摘Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.
