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Otolaryngologic Clinics of North America Dec 2023Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have... (Review)
Review
Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.
Topics: Humans; Mandibular Fractures; Mandibular Condyle; Temporomandibular Joint Disorders; Ankylosis
PubMed: 37353369
DOI: 10.1016/j.otc.2023.05.008 -
Annals of the Rheumatic Diseases Apr 2024Ankylosing spondylitis (AS) is the historic term used for decades for the HLA-B27-associated inflammatory disease affecting mainly the sacroiliac joints (SIJ) and spine....
Ankylosing spondylitis (AS) is the historic term used for decades for the HLA-B27-associated inflammatory disease affecting mainly the sacroiliac joints (SIJ) and spine. Classification criteria for AS have radiographic sacroiliitis as a dominant characteristic. However, with the availability of MRI of SIJ, it could be demonstrated that the disease starts long before definite SIJ changes become visible on radiographs. The Assessment of SpondyloArthritis international Society, representing a worldwide group of experts reached consensus on changes in the nomenclature pertaining to axial spondyloarthritis (axSpA), such as the terminology of diagnosis and of assessment of disease activity tools. These are important changes in the field, as experts in axSpA are now in agreement that the term axSpA is the overall term for the disease. A further differentiation, of which versus is only one aspect, may be relevant for research purposes. Another important decision was that the terms AS and radiographic axSpA (r-axSpA) can be used interchangeably, but that the preferred term is r-axSpA. Based on the decision that axSpA is the correct terminology, a proposal was made to officially change the meaning of the ASDAS acronym to 'Axial Spondyloarthritis Disease Activity Score'. In addition, for simplification it was proposed that the term ASDAS (instead of ASDAS-CRP) should be preferred and applied to the ASDAS calculated with C reactive protein (CRP). It is hoped that these changes will be used consequently for education, in textbooks, manuscripts and presentations.
Topics: Humans; Spondylitis, Ankylosing; Severity of Illness Index; Spondylarthritis; Sacroiliac Joint; Sacroiliitis; C-Reactive Protein
PubMed: 38071514
DOI: 10.1136/ard-2023-225185 -
Biomedical Journal Feb 2024Nod-like receptors (NLRs) are innate immune receptors that play a key role in sensing components from pathogens and from damaged cells or organelles. NLRs form signaling... (Review)
Review
Nod-like receptors (NLRs) are innate immune receptors that play a key role in sensing components from pathogens and from damaged cells or organelles. NLRs form signaling complexes that can lead to activation of transcription factors or effector caspases - by means of inflammasome activation -Inflammatory arthritis (IA) culminating in promoting inflammation. An increasing body of research supports the role of NLRs in driving pathogenesis of IA, a collection of diseases that include rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis, and pediatric arthritis. In this review, we briefly discuss the main drivers of IA diseases and dive into the evidence for - and against - various NLRs in driving these diseases. We also review the studies examining the use of NLR and inflammasome inhibitors as potential therapies for IA.
Topics: Humans; Child; Arthritis, Psoriatic; Inflammasomes; NLR Proteins; Arthritis, Rheumatoid; Spondylitis, Ankylosing
PubMed: 37598797
DOI: 10.1016/j.bj.2023.100655 -
Immunotherapy Oct 2023Janus kinase inhibitors were recently approved for treatment of axial spondyloarthritis following clinical trials demonstrating benefit for symptom control. Upadacitinib... (Review)
Review
Janus kinase inhibitors were recently approved for treatment of axial spondyloarthritis following clinical trials demonstrating benefit for symptom control. Upadacitinib treatment resulted in Assessment of SpondyloArthritis International Society 40 response improvement (defined as at least 40% improvement and an absolute improvement in global assessment of disease activity, patient assessment of back pain and other indices) in 45-52% of trial participants with axial spondyloarthritis. We review the data for efficacy and safety of upadacitinib in this patient population.
Topics: Humans; Axial Spondyloarthritis; Heterocyclic Compounds, 3-Ring; Spondylarthritis; Janus Kinase Inhibitors
PubMed: 37675498
DOI: 10.2217/imt-2023-0032 -
The Korean Journal of Internal Medicine Sep 2023We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical...
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and Kmbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5-12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13-16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
Topics: Humans; Anti-Inflammatory Agents, Non-Steroidal; Axial Spondyloarthritis; Republic of Korea; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 37482652
DOI: 10.3904/kjim.2023.194 -
Scientific Reports Aug 2023Retrospective studies have identified an increased risk of ankylosing spondylitis (AS) in endometriosis patients. The purpose of this study was to investigate the causal... (Randomized Controlled Trial)
Randomized Controlled Trial
Retrospective studies have identified an increased risk of ankylosing spondylitis (AS) in endometriosis patients. The purpose of this study was to investigate the causal relationship between clinical phenotypes of endometriosis and AS using mendelian randomized analysis (MR). MR was performed using data from genome-wide association studies (GWASs). Heterogeneity, pleiotropy and sensitivity analyses were performed to evaluate the robustness of the results by MR Egger and inverse variance weighted (IVW), leave-one-out analysis. IVW, IVW-MRE (inverse variance weighted multiplicative random effects), weighted median and MR Egger were used to explore the relationship between endometriosis and AS. The IVW analysis showed a causal relationship between infertile endometriosis and AS (OR = 0.8334, P = 0.02191), and the same result was observed with IVW-MRE (OR = 0.8334, P = 0.0007933). However, further stratified analysis showed that no matter which statistical method was used, ovarian endometriosis (IVW: OR = 0.1662, P = 0.4986; IVW-MRE: OR = 0.1662, P = 0.4986; MR Egger: OR = - 0.9577, P = 0.2798; Weighted median: OR = 0.2628, P = 0.3452), pelvic peritoneum endometriosis (IVW: OR = 0.4363, P = 0.225; IVW-MRE: OR = 0.4363, P = 0.225, MR Egger: OR = 4.159, P = 0.1705; Weighted median: OR = 0.4112, P = 0.2714), rectovaginal endometriosis (IVW: OR = 0.1365, P = 0.805; IVW-MRE: OR = 0.1365, P = 0.805) there was no causal relationship between endometriosis and AS. This study suggested that patients with infertility endometriosis are at increased risk for AS. This study supports clinicians to pay more attention to the occurrence of AS in endometriosis patients with infertility.
Topics: Female; Humans; Spondylitis, Ankylosing; Endometriosis; Genome-Wide Association Study; Retrospective Studies; Infertility
PubMed: 37591939
DOI: 10.1038/s41598-023-40647-y -
Best Practice & Research. Clinical... Sep 2023Axial spondyloarthritis (axSpA) was historically considered a disease of men, largely due to the recognition of a more severe, progressive phenotype, ankylosing... (Review)
Review
Axial spondyloarthritis (axSpA) was historically considered a disease of men, largely due to the recognition of a more severe, progressive phenotype, ankylosing spondylitis (AS; or radiographic axSpA, r-axSpA) aiding the clinical diagnosis [1,2]. Data demonstrating the near equal prevalence of axSpA in women only started to emerge in the last decades, highlighting intrinsic differences in disease phenotype, and clinical and imaging characteristics between sexes, which partly explain the issue of underdiagnosis in women. Similar to the evolving understanding of spondyloarthritis and the diseases that term describes, the concepts of gender and sex also warrant further clarification to accurately assess their potential role in disease pathophysiology and phenotypic expression. This narrative review delves into the most recent evidence from the literature on the true prevalence of sex differences in axSpA, and the impact of sex and gender on diagnosis, disease characteristics and treatment response in this, still underserved, chronic disease.
Topics: Humans; Female; Male; Spondylarthritis; Spondylitis, Ankylosing; Prevalence
PubMed: 38008661
DOI: 10.1016/j.berh.2023.101875 -
Clinical and Experimental Medicine Nov 2023Ankylosing spondylitis (AS) is a chronic inflammatory disease that frequently results in disability. It has a negative impact on patients' quality of life and puts an... (Review)
Review
Ankylosing spondylitis (AS) is a chronic inflammatory disease that frequently results in disability. It has a negative impact on patients' quality of life and puts an enormous budgetary and societal burden on society. The most effective treatment for AS has grown to be a significant issue worldwide. In order to pinpoint research focus and trends in this region, we performed a bibliometric analysis of the top 100 cited papers in this study. We searched the Science Citation Index Expanded (SCI-Expanded) on the Web of Science (WOS) and selected the top 100 cited papers based on AS. The pertinent literature from various years, journals, nations/regions, institutions, authors, keywords, and references were then examined. To construct knowledge maps, we used the VOSviewer, CiteSpace, and Scimago Graphica programs. Excel was then used to compile the information from the pertinent literature that we had retrieved, and we were able to make predictions about the focus and trends that were currently occurring in the field. Between 1999 and 2019, the top 100 cited papers appeared in 23 journals from 36 different nations and regions. Annals of the rheumatic diseases published the majority of the articles, while Lancet had the highest average number of citations per paper. Germany contributed the most publications, followed by the Netherlands and the USA. In terms of the total number of publications, Rheumazentrum Ruhrgebiet contributed the most papers, followed by University Hospital Maastricht and Leiden University. The three major categories are Rheumatology, Medicine, General & Internal, and Genetics & Heredity, whereas the top 5 co-occurrence of keywords included rheumatoid arthritis, double-blind, disease activity, efficacy, and infliximab. The cluster analysis results indicate that inflammation and immunology, safe and effective therapies, and placebo-controlled trials may be focus and trends for future AS research. Bibliometric analysis can swiftly and visually identify the focus and boundaries of AS research. Our findings imply that inflammation and immunology, safe and effective therapies, and placebo-controlled trials may be focus and trends for future AS research.
Topics: Humans; Spondylitis, Ankylosing; Quality of Life; Arthritis, Rheumatoid; Inflammation; Bibliometrics; Randomized Controlled Trials as Topic
PubMed: 37278932
DOI: 10.1007/s10238-023-01102-4 -
Best Practice & Research. Clinical... Sep 2023Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on... (Review)
Review
Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.
Topics: Humans; Spondylarthritis; Delayed Diagnosis; Axial Spondyloarthritis; Early Diagnosis; Spondylitis, Ankylosing
PubMed: 37658016
DOI: 10.1016/j.berh.2023.101870 -
Nature Reviews. Rheumatology Nov 2023Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and...
Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.
Topics: Humans; Antirheumatic Agents; Axial Spondyloarthritis; Biological Products; Rheumatology; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 37803079
DOI: 10.1038/s41584-023-01034-z