Nai Lee Lui

Effect of Pregnancy on Ankylosing Spondylitis: A Case-Control Study

Objective. To evaluate the effect of pregnancy on ankylosing spondylitis (AS). Methods. Our study aimed to determine the severity of back pain and stiffness pre-, during, and postpartum in patients with AS and controls, and corresponding extraarticular symptoms. Results. Nineteen female patients with AS (35 pregnancies) and 33 controls (77 pregnancies) were studied. Improvement in pain was reported in 51% of AS patients, predominantly in the first trimester, with significant improvement in pain than stiffness. In both groups, pain worsened in later stages, likely secondary to biomechanical loading. Postpartum pain scores in AS returned to prepartum levels in general. Conclusion. Pregnancy does not substantially aggravate disease activity or severity in AS.

Cardiomyopathy in ankylosing spondylitis

Based on clinical observations, the incidence of cardiac involvement in ankylosing spondylitis (AS) appears to have reduced over recent decades. The reason for this is unclear, but may be attributed to earlier recognition of AS and better control of the disease. When faced with unexplained cardiomyopathy in an AS patient, the challenging question facing cardiologists and rheumatologists alike is whether the cardiomyopathy, in the absence of other identifiable causes, is an extraarticular manifestation of AS and, if so, what are the underlying pathogenesis and the effect on the cardiomyopathy following treatment of the underlying inflammatory process in AS. Extraarticular manifestations of AS are not uncommon. In 30–40% of AS patients, anterior uveitis may occur, being the most common extraarticular manifestation of AS (1). While involvement of the ascending aorta, aortic valves, and conduction system have been recognized in AS, myocardial manifestations remain less well defined. Cardiac involvement appears to occur more commonly in patients with a longer duration of disease. For example, aortic incompetence was noted in 3.5% of AS patients with 15 years of disease duration and in 10% with 30 years of disease (2), while cardiac conduction disturbance was noted in 2.7% in those with 15 years of disease duration and in 8.5% after 30 years (1). These data suggest that the underlying inflammation in AS, if untreated, may affect various cardiac tissues, with more involvement after longer periods of inflammation. Although to our knowledge there has been no study to show a decline in the prevalence of these conditions with better control of inflammation, the observation in our AS cohort shows a very low incidence of AS-related valvular heart disease in recent years (3 of 503 AS patients), probably related to improved management of AS. The association between AS and cardiomyopathy is not well defined. Cases of cardiomyopathy in AS in the past were mainly reports of left ventricular dysfunction defined by echocardiography (2–4). In an echocardiographic study of asymptomatic juvenileand adult-onset AS patients with longstanding disease, it was found that up to 25% of juvenile-onset AS patients and 32.2% of adult-onset AS patients had evidence of cardiomyopathy (5). Here we present 4 cases, 2 cases each from Singapore General Hospital (SGH) and Toronto Western Hospital (TWH), of idiopathic cardiomyopathy in AS and a review of the literature. The 2 patients from Singapore are ethnic Chinese, whereas the 2 cases from Canada are white. Case selection excluded circumstances in which the cardiomyopathy had a defined etiology such as coronary artery disease or valvular disease. Two patients were noted to have improvement of their ejection fractions following treatment of their AS, suggesting that cardiomyopathy in AS may be reversible with effective treatment of the underlying inflammatory process. Early detection of cardiomyopathy therefore may lead to better prognosis.

Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi-ethnic, urban Asian population in Singapore

To describe the spectrum of diseases seen in an outpatient setting in the Singapore General Hospital, the largest tertiary referral centre in Singapore.

Validity and reliability of the Health Assessment Questionnaire among patients with spondyloarthritis in Singapore

The Health Assessment Questionnaire (HAQ) is a popular tool used to measure disability. Few studies have assessed its psychometric properties in patients with spondyloarthritis (SpA). We therefore aimed to assess the reliability and validity of the HAQ in patients with SpA in Singapore.

Clinical Correlates of Urolithiasis in Ankylosing Spondylitis

Objective. To determine the association between urolithiasis and syndesmophyte formation and the effect of urolithiasis on ankylosing spondylitis (AS) disease activity. Methods. In a longitudinal cohort of 504 patients with AS, we conducted an analysis of all patients with AS who have a history of urolithiasis. All patients met the modified New York criteria for AS. Demographics, clinical characteristics, extraarticular features, and comorbidities are systematically recorded in the database. We compared disease activity, functional indices, medical therapy and radiographic damage between AS patients with (Uro+) and without urolithiasis (Uro–) using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Results. Thirty-eight patients with AS (7.5%) had a history of urolithiasis in our cohort. Seventy-six patients with AS who did not have urolithiasis, matched for age, sex, and ethnicity, were selected as controls. Patients who were Uro+ were more likely to have more functional disability, based on the Bath AS Functional Index (BASFI; mean 5.3 vs 3.6 in control group, p = 0.003). Trends were noted in the Uro+ group toward higher Bath AS Disease Activity Index (BASDAI; mean 4.9 vs 4.0, p = 0.09), more peripheral joint involvement (p = 0.075), and higher frequency of biologic therapy (p = 0.09). No significant difference was detected in mSASSS or the Bath AS Metrology Index (BASMI). Significant association with diabetes mellitus (DM; p = 0.016) and Crohn’s disease (p = 0.006) was noted in the Uro+ group. Conclusion. Although there is no acceleration of syndesmophyte formation or spinal mobility restriction, more functional disability was detected in the urolithiasis group. The higher risk with concomitant DM or Crohn’s disease should alert clinicians to these comorbidities in Uro+ patients with AS.

A systematic review of quality-of-life domains and items relevant to patients with spondyloarthritis

OBJECTIVES To summarize, from the literature, quality-of-life (QoL) domains and items relevant to patients with spondyloarthritis (SpA), and to determine if commonly used SpA patient-reported outcome (PRO) instruments include the identified domains. METHODS We used PRISMA statement for systematic review and searched Medline® , Embase®, and PsycInfo® using relevant keywords. In addition, hand searches of references of the included articles were conducted. All articles were reviewed for inclusion by 2 independent reviewers. QoL domains and items relevant to patients with axial or peripheral SpA were extracted and presented using the adapted World Health Organization Quality-of-Life (WHOQOL) domain framework. SpA PROs were assessed to determine if they included the domains identified. RESULTS We retrieved 14,343 articles, of which 34 articles fulfilled inclusion criteria for review. Twenty-five articles were conducted in the European population. Domains such as negative feelings and activities of daily living were found to be present in 28 and 27 articles, respectively. SpA impacted QoL in all domains of the adapted WHOQOL framework. Domains that differed between types of SpA were financial resources, general levels of independence and medication side effects. Embarrassment, self-image, and premature ageing were items that differed by geographical setting. PROs to capture domains for peripheral SpA were similar for axial SpA. CONCLUSIONS We found that a wide range of domains and items of QoL were relevant to patients with SpA with minimal differences between patients with axial and peripheral SpA. Clinicians may consider using peripheral SpA PROs to measure QoL of patients with axial SpA.

The impact of axial spondyloarthritis on quality of life (QoL): a comparison with the impact of moderate to end-stage chronic kidney disease on QoL

PurposeThe purpose of the study was to assess the impact of axial spondyloarthritis (axSpA) on patients’ quality of life (QoL) compared to patients with moderate to end-stage chronic kidney disease (CKD).MethodsWe conducted secondary analysis of QoL data obtained from patients with axSpA and CKD from 2011 to 2014. QoL was assessed using the SF-36 version 2 and KDQoL-SF for patients with axSpA and CKD, respectively. Patients with CKD were subcategorized to CKD-pre-dialysis, hemodialysis (CKD-HD) and peritoneal dialysis (CKD-PD). Linear regression was used to compare QoL between patients with axSpA and CKD after adjusting for age, gender, ethnicity, education level, and marital status.ResultsA total of 765 patients (mean age 54.6, 63.0% males, 69.0% Chinese) were analyzed, of which 188 (24.5%) had axSpA. Patients with axSpA had poorer SF-36 bodily pain (BP) scores (axSpA: reference; CKD-pre-dialysis β: 11.04, p < 0.001; CKD-HD β: 9.52, p < 0.001; CKD-PD β: 10.35, p < 0.001) and higher general health scores (axSpA: reference; CKD-pre-dialysis β: − 7.87, p < 0.001; CKD-HD β: − 7.14, p < 0.001, CKD-PD β: − 7.25, p < 0.001) as compared to patients with CKD. Generally, patients with axSpA had poorer SF-36 scores than patients with CKD-pre-dialysis and similar SF-36 scores compared to patients with CKD-HD or CKD-PD.ConclusionsThe burden of axSpA on QoL is not trivial and is comparable to patients with CKD-HD or CKD-PD.