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Clinical Rheumatology Aug 2021Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial...
Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial skeleton, peripheral joints, and entheses. It is estimated that 1 in every 200 people are affected by AS, making it an important healthcare and socioeconomic issue. In this review, we aim to explore the current understanding of AS risk factors and provide a comprehensive update. Multiple search strings were used to identify articles of interest published in PubMed between January 1, 2013, and February 1, 2021. On the basis of the literature review and analysis, we present up-to-date information on the risk factors of developing AS and our viewpoints on disease onset and progression. Multiple genetic and nongenetic risk factors have been suggested in the onset of AS. HLA-B27 is known to have a strong association with the disease, but other genes have been implicated in disease development. Aside from genetics, other factors are thought to be involved; up to 70% of patients with AS have subclinical intestinal inflammation, suggesting that the origin of the disease may be in the gut. The exact mechanism by which AS onset begins is most likely complex and multifactorial. Key Points • It remains unclear how interactions between genes, microbes, mechanical stress, gender, and other environmental and lifestyle factors predispose patients to the development of ankylosing spondylitis (AS). • The exact mechanisms of AS are complex and multifactorial which will require much future research • Recognizing the risk factors, as well as understanding gene-environment interactions, may offer valuable insights into the etiology of AS and have important implications for diagnosis and treatment strategies.
Topics: HLA-B27 Antigen; Humans; Inflammation; Risk Factors; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33754220
DOI: 10.1007/s10067-021-05679-7 -
European Spine Journal : Official... Sep 2020To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS). (Review)
Review
PURPOSE
To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS).
METHODS
A comprehensive literature search was undertaken by 2 independent reviewers with PubMed, Ovid, and Web of Science to identify all published knowledge on DLSS. Search terms included "developmental spinal stenosis" or "congenital spinal stenosis" and "lumbar". The inclusion criteria were English clinical studies with sample size larger than 8, articles examining the etiology, diagnostic criteria, surgical outcomes of DLSS, and its association with other spinal pathologies. Articles that did not specify a developmental component were excluded. The GRADE approach was used to assess their quality of evidence.
RESULTS
The initial database review found 404 articles. Twenty articles with moderate to very low quality met the inclusion criteria for analysis. The bony canal diameter was significantly shorter in patients with DLSS than normal subjects. In addition, the risk of re-operation on adjacent levels (21.7%) was high which could be explained by multi-level stenosis. However, there was a lack of consensus on the methodology of diagnosing DLSS and on its specific surgical techniques.
CONCLUSION
Multi-level stenosis and re-operation at adjacent levels are especially common with DLSS. Identification of these individuals provides better prognostication after surgery. However, current literature provides few consensus on its definition and the required surgical approach. Besides, there are limited reports of its etiology and association with other spinal pathologies. Due to these limitations, standardizing the definition of DLSS and investigating its etiology and expected clinical course are necessary.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Reoperation; Spinal Stenosis
PubMed: 32623513
DOI: 10.1007/s00586-020-06524-2 -
The Spine Journal : Official Journal of... Jan 2018In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown.
PURPOSE
This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy.
STUDY DESIGN
A review of the accuracy of diagnostic tests was carried out.
STUDY SAMPLE
The study sample comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings.
OUTCOME MEASURES
Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity.
METHODS
A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2.
RESULTS
Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59-1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21-0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments.
CONCLUSIONS
There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder.
Topics: Cervical Vertebrae; Humans; Neurologic Examination; Radiculopathy; Sensitivity and Specificity
PubMed: 28838857
DOI: 10.1016/j.spinee.2017.08.241 -
Journal of Anatomy Jan 2019The moment arm of a muscle represents its leverage or torque-producing capacity, and is indicative of the role of the muscle in joint actuation. The objective of this...
The moment arm of a muscle represents its leverage or torque-producing capacity, and is indicative of the role of the muscle in joint actuation. The objective of this study was to undertake a systematic review of the moment arms of the major muscles spanning the glenohumeral joint during abduction, flexion and axial rotation. Moment arm data for the deltoid, pectoralis major, latissimus dorsi, teres major, supraspinatus, infraspinatus, subscapularis and teres minor were reported when measured using the geometric and tendon excursion methods. The anterior and middle sub-regions of the deltoid had the largest humeral elevator moment arm values of all muscles during coronal- and scapular-plane abduction, as well as during flexion. The pectoralis major, latissimus dorsi and teres major had the largest depressor moment arms, with each of these muscles exhibiting prominent leverage in shoulder adduction, and the latissimus dorsi and teres major also in extension. The rotator cuff muscles had the largest axial rotation moment arms regardless of the axial position of the humerus. The supraspinatus had the most prominent elevator moment arms during early abduction in both the coronal and scapular planes as well as in flexion. This systematic review shows that the rotator cuff muscles function as humeral rotators and weak humeral depressors or elevators, while the three sub-regions of the deltoid behave as substantial humeral elevators throughout the range of humeral motion. The pectoralis major, latissimus dorsi and teres major are significant shoulder depressors, particularly during abduction. This study provides muscle moment arm data on functionally relevant shoulder movements that are involved in tasks of daily living, including lifting and pushing. The results may be useful in quantifying shoulder muscle function during specific planes of movement, in designing and validating computational models of the shoulder, and in planning surgical procedures such as tendon transfer surgery.
Topics: Arm; Biomechanical Phenomena; Humans; Movement; Muscle, Skeletal; Range of Motion, Articular; Shoulder Joint
PubMed: 30411350
DOI: 10.1111/joa.12903 -
The International Journal of...To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations.
PURPOSE
To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations.
MATERIALS AND METHODS
A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool.
RESULTS
The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis.
CONCLUSION
No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.
Topics: Adult; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Follow-Up Studies; Humans; Jaw, Edentulous; Maxilla; Mouth, Edentulous; Treatment Outcome
PubMed: 33571327
DOI: 10.11607/ijp.7162 -
Oral Diseases Oct 2023This study aimed to assess the frequency of temporomandibular disorders (TMDs) in patients with axial spondyloarthritis (axSpA) compared with the healthy individuals. We... (Meta-Analysis)
Meta-Analysis Review
This study aimed to assess the frequency of temporomandibular disorders (TMDs) in patients with axial spondyloarthritis (axSpA) compared with the healthy individuals. We systematically searched PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar databases from their inception until 2022, without language restriction. A standardized dataset was used to extract data from the observational studies. Patients were required to have axial spondyloarthritis and clinical and/or radiographic evidence of temporomandibular joint dysfunction. Meta-analysis was performed with a random effects model. A systematic review was registered under number CRD42020206283. We identified seven relevant studies, which provided data for 745 patients and 216 temporomandibular disorders events. The combined odds ratio (OR) showed that the risk of temporomandibular disorders in individuals with axial spondyloarthritis was higher than the control group (pooled OR = 5.26, 95% CI 2.50-11, 06; p < 0.02; I = 58%). Also, these individuals do not appear to refer possible temporomandibular joint symptoms to the rheumatologist or dentist. The results of this systematic review and meta-analysis suggest that patients with axial spondyloarthritis have an increased frequency of temporomandibular disorders. TMDs seem to be secondary to postural alterations rather than direct involvement of the temporomandibular joints (TMJs).
Topics: Humans; Temporomandibular Joint Disorders; Temporomandibular Joint; Axial Spondyloarthritis; Odds Ratio
PubMed: 36578234
DOI: 10.1111/odi.14490 -
The Spine Journal : Official Journal of... Oct 2019Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed.
PURPOSE
To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression.
STUDY DESIGN/SETTING
Systematic review and meta-analysis.
PATIENT SAMPLE
The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7-166).
OUTCOME MEASURES
Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events.
METHODS
This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence intervals, were also calculated. Two subgroup analyses were performed: one for studies in which only myelopathy or radiculopathy (or both) were stated as surgical indications and the other for studies in which only myelopathy or ossification of the posterior longitudinal ligament (or both) were stated as surgical indications. This study was funded by Providence Medical Technology, Inc. ($32,000).
RESULTS
Thirty-three articles were included in the systematic review, and 31 articles were included in the meta-analysis. For all surgical indications and for the 2 subgroup analyses, every cumulative change in patient-reported outcome improved. Many of the reported changes in patient-reported outcome also exceeded the minimal clinically important differences. Pooled outcome rates with all surgical indications were 98.25% for successful fusion, 1.09% for revision, and 9.02% for complications or adverse events. Commonly reported complications or adverse events were axial pain, C5 palsy, transient neurological worsening, and wound infection.
CONCLUSIONS
Posterior cervical fusion with decompression resulted in significant clinical improvement, as indicated by the changes in patient-reported outcomes. Additionally, high fusion rates and low rates of revision and of complications and adverse events were found.
Topics: Adult; Aged; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Spinal Cord Diseases; Spinal Fusion
PubMed: 31075361
DOI: 10.1016/j.spinee.2019.04.019 -
Journal of Indian Prosthodontic Society 2021This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss.
SETTING AND DESIGN
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA).
MATERIALS AND METHODS
The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool.
STATISTICAL ANALYSIS USED
Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software.
RESULTS
Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69).
CONCLUSION
In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.
Topics: Alveolar Bone Loss; Humans; Jaw, Edentulous; Maxilla; Mouth, Edentulous; Prostheses and Implants
PubMed: 34380808
DOI: 10.4103/jips.jips_79_21 -
Neuroradiology Mar 2021The study design of this paper is systematic review. The purpose of this review is to evaluate the existing radiological grading systems that are used to assess cervical... (Review)
Review
The study design of this paper is systematic review. The purpose of this review is to evaluate the existing radiological grading systems that are used to assess cervical foraminal stenosis. The importance of imaging the cervical spine using CT or MRI in evaluating cervical foraminal stenosis is widely accepted; however, there is no consensus for standardized methodology to assess the compression of the cervical nerve roots. A systematic search of Ovid Medline databases, Embase 1947 to present, Cinahl, Web of Science, Cochrane Library, ISRCTN and WHO international clinical trials was performed for reports of cervical foraminal stenosis published before 01 February 2020. In collaboration with the University of Leeds, a search strategy was developed. A total of 6952 articles were identified with 59 included. Most of the reports involved multiple imaging modalities with standard axial and sagittal imaging used most. The grading themes that came from this systematic review show that the most mature for cervical foraminal stenosis is described by (Kim et al. Korean J Radiol 16:1294, 2015) and (Park et al. Br J Radiol 86:20120515, 2013). Imaging of the cervical nerve root canals is mostly performed using MRI and is reported using subjective terminology. The Park, Kim and Modified Kim systems for classifying the degree of stenosis of the nerve root canal have been described. Clinical application of these scoring systems is limited by their reliance on nonstandard imaging (Park), limited validation against clinical symptoms and surgical outcome data. Oblique fine cut images derived from three dimensional MRI datasets may yield more consistency, better clinical correlation, enhanced surgical decision-making and outcomes.
Topics: Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Radiculopathy; Radiography; Spinal Nerve Roots; Spinal Stenosis
PubMed: 33392737
DOI: 10.1007/s00234-020-02596-5 -
Expert Review of Clinical Immunology Jun 2016Psoriatic arthritis (PsA) is characterized by chronic inflammation of peripheral joints and axial skeleton, associated with a strong genetic background. Clinics include... (Review)
Review
Psoriatic arthritis (PsA) is characterized by chronic inflammation of peripheral joints and axial skeleton, associated with a strong genetic background. Clinics include enthesitis or dactylitis and extra-articular involvement as uveitis or inflammatory bowel disease, while treatment options range from nonsteroidal anti-inflammatory drugs (NSAIDs) to biologics, targeting TNF α or Th17. No serum autoantibody is associated with PsA, while other biomarkers have been proposed for early diagnosis or to predict treatment response. To better discuss this area of growing interest we performed a systematic review of the literature on biomarkers in PsA. Our research retrieved 408 papers, and 38 were included in the analysis. Based on the available literature, we draw some recommendations for the use of biomarkers in the management of patients with PsA.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Psoriatic; Biomarkers; Genetic Predisposition to Disease; Humans; Inflammation; Joints; Th17 Cells; Tumor Necrosis Factor-alpha
PubMed: 26821681
DOI: 10.1586/1744666X.2016.1147954