Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P01889 (ankylosing spondylitis)
 5,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.
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PMID:Bone mineral density in ankylosing spondylitis. 892 76

The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.
Baillieres Best Pract Res Clin Rheumatol 2000 Dec
PMID:How important is patient education? 1109 96

Surgery for rheumatoid arthritis (RA) and spondyloarthropathies is a palliative surgery, and testifies to the failure of conservative treatment. In RA, surgery is generally used to deal with upper cervical instability and peridens pannus compression. These complications can have dramatic neurological consequences and can even be life threatening. Every effort must be made to avoid unnecessary surgery but, if needed, the indication must be precise and timely to be efficient. Instrumented fusion is indicated but the need for pannus excision is discussed. In ankylosing spondylitis (AS), major deformity will be the indication for corrective surgery if this deformity induces a marked decrease in the field of vision, thoracicy or abdominal problems or respiratory and mandibular troubles in the cervical spine. Different types of osteotomies with instrumented fixation are described. In AS. surgery is also indicated in fractures that are potentially unstable. At the cervical level these fractures are a surgical emergency. Neurological compressions and spondylodiscitis are other reasons for surgery in AS. Complications of other spondyloarthropathies, which include accompanying psoriasis, reactive arthritis, enteropathic arthritis or Behcet's syndrome are occasionally treated surgically along the same lines as RA or AS. Surgery for spinal inflammatory disorders involves major procedures with a high rate of severe complications. The indications for this type of surgery must be extremely precise and both the surgeon's and the patient's expectations must be clear and realistic. The surgery should only be performed by a surgeon who is experienced with this type of patient and procedure but, furthermore, it should also only be camed out in a centre with a team of neurologists, anaesthetists, nurses and physical therapists who have the expertise to work with these pathologies and these often severely debilitated patients. Only under these conditions will the outcome justify the burden and the risks.
Best Pract Res Clin Rheumatol 2002 Jan
PMID:What are the advances for surgical therapy of inflammatory diseases of the spine? 1198 36

The concept of spondyloarthropathy was recognized first by clinicians based on the aggregation of several diseases occurring either sequentially in the same patient or simultaneously in a family. This concept was thereafter confirmed by the higher prevalence of the HLA-B27 antigen, not only in the group of patients suffering from an axial involvement of ankylosing spondylitis but also in other diseases belonging to the concept of spondyloarthropathy, i.e. psoriatic arthritis, reactive arthritis, inflammatory-bowel-disease-related arthritis and/or other clinical manifestations such as acute anterior uveitis. Recognition of the concept of the spondyloarthropathy is of great importance not only for research purposes but also in daily practice because such recognition has at least a threefold effect: (a) it permits earlier diagnosis, (b) it facilitates patients' education and monitoring, and (c) it has prognostic implications
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Why is the concept of spondyloarthropathies important? 1240 23

Clinical studies indicate an important role for bowel inflammation in ankylosing spondylitis and other spondyloarthropathies whereby two different aspects have to be considered. First, the gut inflammation is clinically and histologically closely related to Crohn's disease. Recent data on subclinical immune alterations confirm this relationship and suggest that spondyloarthropathy is a unique human model for studying early Crohn's disease. Second, bowel and peripheral joint inflammation are clinically, histologically and pathogenetically linked. The most important clinical implication of these observations is that targeted therapies for Crohn's disease could also be effective for intestinal as well as extra-intestinal disease manifestations in spondyloarthropathy, as evidenced by the recent studies on TNF-alpha blockade. Unravelling the gut-synovium axis in spondyloarthopathy could also contribute to the identification of new therapeutic targets. Finally, assessment of subclinical gut inflammation by histology, serology and genetics could contribute to the stratification of individual patients in subgroups with an optimal response to specific therapeutic interventions.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Ankylosing spondylitis and bowel disease. 1240 26

In contrast to rheumatoid arthritis (RA), the concept of disease modification in ankylosing spondylitis (AS) remains to be clarified. Endpoint measures employed in AS trials primarily assess features related to symptomatology while endpoints considered more relevant to the concept of disease modification, such as spinal mobility, acute-phase reactants and radiological progression, either lack sensitivity to change or have not been comprehensively validated. NSAIDs alleviate symptoms of AS but most trials have been short term, precluding meaningful conclusions regarding disease modification. Among disease-modifying therapies used in RA, sulfasalazine has been studied in several controlled trials mostly in patients with longstanding disease, effect sizes being small and limited to those with peripheral synovitis. No conclusions can be drawn from the limited studies evaluating methotrexate.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Ankylosing spondylitis and current disease-controlling agents: do they work? 1240 30

The therapeutic options for patients suffering from the more severe forms of spondyloarthritis (SpA) have been rather limited in recent decades. There is now accumulating evidence that anti-tumour necrosis factor (anti-TNF) therapy is highly effective in SpA, especially in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Based on the data recently published on more than 200 AS patients, and more than 100 PsA patients, this treatment seems to be even more effective than it is in rheumatoid arthritis (RA). The two major anti-TNF-alpha agents currently available, infliximab (Remicade) and etanercept (Enbrel), are approved for the treatment of RA in Europe and in the USA. The situation in SpA is different from RA because there is an unmet medical need, especially in AS, because disease-modifying anti-rheumatic therapy is not available for severely affected patients. Thus, TNF blockers might even be considered first-line immunosuppressive treatment in patients with active AS who are not sufficiently treated with non-steroidal anti-inflammatory drugs (NSAIDs). For infliximab, a dose of 5mg/kg was required, and intervals between 6 and 12 weeks were necessary for constant suppression of disease activity - a major aim also for long-term treatment. However, it remains to be shown whether patients benefit from long-term therapy and whether radiological progression and ankylosis can be stopped. The optimal doses of infliximab might well be determined individually. Allergic reactions and increased susceptibility to tuberculosis are rare side-effects which need to be recognized early. As it stands now, the benefits of anti-TNF therapy in AS seem to outweigh these shortcomings. The efficacy of etanercept was first demonstrated in PsA. A double-blind study has now been performed in AS - with similar results. There is preliminary evidence that both agents also work in other SpA such as undifferentiated SpA. Hopefully, both agents will be approved soon for the short-term treatment of severe SpA. In parallel, studies should be performed to document the long-term efficacy and safety of this treatment.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Therapy for ankylosing spondylitis: new treatment modalities. 1240 31

Physical therapy plays an important role in the overall treatment of ankylosing spondylitis. Apart from exercising at home, patients are advised to follow weekly group physical therapy. In addition, many patients often follow annual courses of in-patient physiotherapy or spa therapy in which exercises also play a central role. This chapter focuses on evidence for benefits of physical therapy and spa therapy in ankylosing spondylitis.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Spa and exercise treatment in ankylosing spondylitis: fact or fancy? 1240 32

There is substantial evidence strongly favouring a direct role for HLA-B27 in genetic susceptibility to ankylosing spondylitis (AS) and related spondyloarthropathies (SpA), although the underlying molecular basis has yet to be identified. HLA-B27 itself is a serologic specificity that encompasses 26 different alleles that encode 24 different subtypes - HLA-B*2701 to B*2725, with the exclusion of B*2722. [The B*2722 allele was deleted as an official WHO allele in April 2002, with a note that the reference cell has been shown to have the same sequence as B*2706. Thus, from now on, with this deletion of B*2722, there will be a "hole" among the HLA-B*2701 to B*2725 group of alleles]. The 24 HLA-B27 alleles (subtypes) seem to have evolved from the most widespread subtype, B*2705. Two B27 alleles have been reported to lack association with AS: B*2706 among Southeast Asian populations, and B*2709 among Sardinians. The distinction between the disease-associated subtypes and those that are not disease-associated may provide some clues to the actual role of HLA-B27 in disease pathogenesis. Genetic family studies in populations of European descent indicate that HLA-B27 contributes only 16 % of the total genetic risk for the disease. The genes in the Major Histocompatibility Complex (MHC) as a whole, that includes HLA-B27, account for about half of the genetic susceptibility for AS. This clearly indicates the presence of additional disease predisposing genes in the MHC region on chromosome 6, and genome-wide studies have identified many areas of interest on other chromosomes that may contain additional disease predisposing genes. Additional studies emanating from the recent mapping of the human genome is expected to lead to better understanding of the genetic basis of these and other rheumatic diseases. Genetic counselling and the use of HLA-B27 typing as an aid to diagnosis are also reviewed.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Genetic aspects of ankylosing spondylitis. 1240 34

Ankylosing spondylitis is a chronic rheumatic disease leading to functional limitations. This has an important impact on participation in the labour force, with high disease-related work disability. As for cost-of-illness studies, which estimate the costs related to a disease, the cost of lost productivity is the major contributor to the total costs of ankylosing spondylitis. Because of the low prevalence of the disease, the costs related to ankylosing spondylitis are a relatively small part of the costs of all diseases to society. However, given the early and the important long-term functional loss, the lifetime costs and socio-economic impact for the individual patient are likely to be high. Because poor physical function is the major determinant of high direct and productivity costs, new (biological) treatments with effects on long-term functional disability will potentially reduce the economic impact of the disease for society and patients.
Best Pract Res Clin Rheumatol 2002 Sep
PMID:Ankylosing spondylitis: what is the cost to society, and can it be reduced? 1240 35


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