Finbar D O'Shea

Increased Body Mass Index in Ankylosing Spondylitis Is Associated with Greater Burden of Symptoms and Poor Perceptions of the Benefits of Exercise

Objective. Increased body mass index (BMI) in patients with ankylosing spondylitis (AS) is associated with a greater burden of symptoms and poor perceptions of the benefits of exercise. In AS, the effect of obesity on disease characteristics and exercise perceptions is unknown. We evaluated the prevalence of obesity in AS, to assess the attitudes of patients toward exercise and to evaluate the effect of obesity on symptoms and disease activity. Methods. Demographic data and disease characteristics were collected from 46 patients with AS. Disease activity, symptomatology, and functional disability were examined using standard AS questionnaires. BMI was calculated. Comorbidity was analyzed using the Charlson Comorbidity Index. Patients’ attitudes toward exercise were assessed using the Exercise Benefits and Barriers Scale (EBBS). We compared the disease characteristics, perceptions regarding exercise, and functional limitations in those who were overweight to those who had a normal BMI. Results. The mean BMI in the group was 27.4; 67.5% of subjects were overweight or obese. There was a statistically significant difference between those who were overweight and those with a normal BMI regarding their perceptions of exercise (EBBS 124.7 vs 136.6, respectively), functional limitation (Bath AS Functional Index 4.7 vs 2.5, Health Assessment Questionnaire 0.88 vs 0.26), and disease activity (Bath AS Disease Activity Index 4.8 vs 2.9). There was no difference between the groups in terms of their comorbid conditions or other demographic variables. Conclusion. The majority of patients in this AS cohort were overweight. They had a greater burden of symptoms, worse perceptions regarding the benefits of exercise, and enhanced awareness of their barriers to exercising. This is of particular concern in a disease where exercise plays a crucial role.

Exercise in Ankylosing Spondylitis: Discrepancies Between Recommendations and Reality

Objective. To determine the type and extent of exercise used by an ankylosing spondylitis (AS) cohort and to examine patients’ perceptions of exercise. Recommendations for the management of AS identify exercise as the cornerstone of comprehensive management. Methods. An exercise inventory questionnaire and the Exercise Benefits and Barriers Scale (EBBS) were administered to patients attending the AS clinic of a large teaching hospital. Benefits and barriers subscales of the EBBS were analyzed to identify the perceived benefits of, and barriers to, exercise. Higher benefits scores (range 29–116) indicate a more positive perception of exercise. Higher barriers scores (range 14–56) indicate a greater perception of barriers to exercise. Results. Sixty-one patients with AS completed the questionnaires. Mean age was 38.0 years, and mean disease duration was 14.7 years. Walking (3 times/week) and stretching (3 times/week) were the most commonly reported types of exercise and were reported in 35.0% and 32.8%, respectively. The mean benefits EBBS score was 87.1 ± 12.5. The most frequently reported benefits of exercise were that it “increases my level of physical fitness” (96.4%) and “improves functioning of my cardiovascular system” (96.4%). The mean barriers EBBS score was 29.2 ± 5.3, and the most frequently reported barrier to exercise was that it “tires me” (71.4%). Conclusion. Patients with AS perceive the benefits of exercise, with average EBBS benefits scores comparable to historical controls with similar conditions. Despite positive perceptions, the majority of patients with AS did not report participating in exercise on a frequent basis.

Postural control is altered in patients with ankylosing spondylitis.

BACKGROUND Ankylosing spondylitis is a chronic inflammatory disorder that can lead to increased axial and peripheral joint stiffness, impairing joint mobility. Impaired axial mobility due to vertebral ankylosis may result in changes in standing postural control. Little research has addressed changes in standing postural control in the ankylosing spondylitis population, nor how these issues might affect clinical understanding and treatment. METHODS Sixteen ankylosing spondylitis patients, and 17 healthy controls participated. Each individual completed two 120-second quiet standing trials with eyes open and eyes closed, while standing upon two force platforms. Net center of pressure displacement and mean power frequency in the frontal and sagittal planes were calculated. A Spearmans rank correlation analysis was performed between net center of pressure measures and several clinical measures of disease activity. FINDINGS Frontal plane net center of pressure displacement and frequency content, and sagittal plane net center of pressure displacement were significantly greater within the ankylosing spondylitis patient group. Ankylosing spondylitis patients demonstrated a significant increase in frontal plane net center of pressure displacement in the eyes-closed condition. Net center of pressure displacement and frequency were significantly correlated to the Bath Ankylosing Spondylitis Functional Index, and individual components of the Bath Ankylosing Spondylitis Metrology Index. INTERPRETATION Quiet standing postural control was altered particularly so in the frontal plane in patients with ankylosing spondylitis, which may be associated with increased fall risk. Posturographic measures of postural control may serve as valuable clinical tools for the monitoring of disease progression and disease status in ankylosing spondylitis.

From gene expression to serum proteins: biomarker discovery in Ankylosing Spondylitis

Objectives: Studying post-infliximab gene expression changes could provide insights into the pathogenesis of ankylosing spondylitis (AS). Methods: Gene expression changes were screened by microarray on peripheral blood RNA of 16 AS patients at baseline and 2 weeks post-infliximab, and selected results were confirmed by quantitative real-time (qRT)–PCR. Corresponding serum-soluble LIGHT (sLIGHT) was estimated by ELISA and the fold change in sLIGHT was correlated to the fold change in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the Bath AS disease activity index. Results: Post-infliximab, 69% of the patients (11/16) achieved an ASAS20 response. Six candidate genes were differentially expressed by microarray; four of which were validated by qRT–PCR. sLIGHT showed the most significant difference. There was good correlation of baseline sLIGHT with CRP (R  =  0.60; p = 0.01) and ESR (R  =  0.51; p = 0.04). The fold change in sLIGHT correlated with change in both CRP (R  =  0.71, p = 0.002) and ESR (R  =  0.77, p<0.001). Conclusion: LIGHT is significantly downregulated by infliximab. sLIGHT correlated well with changes in inflammatory markers.

The prevalence of patellar tendinopathy in elite academy rugby: A clinical and imaging study

OBJECTIVES Patellar tendinopathy (PT) is a challenging condition with variable outcomes. It is not commonly reported in rugby. This study was undertaken to evaluate the prevalence of PT in elite academy rugby. DESIGN Cross-sectional study. METHODS Members of the rugby academies in Ireland were evaluated using blinded, standardised clinical examination, self reported questionnaires and ultrasound. Anthropometrics were examined, body mass and fat% were measured by bio-impedance. The Cincinnati Sports Activity Scale, established activity levels. The VISA-P scale evaluated symptoms. Ultrasound examination established tendon thickness, echogenicity and homogeneity including focal areas of tendinopathy in both transverse and longitudinal planes. Studies were reviewed and graded by two musculoskeletal radiologists. Statistical analysis was performed using PASW 18 and CIA software. Significance was set at p<.05. RESULTS Thirty individuals (36.1%) had US abnormalities identified with 38 abnormal tendons. The abnormalities seen were microcalculi (44.7%; N=17), thickened tendons ± large areas of cystic degenerative change (26.3%) and macrocalculi or large hypoechoic areas (28.9%; N=11). Eleven individuals (13.3%) fulfilled the clinical diagnosis of PT based on clinical examination. Combining both US and clinical the prevalence of PT in this cohort was 9.6% (N=8). There was a statistically significant difference between the prevalence of patellar tendinopathy based upon US findings (p=.027) and the combination of both clinical examination and US (p=.044) in different training academies. CONCLUSIONS This work shows that PT is a relatively common injury in elite academy rugby players and that training practices may contribute to its development.

Decreased health-related physical fitness in adults with ankylosing spondylitis: a cross-sectional controlled study

OBJECTIVES (1) Assess the health-related physical fitness of adults with ankylosing spondylitis (AS) and compare these to the general population, and (2) examine the relationships between physical fitness and condition-specific outcomes. DESIGN Cross-sectional, controlled study. SETTING Exercise research laboratory. PARTICIPANTS Thirty-nine adults with AS (32 men, 7 women) and 39 age- and gender-matched controls. INTERVENTION Comprehensive physical fitness assessment, and completion of questionnaires assessing disease activity, physical function and quality-of-life. MAIN OUTCOME MEASURES Body composition was assessed by bio-impedance analysis. Flexibility was measured with the Bath AS Metrology Index (BASMI). Cardiorespiratory fitness was assessed by submaximal treadmill test with breath-by-breath gas analysis and heart rate monitoring. Muscular strength and endurance were measured by isokinetic dynamometry of concentric knee flexion/extension. RESULTS The AS group demonstrated significantly lower cardiorespiratory fitness [mean difference -1.3mLmin(-1)kg(-1) (95% CI -1.1 to -1.4)], flexibility [0.4 BASMI units (0.2 to 0.7)], muscular strength [-31.6 peak torque per body weight dominant knee extension (-56.1 to -7.1)], and increased body fat [0.4% (0.0 to 1.2)] compared to population controls (p<.05). There were significant associations between each fitness component and physical function (p<.05). Higher aerobic capacity was significantly associated with improved quality-of-life. Fitness was not significantly associated with disease activity. CONCLUSION Adults with AS have significantly reduced health-related physical fitness compared to population controls. Decreased body fat, and higher aerobic capacity, muscular fitness and flexibility are significantly associated with improved function. These findings have implications for clinicians assessing adults with AS, and for targeted-exercise prescription in this cohort.

Schnitzler’s syndrome; a case highlighting the complications of long-standing acquired autoinflammation

The autoinflammatory syndromes are a family of disorders of dysregulated innate immunity that result in the overproduction of pro-inflammatory cytokines, in particular IL-1β [1]. The protean clinical manifestations of these diseases include: recurrent episodic fever, myalgia, arthralgia and arthritis, general malaise, and atypical urticaria or cutaneous features resembling a number of neutrophilic dermatoses, mainly pyoderma gangrenosum [2, 3]. Autoantibodies are characteristically absent. Symptom [...]

Juvenile Versus Adult-Onset Ankylosing Spondylitis: Are We Comparing Apples and Oranges?

Ankylosing spondylitis (AS) is a chronic disabling inflammatory disease affecting the spine, peripheral joints, and extraarticular structures. Depending on the population studied, its prevalence varies between 0.5% and 1% in white populations1. Most frequently presenting in early adulthood, AS can lead to substantial functional limitation in people of working age2. As such it presents a significant burden of morbidity and health care expenditure3. An increasing research interest in the disease over recent years has lead to a number of significant insights in AS. The significant symptomatic relief achievable with nonsteroidal antiinflammatory drugs in a proportion of patients has been known for many years4. The use of biologic agents for symptomatic relief and control of inflammation has been a major step forward. These agents achieve significant symptomatic and functional improvement, minimizing the loss of productivity heretofore inherent in AS5. We have seen the development of a new specific disease activity score, the Ankylosing Spondylitis Disease Activity Score (ASDAS), enabling standardized measuring and monitoring of patients with AS in the outpatient setting6. The Bath Ankylosing Spondylitis Disease Activity Index has been the most widely used disease measure in AS but has been criticized: the BASDAI includes only patient-reported variables, does not weight different clinical manifestations, measures only part of the disease process, and lacks specificity for inflammatory processes7. Similar to the Disease Activity Score (DAS) in rheumatoid arthritis, the ASDAS integrates patient-reported variables and acute-phase reactants to produce a validated disease measure that is highly discriminatory and sensitive to change6. New classification criteria for both axial and peripheral spondyloarthritis have also been developed8. It is hoped that the concept … Address correspondence to Dr. Conway; E-mail: drrichardconway{at}gmail.com

Assessing Back Pain: Does the Oswestry Disability Questionnaire Accurately Measure Function in Ankylosing Spondylitis?

Objective. To determine whether the Oswestry Disability Questionnaire (ODQ) can be used to assess the degree of pain or disability in patients with ankylosing spondylitis (AS). Methods. The ODQ was administered to a cohort of patients with AS. The resulting pain scores were correlated to the conventional measures in AS, the Bath AS Disease Activity Index and Functional Index (BASDAI and BASFI), as well as the Total and Nocturnal Back Pain scores, and the patient global assessment score. Results. A total of 49 patients with AS were assessed (38 men, 11 women), mean age 40 years (range 17–68). The mean ODQ score was 40/100 (range 0–92), the mean BASDAI 3.7/10 (range 0–9.5), the mean BASFI 3.3/10 (range 0–9.7), the mean total back pain score 3.7/10 (range 0–10), and the mean patient global assessment score 3.6/10 (range 0–10). Correlation between the ODQ and the traditional AS outcome measures was very good, with a correlation coefficient of r = 0.73 (BASFI) and r = 0.70 (BASDAI). Correlations between the ODQ and the total back pain score (r = 0.70) and the patient self-reported global assessment (r = 0.61) were good. Conclusion. The strong correlations between the ODQ and BASFI and BASDAI indicate that it identifies both activity and function domains in AS. This is the first demonstration of a role for this outcome measure in the assessment of patients with AS.

Anti-Ro 52 positive dermatomyositis presenting as rapidly progressive interstitial lung disease

Dermatomyositis is frequently accompanied by interstitial lung disease. This varies greatly in severity, from an asymptomatic imaging finding to a fatal rapidly progressive disease. We present a successfully treated case of rapidly progressive anti-Ro 52 positive dermatomyositis-related interstitial lung disease with accompanying images. Figure 1. ( A ) Plain radiograph showing widespread inflammatory changes in both lungs. ( B , C ) Computed Tomography demonstrating ground-glass …