Pub Date : 2023-09-25DOI: 10.1142/s2661341723300045
Laniyati Hamijoyo, Jonathan Paul Consignado, Sandra V. Navarra
Patient empowerment in lupus is a process wherein patients actively participate in decision-making with healthcare professionals and take responsibility for their own condition. In order to effectively be involved in their medical care and achieve the best treatment outcomes, patients have to be equipped with a sufficient body of knowledge and understanding of lupus and its intricacies. Furthermore, the significant roles of families and caregivers, other healthcare professionals and support systems, and policymakers in each country have an immense impact on health outcomes and the overall quality of life.
{"title":"Perspective—The Paramount Impact of Lupus Patient Empowerment","authors":"Laniyati Hamijoyo, Jonathan Paul Consignado, Sandra V. Navarra","doi":"10.1142/s2661341723300045","DOIUrl":"https://doi.org/10.1142/s2661341723300045","url":null,"abstract":"Patient empowerment in lupus is a process wherein patients actively participate in decision-making with healthcare professionals and take responsibility for their own condition. In order to effectively be involved in their medical care and achieve the best treatment outcomes, patients have to be equipped with a sufficient body of knowledge and understanding of lupus and its intricacies. Furthermore, the significant roles of families and caregivers, other healthcare professionals and support systems, and policymakers in each country have an immense impact on health outcomes and the overall quality of life.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135865474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05DOI: 10.1142/s2661341723500025
C. Chu, L. Ho, C. Mok
Objective: To study the predictive value of a positive anti-nuclear antibody (ANA) for a rheumatological diagnosis in an outpatient setting. Methods: Individuals who were referred to the rheumatology outpatient clinics because of a positive ANA between July 2014 and June 2015 were retrospectively reviewed. Presenting symptoms in addition to a positive ANA and whether a final rheumatological diagnosis was made were recorded. The positive predictive value of a positive ANA and its titer for a rheumatological diagnosis, with and without accompanying symptoms was evaluated. Results: A total of 230 patients were included (82% women, age 47.7 ± 14.1 years [range 18-84]). Family medicine and the general outpatient clinic were the main sources of referral (32.2%), followed by ophthalmology (13.0%) and otorhinolaryngology (11.7%). A final rheumatological diagnosis was made in 54 (23.5%) patients, with rheumatoid arthritis being the commonest diagnosis (40.7%). In the absence of any associated symptoms, the predictive value of a positive ANA was 0%. The presence of Raynaud’s phenomenon (100%), joint swelling (59.5%), and joint stiffness (48.9%) predicted a better final rheumatological diagnosis along with a positive ANA. ANA titers of 1:80 or less had a low sensitivity for rheumatic diseases. A receiver operating characteristic (ROC) curve analysis showed that an ANA titer of [Formula: see text]1:128 best predicted a rheumatological diagnosis (AUC 0.78 [0.71–0.85]; sensitivity 0.78; specificity 0.64). Conclusions: To improve the prediction for a rheumatological diagnosis, referral for a positive ANA test should be more appropriately done with compatible symptoms.
{"title":"Prediction of a Positive ANA Result for a Rheumatological Diagnosis in an Outpatient Setting","authors":"C. Chu, L. Ho, C. Mok","doi":"10.1142/s2661341723500025","DOIUrl":"https://doi.org/10.1142/s2661341723500025","url":null,"abstract":"Objective: To study the predictive value of a positive anti-nuclear antibody (ANA) for a rheumatological diagnosis in an outpatient setting. Methods: Individuals who were referred to the rheumatology outpatient clinics because of a positive ANA between July 2014 and June 2015 were retrospectively reviewed. Presenting symptoms in addition to a positive ANA and whether a final rheumatological diagnosis was made were recorded. The positive predictive value of a positive ANA and its titer for a rheumatological diagnosis, with and without accompanying symptoms was evaluated. Results: A total of 230 patients were included (82% women, age 47.7 ± 14.1 years [range 18-84]). Family medicine and the general outpatient clinic were the main sources of referral (32.2%), followed by ophthalmology (13.0%) and otorhinolaryngology (11.7%). A final rheumatological diagnosis was made in 54 (23.5%) patients, with rheumatoid arthritis being the commonest diagnosis (40.7%). In the absence of any associated symptoms, the predictive value of a positive ANA was 0%. The presence of Raynaud’s phenomenon (100%), joint swelling (59.5%), and joint stiffness (48.9%) predicted a better final rheumatological diagnosis along with a positive ANA. ANA titers of 1:80 or less had a low sensitivity for rheumatic diseases. A receiver operating characteristic (ROC) curve analysis showed that an ANA titer of [Formula: see text]1:128 best predicted a rheumatological diagnosis (AUC 0.78 [0.71–0.85]; sensitivity 0.78; specificity 0.64). Conclusions: To improve the prediction for a rheumatological diagnosis, referral for a positive ANA test should be more appropriately done with compatible symptoms.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45070334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05DOI: 10.1142/s266134172372001x
Cheryl Chun Man Ng, A. Leung
Anti-melanoma differentiation-associated gene 5 (MDA5) antibody positive dermatomyositis is known to associate with rapidly progressive interstitial lung disease and cutaneous ulcer. The prognosis is often poor even with intensive treatment, with data from the local cohort showing 37.9% mortality [1]. Here, we report a case of refractory anti-MDA5 antibody-associated dermatomyositis that occurs shortly after COVID-19 infection and was managed using a combination of treatments that target different aspects of disease pathology.
{"title":"Managing a Case of Refractory Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Associated Dermatomyositis with Recent COVID-19 Infection","authors":"Cheryl Chun Man Ng, A. Leung","doi":"10.1142/s266134172372001x","DOIUrl":"https://doi.org/10.1142/s266134172372001x","url":null,"abstract":"Anti-melanoma differentiation-associated gene 5 (MDA5) antibody positive dermatomyositis is known to associate with rapidly progressive interstitial lung disease and cutaneous ulcer. The prognosis is often poor even with intensive treatment, with data from the local cohort showing 37.9% mortality [1]. Here, we report a case of refractory anti-MDA5 antibody-associated dermatomyositis that occurs shortly after COVID-19 infection and was managed using a combination of treatments that target different aspects of disease pathology.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46150231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05DOI: 10.1142/s2661341723300033
Carolyn Lee, C. To
IgG4-related disease (IgG4-RD) is a multi-organ fibroinflammatory disorder that may result in organ dysfunction and complications. Glucocorticoids remain the primary treatment for inducing remission, while recently reported disease phenotypes might inform personalized therapeutic strategies. Progress in understanding the pathophysiology of IgG4-RD has led to the identification of novel treatment targets. Ongoing research will further refine the optimal treatment for IgG4-RD. This review offers an update on the latest evidence on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of IgG4-RD.
{"title":"IgG4-Related Disease: A Concise Review","authors":"Carolyn Lee, C. To","doi":"10.1142/s2661341723300033","DOIUrl":"https://doi.org/10.1142/s2661341723300033","url":null,"abstract":"IgG4-related disease (IgG4-RD) is a multi-organ fibroinflammatory disorder that may result in organ dysfunction and complications. Glucocorticoids remain the primary treatment for inducing remission, while recently reported disease phenotypes might inform personalized therapeutic strategies. Progress in understanding the pathophysiology of IgG4-RD has led to the identification of novel treatment targets. Ongoing research will further refine the optimal treatment for IgG4-RD. This review offers an update on the latest evidence on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of IgG4-RD.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43174534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05DOI: 10.1142/s2661341723300021
J. So, Hoch So
Pre-rheumatoid arthritis (pre-RA) is the preclinical period before the diagnosis of rheumatoid arthritis (RA). Patients may suffer from arthralgia without clinically detectable arthritis. This period is characterized by a complex interaction of genetic, environmental, and host microbiomic factors leading to immune dysregulation, the production of autoantibodies, and finally joint inflammation. Around 30% of patients with undifferentiated arthritis progress to RA. Early identification of patients at the pre-RA stage might provide an opportunity for timely intervention, which may alter the natural history of the disease. In this narrative review, we will summarize the clinical features of pre-RA and the risk factors associated with the development of RA. The management of patients with a high risk of developing RA will also be discussed.
{"title":"Pre-Rheumatoid Arthritis: A Review","authors":"J. So, Hoch So","doi":"10.1142/s2661341723300021","DOIUrl":"https://doi.org/10.1142/s2661341723300021","url":null,"abstract":"Pre-rheumatoid arthritis (pre-RA) is the preclinical period before the diagnosis of rheumatoid arthritis (RA). Patients may suffer from arthralgia without clinically detectable arthritis. This period is characterized by a complex interaction of genetic, environmental, and host microbiomic factors leading to immune dysregulation, the production of autoantibodies, and finally joint inflammation. Around 30% of patients with undifferentiated arthritis progress to RA. Early identification of patients at the pre-RA stage might provide an opportunity for timely intervention, which may alter the natural history of the disease. In this narrative review, we will summarize the clinical features of pre-RA and the risk factors associated with the development of RA. The management of patients with a high risk of developing RA will also be discussed.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44778233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-13DOI: 10.1142/s266134172330001x
Dennis Tin Ho Chan, Hoch So
Systemic sclerosis (SSc) is a connective tissue disorder with multiple organ involvement. Interstitial lung disease (ILD) is particularly significant as it is the leading cause of death in SSc patients. The clinical course of SSc-ILD is highly variable. It can progress rapidly or remain stable without treatment. Disease progression can occur both early and late in the course of the disease. This heterogeneity exemplifies the need to identify those who are at risk of developing ILD and those who are at risk of deterioration. In this article, we will review the latest evidence on the prevalence of SSc-ILD, the predictors of SSc-ILD development, and the risk factors for its progression.
{"title":"Systemic Sclerosis-Associated Interstitial Lung Disease: Prevalence and Risk Factors","authors":"Dennis Tin Ho Chan, Hoch So","doi":"10.1142/s266134172330001x","DOIUrl":"https://doi.org/10.1142/s266134172330001x","url":null,"abstract":"Systemic sclerosis (SSc) is a connective tissue disorder with multiple organ involvement. Interstitial lung disease (ILD) is particularly significant as it is the leading cause of death in SSc patients. The clinical course of SSc-ILD is highly variable. It can progress rapidly or remain stable without treatment. Disease progression can occur both early and late in the course of the disease. This heterogeneity exemplifies the need to identify those who are at risk of developing ILD and those who are at risk of deterioration. In this article, we will review the latest evidence on the prevalence of SSc-ILD, the predictors of SSc-ILD development, and the risk factors for its progression.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48169275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-31DOI: 10.1142/s2661341723010010
R. Yip
{"title":"Treatment of Gout in Hong Kong: Consensus and Controversy","authors":"R. Yip","doi":"10.1142/s2661341723010010","DOIUrl":"https://doi.org/10.1142/s2661341723010010","url":null,"abstract":"","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42818328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-17DOI: 10.1142/s2661341723500013
Amy Cheung Chung Ting, H. Chung, S. C. Chan, Vanessa Ip Yan Lam
Objectives: To investigate the risk of flare-ups after COVID-19 vaccination in patients with rheumatic disease. Methods: A total of 1,617 patients with rheumatic diseases were identified from three rheumatology clinics. Patients were interviewed for demographic data, disease activity, and vaccination status. Disease flare-up was determined clinically by independent rheumatologists. Change of serum markers and medications were retrieved from medical records. The risk of exacerbation of rheumatic disease, change in serum markers, and escalation of rheumatic medications between vaccinated and nonvaccinated patients were determined using Cox, linear, and logistic regression models, respectively. Possible confounding factors were also taken into consideration. Results: Among 562 (34.76%) patients who received COVID-19 vaccination, rheumatic disease (HR = 2.10, [Formula: see text] 0.001), inflammatory arthritis (HR = 2.71, [Formula: see text] 0.001), rheumatoid arthritis (RA) (HR = 2.03, [Formula: see text] = 0.002), spondyloarthritis (SpA) (HR = 4.78, [Formula: see text] 0.001), autoimmune disease (HR = 1.77, [Formula: see text] = 0.01), and systemic lupus erythematosus (SLE) (HR = 1.99, [Formula: see text] = 0.02) were associated with postvaccination clinical flare-up. Adult Still’s disease (B = 12.76, [Formula: see text] = 0.03) was associated with increased serum C-reactive protein (CRP). No association was found between vaccination and escalation of rheumatic medication. Subgroup analyses showed that only the mRNA vaccine was associated with flare-ups. Conclusion: COVID-19 vaccination was associated with minor disease flare-up but not escalation of rheumatic medications. In the absence of absolute contraindications, COVID-19 vaccination is recommended in patients with rheumatic disease. KEY MESSAGES 1. Vaccination is effective in the prevention of morbidity due to COVID-19 in patients with autoimmune diseases. 2. The mRNA vaccine was associated with mild rheumatic disease flare-up. 3. Inactivated virus vaccine is preferable to mRNA vaccine in patients with active autoimmune disease.
{"title":"Risk of Exacerbation of Rheumatic Disease after COVID-19 Vaccination","authors":"Amy Cheung Chung Ting, H. Chung, S. C. Chan, Vanessa Ip Yan Lam","doi":"10.1142/s2661341723500013","DOIUrl":"https://doi.org/10.1142/s2661341723500013","url":null,"abstract":"Objectives: To investigate the risk of flare-ups after COVID-19 vaccination in patients with rheumatic disease. Methods: A total of 1,617 patients with rheumatic diseases were identified from three rheumatology clinics. Patients were interviewed for demographic data, disease activity, and vaccination status. Disease flare-up was determined clinically by independent rheumatologists. Change of serum markers and medications were retrieved from medical records. The risk of exacerbation of rheumatic disease, change in serum markers, and escalation of rheumatic medications between vaccinated and nonvaccinated patients were determined using Cox, linear, and logistic regression models, respectively. Possible confounding factors were also taken into consideration. Results: Among 562 (34.76%) patients who received COVID-19 vaccination, rheumatic disease (HR = 2.10, [Formula: see text] 0.001), inflammatory arthritis (HR = 2.71, [Formula: see text] 0.001), rheumatoid arthritis (RA) (HR = 2.03, [Formula: see text] = 0.002), spondyloarthritis (SpA) (HR = 4.78, [Formula: see text] 0.001), autoimmune disease (HR = 1.77, [Formula: see text] = 0.01), and systemic lupus erythematosus (SLE) (HR = 1.99, [Formula: see text] = 0.02) were associated with postvaccination clinical flare-up. Adult Still’s disease (B = 12.76, [Formula: see text] = 0.03) was associated with increased serum C-reactive protein (CRP). No association was found between vaccination and escalation of rheumatic medication. Subgroup analyses showed that only the mRNA vaccine was associated with flare-ups. Conclusion: COVID-19 vaccination was associated with minor disease flare-up but not escalation of rheumatic medications. In the absence of absolute contraindications, COVID-19 vaccination is recommended in patients with rheumatic disease. KEY MESSAGES 1. Vaccination is effective in the prevention of morbidity due to COVID-19 in patients with autoimmune diseases. 2. The mRNA vaccine was associated with mild rheumatic disease flare-up. 3. Inactivated virus vaccine is preferable to mRNA vaccine in patients with active autoimmune disease.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49352320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-21DOI: 10.1142/s2661341722300105
S. C. Chan, Ian Yue Kit Kwan, W. Shum, M. Yeung, H. Chung
Axial spondyloarthritis (SpA) is a spectrum of inflammatory conditions predominantly involving the spine and sacroiliac (SI) joints. The development of biological therapies has revolutionized the treatment paradigm in SpA. This has led to a great improvement in clinical outcomes, including inflammation suppression, symptom alleviation, and functional improvement. Despite its usefulness, the question regarding the optimal duration of therapy remains unanswered. This is particularly important given the cost associated with biological therapies, and the potential side effects related to immune suppression. Currently, guideline and data regarding dose reduction of biologics treatment in axial SpA has not been well established. This randomized controlled trial aims to study the possibility of biologic dose reduction in patients with axial SpA. The primary measure will be the occurrence of disease flare up in participants undergoing biologics tapering compared with participants on standard dose of treatment. The study also aims to evaluate the role of anti-drug antibodies in disease flare, the effect of biologics dose reduction on structural changes, and the cost effectiveness of biologics dose reduction. The results of this study will be crucial for clinical decisions and establishing future guidelines regarding dose reduction of biologics in SpA.
{"title":"A Randomized Controlled Trial of Dose Reduction of Biologic Therapy in Axial Spondyloarthritis: Rationale and Protocol of an Open-Label Non-inferiority Study and a Review of Literature","authors":"S. C. Chan, Ian Yue Kit Kwan, W. Shum, M. Yeung, H. Chung","doi":"10.1142/s2661341722300105","DOIUrl":"https://doi.org/10.1142/s2661341722300105","url":null,"abstract":"Axial spondyloarthritis (SpA) is a spectrum of inflammatory conditions predominantly involving the spine and sacroiliac (SI) joints. The development of biological therapies has revolutionized the treatment paradigm in SpA. This has led to a great improvement in clinical outcomes, including inflammation suppression, symptom alleviation, and functional improvement. Despite its usefulness, the question regarding the optimal duration of therapy remains unanswered. This is particularly important given the cost associated with biological therapies, and the potential side effects related to immune suppression. Currently, guideline and data regarding dose reduction of biologics treatment in axial SpA has not been well established. This randomized controlled trial aims to study the possibility of biologic dose reduction in patients with axial SpA. The primary measure will be the occurrence of disease flare up in participants undergoing biologics tapering compared with participants on standard dose of treatment. The study also aims to evaluate the role of anti-drug antibodies in disease flare, the effect of biologics dose reduction on structural changes, and the cost effectiveness of biologics dose reduction. The results of this study will be crucial for clinical decisions and establishing future guidelines regarding dose reduction of biologics in SpA.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47716095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-21DOI: 10.1142/s2661341722300117
W. Kwok, H. Chung
Introduction: To investigate the relationship between spondyloarthritis (SpA) and osteoporosis including any association or prediction, and hence suggesting a plan of screening and management for osteoporosis in SpA. Methods: 168 and 538 research articles with keywords “osteoporosis” and “spondyloarthritis” or “ankylosing spondylitis” conducted between 1990 and 2021 were collected in Medline and PubMed, respectively. Focused review was conducted in 34 articles. Results: Osteoporosis is a common comorbidity in both ankylosing spondylitis and spondyloarthropathy as suggested by multiple studies across different countries, with a reduction in bone mineral density (BMD) and altered bone microarchitecture in vertebrae and cortical bone of proximal femur, leading to an increased risk of vertebral fractures and sarcopenia. Associated factors include male sex, advanced age, long disease duration, high serum erythrocyte sedimentation rate (ESR), decreased femoral and lateral lumbar BMD, and high radiological indices. It is likely to be related to chronic systemic inflammation and immobility. Serum uric acid level, certain genes and antibodies may also contribute to the pathology. The likelihood of osteoporosis in SpA can be evaluated by trabecular bone score, which are negatively correlated with serum levels of ESR and C-reactive protein (CRP). Alendronate with adequate dietary intake of calcium and vitamin D is the recommended management. Conclusion: The prevalence of osteoporosis is higher in patients with SpA due to the chronic presence of pro-inflammatory cytokines, functional impairment, and steroid therapy. With the help of inflammatory markers, imaging and radiological indices, the risk of osteoporosis, and vertebral fractures can be predicted. The management plan should be modified to include prevention and treatment of osteoporosis.
{"title":"Review Article on the Relationship between Spondyloarthritis and Osteoporosis","authors":"W. Kwok, H. Chung","doi":"10.1142/s2661341722300117","DOIUrl":"https://doi.org/10.1142/s2661341722300117","url":null,"abstract":"Introduction: To investigate the relationship between spondyloarthritis (SpA) and osteoporosis including any association or prediction, and hence suggesting a plan of screening and management for osteoporosis in SpA. Methods: 168 and 538 research articles with keywords “osteoporosis” and “spondyloarthritis” or “ankylosing spondylitis” conducted between 1990 and 2021 were collected in Medline and PubMed, respectively. Focused review was conducted in 34 articles. Results: Osteoporosis is a common comorbidity in both ankylosing spondylitis and spondyloarthropathy as suggested by multiple studies across different countries, with a reduction in bone mineral density (BMD) and altered bone microarchitecture in vertebrae and cortical bone of proximal femur, leading to an increased risk of vertebral fractures and sarcopenia. Associated factors include male sex, advanced age, long disease duration, high serum erythrocyte sedimentation rate (ESR), decreased femoral and lateral lumbar BMD, and high radiological indices. It is likely to be related to chronic systemic inflammation and immobility. Serum uric acid level, certain genes and antibodies may also contribute to the pathology. The likelihood of osteoporosis in SpA can be evaluated by trabecular bone score, which are negatively correlated with serum levels of ESR and C-reactive protein (CRP). Alendronate with adequate dietary intake of calcium and vitamin D is the recommended management. Conclusion: The prevalence of osteoporosis is higher in patients with SpA due to the chronic presence of pro-inflammatory cytokines, functional impairment, and steroid therapy. With the help of inflammatory markers, imaging and radiological indices, the risk of osteoporosis, and vertebral fractures can be predicted. The management plan should be modified to include prevention and treatment of osteoporosis.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46778999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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