BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune respons...BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune responses.Numerous studies have investigated links between AS and various infections-bacterial,viral,fungal,and other microorganism infections.However,limited attention has been given to the association between AS and Clonorchis sinensis(C.sinensis)infection.CASE SUMMARY A 27-year-old male with a 10-yr history of AS presented to our hospital with inflammatory lower back pain as the primary manifestation.Ten years ago,the patient had achieved a stable condition after treatment with biological agents.However,he experienced a recurrence of lumbosacral pain with an unexplained cause 10 d before hospital admission.A lumbosacral magnetic resonance imaging(MRI)scan revealed bone marrow edema in the left sacroiliac joint,and laboratory indicators were elevated.Moreover,the presence of C.sinensis eggs was detected in the stool.The patient was prescribed praziquantel,resulting in the disap-pearance of C.sinensis eggs in subsequent routine stool tests and relief from lumbosacral pain.A follow-up MRI scan performed after 4 months revealed a reduction in bone marrow edema around the left sacroiliac joint.CONCLUSION C.sinensis infections could potentially trigger the exacerbation of AS.Clinicians should pay attention to investigating the presence of infections.INTRODUCTION Ankylosing spondylitis(AS)is a chronic inflammatory and rheumatic disease resulting from an imbalance between innate and acquired immune responses[1].While it can affect any part of the spine,its primary symptoms are persistent back pain and stiffness in the lower back and pelvis.The prevalence of AS per 10000 individuals is 23.8 in Europe,31.9 in North America,16.7 in Asia,10.2 in Latin America,and 7.4 in Africa[2].Infections commonly occur in the first 3 months and may act as potential triggers for the first symptoms of AS,often manifesting as gastrointestinal,urinary tract,and respiratory infections of microbiological origin[3,4].Clonorchis sinensis(C.sinensis)infection is a severe parasitic disease affecting millions globally,especially prevalent in China,South Korea,the Far East of Russia,and Vietnam,with an estimated 15 million cases[5].Transmission occurs through the consumption of undercooked freshwater fish containing metacercariae.Adult C.sinensis parasites then establish themselves within the human hepatobiliary system[6].C.sinensis infection triggers the activation of sphingosine 1-phosphate receptor 2,leading to the injury and fibrosis of the hepatobiliary[7].Recent research in a rat model found that C.sinensis infection increases the risk of hepatocellular carcinoma by stimulating hepatic progenitor cell proliferation[8].Complications of C.sinensis infection include cholestasis,cholangitis,biliary system fibrosis,and in severe cases,the development of cholangiocarcinoma[9].Consequently,the primary preventive measure is to abstain from consuming raw or undercooked freshwater fish.Praziquantel is the recommended and effective treatment for this infection[10].While there is existing literature on the coexistence of AS and parasitic infections,there is limited research specifically addressing the simultaneous presence of AS and C.sinensis infection.This case report details a rare scenario of AS coexisting with C.sinensis infection,underscoring the potential impact of C.sinensis infection on AS disease activity.展开更多
Ankylosing spondylitis(AS)has a very high disability rate.How to effectively inhibit the formation of new bones has become a difficult point in clinical treatment.In recent years,research has shown that different trea...Ankylosing spondylitis(AS)has a very high disability rate.How to effectively inhibit the formation of new bones has become a difficult point in clinical treatment.In recent years,research has shown that different treatment plans can have an impact on inhibiting new bone formation.In this paper,the different effects of new bone formation in the treatment of AS with traditional Chinese and Western medicine are systematically listed.展开更多
BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,ch...BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.展开更多
Ankylosing spondylitis(AS)is a chronic progressive inflammatory immune disease,which mainly affects the spine and sacroiliac joints,with a high rate of late disability.At present,because the pathogenesis of the diseas...Ankylosing spondylitis(AS)is a chronic progressive inflammatory immune disease,which mainly affects the spine and sacroiliac joints,with a high rate of late disability.At present,because the pathogenesis of the disease is not clear,its treatment targets are not clear,and there is no consensus on intervention measures.Therefore,further exploration of the mechanism of the disease has certain guiding significance for clinical application.At the same time,non-coding RNA can regulate protein translation,participate in the physiological and pathological changes of AS,and is closely related to the progress of AS.Its internal mechanism and potential targets are worthy of in-depth study.This article summarizes the research progress of non-coding RNA involved in AS through the regulation of bone metabolism,inflammation,cell death and autophagy,in order to provide a theoretical basis for exploring potential clinical diagnostic markers and therapeutic targets of AS.展开更多
BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint s...BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.展开更多
This paper reviews the advances in research of co-pathogenesis and clinical treatment of ankylosing spondylitis(AS)and inflammatory bowel disease(IBD),in order to offer ideal therapeutic effects for comorbid patients ...This paper reviews the advances in research of co-pathogenesis and clinical treatment of ankylosing spondylitis(AS)and inflammatory bowel disease(IBD),in order to offer ideal therapeutic effects for comorbid patients and to provide new ideas for clinical practice.展开更多
Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80%...Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.展开更多
Ankylosing Spondylitis (AS), also known as spondylitis, is a rheumatic disorder that develops gradually in the sacroiliac, lumbar, thoracic and cervical spine and can involve peripheral joints in severe cases. The dis...Ankylosing Spondylitis (AS), also known as spondylitis, is a rheumatic disorder that develops gradually in the sacroiliac, lumbar, thoracic and cervical spine and can involve peripheral joints in severe cases. The disease is insidious, starting in the sacroiliac and hip joints and gradually involving the entire spine. AS, also known as seronegative arthritis, is primarily due to a negative response to the susceptibility sheep blood clotting test (RF). Until the 1960s, it was known as “central rheumatoid arthritis” and “rheumatoid spondylitis”. At present, modern medicine has no effective treatment for this disease, but Chinese medicine treatment for ankylosing spondylitis is based on the concept of treating both the symptoms and the underlying cause of the disease, with few side effects and significant clinical effects, and has become a research hotspot in recent years, worthy of further investigation.展开更多
Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on ...Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.展开更多
Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Meth...Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Method 29 patients with active AS were selected to take GTT (1mg per kg) three times a day for one year. After that, its curative effect was evaluated. The serum level of sIL-2R of these patients was measured by sandwich ELISA method and was compared with that of normal subjects. Result The serum level of sIL-2R in active AS patients was obviously higher than that of the non-active AS patients. (P<0.01). The total effective rate of GTT on AS was 89.6%, while clinical relief rate 27.6%, obvious effective rate 44.8%, effective rate 17.2% and non-effective rate 10.4%. The patients’ serum level of sIL-2R after therapy was significantly lower than that before therapy except patients with no effect. (P<0.05). Conclusion GTT has positive curative effect on active AS patients and could cause obvious decrease of the serum level of sIL-2R. The serum level of sIL-2R can be used as an important index of activity of AS and as a guide of therapy.展开更多
Objective:To explore the expression of IL-2 and IL-11 and its significance in patients with ankylosing spondylitis(AS).Methods:A total of 48 active AS patients in our hospital and 40 normal control subjects were selec...Objective:To explore the expression of IL-2 and IL-11 and its significance in patients with ankylosing spondylitis(AS).Methods:A total of 48 active AS patients in our hospital and 40 normal control subjects were selected in our study.Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis functional index(BASFI),Bath ankylosing spondylitis metrology index(BASMI),ESR and CRP expression levels were compared before treatment,12 h after treatment and 24 h after treatment.IL-2 and IL-11 expression were also compared between these two groups.Results:The BASDAI score,BASH score and BASMI score of the AS patients before treatment significantly decreased compared with those 12 weeks and 24 weeks after treatment(P【0.05).ESB and CRP levels of the AS patients 12 weeks and 24 weeks after treatment significantly decreased compared with those before treatment(P【0.05).Difference was significant in serum IL-2 and IL-11 levels between 12 weeks and 24 weeks after treatment and before treatment(P【0.05).And no statistically significance was observed for serum IL-2 and IL-11 levels between normal control group and those of patients in AS group 24 weeks after treatment(P】0.05). Pearson’s linear-correlation analysis showed that serum IL-2 level had a positive correlation with BASDAI,BASFI,BASMI,ESR and CRP(r=0.661.0.547,0.474,0.362,0.416,P【0.05) and serum IL-11 level had a negative correlation with BASDAI,BASFI,BASMI,ESR and CRP(r=-0.629, -0.412,-0.422,-0.387,-0.408,-0.315,P【0.05).Conclusions:Serum levels of IL-2 in active AS patients significantly increase and will decrease after treatment.However,serum levels of IL- 11 significantly decrease and will increase after treatment,which indicates that serum IL-2 has a positive correlation with the degree of AS and serum IL-11 has a negative correlation with the degree of AS,both of which are correlated closely with the onset of AS.展开更多
BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and ...BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists.Bronchial blockers(BBs)have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODS We studied 12 AS patients(11 men and one woman)with lung or esophageal cancer who underwent thoracotomy with a BB.Preoperative airway evaluation found that all patients had a difficult airway.All patients received an intramuscular injection of penehyclidine hydrochloride(0.01 mg/kg)before anesthesia.In the operating room,dexmedetomidine(0.5μg/kg)was infused intravenously for 10 min,with 2%lidocaine for airway surface anesthesia,and a 3%ephedrine cotton swab was used to contract the nasal mucosa vessels.Before tracheal intubation,fentanyl(1μg/kg)and midazolam(0.02 mg/kg)were administered intravenously.Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position.Intravenous anesthesia was administered immediately after successful intubation,and a BB was inserted laterally.The pre-intubation preparation time,intubation time,facial grimace score,airway responsiveness score during the fiberoptic introduction,time of end tracheal catheter entry into the nostril,and lung collapse and surgical field score were measured.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded while entering the operation room(T1),before intubation(T2),immediately after intubation(T3),2 min after intubation(T4),and 10 min after intubation(T5).After surgery,all patients were followed for adverse reactions such as epistaxis,sore throat,hoarseness,and dysphagia.RESULTS All patients had a history of AS(20.4±9.6 years).They had a Willson's score of 5 or above,grade III or IV Mallampati tests,an inter-incisor distance of 2.9±0.3 cm,and a thyromental(T-M)distance of 4.8±0.7 cm.The average pre-intubation preparation time was 20.4±3.4 min,intubation time was 2.6±0.4 min,facial grimace score was 1.7±0.7,airway responsiveness score was 1.1±0.7,and pulmonary collapse and surgical exposure score was 1.2±0.4.The SBP,DBP,and HR at T5 were significantly lower than those at T1-T4(P<0.05).While the values at T1 were not significantly different from those at T2-T4(P>0.05),they were significantly different from those at T5(P<0.05).Seven patients had minor epistaxis during endotracheal intubation,two were followed 24 h after surgery with a mild sore throat,and two had hoarseness without dysphagia.CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia.Proper doses of penehyclidine hydrochloride,dexmedetomidine,fentanyl,and midazolam,combined with 2%lidocaine,administered prior to intubation,can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients.BBs are safe and effective for onelung ventilation in such patients during thoracotomy.展开更多
Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predomin...Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.展开更多
Objective: To observe the expression and significance of fibronectin and metalloproteinase-3(MMP-3) in patients with ankylosing spondylitis(AS). Methods: A total of 30 AS patients in our hospital and 30 healthy volunt...Objective: To observe the expression and significance of fibronectin and metalloproteinase-3(MMP-3) in patients with ankylosing spondylitis(AS). Methods: A total of 30 AS patients in our hospital and 30 healthy volunteers were selected in our study. Fibronectin and MMP-3 were measured and compared between these two groups. The AS group received sulfasalazine2 g daily for 3 months. Bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, bath ankylosing spondylitis metrology index, erythrocyte sedimentation rate and C-reactive protein were compared before and after treatment.Pearson's linear-correlation analysis was used to determine relationships between parameters.Results: Totally 28 patients in the AS group completed the study. Fibronectin and MMP-3 in peripheral blood of AS patients were evidently higher than that in the normal control group(P<0.05). After treated by sulfasalazine, the level of expressing Fibronectin and MMP-3 significantly decreased compared with baseline values(P<0.05). Pearson's linear-correlation analysis showed that serum fibronectin and MMP-3 level had a positive correlation with bath ankylosing spondylitis disease activity index global assessment, spine pain, night pain, general pain, erythrocyte sedimentation rate and C-reactive protein(P<0.05). Conclusions: The expression of fibronectin and MMP-3 in AS patients were significantly higher than that in the normal control group, and they all decreased significantly after treatment. It indicated that both fibronectin and MMP-3 were correlated closely with the onset of AS.展开更多
BACKGROUND Ankylosing spondylitis(AS)is an autoimmune disease characterized by sacroiliitis and spondylitis,with a few hematological abnormalities.Myelodysplastic syndromes(MDS)are a heterogeneous group of hematopoiet...BACKGROUND Ankylosing spondylitis(AS)is an autoimmune disease characterized by sacroiliitis and spondylitis,with a few hematological abnormalities.Myelodysplastic syndromes(MDS)are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena.The relationship between AS and MDS remains unknown.CASE SUMMARY We describe a rare case of concurrent AS and MDS.An 18-year-old man with low back pain and anemia was diagnosed with AS;however,the cause of anemia could not be determined by the first bone marrow examination.He recovered from anemia and the symptoms of AS resolved after treatment with etanercept,glucocorticoid,and blood transfusion,but he developed pancytopenia with an increased myeloblast count(from 2.5%to 9%).Chromosome analysis revealed del(7q)and trisomy 8.Refractory anemia with excess of blasts-1(RAEB-1)/MDS was confirmed by repeating the bone marrow examination.He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.CONCLUSION We suspect that AS may be an early autoimmune phenomenon related to MDS.However,a condition of coexistence cannot be excluded.展开更多
BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral bo...BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc.According to the literature,Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine(C5/6 and C6/7).One-stage anterior-posterior approach surgery was successfully performed.At the 6-month follow-up,the pain was significantly reduced,and the limb function was gradually improved.CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis.Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.展开更多
BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is s...BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.展开更多
BACKGROUND Ankylosing spondylitis(AS)is a systematic and rheumatic disease,which causes multiple symptoms.However,dysphagia due to the formation of a giant anterior cervical osteophyte is rare in patients with AS.CASE...BACKGROUND Ankylosing spondylitis(AS)is a systematic and rheumatic disease,which causes multiple symptoms.However,dysphagia due to the formation of a giant anterior cervical osteophyte is rare in patients with AS.CASE SUMMARY We present the case of a 65-year-old male patient who was diagnosed with AS and visited the hospital with a complaint of progressive dysphagia.The appropriate imaging examinations indicated that a giant anterior cervical osteophyte at C3-4 caused esophageal compression,which led to dysphagia.An operation for resection was performed without complications.CONCLUSION This case demonstrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS,and early accurate diagnosis and surgical treatment are very important for the improvement of symptoms.Anterior cervical discectomy and fusion are extremely effective and should be taken into consideration.展开更多
BACKGROUND Ankylosing spondylitis(AS)is strongly associated with the human leukocyte antigen(HLA)B27 haplotype.In regions where conventional polymerase chain reaction for HLA typing is available for antigens such as H...BACKGROUND Ankylosing spondylitis(AS)is strongly associated with the human leukocyte antigen(HLA)B27 haplotype.In regions where conventional polymerase chain reaction for HLA typing is available for antigens such as HLA B27 or HLA B51,it is common to perform the HLA B27 test for evaluation of AS.While HLA B27-associated clustered occurrences of AS have been reported in families,we report the first case series of HLA B51-related occurrences of AS in a family.CASE SUMMARY A father and his daughters were diagnosed with AS and did not have the HLA B27 haplotype.Although they were positive for HLA B51,they exhibited no signs of Behçet’s disease(BD).Of the five daughters,one had AS,and three,including the daughter with AS,were positive for HLA B51.The two daughters with the HLA B51 haplotype(excluding the daughter with AS)exhibited bilateral grade 1 sacroiliitis,whereas the daughters without the HLA B51 haplotype did not have sacroiliitis.Thus,this Korean family exhibited a strong association with the HLA B51 haplotype and clinical sacroiliitis,irrespective of the symptoms of BD.CONCLUSION It is advisable to check for HLA B51 positivity in patients with AS/spondyloarthropathy who test negative for HLA B27.展开更多
BACKGROUND Ankylosing spondylitis(AS)is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints.To the best of our knowledge,AS with acute myocardial infarction(AMI)has rarely be...BACKGROUND Ankylosing spondylitis(AS)is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints.To the best of our knowledge,AS with acute myocardial infarction(AMI)has rarely been reported.Here,we report an unusual case of AS with AMI in a young patient.CASE SUMMARY A 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14,2020,for low back pain.Further evaluation with clinical examinations,laboratory tests,and imaging resulted in a diagnosis of AS.Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms.However,his back pain persisted.After 6 wk of treatment,he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI.Angiography revealed severe narrowing of the coronary arteries.Surgical placement of two coronary stents completely relieved his back pain.CONCLUSION AS can cause cardiovascular diseases,including AMI.It is important to consider the cardiovascular risks in the management of AS.展开更多
基金Supported by Chongqing Municipal Health Commission's Key Discipline Construction Project of Traditional Chinese Medicine Bi Disease,Yu Traditional Chinese Medicine(2021),No.16.
文摘BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune responses.Numerous studies have investigated links between AS and various infections-bacterial,viral,fungal,and other microorganism infections.However,limited attention has been given to the association between AS and Clonorchis sinensis(C.sinensis)infection.CASE SUMMARY A 27-year-old male with a 10-yr history of AS presented to our hospital with inflammatory lower back pain as the primary manifestation.Ten years ago,the patient had achieved a stable condition after treatment with biological agents.However,he experienced a recurrence of lumbosacral pain with an unexplained cause 10 d before hospital admission.A lumbosacral magnetic resonance imaging(MRI)scan revealed bone marrow edema in the left sacroiliac joint,and laboratory indicators were elevated.Moreover,the presence of C.sinensis eggs was detected in the stool.The patient was prescribed praziquantel,resulting in the disap-pearance of C.sinensis eggs in subsequent routine stool tests and relief from lumbosacral pain.A follow-up MRI scan performed after 4 months revealed a reduction in bone marrow edema around the left sacroiliac joint.CONCLUSION C.sinensis infections could potentially trigger the exacerbation of AS.Clinicians should pay attention to investigating the presence of infections.INTRODUCTION Ankylosing spondylitis(AS)is a chronic inflammatory and rheumatic disease resulting from an imbalance between innate and acquired immune responses[1].While it can affect any part of the spine,its primary symptoms are persistent back pain and stiffness in the lower back and pelvis.The prevalence of AS per 10000 individuals is 23.8 in Europe,31.9 in North America,16.7 in Asia,10.2 in Latin America,and 7.4 in Africa[2].Infections commonly occur in the first 3 months and may act as potential triggers for the first symptoms of AS,often manifesting as gastrointestinal,urinary tract,and respiratory infections of microbiological origin[3,4].Clonorchis sinensis(C.sinensis)infection is a severe parasitic disease affecting millions globally,especially prevalent in China,South Korea,the Far East of Russia,and Vietnam,with an estimated 15 million cases[5].Transmission occurs through the consumption of undercooked freshwater fish containing metacercariae.Adult C.sinensis parasites then establish themselves within the human hepatobiliary system[6].C.sinensis infection triggers the activation of sphingosine 1-phosphate receptor 2,leading to the injury and fibrosis of the hepatobiliary[7].Recent research in a rat model found that C.sinensis infection increases the risk of hepatocellular carcinoma by stimulating hepatic progenitor cell proliferation[8].Complications of C.sinensis infection include cholestasis,cholangitis,biliary system fibrosis,and in severe cases,the development of cholangiocarcinoma[9].Consequently,the primary preventive measure is to abstain from consuming raw or undercooked freshwater fish.Praziquantel is the recommended and effective treatment for this infection[10].While there is existing literature on the coexistence of AS and parasitic infections,there is limited research specifically addressing the simultaneous presence of AS and C.sinensis infection.This case report details a rare scenario of AS coexisting with C.sinensis infection,underscoring the potential impact of C.sinensis infection on AS disease activity.
基金Supported by the National Natural Science Foundation of China(82205105).
文摘Ankylosing spondylitis(AS)has a very high disability rate.How to effectively inhibit the formation of new bones has become a difficult point in clinical treatment.In recent years,research has shown that different treatment plans can have an impact on inhibiting new bone formation.In this paper,the different effects of new bone formation in the treatment of AS with traditional Chinese and Western medicine are systematically listed.
文摘BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.
基金National Natural Science Foundation Regional Fund Project(No.81660800)2021 Guangxi Famous Traditional Chinese Medicine Studio Construction Project。
文摘Ankylosing spondylitis(AS)is a chronic progressive inflammatory immune disease,which mainly affects the spine and sacroiliac joints,with a high rate of late disability.At present,because the pathogenesis of the disease is not clear,its treatment targets are not clear,and there is no consensus on intervention measures.Therefore,further exploration of the mechanism of the disease has certain guiding significance for clinical application.At the same time,non-coding RNA can regulate protein translation,participate in the physiological and pathological changes of AS,and is closely related to the progress of AS.Its internal mechanism and potential targets are worthy of in-depth study.This article summarizes the research progress of non-coding RNA involved in AS through the regulation of bone metabolism,inflammation,cell death and autophagy,in order to provide a theoretical basis for exploring potential clinical diagnostic markers and therapeutic targets of AS.
文摘BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.
文摘This paper reviews the advances in research of co-pathogenesis and clinical treatment of ankylosing spondylitis(AS)and inflammatory bowel disease(IBD),in order to offer ideal therapeutic effects for comorbid patients and to provide new ideas for clinical practice.
文摘Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.
文摘Ankylosing Spondylitis (AS), also known as spondylitis, is a rheumatic disorder that develops gradually in the sacroiliac, lumbar, thoracic and cervical spine and can involve peripheral joints in severe cases. The disease is insidious, starting in the sacroiliac and hip joints and gradually involving the entire spine. AS, also known as seronegative arthritis, is primarily due to a negative response to the susceptibility sheep blood clotting test (RF). Until the 1960s, it was known as “central rheumatoid arthritis” and “rheumatoid spondylitis”. At present, modern medicine has no effective treatment for this disease, but Chinese medicine treatment for ankylosing spondylitis is based on the concept of treating both the symptoms and the underlying cause of the disease, with few side effects and significant clinical effects, and has become a research hotspot in recent years, worthy of further investigation.
基金Scientific Research and Cultivation Plan project of Beijing Municipal Hospital(No.PZ2019018).
文摘Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.
文摘Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum (GTT) on the serum level of soluble interleukin-2 receptor (sIL-2R) in patient with ankylosing spondylitis (AS). Method 29 patients with active AS were selected to take GTT (1mg per kg) three times a day for one year. After that, its curative effect was evaluated. The serum level of sIL-2R of these patients was measured by sandwich ELISA method and was compared with that of normal subjects. Result The serum level of sIL-2R in active AS patients was obviously higher than that of the non-active AS patients. (P<0.01). The total effective rate of GTT on AS was 89.6%, while clinical relief rate 27.6%, obvious effective rate 44.8%, effective rate 17.2% and non-effective rate 10.4%. The patients’ serum level of sIL-2R after therapy was significantly lower than that before therapy except patients with no effect. (P<0.05). Conclusion GTT has positive curative effect on active AS patients and could cause obvious decrease of the serum level of sIL-2R. The serum level of sIL-2R can be used as an important index of activity of AS and as a guide of therapy.
文摘Objective:To explore the expression of IL-2 and IL-11 and its significance in patients with ankylosing spondylitis(AS).Methods:A total of 48 active AS patients in our hospital and 40 normal control subjects were selected in our study.Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis functional index(BASFI),Bath ankylosing spondylitis metrology index(BASMI),ESR and CRP expression levels were compared before treatment,12 h after treatment and 24 h after treatment.IL-2 and IL-11 expression were also compared between these two groups.Results:The BASDAI score,BASH score and BASMI score of the AS patients before treatment significantly decreased compared with those 12 weeks and 24 weeks after treatment(P【0.05).ESB and CRP levels of the AS patients 12 weeks and 24 weeks after treatment significantly decreased compared with those before treatment(P【0.05).Difference was significant in serum IL-2 and IL-11 levels between 12 weeks and 24 weeks after treatment and before treatment(P【0.05).And no statistically significance was observed for serum IL-2 and IL-11 levels between normal control group and those of patients in AS group 24 weeks after treatment(P】0.05). Pearson’s linear-correlation analysis showed that serum IL-2 level had a positive correlation with BASDAI,BASFI,BASMI,ESR and CRP(r=0.661.0.547,0.474,0.362,0.416,P【0.05) and serum IL-11 level had a negative correlation with BASDAI,BASFI,BASMI,ESR and CRP(r=-0.629, -0.412,-0.422,-0.387,-0.408,-0.315,P【0.05).Conclusions:Serum levels of IL-2 in active AS patients significantly increase and will decrease after treatment.However,serum levels of IL- 11 significantly decrease and will increase after treatment,which indicates that serum IL-2 has a positive correlation with the degree of AS and serum IL-11 has a negative correlation with the degree of AS,both of which are correlated closely with the onset of AS.
基金Supported by National Natural Science Foundation of China,No.81672250Special Fund for Resident Training in Qilu Hospital of Shandong University,No.ZPZX2019A08.
文摘BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists.Bronchial blockers(BBs)have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODS We studied 12 AS patients(11 men and one woman)with lung or esophageal cancer who underwent thoracotomy with a BB.Preoperative airway evaluation found that all patients had a difficult airway.All patients received an intramuscular injection of penehyclidine hydrochloride(0.01 mg/kg)before anesthesia.In the operating room,dexmedetomidine(0.5μg/kg)was infused intravenously for 10 min,with 2%lidocaine for airway surface anesthesia,and a 3%ephedrine cotton swab was used to contract the nasal mucosa vessels.Before tracheal intubation,fentanyl(1μg/kg)and midazolam(0.02 mg/kg)were administered intravenously.Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position.Intravenous anesthesia was administered immediately after successful intubation,and a BB was inserted laterally.The pre-intubation preparation time,intubation time,facial grimace score,airway responsiveness score during the fiberoptic introduction,time of end tracheal catheter entry into the nostril,and lung collapse and surgical field score were measured.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded while entering the operation room(T1),before intubation(T2),immediately after intubation(T3),2 min after intubation(T4),and 10 min after intubation(T5).After surgery,all patients were followed for adverse reactions such as epistaxis,sore throat,hoarseness,and dysphagia.RESULTS All patients had a history of AS(20.4±9.6 years).They had a Willson's score of 5 or above,grade III or IV Mallampati tests,an inter-incisor distance of 2.9±0.3 cm,and a thyromental(T-M)distance of 4.8±0.7 cm.The average pre-intubation preparation time was 20.4±3.4 min,intubation time was 2.6±0.4 min,facial grimace score was 1.7±0.7,airway responsiveness score was 1.1±0.7,and pulmonary collapse and surgical exposure score was 1.2±0.4.The SBP,DBP,and HR at T5 were significantly lower than those at T1-T4(P<0.05).While the values at T1 were not significantly different from those at T2-T4(P>0.05),they were significantly different from those at T5(P<0.05).Seven patients had minor epistaxis during endotracheal intubation,two were followed 24 h after surgery with a mild sore throat,and two had hoarseness without dysphagia.CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia.Proper doses of penehyclidine hydrochloride,dexmedetomidine,fentanyl,and midazolam,combined with 2%lidocaine,administered prior to intubation,can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients.BBs are safe and effective for onelung ventilation in such patients during thoracotomy.
文摘Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.
基金supported by Chinese Medicine Research Program of Zhejiang Province(No.2015ZB121)
文摘Objective: To observe the expression and significance of fibronectin and metalloproteinase-3(MMP-3) in patients with ankylosing spondylitis(AS). Methods: A total of 30 AS patients in our hospital and 30 healthy volunteers were selected in our study. Fibronectin and MMP-3 were measured and compared between these two groups. The AS group received sulfasalazine2 g daily for 3 months. Bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, bath ankylosing spondylitis metrology index, erythrocyte sedimentation rate and C-reactive protein were compared before and after treatment.Pearson's linear-correlation analysis was used to determine relationships between parameters.Results: Totally 28 patients in the AS group completed the study. Fibronectin and MMP-3 in peripheral blood of AS patients were evidently higher than that in the normal control group(P<0.05). After treated by sulfasalazine, the level of expressing Fibronectin and MMP-3 significantly decreased compared with baseline values(P<0.05). Pearson's linear-correlation analysis showed that serum fibronectin and MMP-3 level had a positive correlation with bath ankylosing spondylitis disease activity index global assessment, spine pain, night pain, general pain, erythrocyte sedimentation rate and C-reactive protein(P<0.05). Conclusions: The expression of fibronectin and MMP-3 in AS patients were significantly higher than that in the normal control group, and they all decreased significantly after treatment. It indicated that both fibronectin and MMP-3 were correlated closely with the onset of AS.
基金Supported by National Natural Science Foundation of China,No.81701600.
文摘BACKGROUND Ankylosing spondylitis(AS)is an autoimmune disease characterized by sacroiliitis and spondylitis,with a few hematological abnormalities.Myelodysplastic syndromes(MDS)are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena.The relationship between AS and MDS remains unknown.CASE SUMMARY We describe a rare case of concurrent AS and MDS.An 18-year-old man with low back pain and anemia was diagnosed with AS;however,the cause of anemia could not be determined by the first bone marrow examination.He recovered from anemia and the symptoms of AS resolved after treatment with etanercept,glucocorticoid,and blood transfusion,but he developed pancytopenia with an increased myeloblast count(from 2.5%to 9%).Chromosome analysis revealed del(7q)and trisomy 8.Refractory anemia with excess of blasts-1(RAEB-1)/MDS was confirmed by repeating the bone marrow examination.He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.CONCLUSION We suspect that AS may be an early autoimmune phenomenon related to MDS.However,a condition of coexistence cannot be excluded.
基金Supported by the National Natural Science Foundation of China,No. 81902239the Natural Science Foundation of Jiangsu Province,No. BK20191169
文摘BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc.According to the literature,Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine(C5/6 and C6/7).One-stage anterior-posterior approach surgery was successfully performed.At the 6-month follow-up,the pain was significantly reduced,and the limb function was gradually improved.CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis.Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.
文摘BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.
文摘BACKGROUND Ankylosing spondylitis(AS)is a systematic and rheumatic disease,which causes multiple symptoms.However,dysphagia due to the formation of a giant anterior cervical osteophyte is rare in patients with AS.CASE SUMMARY We present the case of a 65-year-old male patient who was diagnosed with AS and visited the hospital with a complaint of progressive dysphagia.The appropriate imaging examinations indicated that a giant anterior cervical osteophyte at C3-4 caused esophageal compression,which led to dysphagia.An operation for resection was performed without complications.CONCLUSION This case demonstrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS,and early accurate diagnosis and surgical treatment are very important for the improvement of symptoms.Anterior cervical discectomy and fusion are extremely effective and should be taken into consideration.
文摘BACKGROUND Ankylosing spondylitis(AS)is strongly associated with the human leukocyte antigen(HLA)B27 haplotype.In regions where conventional polymerase chain reaction for HLA typing is available for antigens such as HLA B27 or HLA B51,it is common to perform the HLA B27 test for evaluation of AS.While HLA B27-associated clustered occurrences of AS have been reported in families,we report the first case series of HLA B51-related occurrences of AS in a family.CASE SUMMARY A father and his daughters were diagnosed with AS and did not have the HLA B27 haplotype.Although they were positive for HLA B51,they exhibited no signs of Behçet’s disease(BD).Of the five daughters,one had AS,and three,including the daughter with AS,were positive for HLA B51.The two daughters with the HLA B51 haplotype(excluding the daughter with AS)exhibited bilateral grade 1 sacroiliitis,whereas the daughters without the HLA B51 haplotype did not have sacroiliitis.Thus,this Korean family exhibited a strong association with the HLA B51 haplotype and clinical sacroiliitis,irrespective of the symptoms of BD.CONCLUSION It is advisable to check for HLA B51 positivity in patients with AS/spondyloarthropathy who test negative for HLA B27.
文摘BACKGROUND Ankylosing spondylitis(AS)is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints.To the best of our knowledge,AS with acute myocardial infarction(AMI)has rarely been reported.Here,we report an unusual case of AS with AMI in a young patient.CASE SUMMARY A 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14,2020,for low back pain.Further evaluation with clinical examinations,laboratory tests,and imaging resulted in a diagnosis of AS.Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms.However,his back pain persisted.After 6 wk of treatment,he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI.Angiography revealed severe narrowing of the coronary arteries.Surgical placement of two coronary stents completely relieved his back pain.CONCLUSION AS can cause cardiovascular diseases,including AMI.It is important to consider the cardiovascular risks in the management of AS.
