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Journal of Cranio-maxillo-facial... Aug 2020The patient-reported outcome measures are endorsed for better evaluation of disease impact and treatment outcomes. Temporomandibular joint (TMJ) ankylosis has been...
The patient-reported outcome measures are endorsed for better evaluation of disease impact and treatment outcomes. Temporomandibular joint (TMJ) ankylosis has been observed to adversely impact the quality of life (QoL) of the patients, affecting both the physical and psychosocial aspects of their lives. The study was conducted to develop and validate a TMJ ankylosis specific QoL questionnaire (TMJAQoL). It had two phases. Phase 1 was associated with the development of the questionnaire while phase 2 examined its psychometric properties and validated the instrument. In phase 1, a 65 item pool was generated and was eventually reduced to a 37 item pool after sequential evaluation by two expert groups. The 37 item draft was subjected to item reduction by the impact method, resulting in a 12 item draft divided into 4 domains, which formed the TMJAQoL questionnaire. In phase 2, the TMJAQoL was completed by 51 TMJ ankylosis patients and was found to have optimum validity, reliability and internal consistency. 44 of these patients completed the TMJAQoL again after the surgery. A significant change in mean cumulative TMJAQoL scores (pre-op = 14.10, post op = 4.05, p = .001) was found after the surgery. This change was significantly correlated to the improvement in the maximal incisal opening and the right and left lateral movements (r > .30). Amongst the TMJAQoL domains, significant improvement was seen in functional limitation (p = .026), psychological well being (p = .017) and social wellbeing domains (p = .038). Overall, improved QoL was observed after the TMJ surgery. The TMJAQoL demonstrated optimum psychometric properties and promises to be an effective QoL instrument for the TMJ ankylosis patients.
Topics: Ankylosis; Humans; Quality of Life; Reproducibility of Results; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 32709503
DOI: 10.1016/j.jcms.2020.06.005 -
Nature Reviews. Rheumatology Apr 2023
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Spondylitis, Ankylosing; Spondylarthritis; Axial Spondyloarthritis
PubMed: 36810449
DOI: 10.1038/s41584-023-00930-8 -
Clinical Reviews in Allergy & Immunology Aug 2023Axial spondyloarthritis (Ax-SpA) is a chronic inflammatory disease that predominantly affects the axial joints and is most common in young men. However, the precise... (Review)
Review
Axial spondyloarthritis (Ax-SpA) is a chronic inflammatory disease that predominantly affects the axial joints and is most common in young men. However, the precise immune cell subset involved in Ax-SpA remains unclear. Our study characterized the periphery immune landscape of Ax-SpA patients before and after anti-TNFα treatment using single-cell transcriptomics and proteomics sequencing and elucidated the effects of anti-TNFα treatment at the single-cell level. First, we found that peripheral granulocytes and monocytes significantly increased in Ax-SpA patients. Second, we identified a more functional subtype of regulatory T cells, which was present in synovial fluid and increased in patients after treatment. Third, we identified a cluster of inflammatory monocyte subset with stronger inflammatory and chemotactic characteristics. A potential interaction between classical monocytes and granulocytes via the CXCL8/2-CXCR1/2 signaling pathway was observed, which decreased after treatment. Together, these results defined the complex expression profiles and advanced our understanding of the immune atlas in Ax-SpA patients before and after anti-TNFα treatment.
Topics: Male; Humans; Spondylitis, Ankylosing; Joints; Axial Spondyloarthritis; Monocytes; Single-Cell Analysis
PubMed: 36884135
DOI: 10.1007/s12016-023-08959-z -
Autoimmunity Reviews Jan 2024Axial spondyloarthritis (axSpA) encompasses radiographic axial SpA (r-axSpA), formally designated as ankylosing spondylitis (AS) and non-radiographic axial SpA... (Review)
Review
Axial spondyloarthritis (axSpA) encompasses radiographic axial SpA (r-axSpA), formally designated as ankylosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA). The advent of MRI permitted the description of the "pre-radiographic" (nr-AxSpA) stage characterized by bone marrow oedema lesions, histologically an osteitis, not yet visible on X-rays. Most subjects with a diagnosis of nr-axSpA do not progress to r-axSpA and the risk of misdiagnosis of nr-axSpA is considerable because back pain related to malalignment, degenerative conditions or biomechanical stress including intense exercise may lead to positive MRI scans. Even when nr-axSpA or r-axSpA are accurately diagnosed only about 40-50% achieve the ASAS40 responses with licensed therapies. It is likely that spinal enthesitis/osteitis leading to structural damage and associated damage contributes to post inflammatory disc territory secondary pain responses. Things are complicated as the concept of refractory axSpA itself is not well defined since there is no gold standard test to capture the full burden of inflammatory disease and, in any event, MRI has not been systematically applied. Nevertheless, there is sufficient evidence to borrow from the refractory rheumatoid arthritis field to propose two types of refractory axial SpA- a persistent inflammatory refractory ax-SpA (PIRaxSpA) and non-inflammatory refractory ax-SpA (NIRaxSpA). Both axSpA refractoriness and misdiagnosis need careful considerations when evaluating treatment failure. The immunological basis for axSpA immunotherapeutics non-responses is still rudimentary beyond the knowledge of HLA-B27 positivity status, CRP elevation, and MRI bone oedema that represents osteitis being equated with responder status.
Topics: Humans; Spondylarthritis; Osteitis; Non-Radiographic Axial Spondyloarthritis; Spondylitis, Ankylosing; Edema
PubMed: 37543288
DOI: 10.1016/j.autrev.2023.103405 -
Joint Bone Spine Jul 2023To evaluate costovertebral joint involvement in patients with axial spondyloarthritis (axSpA) and to assess its association with disease features. (Observational Study)
Observational Study
OBJECTIVES
To evaluate costovertebral joint involvement in patients with axial spondyloarthritis (axSpA) and to assess its association with disease features.
METHODS
We included 150 patients from the Incheon Saint Mary's axSpA observational cohort who underwent whole spine low-dose computed tomography (ldCT). Costovertebral joint abnormalities were scored by two readers on a scale of 0-48 based on the presence or absence of erosion, syndesmophyte, and ankylosis. The interobserver reliability of costovertebral joint abnormalities was assessed using intraclass correlation coefficients (ICCs). Associations between costovertebral joint abnormality scores and clinical variables were evaluated using a generalized linear model.
RESULTS
Two independent readers found costovertebral joint abnormalities in 74 (49%) patients and 108 (72%) patients. The ICCs of scores for erosion, syndesmophyte, ankylosis, and total abnormality were 0.85, 0.77, 0.93, and 0.95, respectively. For both readers, total abnormality score was correlated with age, symptom duration, Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath AS functional index (BASFI), CT syndesmophyte score (CTSS), and number of bridging spines. Multivariate analyses showed age, ASDAS, CTSS to be independently associated with total abnormality scores in both readers. The frequency of ankylosed costovertebral joint was 10.2% (reader 1) and 17.0% (reader 2) in patients without radiographic syndesmophytes (n=62), and 10.3% (reader 1) and 17.2% (reader 2) in patients without radiographic sacroiliitis (n=29).
CONCLUSIONS
Costovertebral joint involvement was common in patients with axSpA, even in the absence of radiographic damage. LdCT is recommended for evaluating structural damage in patients with clinically suspected costovertebral joint involvement.
Topics: Humans; Reproducibility of Results; Sacroiliitis; Severity of Illness Index; Spine; Spondylarthritis; Spondylitis, Ankylosing; Tomography, X-Ray Computed
PubMed: 36796582
DOI: 10.1016/j.jbspin.2023.105546 -
Medicine Apr 2022Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a... (Review)
Review
Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.The lack of adequate epidemiological data and incomplete understanding of nr-axSpA among rheumatologists and nonrheumatologists contributes to delayed referrals and diagnosis. This delay results in a substantial burden on patients, physically and psychologically, and the healthcare system. Targeted therapies, such as biologics, including inhibitors of tumor necrosis factor or interleukin-17A, have been approved and utilized for the management of nr-axSpA, and other novel therapeutics with different mechanisms of action are in development. Raising awareness among US internists regarding the prevalence of nr-axSpA, disease burden, clinical presentation, diagnostic tools, and available treatments is important for improved disease management.Future clinical investigations focusing on the development of markers that aid early diagnosis and predict treatment response may also improve the management of nr-axSpA. This review provides an overview of nr-axSpA with the aim of raising awareness of the disease among US internists, with an overarching goal to contribute toward the improved recognition and timely referral of these patients to rheumatologists for diagnosis and management.
Topics: Axial Spondyloarthritis; Humans; Non-Radiographic Axial Spondyloarthritis; Spondylarthritis; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha
PubMed: 35475794
DOI: 10.1097/MD.0000000000029063 -
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 -
BMJ Case Reports Aug 2020A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was...
A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a 'coronoidoplasty' after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, 'coronoidoplasty', as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.
Topics: Ankylosis; Child, Preschool; Humans; Male; Mandible; Orthognathic Surgical Procedures; Temporomandibular Joint Disorders
PubMed: 32843377
DOI: 10.1136/bcr-2020-235698 -
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 -
Journal of Comparative Pathology Feb 2020Temporomandibular joint (TMJ) ankylosis is an uncommon clinical entity in human and veterinary medicine. However, the condition is severely debilitating and is...
Temporomandibular joint (TMJ) ankylosis is an uncommon clinical entity in human and veterinary medicine. However, the condition is severely debilitating and is life-limiting if not treated. This study sought to characterize the intra- and extra-articular features of naturally occurring TMJ ankylosis in cats. TMJs from client-owned cats (n = 5) that underwent bilateral TMJ gap arthroplasty were examined and compared with TMJs from healthy, age-matched feline cadavers (n = 2) by cone-beam computed tomography (CBCT), micro-computed tomography (μCT) and histologically. Features of bilateral intra- and extra-articular ankylosis compounded by degenerative joint lesions were identified radiographically and histologically in all affected cats. Features of TMJ 'true' ankylosis included variable intracapsular fibro-osseous bridging, degeneration of the disc and the articular surfaces, narrowing of the joint space and flattening of the condylar process of the mandible. Extra-articular features of TMJ ankylosis included periarticular bone formation and fibro-osseous bridging between the mandible, zygomatic arch and coronoid process. In addition, subchondral bone loss or sclerosis, irregular and altered joint contours and irregularly increased density of the medullary bone characterized the degenerative changes of the osseous components of the TMJ. Complex radiological and histological features of both ankylosis and pseudoankylosis were identified that clinically manifested in complete inability to open the mouth.
Topics: Animals; Ankylosis; Cat Diseases; Cats; Female; Male; Temporomandibular Joint Disorders
PubMed: 32138841
DOI: 10.1016/j.jcpa.2019.12.006