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Gastroenterologia Y Hepatologia Jan 2018To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for... (Review)
Review
OBJECTIVE
To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service.
METHOD
Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria.
RESULTS
Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD.
CONCLUSION
Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases.
Topics: Delphi Technique; Diarrhea; Early Diagnosis; Gastroenterology; Gastrointestinal Hemorrhage; HLA-B27 Antigen; Humans; Inflammatory Bowel Diseases; Low Back Pain; Rectum; Referral and Consultation; Rheumatology; Sacroiliitis; Sensitivity and Specificity; Spondylarthritis; Symptom Assessment
PubMed: 28882616
DOI: 10.1016/j.gastrohep.2017.03.012 -
The Cochrane Database of Systematic... Dec 2011Ulcerative colitis is a chronic relapsing disease characterised by diffuse mucosal inflammation limited to the colon. Current maintenance treatments have multiple... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ulcerative colitis is a chronic relapsing disease characterised by diffuse mucosal inflammation limited to the colon. Current maintenance treatments have multiple adverse events and an effective treatment with minimal adverse events is desired. Several studies have demonstrated the importance of intestinal flora in the pathogenesis of ulcerative colitis. It has been suggested that modifying the bacterial flora with probiotics may attenuate the inflammatory process and prevent relapses in ulcerative colitis.
OBJECTIVES
The primary objectives were to determine the efficacy and safety of probiotics for the maintenance of remission in ulcerative colitis.
SEARCH METHODS
The Cochrane Central Register of Controlled Tials (CENTRAL), MEDLINE (1966 to July 2011), EMBASE (1974 to July 2011), CINAHL (1982 to July 2011) and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched. Manufacturers of probiotics were contacted to identify any unpublished trials. References of trials were also searched for any additional trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention for the maintenance of remission in ulcerative colitis were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical or endoscopic relapse.
MAIN RESULTS
Four studies (n = 587) met the inclusion criteria and were included in the review. Three trials compared probiotics to mesalazine and one trial compared probiotics with placebo. The studies ranged in length from 3 to 12 months. The risk of bias was high in two studies due to incomplete outcome data and lack of blinding. The methods used for allocation concealment were unclear for all four studies. There was no statistically significant difference between probiotics and mesalazine for maintenance of remission in UC. Relapse was reported in 40.1% of patients in the probiotics group compared to 34.1% of patients in the mesalazine group (3 studies; 555 patients: OR 1.33; 95% CI 0.94 to 1.90 ; I(2) = 11%). There was no statistically significant difference in the incidence of adverse events. Twenty-six per cent of patients in the probiotics group experienced at least one adverse event compared to 24% of patients in the mesalazine group (2 studies; 430 patients OR 1.21; 95% CI 0.80 to 1.84; I(2) =27%). Adverse events reported in the mesalazine-controlled studies include diarrhea, mucous secretion, bloody stools, abdominal pain, flatulence and distension, nausea and vomiting and headache. A small placebo controlled trial (n = 32) found no statistically significant difference in efficacy. Seventy-five per cent of probiotic patients relapsed at one year compared to 92% of placebo patients (OR 0.27; 95% CI 0.03 to 2.68). Adverse events reported in the placebo-controlled study include flatulence, abdominal bloating and pain, changes in faecal consistency, arthralgia, sacroiliitis, tiredness, incontinence, stress, oral blisters, eye dryness, headache, dizziness, influenza, gastroenteritis, cystitis and pneumonia.
AUTHORS' CONCLUSIONS
Given the relatively small number of patients in the pooled analysis, the small number of events and the high risk and unclear risk of bias in the included studies, there is insufficient evidence to make conclusions about the efficacy of probiotics for maintenance of remission in UC. There is a lack of well-designed RCTs in this area and further research is needed.
Topics: Colitis, Ulcerative; Humans; Probiotics; Randomized Controlled Trials as Topic; Remission Induction
PubMed: 22161412
DOI: 10.1002/14651858.CD007443.pub2 -
Therapeutic Advances in Musculoskeletal... 2021Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical... (Review)
Review
BACKGROUND
Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical outcomes. We aimed to estimate the prevalence of axSpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging and identify the IBD features potentially associated with axSpA.
METHODS
PubMed, Embase and Cochrane databases were searched systematically between 1990 and 2018. Article reference lists and key conference abstract lists from 2012 to 2018 were also reviewed. All abstracts were reviewed by two authors to determine eligibility for inclusion. The study inclusion criteria were (a) adults aged 18 years or above, (b) a clinical diagnosis of IBD and (c) reporting identification of sacroiliitis using cross-sectional imaging.
RESULTS
A total of 20 observational studies were identified: 12 used CT, 6 used MR and 2 utilised both computed tomography (CT) and magnetic resonance (MR) imaging. Sample sizes ranged from 25 to 1247 (a total of 4096 patients); 31 studies were considered to have low selection bias, 13 included two or more radiology readers, and 3 included rheumatological assessments. The prevalence of sacroiliitis, the most commonly reported axSpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% [95% confidence interval (CI) 17-26%]. Associated IBD features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn's disease and ulcerative colitis was identified. Study limitations include variability in the individual study sample sizes and patient demographics.
CONCLUSION
This review highlights the need for larger, well-designed studies using more sensitive imaging modalities and multivariable modelling to better estimate the prevalence of axSpA in IBD. An improved knowledge of the IBD phenotype(s) associated with axSpA and use of cross-sectional imaging intended for IBD assessment to screen for axSpA may help clinicians identify those patients most at risk.
PubMed: 33786068
DOI: 10.1177/1759720X21996973 -
The Cochrane Database of Systematic... 2004Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause, characterized by sacroiliitis and spondylitis. To date, treatment of AS has been limited... (Review)
Review
BACKGROUND
Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause, characterized by sacroiliitis and spondylitis. To date, treatment of AS has been limited to the alleviation of symptoms, mainly using non-steroidal anti-inflammatory drugs (NSAIDs). For patients refractory or intolerant to NSAIDs, the disease modifying antirheumatic drugs (DMARDs) have been used as a second line approach. Methotrexate (MTX) is currently one of the most widely used DMARDs and its efficacy in rheumatoid arthritis (RA) has been confirmed (Suarez-Almazor 2003). There is uncertainty whether MTX works in the treatment of AS.
OBJECTIVES
To evaluate the efficacy and toxicity of methotrexate in the treatment of ankylosing spondylitis.
SEARCH STRATEGY
Relevant randomised and quasi-randomised trials in any language were sought using the following sources: CENTRAL (Cochrane Central Register of Controlled Trials, Issue 2, 2003), MEDLINE (1966 to June Week 4 2003), EMBASE (1980 to 2003 Week 26), CINAHL (1982 to June Week 3 2003) and the reference section of retrieved articles.
SELECTION CRITERIA
We evaluated randomised and quasi-randomised trials examining the efficacy of methotrexate on AS.
DATA COLLECTION AND ANALYSIS
Unblinded trial reports were reviewed independently by two reviewers according to the selection criteria. Disagreements on the inclusion of the studies were resolved, where necessary, by recourse to a third reviewer. The methodological quality of included trials were independently assessed by the same reviewers on randomization, concealment, blindness (participants, care providers and outcome investigators), description of withdrawals and drop-outs and intention-to-treat analysis. The same reviewers independently entered the data extracted from the included trials, using RevMan's double entry facility. In the absence of significant heterogeneity, results were combined using weighted mean difference or standardised mean difference for continuous data, and relative risk for dichotomous data.
MAIN RESULTS
Two trials met the inclusion criteria. Altan 2001compared naproxen plus MTX (7.5 mg/week orally) with naproxen alone and Roychowdhury 2002 compared MTX (10 mg/week orally) with placebo. The duration of the trials were 12 months and 24 weeks, respectively. They assessed different outcomes except for C-reactive protein (CRP). The included trials treated a total of 81 patients and assessed more than 10 outcomes relevant to the review, covering function, pain, peripheral arthritis/enthesitis, morning stiffness, patient and physician global assessment, CRP and erythrocyte sedimentation rate (ESR). No significant difference between intervention groups was found favouring MTX over no MTX. No serious side effect was reported in either trial.
REVIEWERS' CONCLUSIONS
There was no statistically significant benefit of MTX in the examined outcomes for AS patients. High quality, larger sample and longer period of randomized controlled trials (possibly with higher dosage of MTX) are needed to verify the uncertainty about the efficacy and toxicity of MTX for the treatment of AS.
Topics: Antirheumatic Agents; Humans; Methotrexate; Naproxen; Randomized Controlled Trials as Topic; Spondylitis, Ankylosing
PubMed: 15266537
DOI: 10.1002/14651858.CD004524.pub2 -
Iranian Journal of Medical Sciences Dec 2013Brucellosis is a protean disease and should be excluded in any febrile child with a constellation of symptoms such as fever, malaise, sweating, arthralgia, and joint... (Review)
Review
Brucellosis is a protean disease and should be excluded in any febrile child with a constellation of symptoms such as fever, malaise, sweating, arthralgia, and joint swelling in endemic areas. Skeletal system involvement is the most common source of complaints in brucellosis. The frequency of skeletal involvement in children is 6.4% to 73.5%. There are some controversies regarding the most common sites of involvement: sacroiliac versus peripheral joints. In the vast majority of cases, peripheral joint involvement in pediatric brucellosis has a monoarticular pattern, although there is no agreement about the most commonly involved peripheral joint. In this systematic review, published articles that describe the bone involvement of Brucella melitensis, as the most prevalent kind of the microorganism in the region, in children are evaluated.
PubMed: 24293781
DOI: No ID Found -
Medicine Jan 2024This systematic literature review and meta-analysis aimed to assess the accuracy, sensitivity, and specificity of dual-energy computed tomography (DECT) of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic literature review and meta-analysis aimed to assess the accuracy, sensitivity, and specificity of dual-energy computed tomography (DECT) of the sacroiliac joint. Bone marrow edema (BME) of the sacroiliac joint is an early manifestation of some diseases, such as ankylosing spondylitis, and is usually examined by nuclear magnetic resonance imaging (MRI); however, MRI can be intolerable for some patients; hence, numerous studies have analyzed DECT examinations.
METHODS
We searched PUBMED, CNKI, and EMBASE in 2023 for articles containing the following terms (DECT) or (DE-CT) or (dual-energy CT) or "dual-energy CT" or (dual-energy computed tomography) and ((sacroiliac joint) or (ankylosing spondylitis) or (sacroiliac arthritis) or (sacroiliitis)). An initial search identified 444 articles, of which 7 met the criteria. Data were extracted to calculate the sensitivity, specificity, and diagnostic odds for analysis using R software.
RESULTS
Out of 291 patients and 577 sacroiliac joints, 429 (74.35%) exhibited BME. All studies used magnetic resonance as the control group. The overall sensitivity and specificity of DECT were 79%, and 92%, respectively, with positive prediction rate of 92.55% and negative prediction rate of 83.73%.
CONCLUSION
DECT appears to be a promising diagnostic tool for detecting BME in the sacroiliac joint and can be used as an alternative examination method for patients in whom MRI is contraindicated.
Topics: Humans; Sacroiliac Joint; Spondylitis, Ankylosing; Bone Marrow; Edema; Tomography
PubMed: 38181261
DOI: 10.1097/MD.0000000000036708 -
The Journal of Rheumatology Dec 2003To determine the standardization and the observer reliability of potentially diagnostic plain radiographic features of psoriatic arthritis (PsA). (Review)
Review
OBJECTIVE
To determine the standardization and the observer reliability of potentially diagnostic plain radiographic features of psoriatic arthritis (PsA).
METHODS
Radiographic features were chosen on the basis of a systematic review of the literature. One hundred sixty-four radiographs from 62 patients were selected from various sources by a musculoskeletal radiologist. Radiographs were read independently by 2 observers (WJT, PSH) and scored for the presence or absence of each evaluated feature. Cohen's kappa was used to determine observer agreement beyond chance, and the accuracy of each observer (with reference to the radiologist's judgment) was determined by likelihood ratios.
RESULTS
The 2 observers demonstrated similar accuracy, although WJT tended to be more accurate for items classed as absent and PSH more accurate for items classed as present. The following features showed sufficient reliability to be reasonably included in further testing of their discriminatory value (intra- and interobserver kappa values): marginal syndesmophyte (0.68, 0.69), non-marginal syndesmophyte (0.75, 0.59), paravertebral ossification (0.89, 0.79), destructive discovertebral lesion (0.85, 0.65), Romanus lesion (0.64, 0.43), sacroiliitis (0.99, 0.86), entheseal erosion (0.80, 0.71), entheseal ossification (0.69, 0.76), distal interphalangeal erosive disease (0.58, 0.52), joint osteolysis (0.62, 0.47), juxtaarticular bony proliferation (0.43, 0.42), bony ankylosis (0.53, 0.54), tuft osteolysis (0.51, 0.36). The features that showed inadequate reliability were: loss of cortical definition of terminal tuft (0.33, 0.31) and periosteal new bone formation (0.42, 0.03).
CONCLUSION
A number of plain radiographic features of PsA have sufficient reliability to justify inclusion in diagnostic classification criteria sets for further testing.
Topics: Arthritis, Psoriatic; Arthrography; Databases, Factual; Humans; Observer Variation; Reproducibility of Results
PubMed: 14719209
DOI: No ID Found -
Annals of the Rheumatic Diseases Aug 2015The aim of this work was to develop a consensual recommendation under the auspices of the Assessment of SpondyloArthritis international Society (ASAS) for early referral... (Review)
Review
The aim of this work was to develop a consensual recommendation under the auspices of the Assessment of SpondyloArthritis international Society (ASAS) for early referral of patients with a suspicion of axial spondyloarthritis by non-rheumatologists. The development of a referral recommendation consisted of four phases: (1) systematic literature review, (2) the first Delphi round aiming at identification of unmet needs and development of a candidate list of referral parameters, (3) the second Delphi round aiming at identification of the most useful combination of referral parameters and (4) final discussion and formal endorsement by ASAS membership. The following consensus on a referral recommendation was achieved as a result of the Delphi processes and final voting: "Patients with chronic back pain (duration ≥3 months) and back pain onset before 45 years of age should be referred to a rheumatologist if at least one of the following parameters is present: Inflammatory back pain; human leucocyte antigen-B27; Sacroiliitis on imaging if available (X-rays or magnetic resonance imaging); Peripheral manifestations (arthritis, enthesitis, dactylitis); Extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis); Positive family history for spondyloarthritis; Good response to non-steroidal anti-inflammatory drugs; Elevated acute phase reactant." A consensual ASAS-endorsed referral recommendation for patients suspected of having axial spondyloarthritis was developed as a flexible and universal strategy to be used in clinical practice by primary care physicians or non-rheumatology specialists. The practical value of this strategy applied in different settings should be determined in future studies.
Topics: Back Pain; Chronic Disease; Delphi Technique; Humans; Program Development; Referral and Consultation; Rheumatology; Spondylarthropathies
PubMed: 25990288
DOI: 10.1136/annrheumdis-2014-207151 -
Advances in Rheumatology (London,... Feb 2020Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular...
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Biological Therapy; Brazil; Exercise; Exercise Therapy; Glucocorticoids; HLA-B27 Antigen; Humans; Magnetic Resonance Imaging; Patient Education as Topic; Prognosis; Reproducibility of Results; Rheumatology; Sacroiliac Joint; Sacroiliitis; Societies, Medical; Spine; Spondylarthritis
PubMed: 32171329
DOI: 10.1186/s42358-020-0116-2 -
Skeletal Radiology Sep 2021MRI criteria are central to the diagnosis of non-radiographic axial spondyloarthropathy (nr-axSpA). The cardinal feature of nr-axSpa is inflammatory low back pain, which... (Review)
Review
INTRODUCTION
MRI criteria are central to the diagnosis of non-radiographic axial spondyloarthropathy (nr-axSpA). The cardinal feature of nr-axSpa is inflammatory low back pain, which may be difficult to distinguish from highly prevalent non-specific low back pain. This study aims to determine the frequency of relevant MRI findings in the sacroiliac joints (SIJ) of patients without Spondyloarthropathy (SpA), and therefore estimate the specificity of MRI scans for SpA.
METHODS
EMBASE and Medline were searched and limited to English. Titles were screened for relevance, with studies that included primary MRI findings in patients without SpA triggering retrieval. Retrieved papers were reviewed, data extracted by two authors and quality criteria (QUADAS 2) were applied. Findings were considered for asymptomatic and symptomatic individuals.
RESULTS
The search recovered 2172 articles. Abstracts of 117 were reviewed for full text retrieval, 11 papers met eligibility criteria. These papers described MRI findings of 1180 asymptomatic patients and 1318 with low back symptoms but without SpA. In relevant populations, bone marrow oedema was found in 22% (95% CI 19-25) of asymptomatic and 20% (95% CI 18-22) of asymptomatic individuals. In all non-Spa patients, sclerosis was found in 13.4% and erosions in 6.5%.
CONCLUSIONS
There is a significant frequency of diagnostically pertinent MRI abnormalities in the SIJ of patients without SpA. These are present in both asymptomatic and symptomatic individuals. Findings, such as oedema and sclerosis, lack specificity and should be interpreted with caution. Erosions are less frequent and are likely more specific for SpA.
Topics: Back Pain; Humans; Magnetic Resonance Imaging; Sacroiliac Joint; Sacroiliitis; Spondylarthritis; Spondylarthropathies
PubMed: 33547535
DOI: 10.1007/s00256-021-03719-6