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The Journal of Rheumatology Nov 2023
Topics: Humans; Spine; Spondylarthritis; Axial Spondyloarthritis; Spondylitis, Ankylosing
PubMed: 37778767
DOI: 10.3899/jrheum.2023-0852 -
BMJ Case Reports Feb 2022
Topics: Humans; Kyphosis; Lumbar Vertebrae; Spondylitis, Ankylosing
PubMed: 35217558
DOI: 10.1136/bcr-2021-248542 -
Emergency Radiology Jun 2022To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine,...
PURPOSE
To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine, imaged with CT angiography (CTA) after blunt trauma. The related etiologies of ankylosis had an additional focus.
MATERIALS AND METHODS
Altogether of 5867 CTAs of the craniocervical arteries imaged after blunt trauma between October 2011 and March 2020 were manually reviewed for a threshold value of ankylosis of at least three consecutive cervical vertebrae. BCVI was the primary outcome and associated stroke as the secondary outcome. Variables were craniofacial and cervical spine fractures, etiology and levels of ankylosis, traumatic brain injury, spinal hematoma, spinal cord injury, and spinal cord impingement, for which correlations with BCVI were examined.
RESULTS
Of the 153 patients with ankylosis and blunt trauma of the cervical spine, 29 had a total of 36 BCVIs, of whom two had anterior and 4 posterior circulation strokes. Most of the BCVIs (n = 32) were in the vertebral arteries. Injuries were graded according to the Biffl scale: 17 grade II, 4 grade III, 14 grade IV, and 1 grade V. A ground-level fall was the most common trauma mechanism. Cervical spine fracture was the only statistically significant predictor for BCVI (OR 7.44). Degenerative spondylosis was the most prevalent etiology for ankylosis.
CONCLUSION
Ankylosis of the cervical spine increases the incidence of BCVI up to sevenfold compared to general blunt trauma populations, affecting especially the vertebral arteries.
Topics: Ankylosis; Cerebrovascular Trauma; Cervical Vertebrae; Computed Tomography Angiography; Humans; Incidence; Neck Injuries; Retrospective Studies; Spinal Fractures; Stroke; Wounds, Nonpenetrating
PubMed: 35296926
DOI: 10.1007/s10140-022-02022-8 -
Journal of Oral Rehabilitation Oct 2023Pediatric dentists should have information regarding whether mouth opening is limited. In clinical practice, these professionals should collect and record oral area...
BACKGROUND
Pediatric dentists should have information regarding whether mouth opening is limited. In clinical practice, these professionals should collect and record oral area measurements at the pediatric patient's first medical examination.
OBJECTIVES
The study's aim developed the standard mouth opening measurement in children by using ordinary least squares regression to develop a clinical prediction model in children with Temporomandibular Joint Ankylosis before preoperative surgery.
METHODS
All participants completed their age, gender, and calculated height, weight, body mass index, and birth weight. Pediatric dentist performed all mouth-opening measurements. The oral-maxillofacial surgeon marked subnasal and pogonion points for the lower facial length of soft tissue. It was measured using the distance between the subnasal and pogonion with a digital vernier caliper. The widths of the three fingers (index, middle, and ring fingers) and four fingers (index, middle, ring, and little fingers) were also measured using a digital vernier caliper.
RESULTS
Maximum mouth opening showed that three-finger width (R2 = 0.566, F = 185.479) and four-finger width (R2 = 0.462, F = 122.209) had a significant influence on the Maximum mouth opening (MMO) (p < 0.001).
CONCLUSION
Pediatric dentists should collaborate with the treating maxillofacial surgeon to manage long-term treatment needs for individuals with Temporomandibular Joint Ankylosis.
Topics: Humans; Child; Models, Statistical; Prognosis; Ankylosis; Mouth; Temporomandibular Joint
PubMed: 37221976
DOI: 10.1111/joor.13498 -
Rheumatology (Oxford, England) Dec 2020To evaluate the occurrence and progression of facet joint ankylosis in the whole spine using low-dose CT (ldCT) in radiographic axial spondyloarthritis (r-axSpA) and...
OBJECTIVES
To evaluate the occurrence and progression of facet joint ankylosis in the whole spine using low-dose CT (ldCT) in radiographic axial spondyloarthritis (r-axSpA) and compare progression of facet joint ankylosis and syndesmophytes.
METHODS
Patients with r-axSpA from the Sensitive Imaging in Ankylosing Spondylitis (SIAS) cohort underwent ldCT at baseline (n = 60) and 2 years (n = 53). Facet joints (right and left, levels C2-S1) were scored as ankylosed, not ankylosed or unable to assess. Joints that were frequently poorly visible (>15% missing), were excluded. Inter-reader reliability on the patient level was assessed with intraclass correlation coefficients (ICCs) and smallest detectable change (SDC). Ankylosis was assessed at joint level and patient level for both timepoints. Syndesmophytes were assessed with CT syndesmophyte score.
RESULTS
Levels C5-T2 were difficult to assess and excluded from all further analyses. Facet joint ICCs were good to excellent for status scores (0.72-0.93) and poor to excellent for progression scores (0.10-0.91). Facet joint ankylosis was detected at every level but most frequently in the thoracic joints. In total, 48% of patients showed 2-year progression. Most progression occurred in the thoracic segment. Using SDCs as cutoff, 18% of patients had progression of facet joint ankylosis only, whereas 20% of patients had progression of syndesmophytes only.
CONCLUSION
This is the first study evaluating facet joints in the whole spine by ldCT in r-axSpA. Facet joint ankylosis was detected most often in the thoracic spine. Assessing facet joints in addition to syndesmophytes detected substantially more patients with damage progression over two years.
Topics: Adult; Cohort Studies; Disease Progression; Female; Humans; Male; Middle Aged; Osteophyte; Spinal Osteophytosis; Spondylitis, Ankylosing; Tomography, X-Ray Computed; Zygapophyseal Joint
PubMed: 32417911
DOI: 10.1093/rheumatology/keaa155 -
Nature Reviews. Rheumatology Mar 2023
Topics: Humans; Antibodies, Monoclonal, Humanized; Psoriasis; Axial Spondyloarthritis; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 36755118
DOI: 10.1038/s41584-023-00927-3 -
Arthritis Care & Research Sep 2022To describe the driving difficulties experienced by individuals with axial spondyloarthritis (SpA), and to characterize associated clinical and sociodemographic features...
OBJECTIVE
To describe the driving difficulties experienced by individuals with axial spondyloarthritis (SpA), and to characterize associated clinical and sociodemographic features and impact on work.
METHODS
The Scotland Registry for Ankylosing Spondylitis (SIRAS) is a cohort study of patients with a clinical diagnosis of axial SpA. Baseline information was collected on clinical and patient-reported measures and work participation measures (using the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Patient-rated difficulties with 9 driving tasks were used in a factor analysis, and relationships between driving difficulty and work participation were investigated.
RESULTS
In total, 718 patients provided data for analysis, of which 642 (89%) had some difficulty with at least 1 driving task, and 72 (10%) had some difficulty with all 9 tasks. Three domains of driving difficulty were identified: dynamic driving scenarios, crossing traffic, and the physical act of driving. Chronic widespread pain, knee and back pain, fatigue, high disease activity, and anxiety/depression were significantly associated with reporting driving difficulties across all 3 domains, particularly the physical act of driving. After adjusting for sociodemographic, disease activity, physical and mental health, driving difficulties in each domain were associated with a 2-3 times increased likelihood of restricted work productivity and with an increased risk of sickness absence in the past 7 days.
CONCLUSION
Driving difficulties are common in individuals with axial SpA and impact on work, even after adjusting for clinical status. Improving understanding and awareness of driving disability will help direct advice and resources to enable individuals to remain independent and economically active.
Topics: Axial Spondyloarthritis; Cohort Studies; Humans; Quality of Life; Registries; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33734612
DOI: 10.1002/acr.24595 -
The British Journal of Oral &... Nov 2022Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present... (Meta-Analysis)
Meta-Analysis Review
Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present review was aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis. Major electronic databases and prominent subject-specific journals were searched up to December 2020. Randomised controlled trials (RCT), cohort studies, and retrospective studies reporting outcomes of autogenous grafts for RA in TMJ ankylosis were included. A total of 35 studies with 700 subjects was included. The most commonly employed grafts were costochondral grafts (CCG) and coronoid process grafts. Postoperative change in maximum incisor opening (MIO) was comparable amongst all grafts and was in the clinically acceptable range (27.21-31.38 mm). The recurrence rate was comparable for all grafts and was ≈ 8% except for coronoid grafts, where the recurrence rate was 2.98%. Growth assessment for CCG revealed that 55.89%, 30.89%, and 13.24% of subjects depicted optimal growth, overgrowth, and undergrowth, respectively. Within the limitations of the present review, the recurrence rate for all grafts was comparable except for coronoid graft, which depicted least recurrence rate and resultant postoperative change in MIO was in the clinically acceptable range.
Topics: Humans; Bone Transplantation; Ankylosis; Temporomandibular Joint; Arthroplasty
PubMed: 35811261
DOI: 10.1016/j.bjoms.2022.05.012 -
Expert Review of Clinical Immunology Feb 2024Non-radiographic axial spondyloarthritis (nr-axSpA) is a chronic inflammatory condition with axial and peripheral musculoskeletal involvement, fulfilling criteria of... (Review)
Review
INTRODUCTION
Non-radiographic axial spondyloarthritis (nr-axSpA) is a chronic inflammatory condition with axial and peripheral musculoskeletal involvement, fulfilling criteria of axSpA in the absence of advanced radiographic sacroiliitis. While appropriate treatment is required for chronic pain and disability resulting from disease progression, the limited availability of treatment options becomes evident. Upadacitinib, an oral selective Janus kinase 1 inhibitor, was approved in Europe, the United States, and other countries for management of nr-axSpA with inadequate response to existing therapies.
AREA COVERED
This review summarizes essential drug profiles, efficacy, and safety of upadacitinib for nr-axSpA in conjunction with data pertaining to radiographic axSpA.
EXPERT OPINION
In a phase 3 trial, upadacitinib exhibited efficacy for patients with nr-axSpA, irrespective of prior exposures to biological disease-modifying antirheumatic drugs (bDMARDs). The safety profiles of upadacitinib in nr-axSpA mirrored those in other indications, underscoring its potential as a promising treatment option for nr-axSpA. Concurrently, physicians should be aware of the absence of real-world data, longitudinal efficacy and safety, direct comparative studies between upadacitinib and bDMARDs in nr-axSpA, and evidence for precision medicine to identify patients who may optimally benefit from upadacitinib over bDMARDs. Future research is imperative to facilitate the effective utilization of upadacitinib in daily clinical practice.
Topics: Adult; Humans; Spondylarthritis; Non-Radiographic Axial Spondyloarthritis; Spondylitis, Ankylosing; Heterocyclic Compounds, 3-Ring; Antirheumatic Agents
PubMed: 37955181
DOI: 10.1080/1744666X.2023.2282696 -
BMJ Case Reports Nov 2021Pseudoankylosis is a rare condition that causes inability to open the mouth due to condition related to outside of the temporomandibular joint. Most literature refers to...
Pseudoankylosis is a rare condition that causes inability to open the mouth due to condition related to outside of the temporomandibular joint. Most literature refers to this hypomobility disorder, a result of fusion of the zygomatic bone to the coronoid process, and very rarely is insidious coronoid hyperplasia causing mechanical interference with the posterior maxilla has been reported. We present a case of a 45-year-old woman, who presented with coronoid malformation and overgrowth resulting in progressive decrease in mouth opening. She was managed with coronoidectomy, following which good mouth opening was obtained. In this paper we discuss about the diagnosis and management of this rare disorder.
Topics: Ankylosis; Female; Humans; Mandible; Middle Aged; Mouth; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 34844960
DOI: 10.1136/bcr-2021-244616