ObjectivesTo systematically review the proportion of Tregs in peripheral blood of patients with ankylosing spondylitis (AS) and its relationship with Treg's diffrent phenotypes.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect case-control studies on peripheral Tregs of AS patients from inception to November 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 61 case-control studies involving 2 466 AS patients and 1 879 controls were included. The results of meta-analysis showed that: the proportion of peripheral Tregs of patients with AS was significantly lower than that of the normal control (SMD=−0.905, 95%CI −1.294 to −0.517, P<0.000 1), and the proportion of Tregs in the disease-active group was significantly lower than that in disease-inactive group (SMD=−0.928, 95%CI −1.431 to −0.425, P<0.000 1). The proportion of CD4+CD25+FOXP3+Tregs and CD4+CD25+CD127low/−Tregs were lower in AS patients than that in control subjects (SMD=−2.547, 95%CI −3.521 to −1.573, P<0.000 1; SMD=−0.709, 95% CI −1.056 to −0.362, P<0.000 1). The proportion of Tregs defined by CD4+CD25low/−FOXP3+ was higher in AS patients (SMD=0.683, 95%CI 0.161 to 1.206, P=0.01). There was no significant difference betweew other phenotypes of Tregs groups.roups.ConclusionsThe reduction of Tregs may be one of the important reasons for the occurrence and development of AS, which may provide a new approach for the diagnosis and treatment of AS.
【Abstract】 Objective To explore the effectiveness of multiple joint arthroplasty in treating lower limb joint disease. Methods Between January 2000 and December 2007, 5 patients with lower limb joint disease (three or more joints were involved) were treated with total hip and knee arthroplasty. There were 3 males and 2 females, aged from 27 to 59 years (mean, 41.8 years). Two patients had ankylosing spondylitis and 3 had rheumatoid arthritis, whose hip and knee joints were involved. Four patients lost the ability of walking preoperatively, 1 patient could only walk with crutch. The Harris score was 24 ± 24 and the Hospital for Special Surgery (HSS) score was 28 ± 15. All patients underwent multiple joint arthroplasty simultaneously (2 cases) or multiple-stage (3 cases). Results Wounds healed by first intention in all patients. In 1 patient who had dislocation of the hip after operation, manipulative reduction and immobilization with skin traction were given for 3 weeks, and no dislocation occurred; in 2 patients who had early sign of anemia, blood transfusion was given. All patients were followed up 46-140 months with an average of 75 months. The patients could walk normally, and had no difficulty in upstairs and downstairs. The stability of the hip and knee was good, and no joint infection or loosening occurred. The Harris score was 88 ± 6 at last follow-up, showing significant difference when compared with the preoperative score (t=8.16, P=0.00); the HSS score was 86 ± 6, showing significant difference when compared with the preoperative score (t=13.96, P=0.00). Conclusion Multiple joint arthroplasty is an effective treatment method in patients with lower limb joint disease, which can significantly improve life quality of patients.
ObjectiveTo understand the self management status of patients with ankylosing spondylitis (AS). MethodsSixty inpatients and outpatients with AS in the Department of Rheumatology between December 2011 and December 2012 were selected as the study subjects by judgment sampling method. A self-made questionnaire was used for investigation. ResultsThe self-management skills of 10.0% of the patients were poor, 78.3% were moderate and 11.7% were fine. The self-management skills of functional training and keeping healthy lifestyle were relatively poor. The factors with a score from the highest to the lowest were:the mental self-management, symptom management, keeping healthy lifestyle, and the self-management of functional training. ConclusionsThe self-management skills of patients with ankylosing spondylitis range from moderate to relatively poor. Our results suggest that cultural factors and the course of disease may be the main influence factors for self-management skills of patients. Clinical medical personnel should know the situation of patients sufficiently, improve the processes of health education and take corresponding intervention measures to the lack of self management ability. By the above ways, we can improve the compliance obedience and the self-management skills of patients, then the patients' condition and living quality will be greatly improved.
ObjectiveTo introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. MethodsBetween March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). ResultsNo complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2±10.5)° and (33.7±9.7)° respectively, showing no significant difference (t=0.84, P=0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained. ConclusionThe preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.
ObjectiveTo evaluate the inflammatory markers in patients with ankylosing spondylitis (AS) or non-inflammatory diseases undergoing total hip arthroplasty (THA) and to ascertain the variation trend of perioperative inflammatory markers and the influence of inflammation markers after THA. MethodsBetween January 2013 and December 2014, 153 consecutive patients with AS were included. According to the range of motion (ROM), the patients were divided into ankylosis group (ROM: 0°; group A, n=92) and stiff group (ROM: 3-46°; group B, n=61); 120 noninflammatory diseases patients having no bacterial infection and undergoing primary THA served as non-inflammatory group (group C). The inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) concentrations were measured before operation and at 1, 3, 5, and 7 days after operation, and the complication was observed. ResultsPerioperative serum CRP, IL-6, and ESR increased at first after operation, and then decreased in 3 groups. There were significant differences in CRP and ESR between at pre- and post-operation (P<0.05); the IL-6 at 1, 3, and 5 days after operation were significantly higher than that at preoperation (P<0.05), but no significant difference was found between at 7 days and at preoperation (P>0.05). CRP, IL-6, and ESR of group B were significantly higher than those of group A at preoperation (P<0.05); CRP and IL-6 of groups A and B were significantly higher than those of group C at preoperation and at 1 day after operation (P<0.05); ESR of groups A and B was significantly higher than that of group C at preoperation, and at 1 day and 3 days after operation (P<0.05); and no significant difference was shown among 3 groups at the other time points (P>0.05). No inflammatory activity or increased complication was observed. ConclusionAS and non-inflammatory diseases show similar change trend of inflammatory markers at preand post-operation. The inflammatory activity of AS has no significant effect on the changes of inflammation markers and does not increase the incidence of postoperative complications.
Objective To explore the MRI features of juvenile-onset ankylosing spondylitis (JoAS) for improving the level of diagnosis and therapy. Methods MRI findings of JoAS in 25 patients confirmed by clinical and laboratory results between October 2010 and September 2014 were retrospectively analyzed. Results There were a total of 67 locations of lesion in the 25 cases, including 19 in sacroiliac joint, 21 in hip joint, 6 in ischial tuberosity, 6 in crista iliaca, 9 in knee joint, 4 in ankle joint, and 2 in foot. MRI showed 63 locations with bone marrow edema, 36 with joint effusion, 26 with bone destruction, and 19 with enthesitis. Conclusions Bone marrow edema is the most common MRI manifestation of JoAS, and the main bone destruction is middle axis joint. MRI is sensitive but not specific to lesions, so differential diagnosis is needed and helpful.
ObjectiveTo evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. MethodsBetween September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. ResultsOne-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones (P < 0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of > 2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up (P > 0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint (P < 0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found (P > 0.05). ConclusionA combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.
Objective To explore the characteristics and the related factors of the lipid profiles in patients with ankylosing spondylitis (AS). Methods Sixty AS patients and 60 healthy controls were included retrospectively from January 2005 to January 2015. Information including general data, physical examination, and blood sample were collected; triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C), and C-reactive protein (CRP) were assessed. Results TG increased in 46.7% (28/60) patients, and HDL-C decreased in 50.0% (30/60). Compared with the control group, AS patients had lower levels of HDL-C, TC and LDL-C, and higher levels of TG, VLDL-C, VLDL-C/LDL-C ratio, LDL-C/HDL-C ratio, and TC/HDL-C ratio; the differences above were all statistically significant (P<0.01). Spearman correlation test demonstrated that HDL-C level was correlated negatively with serum CRP (rs=–0.359, P=0.005). Multiple linear regression model demonstrated that CRP was associated with HDL-C in AS patients (P=0.019). Conclusions Dyslipoproteinemia is a common feature in AS patients. The main characteristic is the increase of TG and decrease of HDL-C, related with inflammation. It suggests a high risk of atherosclerosis.
Therapeutic drug monitoring (TDM) has been more widely used in small molecule agents, such as immuno-suppressants, antiepileptic drugs and antibiotics, with less attention in the field of therapeutic biological agents. Monoclonal drugs represented by tumor necrosis factor alpha (TNF-α) inhibitors have shown a good relationship between exposure and efficacy in clinical studies. There are corresponding guidelines and consensus for the recommendations of TDM based on current research evidence. Therefore, this paper introduced the current evidence, strategies and considerations for TDM in the optimal treatment of adalimumab from the perspective of adalimumab TDM to provide references for the clinical practice of adalimumab TDM.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.