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Seminars in Immunology Dec 2021The spondyloarthritides are a cluster of inflammatory rheumatic diseases characterized by different diagnostic entities with heterogeneous phenotypes. The current... (Review)
Review
The spondyloarthritides are a cluster of inflammatory rheumatic diseases characterized by different diagnostic entities with heterogeneous phenotypes. The current classification system groups spondyloarthritis patients in two main categories, axial and peripheral spondyloarthritis, providing a framework wherein the clinical picture guides the treatment. However, the heterogeneity of the clinical manifestations of the pathologies, even when residing in the same group, highlights the importance of analyzing the smallest features of each entity to understand how different cellular subsets evolve, what the underlying mechanisms are and what biological markers can be identified and validated to evaluate the stage of disease and the corresponding efficacy of treatments. In this review, we will focus mostly on axial spondyloarthritis, report current knowledge concerning the cellular populations involved in its pathophysiology, and their molecular diversity. We will discuss the implications of such a diversity, and their meaning in terms of patients' stratification.
Topics: Humans; Spondylitis, Ankylosing; Spondylarthritis
PubMed: 34763975
DOI: 10.1016/j.smim.2021.101521 -
European Spine Journal : Official... Feb 2018This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a... (Review)
Review
INTRODUCTION
This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine.
METHODS
This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed.
RESULTS
Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented.
CONCLUSION
The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.
Topics: Cervical Vertebrae; Humans; Osteotomy; Spondylitis, Ankylosing
PubMed: 29290050
DOI: 10.1007/s00586-017-5421-z -
Current Opinion in Rheumatology Mar 2019Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to... (Review)
Review
PURPOSE OF REVIEW
Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures.
RECENT FINDINGS
Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings.
SUMMARY
The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.
Topics: Biological Factors; Biomarkers; Global Health; Humans; Morbidity; Outcome Assessment, Health Care; Prognosis; Reproducibility of Results; Severity of Illness Index; Spondylitis, Ankylosing
PubMed: 30624284
DOI: 10.1097/BOR.0000000000000588 -
Journal of General Internal Medicine Oct 2022It has been hypothesized that ankylosing spondylitis is associated with an increased risk of incident hip fractures due to osteoporosis and risk of falls but the...
BACKGROUNDS
It has been hypothesized that ankylosing spondylitis is associated with an increased risk of incident hip fractures due to osteoporosis and risk of falls but the supporting evidence is limited and mixed.
OBJECTIVES
To assess the risk of hip fractures in a large cohort of patients with ankylosing spondylitis compared to a matched cohort.
DESIGN
A retrospective cohort study.
SUBJECTS
Men and women diagnosed with ankylosing spondylitis from 1 January 2002 to 31 December 2018. Matching in a 5:1 ratio was based on age and sex. Follow-up ended on 23 June 2019.
MAIN MEASURES
Cox regression models adjusting for confounders defined in a causal inference framework were used to determine the hazard ratio for hip fractures.
KEY RESULT
The final cohorts included 5,909 ankylosing spondylitis patients and 28,671 matched patients. The ankylosing spondylitis cohort had a mean age of 49 (17) years and was composed of 3,762 (64%) men, 3,638 (62%) patients born in Israel, and 1,532 (26%) patients of low residential socioeconomic status. During 45,388 and 224,192 cumulative person-years of follow-up, the ankylosing spondylitis and matched cohorts had 2.47 and 1.63 cases of hip fractures per 1,000 person-years, respectively. Ankylosing spondylitis patients also developed hip fractures earlier (74 [13] vs. 79 [10] years, p = 0.002). Ankylosing spondylitis was associated with hip fractures in the unadjusted (HR = 1.52, 95% CI [1.23-1.88]) and adjusted (HR = 1.56, 95% CI [1.27-1.93]) models. The association was evident in men (HR = 1.65, 95% CI [1.25-2.18]) and women (HR = 1.48, 95% CI [1.07-2.05]).
CONCLUSION
This study found that ankylosing spondylitis patients developed hip fractures earlier and more often compared to a matched cohort. This study suggests that ankylosing spondylitis patients might benefit from more proactive screening, mitigation, and prevention of risk factors for hip fractures.
Topics: Cohort Studies; Female; Hip Fractures; Humans; Male; Middle Aged; Osteoporosis; Retrospective Studies; Risk Factors; Spondylitis, Ankylosing
PubMed: 35411534
DOI: 10.1007/s11606-021-07241-2 -
Rheumatic Diseases Clinics of North... Feb 2018The association of inflammatory arthritis with intestinal pathology extends back more than 100 years. This association is now supported by epidemiologic studies... (Review)
Review
The association of inflammatory arthritis with intestinal pathology extends back more than 100 years. This association is now supported by epidemiologic studies demonstrating an elevated prevalence of inflammatory bowel disease in spondyloarthritis and vice versa, compared with the general population. Genetic and intestinal microbiome studies have further linked these diseases. Although diabetes and nonalcoholic fatty liver disease disproportionately affect individuals with psoriatic arthritis, diseases of the esophagus, stomach, pancreas, and liver are not particularly common in spondyloarthritis. Clinicians should be aware of the differential diagnosis and the appropriate diagnostic tools available when evaluating digestive and hepatic disorders in spondyloarthritis.
Topics: Diagnosis, Differential; Gastrointestinal Tract; Humans; Inflammation; Inflammatory Bowel Diseases; Spondylitis, Ankylosing
PubMed: 29149924
DOI: 10.1016/j.rdc.2017.09.004 -
Clinics in Chest Medicine Sep 2019Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs,... (Review)
Review
Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs, heart and the chest wall. Ankylosing spondylitis is associated with anterior chest wall pain, restrictive lung disease, obstructive sleep apnea, apical fibrosis, spontaneous pneumothorax, abnormalities of cardiac valves and conduction system, and aortitis. Patients with IBD can develop necrobiotic lung nodules that can be misdiagnosed as malignancy or infection. Relapsing polychondritis involves large airways in at least half of the patients. Relapsing polychondritis can mimic asthma in some patients. Medications used to treat these inflammatory conditions can cause pulmonary complications such as infections, pneumonitis, and rarely serositis.
Topics: Female; Humans; Inflammatory Bowel Diseases; Male; Polychondritis, Relapsing; Spondylitis, Ankylosing; Thoracic Wall
PubMed: 31376894
DOI: 10.1016/j.ccm.2019.05.006 -
FP Essentials Jul 2020Ankylosing spondylitis (AS) is a rare yet significant cause of back pain in young adults that often is overlooked. AS should be suspected if symptoms of inflammatory...
Ankylosing spondylitis (AS) is a rare yet significant cause of back pain in young adults that often is overlooked. AS should be suspected if symptoms of inflammatory back pain are present or if the patient has a personal or family history of related conditions. X-rays are the initial imaging modality of choice. If suspicion of AS remains high but no sacroiliitis is present on x-ray, an HLA-B27 test should be obtained. The Assessment of SpondyloArthritis International Society (ASAS) criteria are helpful in the diagnosis of AS. Continuous use of nonsteroidal anti-inflammatory drugs is the first-line therapy, followed by tumor necrosis factor-alpha inhibitors, followed by slow-acting antirheumatic drugs (eg, methotrexate). Patients also should undergo physical therapy and, if applicable, should quit smoking and maintain a healthy weight. Patients with AS are at increased risk of complications, such as spinal fracture. Other conditions associated with AS include anterior uveitis, inflammatory bowel disease, and osteoporosis.
Topics: Back Pain; HLA-B27 Antigen; Humans; Inflammatory Bowel Diseases; Spondylitis, Ankylosing; Young Adult
PubMed: 32640152
DOI: No ID Found -
Arthritis Research & Therapy Jan 2022Ankylosing spondylitis is a progressive, disabling joint disease that affects millions worldwide. Given its unclear etiology, studies of ankylosing spondylitis relied...
BACKGROUND
Ankylosing spondylitis is a progressive, disabling joint disease that affects millions worldwide. Given its unclear etiology, studies of ankylosing spondylitis relied heavily on drug-induced or transgenic rodent models which retain only partial clinical features. There is obviously a lack of a useful disease model to conduct comprehensive mechanistic studies.
METHODS
We followed a group of cynomolgus monkeys having joint lesions reported of spinal stiffness for 2 years by conducting hematological testing, radiographic examination, family aggregation analysis, pathological analysis, and genetic testing.
RESULTS
The results confirmed that these diseased animals suffered from spontaneous ankylosing spondylitis with clinical features recapitulating human ankylosing spondylitis disease progression, manifested by pathological changes and biochemical indicators similar to that of ankylosing spondylitis patients.
CONCLUSION
The study offers a promising non-human primate model for spontaneous ankylosing spondylitis which may serve as an excellent substitute for its pre-clinical research.
Topics: Animals; Disease Progression; Humans; Macaca fascicularis; Models, Animal; Spine; Spondylitis, Ankylosing
PubMed: 34980262
DOI: 10.1186/s13075-021-02679-5 -
International Journal of Rheumatic... Dec 2023The association between gut microbiota and ankylosing spondylitis (AS) has been reported in the literature; however, whether the two are correlative is unclear.
BACKGROUND
The association between gut microbiota and ankylosing spondylitis (AS) has been reported in the literature; however, whether the two are correlative is unclear.
METHODS
Single nucleotide polymorphisms associated with the gut microbiome composition and AS (968 AS cases and 336 191 controls) were obtained from published genome-wide association studies in this two-sample Mendelian randomization (MR) study. The causal relationship between gut microbiota and AS was estimated using the inverse-variance weighted method, and the robustness of our findings was confirmed through a comprehensive series of sensitivity analyses.
RESULTS
Anaerotruncus (OR = 0.9984, 95% CI, 0.9968-0.9999, p = .0405) and Ruminococcaceae UCG002 (OR = 0.9989, 95% CI, 0.9979-0.9999, p = .0375) were protective against AS. Defluviitaleaceae (OR = 1.0015, 95% CI, 1.0005-1.0025, p = .0048), Butyricicoccus (OR = 1.0016, 95% CI, 1.0001-1.0032, p = .0429), Coprococcus 3 (OR = 1.0016, 95% CI, 1.0000-1.0032, p = .0463), and Defluviitaleaceae UCG011 (OR = 1.0016, 95% CI, 1.0005-1.0027, p = .0041) exhibited significant positive correlations with heightened susceptibility to AS. Reverse MR revealed that AS does not affect the gut microbial composition.
CONCLUSION
Our study has established a genetically-based causal relationship between gut microbiota and AS. This finding suggests that we may be able to target and regulate specific bacterial groups in the gut to prevent and treat AS.
Topics: Humans; Gastrointestinal Microbiome; Genome-Wide Association Study; Mendelian Randomization Analysis; Spondylitis, Ankylosing; Causality
PubMed: 37875269
DOI: 10.1111/1756-185X.14938 -
Annals of the Rheumatic Diseases Apr 2023To identify clinical and genetic factors associated with severe radiographic damage in patients with ankylosing spondylitis (AS).
OBJECTIVES
To identify clinical and genetic factors associated with severe radiographic damage in patients with ankylosing spondylitis (AS).
METHODS
We newly generated genome-wide single nucleotide polymorphism data (833K) for 444 patients with AS. The severity of radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). To identify clinical and genetic factors associated with severe radiographic damage, multiple linear regression analyses were performed. Human AS-osteoprogenitor and control-osteoprogenitor cells were used for functional validation.
RESULTS
The significant clinical factors of final mSASSS were baseline mSASSS (β=0.796, p3.22×10), peripheral joint arthritis (β=-0.246, p6.85×10), uveitis (β=0.157, p1.95×10), and smoking (β=0.130, p=2.72×10) after adjusting for sex, age and disease duration. After adjusting significant clinical factors, the () gene was associated with severe radiographic damage (p=1.00×10). For pathway analysis, the PI3K-Akt signalling pathway was associated with severe radiographic damage in AS (p=2.21×10, false discovery rate=0.040). Treatment with rhodamine B, a ligand of RYR3, dose-dependently induced matrix mineralisation of AS osteoprogenitors. However, the rhodamine B-induced accelerated matrix mineralisation was not definitive in control osteoprogenitors. Knockdown of RYR3 inhibited matrix mineralisation in SaOS2 cell lines.
CONCLUSIONS
This study identified clinical and genetic factors that contributed to better understanding of the pathogenesis and biology associated with radiographic damage in AS.
Topics: Humans; Spondylitis, Ankylosing; Phosphatidylinositol 3-Kinases; Ryanodine Receptor Calcium Release Channel; Radiography; Spine; Disease Progression; Severity of Illness Index
PubMed: 36543524
DOI: 10.1136/ard-2022-222796