scholarly journals Younger age of onset and uveitis associated with HLA-B27 and delayed diagnosis in Thai patients with axial spondyloarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Naphruet Limsakul ◽  
Praveena Chiowchanwisawakit ◽  
Parichart Permpikul ◽  
Yubolrat Thanaketpaisarn
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Delayed Diagnosis ◽  
Musculoskeletal Symptom ◽  
Hla B27 ◽  
Delay In Diagnosis ◽  
Factors Associated ◽  
Younger Age

AbstractTo identify characteristics associated with HLA-B27, and to identify factors associated with delayed diagnosis in Thai patients with axial spondyloarthritis (axSpA). This cross-sectional study included Thai patients were diagnosed with axSpA by a rheumatologist at Siriraj Hospital. Clinical data were collected. Regression analyses were employed to identify factors associated with study outcomes. Of total 177 patients, 127 (72%) were positive HLA-B27. Uveitis [Odds ratio (OR) 4.0], age at onset of the first musculoskeletal symptom of ≤ 28 years [OR 3.5], female [OR 0.4], and psoriasis [OR 0.4] were significantly associated with HLA-B27 in multiple regression analysis. Those with positive HLA-B27 had less spinal flexibility. Elevated C-reactive protein (p = 0.012) was associated with shorter delay in diagnosis, while uveitis (p < 0.001) and younger age at onset of the first symptom (p = 0.002) were associated with longer delay in diagnosis in multiple regression analysis. Younger age at onset of the first musculoskeletal symptom and uveitis were associated with HLA-B27 and delayed diagnosis in axSpA patients. Young people with musculoskeletal symptom and uveitis should be referred to a rheumatologist to rule out or make a timely diagnosis of axSpA.

Temporomandibular Joint Involvement in Children with Juvenile Idiopathic Arthritis

2010 ◽  
Vol 38 (3) ◽  
pp. 510-515 ◽  
Author(s):  
ELVIRA CANNIZZARO ◽  
SILKE SCHROEDER ◽  
LUKAS M. MÜLLER ◽  
CHRISTIAN J. KELLENBERGER ◽  
ROTRAUD K. SAURENMANN
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Temporomandibular Joint ◽  
Upper Extremity ◽  
Age At Onset ◽  
Disease Onset ◽  
Joint Involvement ◽  
Hla B27 ◽  
Radiological Findings ◽  
Rheumatology Clinic ◽  
Younger Age

Objective.To determine the rate of temporomandibular joint (TMJ) involvement and find factors associated with TMJ arthritis in a single-center cohort of patients with juvenile idiopathic arthritis (JIA).Methods.Retrospective analysis of all patients with JIA visiting the rheumatology clinic between January 1, 2005, and December 31, 2006. Followup information was included until August 2008. A diagnosis of TMJ arthritis was based on clinical rheumatological and/or radiological findings.Results.After a mean followup time for JIA of 4.6 years (range 0.08–14.17), 86/223 patients (38.6%) had developed TMJ arthritis. The rate of TMJ involvement differed significantly among JIA subtypes (p = 0.0016), with 61% in extended oligoarticular, 52% in polyarticular rheumatoid factor (RF)-negative, 50% in psoriatic, 36% in systemic, 33% in polyarticular RF-positive, 33% in persistent oligoarticular, 30% in unclassified JIA, and 11% in enthesitis-related arthritis. The rate of TMJ involvement in our cohort was statistically significantly lower for patients who were HLA-B27-positive (p = 0.0002). In a multivariate analysis, the association of the following factors was confirmed: JIA subtype (p = 0.0001), a higher erythrocyte sedimentation rate (ESR) at diagnosis (p = 0.0038), involvement of joints of the upper extremity (p = 0.011), the absence of HLA-B27 (p = 0.023), and younger age at onset of JIA (p = 0.050).Conclusion.In our cohort of children with JIA, the overall rate of TMJ involvement was 38.6%. Patients with certain JIA subtypes, a higher ESR at disease onset, involvement of upper extremity joints, and younger age at diagnosis were more likely to develop TMJ arthritis. The presence of HLA-B27 seemed to be protective.

scholarly journals Comparison of Clinical Features in HLA-B27 Positive and Negative Patients With Axial Spondyloarthritis: Results From a Cohort of 4,131 Patients

2020 ◽  
Vol 7 ◽  
Author(s):  
Shangzhu Zhang ◽  
Yanhong Wang ◽  
Linyi Peng ◽  
Jinmei Su ◽  
Xiaofeng Zeng ◽  
...  
Keyword(s):  
Delay Time ◽  
Disease Duration ◽  
Axial Spondyloarthritis ◽  
Diagnosis Delay ◽  
Hla B27 ◽  
Biologic Treatment ◽  
Cross Sectional ◽  
Younger Age ◽  
History Of ◽  
Family Aggregation

Objective: The aim of our study was to assess the influence of the HLA-B27 status on axial spondyloarthritis (axSpA) in the largest cohort in China.Methods: An observational, cross-sectional, and analytic study of axSpA patients from the China axSpA database was performed. Demographic and clinical data were compared in terms of the HLA-B27 status. Univariate and multivariate analyses were performed to identify variables related to HLA-B27 presence.Results: We enrolled 4,131 patients in this study; of those, 36,95 (89.4%) were HLA-B27 positive. In the multivariate analysis, male gender (p &lt; 0.001), younger age (p &lt; 0.001), a disease duration of more than 3 years (p &lt; 0.001), a family history of SpA (p &lt; 0.001), uveitis (p &lt; 0.001), ASDAS-CRP (p &lt; 0.001), and biologic treatment (p &lt; 0.001) were the main variables that were independently related to HLA-B27 presence, whereas a diagnosis delay time &gt;36 months (p &lt; 0.001) and psoriasis (p &lt; 0.001) were independently related to HLA-B27 absence.Conclusion: In Chinese axial SpA patients, presence of HLA-B27 is associated with the male sex, younger age, longer disease duration, greater family aggregation, and higher frequency of uveitis; absence of HLA-B27 is associated with longer diagnosis delay time and higher frequency of psoriasis.

Response of 864 Patients to Steroids as Primary Therapy for Acute Gvhd at a Single Institution: Day 28 Response Is the Best Endpoint to Predict Transplant-Related Mortality.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1134-1134
Author(s):  
Margaret L. MacMillan ◽  
Todd E. DeFor ◽  
Daniel J Weisdorf
Keyword(s):  
Regression Analysis ◽  
Partial Response ◽  
Multiple Regression Analysis ◽  
Acute Gvhd ◽  
Initial Therapy ◽  
P Value ◽  
Single Institution ◽  
Factors Associated ◽  
Matched Sibling ◽  
Related Mortality

Abstract Abstract 1134 Poster Board I-156 The optimal primary endpoint for acute GVHD treatment trials has not been established. In a retrospective analysis, we examined the response of 864 patients who received prednisone 60 mg/m2 for 14 days, followed by an 8 week taper, as initial therapy for acute GVHD from 1990-2007 at a single institution. Complete response (CR), partial response (PR), very good partial response (VGPR), and no response (NR) were scored at day 14, day 28 and day 56 after initiation of steroids. To determine the best endpoint, an index of concordance, the c-statistic (C), was performed to estimate the probability that patients with the better GVHD response will have lower transplant related mortality (TRM) than patients with a worse response. Median patient age was 32 (range, 0.2-69) years; 35% were <18 years old. Patients received grafts of HLA-matched sibling bone marrow (BM) or peripheral blood (PB, n=315), partially matched sibling BM or PB (n=24), unrelated donor (URD) BM or PB (n=313), single umbilical cord blood (sUCB, n=89) or double UCB (dUCB, n=123). Prior to initiation of steroid therapy, initial GVHD grades were grade I in 230 (27%), grade II in 504 (58%), grade III in 119 (14%), and grade IV in 11 (1%). Initial GVHD organ involvement was skin only (57%), gut only (17%), liver only (1%) or multiorgan (25%). Day 28 responses were similar to day 56 responses (p=0.14) and better than day 14 responses (p=0.03) in predicting TRM. In multiple regression analysis, patients with NR at day 28 were 2.77 times more likely to have TRM than patients with CR, VGPR or PR while any response favored lower TRM (table). Factors associated with significantly worse 2 year TRM in patients with acute GVHD include: NR to steroids, partially matched BM/PB, high risk disease, older age and skin only GVHD. Factors not associated with TRM include CMV serostatus, conditioning therapy, GVHD prophylaxis, days to steroid treatment, and initial grade of GVHD. Table: Factors associated with 2 year TRM: multiple regression analysis Factor Relative Risk P value Overall P Value Day 28 Response (% patients) . . <0.001     CR (53%) 1.0 .     VGPR (7%) 0.63 0.13     PR (4%) 1.22 0.45     NR (31%) 2.77 <0.001 Donor Type . . <0.01     MSD BM/PBSC 1.0 .     URD well matched BM/PBSC 1.35 0.17     URD partial matched BM/PBSC 1.54 0.03     URD or sibling MM BM/PBSC 1.77 <0.001     Single UCB 1.06 0.83     Double UCB 0.79 0.36 Disease Risk . . 0.02     Standard 1.0 .     High 1.35 0.02 Age 1.0 0.02 0.02     <18 years 1.40     318 years Affected Organs (skin only) . . 0.05     Yes 1.0 .     No 1.36 0.05 Grade at Start of Steroid Therapy . . 0.11     I 1.0 .     II 1.08 0.60     III-IV 1.51 0.10 These data suggest that responses at day 28 or 56 are equally effective endpoints for acute GVHD trials. Day 14 responses cannot as accurately predict TRM. As patients with NR require further therapy in a timely manner, early progression or response by day 28 is the best endpoint to assess efficacy of initial therapy for acute GVHD. Prospective trials are still required to determine the best therapy for different subgroups of patients with acute GVHD, especially those identified to have predictably poor responses and high TRM. Disclosures No relevant conflicts of interest to declare.

scholarly journals Predictors of remission in patients with non-radiographic axial spondyloarthritis receiving open-label adalimumab in the ABILITY-3 study

RMD Open ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e000917 ◽  
Author(s):  
Joachim Sieper ◽  
Robert Landewé ◽  
Marina Magrey ◽  
Jaclyn K Anderson ◽  
Sheng Zhong ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Inactive Disease ◽  
Final Visit ◽  
Hla B27 ◽  
Open Label ◽  
Younger Age ◽  
Adalimumab Therapy ◽  
Male Sex

BackgroundThis analysis assessed baseline predictors of remission in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who received open-label adalimumab therapy.MethodsABILITY-3 enrolled 673 adult patients with nr-axSpA who had objective evidence of inflammation by MRI or elevated high-sensitivity C reactive protein at screening, active disease and an inadequate response to two or more non-steroidal anti-inflammatory drugs. Patients received adalimumab 40 mg every other week during a 28-week open-label lead-in period. Clinical remission was defined as Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID; score <1.3) and Assessment of SpondyloArthritis international Society partial remission (ASAS PR; score <2/10 in each of the four ASAS domains). Stepwise logistic regression was used to identify baseline predictors of remission at week 12 and at final visit (last postbaseline visit up to week 28). Only patients without missing data were included.ResultsOverall, 593 patients were included in the ASDAS ID and 596 in the ASAS PR analysis at week 12. Younger age (≤45 years), male sex, positive human leucocyte antigen (HLA)-B27 and higher Spondyloarthritis Research Consortium of Canada (SPARCC) MRI sacroiliac joint score were consistent predictors of remission by both ASAS ID and ASDAS PR at week 12. Results were generally similar in the final visit analysis. Other variables did not consistently predict remission.ConclusionsIn ABILITY-3, consistent and strong baseline predictors of remission included younger age, male sex, HLA-B27 positivity and higher SPARCC MRI sacroiliac joint score among patients with active nr-axSpA receiving adalimumab therapy, similar to previous findings in ankylosing spondylitis.

scholarly journals POS1016 ANKYLOSING SPONDYLITIS IN WEST AFRICAN PATIENTS: A SERIES OF 37 CASES REPORTED IN TOGO

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 776.1-776
Author(s):  
P. Houzou ◽  
V. E. S. Koffi-Tessio ◽  
S. Oniankitan ◽  
K. Kakpovi ◽  
E. Fianyo ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Delayed Diagnosis ◽  
Symptomatic Treatment ◽  
Sub Saharan Africa ◽  
Lumbar Pain ◽  
Diagnosis Delay ◽  
Hla B27 ◽  
Delay In Diagnosis ◽  
Male Predominance ◽  
Sub Saharan

Background:Spondyloarthritis (SpA) is generally uncommon in sub-Saharan Africa, in part because of the rarity of HLA-B27 in this region.Objectives:The aim of our study was to determine the epidemiological, semiological, paraclinical and therapeutic aspects of ankylosing spondylitis in rheumatology in Togo.Methods:This was a retrospective multicenter descriptive study on the files of patients suffering from ankylosing spondylitis seen in an outpatient setting or hospitalized in one of the four Rheumatology departments of Togo in the period from January 1, 2000 to December 31, 2019. The diagnosis was essentially radio-clinical based on the modified New York criteria.Results:In 20 years, and out of a population of 35,304 rheumatic patients, we have collected 37 cases of ankylosing spondylitis, meaning a hospital frequency of 0.10% and an annual frequency of 1.85 cases. There was clearly a male predominance with an M / F ratio of 4.28. The onset of the disease was on average of 29.62 ± 10.27 years and the diagnosis delay on average of 9.45 ± 9.20 years. The clinic was dominated by spinal pain in the form of chronic inflammatory cervical-dorsal-lumbar pain (41.2%) or lumbar pain (29.4%). Common joint injuries were those of the knees (57.69%), ankles (26.9%) and shoulders (23.1%). The most frequent extra-articular manifestations were ocular with conjunctivitis (62.5%) and uveitis (37.5%). Due to the delayed diagnosis, significant spinal deformities including hypercyphosis, straightness and ankylosis were found; the radiography of the spine objectified syndesmophytes (50.0%) with ankyloses and the bamboo column (23.5%) and that of the pelvis objectified sacroiliitis at stage 3 (54.6%) and at stage 4 (27.3%). The HLA B27 antigen was positive in 10.8% of cases. NSAIDs and sulfasalazine were the most commonly used drugs in management, respectively in 94.3% of symptomatic treatment and 92.6% of background therapy.Conclusion:Ankylosing spondylitis is relatively rare in Togo, affecting more men and young adults. There are no clinical or paraclinical particularity. The delay in diagnosis reflects the importance of the radiological signs. Treatment is mainly done by NSAIDs and DMRADs in particular sulfasalazine, due to their accessibility.References:[1]Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global Prevalence of Ankylosing Spondylitis. Rheumatology (Oxford). 2014;53:650-7.[2]Zabsonre TWJ, Sawadogo SA, Kabore F, Ilboudo A, Sougue C, Zongo E, et al. Ankylosing Spondylitis in Sub-Saharan Africa: A Series of 48 Cases Reported in Burkina Faso (West Africa). Open J Rheumatol Autoimmune Dis. 2018;8:87-92.[3]Mijiyawa M. Ankylosing Spondylitis in Togolese Patients. Med Trop. 1993;53:185-9.Disclosure of Interests:None declared.

scholarly journals FRI0303 PERIPHERAL SYMPTOMS ARE ASSOCIATED WITH LESS SPINAL RADIOGRAPHIC PROGRESSION IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE GERMAN SPONDYLOARTHRITIS INCEPTION COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 741-741
Author(s):  
M. Torgutalp ◽  
M. Protopopov ◽  
F. Proft ◽  
J. Sieper ◽  
V. Rios Rodriguez ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ankylosing Spondylitis ◽  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Smoking Status ◽  
Hla B27 ◽  
Research Support ◽  
Sum Score ◽  
Multivariable Regression

Background:Peripheral symptoms (PS), such as arthritis, enthesitis, and dactylitis, are common in axial spondyloarthritis (axSpA); data showing the association of PS and spinal radiographic progression in axSpA are controversial.Objectives:To analyze the association of PS and spinal radiographic progression in patients with axSpA.Methods:A total of 210 patients with axSpA (115 with radiographic and 95 with non-radiographic axSpA) were selected for analysis. Spinal radiographs were scored by two readers in a random order according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Pelvic radiographs were scored according to the grading system of the modified New York criteria; a sacroiliitis sum score was calculated as a sum of the grades for both sacroiliac joints. Mann-Whitney and Fisher exact tests were performed for group comparisons. A multivariable regression analysis was performed to analyze the influence of PS on radiographic progression.Results:Of the 101 (48.1%) patients with PS, 78 had peripheral arthritis, 48 - enthesitis, 12 - dactylitis. 32 patients had ≤1 PS. Patients with PS were older, less frequently HLA-B27 positive, compared with patients with no PS (73 (73.0%) vs. 93 (85.3%), p=0.028), had higher disease activity (time-averaged ASDAS over 2 years 2.6 ± 0.9 vs. 2.3 ± 0.9; p=0.032), worse physical function (BASFI 3.5 ± 2.3 vs. 2.3 ± 2.2, p<0.001), higher exposure to disease modifying anti-rheumatic drugs (39 (38.6%) vs. 22 (20.2%), p=0.003) and lower baseline radiographic sacroiliitis sum score (3.8 ± 1.9 vs. 4.4 ± 2.1, p=0.026); other baseline characteristics were similar. Patients with PS had lower absolute progression in mSASSS after 2 years of follow-up than those without (0.28 ± 1.39 vs 1.15 ± 2.9, p=0.045); 7.9% of patients with PS had a progression of mSASSS by ≥2 points compared to 20.2% in patients without PS (p=0.011). Radiographic progression of sacroiliitis was similar in both groups. In a multivariable regression analysis, presence of PS was associated with a lower mSASSS progression and lower odds for the mSASSS progression by ≥2 points after 2 years of follow-up: β=-0.98 (95% -1.68 to -0.28) OR=0.33 (95% CI 0.12 to 0.91), respectively – Table 1.Table 1.Association of peripheral symptoms with radiographic progression in axial spondyloarthritis after 2 years of follow-up.Multivariable linear regression analysisOutcomeβ (95 %CI)mSASSS change score−0.98 (-1.68 to -0.28)*Change of the sacroiliitis sum score−0.06 (-0.32 to 0.20)**Multivariable logistic regression analysisOutcomeOdds ratio (95 %CI)Progression of mSASSS by ≥2 points0.33 (0.12 to 0.91)*Progression of sacroiliitis by at least 1 grade in opinion of both readers0.84 (0.33 to 2.09)**mSASSS - modified Stoke Ankylosing Spondylitis Spine Score.*Adjusted for the smoking status, HLA-B27 status, NSAIDs intake, baseline syndesmophytes, and time-averaged ASDAS.**Adjusted for the smoking status, HLA-B27 status, NSAIDs intake, sacroiliitis sum score at baseline, and time-averaged ASDAS.Conclusion:Presence of PS is associated with distinct characteristics of SpA including slower radiographic spinal progression which might be explained partly by the numerically lower mSASSS score at baseline.Acknowledgments:GESPIC has been financially supported by the German Federal Ministry of Education and Research (BMBF). As funding by BMBF was reduced in 2005 and stopped in 2007, financial support has been obtained from Abbott / Abbvie, Amgen, Centocor, Schering-Plough, and Wyeth. Since 2010 GESPIC is supported by Abbvie.Dr. Murat Torgutalp was supported by the Scientific and Technological Research Council of Turkey (TUBITAK).Disclosure of Interests:Murat Torgutalp: None declared, Mikhail Protopopov Consultant of: Novartis, Fabian Proft Grant/research support from: Novartis Pharma GmbH, Consultant of: Consultancy / speaker fees from: Abbvie, BMS, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: Consultancy / speaker fees from: Abbvie, BMS, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Joachim Sieper Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Valeria Rios Rodriguez Consultant of: Abbvie, Novartis, Hildrun Haibel Consultant of: Abbvie, Jansen, MSD, and Novartis, Speakers bureau: Abbvie, Jansen, MSD, and Novartis, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB

scholarly journals Socio-demographic risk factors associated with febrile seizures at Puducherry: a retrospective study

2020 ◽  
Vol 7 (5) ◽  
pp. 1130
Author(s):  
Gobinaath . ◽  
Arun Daniel J.
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Age At Onset ◽  
Febrile Seizures ◽  
Factors Associated ◽  
Younger Age ◽  
History Of ◽  
Demographic Risk ◽  
Tract Infections ◽  
Demographic Risk Factors

Background: Febrile seizures occur commonly in the under 5 age group and is associated with few risk factors causing its recurrence like very high fever, family history of seizures, low sodium levels and younger age of onset which are subject to seasonal and wide geographical variations. This study aimed at detecting the major risk factors associated with recurrent febrile seizures in an Indian population.Methods: A retrospective hospital-based study was conducted among a total of 300 cases aged 6 months to 5 years attending to the paediatric OPD with history of fever followed by febrile seizures. Information regarding socio-demographic and clinical variables associated with febrile seizure was collected and analyzed.Results: The mean age of the study participants was 25.6±2.2 months and majority (60%) were males. Family history of seizures was present in 25.3% (n=76) of the children with febrile seizures. Respiratory infections (73.3%) and gastroenteritis (17%) were the major infective reasons associated with the occurrence of febrile seizures followed by pneumonia (6.3%) and urinary tract infections (5%). Recurrence of FS was significantly higher among the children with family history of FS (p=0.009), age at onset lesser (p<0.001) and simple FS seizures.Conclusions: Younger age at onset and positive family history of seizures were important socio-demographic risk factors associated with recurrent febrile seizures.

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