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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A multiplanar approach and a good tissue differentiation characterize magnetic resonance imaging which have a great role in exploring numerous musculo-skeletal lesions; review of main indications and limits. MRI is useful in diagnosing certain undisplaced fractures, fatigue and insufficiency fractures, and consequences. Fibrous cartilage and hyalin cartilage lesions, tears of tendons, ligaments and muscles are well appreciated. MRI is also very good for an early and correct diagnosis of avascular necrosis, spinal degenerative lesions, spinal consequences of rheumatoid arthritis and ankylosing spondylitis, and bone metastases. It is the technique of choice for local staging of bone and soft tissue sarcomas.
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PMID:[Magnetic resonance imaging of the locomotor apparatus]. 876 42

Although a number of reports have now described an association between polymorphism of the LMP2 gene and disease phenotype in HLA-B27 positive individuals with ankylosing spondylitis (AS), some describe associations with acute anterior uveitis, others with juvenile onset disease, and one report provides no association. A recent study describes yet a further association with disease severity in patients with juvenile rheumatoid arthritis. We therefore hypothesized that the discrepant findings in adult disease may be a reflection of an underlying association with disease severity. Our study population consisted of 100 HLA-B27 positive Caucasians with AS of ten or more years duration. Clinical assessment of disease severity was based on a metrology index scoring five measurements, the modified health assessment questionnaire for the spondyloarthropathies, and a disease activity index consisting of a visual analog scale to score the amount of pain, stiffness and fatigue. LMP2 genotypes were assigned following polymerase chain reaction amplification from genomic DNA and restriction enzyme digestion with CfoI. Despite confirmation of a significantly higher prevalence of the LMP2 BB genotype in AAU positive (66.0%) versus AAU negative (45.2%) patients (P < 0.05), we observed no association between LMP2 genotypes and any of the indices of disease severity. Furthermore, although a significant association was noted between the presence of peripheral synovitis and the functional index score (P < 0.05), a history of AAU was not associated with more severe disease. Our data is thus internally consistent in demonstrating no association between LMP2 genotypes and either disease severity or peripheral arthritis, and supports the notion that polymorphism of LMP2 primarily influences the development of AAU and not some other phenotype of AS.
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PMID:Polymorphism of the LMP2 gene and disease phenotype in ankylosing spondylitis: no association with disease severity. 934 40

Developed by Orthotronic Medizintechnik GmbH, the so-called Triflexometer, version 3.22 was tested for its reliability and validity in measuring spinal posture and mobility. Reliability studies on 20 healthy subjects have shown this measurement method to be reliable, yet intra- and inter-rater reliability analyses also revealed that even for this healthy population discrepancies in the various measures may occur, both due to differences in compliance as well as fatigue and learning effects, and due to difficulties in stabilization of the normal posture, to a lesser extent due to certain specifics of the measurement technique (placing the markers, guiding the sensor). In total spinal immobility (ankylosing spondylitis), practically identical measurements are found, as is the case in dummy studies. The validity study on 20 healthy subjects found good correlations between the measurements obtaining using the triflexometer and those for double inclinometer, respectively, and that only minor mean value differences occur for the two methods. Also, triflexometer measurements for total anteflexion were found to correlate with those determined with the fingertip-to-floor method, no correlation was present however between the Triflexometer values and the Schober test. Triflexometer measurements performed on 114 healthy subjects of various ages served to prove that the range of spinal movement in the directions measured (sagittal and frontal) will reduce with age. To a lesser extent, this also applies to hip movement. Overall, our findings prove the triflexometer an easy-to-handle system which possesses high reliability and is suitable for valid and objective noninvasive assessment of global and segmental spinal mobility. Triflexometer examinations are highly uncomplicated to implement, and print-outs of the results obtained permit lasting documentation of the present status.
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PMID:[Reliability and validity studies with the triflexometer, a new method for assessing form and flexibility of the spine]. 965 93

Quality of life encompasses the net effects that a patient perceives an illness to have on his or her life. Quality of life commonly includes symptoms, physical functioning, work ability, social interaction, psychological functioning, treatment side effects, and financial costs. In ankylosing spondylitis, although symptoms of pain, stiffness, and fatigue are common and moderately severe, few patients develop severe functional disability and most remain employed. The limited information available suggests that most patients with ankylosing spondylitis have few problems with social interactions, although depression is not uncommon. Direct medical costs of ankylosing spondylitis are low, compared with those of other rheumatic diseases.
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PMID:Quality of life in patients with ankylosing spondylitis. 989 12

To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group. The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue. For each instrument the members were asked to judge if the instrument was feasible and relevant. If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list. These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set. This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping. The response rate to the questionnaire was 72%. For each domain one or more instruments were selected, except for Entheses and Fatigue. The chosen instruments were similar for the 3 above settings. Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility. For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research. It is recommended to use these instruments in all research projects in AS.
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PMID:Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis. 1022 26

Ankylosing spondylitis (AS) has been shown to produce exercise limitation and breathlessness. The purpose of this study was to investigate factors which may be responsible for limiting aerobic capacity in patients with AS. Twenty patients with no other cardio-respiratory disease performed integrative cardiopulmonary exercise testing (CPET). The results were compared to 20 age and gender matched healthy controls. Variables that might influence exercise tolerance, including pulmonary function tests (body plethysmography), respiratory muscle strength (MIP, MEP) and endurance (Tlim), AS severity assessment including chest expansion (CE), thoracolumber movement (TL), wall tragus distance and peripheral muscle strength assessed by maximum voluntary contraction of the knee extensors (Qds), hand grip strength and lean body mass (LBM), were measured in the patients with AS and used as explanatory variables against the peak VO2 achieved during CPET. As subjects achieved a lower peak VO2 than controls (25.2 +/- 1.4 vs. 33.1 +/- 1.6 ml kg-1min-1, mean +/- SEM, P = 0.001). When compared with controls, ventilatory response (VE/VCO2) in AS was elevated (P = 0.01); however gas exchange indices, transcutaneous blood gases and breathing reserve were similar to controls. AS subjects developed a higher HR/VO2 response (P < 0.01) on exertion but without associated abnormalities in ECG, blood pressure response or anaerobic threshold. The AS group experienced a greater degree of leg fatigue (P < 0.01) than controls at peak exercise. Although the breathlessness scores (BS) were comparable to controls at peak exercise, the slopes of the relationship between BS and work rate (WR) [AS 0.054 (0.1), Controls 0.043 (0.06); P < 0.05] and BS and % predicted oxygen uptake [AS 0.084 (0.18), Controls 0.045 (0.06); P < 0.01] were steeper in the AS subjects. There was weak association between peak VO2 and vital capacity (r2% 12.0), MIP (11.8) but no association between Tlim, CE, Wall tragus distance or TL movement. The strongest association with aerobic capacity was between measurements of peripheral muscle strength (Qds; r = 0.75; hand grip; r = 0.47) accounting for 53% (P < 0.001) and 23.5% (P < 0.01) of the total variance in peak VO2, respectively. The addition of LBM to Qds in the regression model significantly improved the explained variance to 78.3% (P < 0.001). This study shows that peripheral muscle function is the most important determinant of exercise intolerance in AS patients suggesting that deconditioning is the main factor in the production of the reduced aerobic capacity.
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PMID:An investigation of factors limiting aerobic capacity in patients with ankylosing spondylitis. 1058 58

Symptoms, Effects on Quality of Life, Judgement and Expectations of Treatment in Active Ankylosing Spondylitis: The Patient's View.In ankylosing spondylitis uncertainty prevails among rheumatologists on how to define and measure activity. In the present study the patient's view of activity was evaluated. What does active ankylosing spondylitis mean for the patient? In a standardized interview the patient was asked to describe, from his own experience, what active ankylosing spondylitis means, what bothers him most, what helps most, and what he expects from therapy. For the patient, active ankylosing spondylitis means pain (99 responses), mobility restriction (19), muscle tension (10), inability to stay supine (6), restriction in chest mobility (5) and dyspnea (5). Fatigue was mentioned by two patients. In active states patients are mainly bothered by pain (77), mobility restriction (55), consequences for social life (20) and work (18), disturbed sleep (17) and difficult breathing (16). Drugs (84) and physical activity (42) were judged the best treatments during active ankylosing spondylitis. It was no surprise that pain and mobility restriction were cited most often by the patients. Breathing difficulties were cited rather often, whereas fatigue seems not to play an important role for most patients. The results suggest that modern rheumatology may have underestimated the relevance of difficult breathing and paid too much attention to fatigue.
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PMID:[Symptoms, effects on quality of life, judgement and expectations of treatment in active ankylosing spondylitis: the patient's view]. 1157 74

Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2 % is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99 % of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5 - 9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchondritis of the pubic symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called "biologicals" are employed.
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PMID:[Magnetic resonance imaging in ankylosing spondylitis (Marie-Struempell-Bechterew disease)]. 1247 19

Rheumatic diseases do not usually cluster in time and space. It has been proposed that environmental exposures may initiate autoimmune responses. We describe a cluster of rheumatic diseases among a group of health center employees who began to complain of symptoms typically related to moldy houses, including mucocutaneous symptoms, nausea and fatigue, within a year of moving into a new building. Dampness was found in the insulation space of the concrete floor below ground level. Microbes indicating mold damage and actinobacteria were found in the flooring material and in the outer wall insulation. The case histories of the personnel involved were examined. All 34 subjects working at the health center had at least some rheumatic complaints. Two fell ill with a typical rheumatoid factor (RF)-positive rheumatoid arthritis (RA), and 10 had arthritis that did not conform to any definite arthritic syndrome (three met the classification criteria for RA). Prior to moving into the problem building one subject had suffered reactive arthritis, which had then recurred. Another employee had undiagnosed ankylosing spondylitis and later developed psoriatic arthritis, and another developed undifferentiated vasculitis. A total of 16 subjects developed joint pains, 11 of these after beginning work at the health center. Three subjects developed Raynaud's symptom. Fourteen cases had elevated levels of circulating immune complexes in 1998, 17 in 1999, but there were only three cases in 2001, when the health center had been closed for 18 months. The high incidence of joint problems among these employees suggests a common triggering factor for most of the cases. As some of the symptoms had tended to subside while the health center was closed, the underlying causes are probably related to the building itself and possibly to the abnormal microbial growth in its structures.
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PMID:Joint symptoms and diseases associated with moisture damage in a health center. 1580 Oct 83

In 2003, several manuscripts on the classification of patients as having ankylosing spondylitis and the further development of outcome assessment tools have been published. It is obvious that the use of radiographic sacroiliitis is a problematic part of the classification criteria because there is major interobserver variation and is one of the causes of a long delay between onset of symptoms and diagnosis. Especially in patients without human leukocyte antigen B27, the diagnostic delay is long. Existing outcome tools, such as the Bath Ankylosing Spondylitis Disease Activity Index, have been adapted and validated for use in other languages. New instruments to assess quality of life (Ankylosing Spondylitis Quality of Life Index; Patient Generated Index) and physical functioning (World Health Organization Disability Assessment Schedule II) have been developed and validated for the use in ankylosing spondylitis. In addition, a new and feasible tool to assess enthesitis has been constructed and validated. Because fatigue is an important symptom for patients with ankylosing spondylitis, a recommendation to use a specific fatigue instrument was created. The statistically derived Assessment in Ankylosing Spondylitis response criteria have been compared with expert opinion and are strict criteria. Responders as defined by the Assessment in Ankylosing Spondylitis response criteria also are considered by the experts as responders.
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PMID:New directions in classification and outcome assessment in ankylosing spondylitis. 1501 39


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