-
Heterotopic ossification after alloplastic temporomandibular joint replacement: a case cohort study.BMC Musculoskeletal Disorders Jul 2022Heterotopic ossification (HO) is one of the serious complications leading to the failure of alloplastic temporomandibular joint replacement (TJR). However, there was few...
BACKGROUND
Heterotopic ossification (HO) is one of the serious complications leading to the failure of alloplastic temporomandibular joint replacement (TJR). However, there was few research on its exact incidence and occurrence. Severe HO might result in pain and limited mouth opening after surgery. Therefore, it is necessary to clarify its clinical and imaging manifestations. The purpose of this study was to study the occurrence and classify HO after the alloplastic TJR.
METHOD
Patients who underwent standard TJR (Zimmer Biomet stock prostheses or Chinese stock prostheses) with fat graft and at least 1-year-follow-up were included. HO was classified into 4 types according to postoperative computed tomography (CT) scans. Type and occurrence in different TMJ disease were compared. Joint space within 1 week after operation was measured and compared between HO and non-HO TJRs. Maximum incisal opening (MIO), pain, and quality of life (QoL) were recorded and their relevance with HO was analyzed statistically.
RESULT
81cases with 101 joints were included in the study. The mean follow-up time was 22.9 months (12 ~ 56 months). Among the 48 joints, 27 (56.3%) were type I (bone islands); 16 (33.3%) were type II (bone spurs from the mandibular ramus); 3 (6.3%) were type III (bone spurs from the fossa); and 2 (4.2%) were type IV (bone spurs from both the mandibular ramus and fossa). In HO patients, joint space in type IV was smaller than the other 3 types. Pain scores in HO were significantly greater than non-HO patients before and after operations (p < 0.05). 1 patient in Type IV HO developed ankylosis and had prosthesis revision which accounted for 2.1% in HO patients and 1.0% in all TJR patients.
CONCLUSION
HO after alloplastic TJR with fat graft was not severe except for type IV, which was easy to cause ankylosis. Preserving sufficient TJR space was important for ankylosis prevention.
Topics: Ankylosis; Arthroplasty, Replacement; Cohort Studies; Humans; Ossification, Heterotopic; Osteophyte; Pain; Quality of Life; Temporomandibular Joint; Treatment Outcome
PubMed: 35787680
DOI: 10.1186/s12891-022-05582-5 -
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 -
Current Opinion in Rheumatology Jul 2013To review the optimal criteria and conditions for establishing a clinical registry, as well as detailing their application in a number of ankylosing spondylitis (AS) and... (Review)
Review
PURPOSE OF REVIEW
To review the optimal criteria and conditions for establishing a clinical registry, as well as detailing their application in a number of ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) Registries already in existence.
RECENT FINDINGS
Recent genetic studies and studies of long-term treatment efficacy and side-effects have underscored the need for large numbers of patients, much larger than would be possible from a single center or consortium. An optimal Registry should have its aims established upfront, with appropriate governance and oversight, and inclusion and exclusion criteria for participating collaborators and subject defined. Collaborators contributing subjects to a Registry should use validated instruments for which they have been previously trained. The numerous cross-sectional and longitudinal Registries on AS and axSpA have been recently established that differ widely depending on the referral and selection issues.
SUMMARY
The challenge of large-scale examinations of genetics, comorbidities, medication usage, and side-effects in spondyloarthritis underscores the need for combining data from well characterized registries of AS patients which require careful planning. There are currently many such registries available internationally, offering promise for collaborations and data pooling that can answer some of the pressing questions facing rheumatology clinicians and researchers.
Topics: Humans; International Cooperation; Prevalence; Registries; Spondylitis, Ankylosing; Treatment Outcome
PubMed: 23656716
DOI: 10.1097/BOR.0b013e3283620e1d -
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 -
The Korean Journal of Gastroenterology... Jun 2022Primary biliary cholangitis is a chronic inflammatory autoimmune liver disease that is characterized by a positive antimitochondrial antibodies test and progressive...
Primary biliary cholangitis is a chronic inflammatory autoimmune liver disease that is characterized by a positive antimitochondrial antibodies test and progressive destruction of the small intrahepatic bile duct. Ankylosing spondylitis is a chronic, systemic, inflammatory disease of the spine and the sacroiliac joints. The association between these two is very low. This paper reports a rare case who had ankylosing spondylitis and developed primary biliary cholangitis.
Topics: Autoimmune Diseases; Bile Ducts, Intrahepatic; Cholangitis; Humans; Liver Cirrhosis, Biliary; Spondylitis, Ankylosing
PubMed: 35746842
DOI: 10.4166/kjg.2022.048 -
Health and Quality of Life Outcomes Jul 2022Patients who suffered from ankylosing spondylitis (AS) or non-radiographic axial spondyloarthritis (nr-axSpA) often have poor quality of life (QoL) and there has been a... (Meta-Analysis)
Meta-Analysis Review
The validity and reliability of quality of life questionnaires in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and meta-analysis.
BACKGROUND
Patients who suffered from ankylosing spondylitis (AS) or non-radiographic axial spondyloarthritis (nr-axSpA) often have poor quality of life (QoL) and there has been a substantial increase in research on acceptable questionnaires for assessment of QoL. This systematic review aims at examining the validity and reliability of QoL questionnaires in patients with AS/nr-axSpA.
METHODS
Randomized controlled trials (RCTs), cohort trials, and cross-sectional trails were retrieved by searching seven databases. Primary outcomes included test-retest reliability and construct validity. Secondary outcomes included internal consistency, structural validity, responsiveness and so on. Data extraction and analyses were conducted according to the Cochrane standards. The Agency for Healthcare Research and Quality (AHRQ) checklists was used to assess the risk of bias for each included study. We used the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) to assess the methodological quality and measurement property of included instruments. The quality of evidence on pre-specified outcomes were assessed by the Grades of Recommendations, Development and Evaluation (GRADE) approach.
RESULTS
22 publications containing 10 self-rating instruments were included in this study. Most studies were cross-sectional in design and a total of 3,085 participants were enrolled. 19 studies had moderate to high test-retest reliability. Cronbach's alpha (α) Coefficients were generally high (0.79-0.97) for overall scales. The ankylosing spondylitis quality of life (ASQOL) and evaluation of ankylosing spondylitis quality of life (EASi-QoL) questionnaires showed the strongest measurement properties in high-quality studies. The correlation coefficient for test-retest reliability of the ASQOL questionnaire was 0.85 (95% CI 0.80 to 0.89). The pooled Cronbach's α coefficients of the ASQOL questionnaire and the EASi-QoL questionnaire were high. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were considered as two validity criteria. For the ASQOL and EASi-QoL questionnaire, pooled convergent validity associations with BASDAI and BASFI were low to strong (0.24-0.81).
CONCLUSIONS
This study indicated acceptable reliability and stability of included QoL questionnaires. The ASQOL and the EASi-QoL questionnaires are validated and reliable disease-specific questionnaires for the assessment of QoL in patients with AS/nr-axSpA.
Topics: Axial Spondyloarthritis; Humans; Non-Radiographic Axial Spondyloarthritis; Quality of Life; Reproducibility of Results; Severity of Illness Index; Spondylitis, Ankylosing; Surveys and Questionnaires
PubMed: 35907948
DOI: 10.1186/s12955-022-02026-5 -
British Medical Journal Sep 1978
Topics: Exercise Therapy; Humans; Spondylitis, Ankylosing
PubMed: 698694
DOI: No ID Found -
Osteoarthritis and Cartilage Feb 2022Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing...
OBJECTIVE
Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing spondylitis (AS), no evident mechanisms are known.
DESIGN
To identify histopathological and physiological changes in enthesitis-related ankylosis in AS, we performed molecular characterization of transcription factors and surface markers, and transcriptome analysis with human tissues. Entheseal tissue containing subchondral bone was obtained from the facet joints of 9 patients with AS and 10 disease controls, and assessed by using differential staining techniques. Enthesis cells were isolated, characterized, stimulated with TNF and/or IL-17A, and analysed by cell-based experimental tools.
RESULTS
We found diffusely distributed granular tissue and cartilage in the subchondral bone in AS. Co-expression of SOX9, a specific transcription factor in cartilage, and matrix metalloproteinase 13 (MMP13) was found in the granular tissues within the subchondral bone from AS patients. Intriguingly, SOX9 expression was significantly higher in AS enthesis cells than controls and correlated with TNFR1 and IL-17RA expressions, which is important for high reactivity to TNF and IL-17A cytokines. Co-stimulation by TNF and IL-17A resulted in accelerated mineralization/calcification features, and increased OCN expression in AS enthesis cells. Furthermore, SOX9 overexpression in enthesis leads to promoting mineralization feature by TNF and IL-17A stimuli. Finally, OCN expression is elevated in the destructive enthesis of advanced AS.
CONCLUSION
These findings provide insight into the links between inflammation and the mineralization of entheseal tissue as the initiation of spinal ankylosis, emphasizing the importance of SOX9 enthesis cells.
Topics: Adult; Ankylosis; Cells; Female; Humans; Ligaments, Articular; Male; Middle Aged; SOX9 Transcription Factor; Spinal Diseases; Spondylitis, Ankylosing; Tendons
PubMed: 34826571
DOI: 10.1016/j.joca.2021.11.013 -
BMJ Case Reports Feb 2022
Topics: Humans; Kyphosis; Lumbar Vertebrae; Spondylitis, Ankylosing
PubMed: 35217558
DOI: 10.1136/bcr-2021-248542