This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made — if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.

Little is known about the effect of hemodialysis (HD) on gas exchange in subjects with chronic obstructive pulmonary disease (COPD). The purpose of this study was to examine blood gases and pH in COPD patients undergoing HD with bicarbonate dialysate. We studied thirteen subjects with COPD and thirteen controls (CON). All were dialyzed for 4 hrs against a bicarbonate HD solution. Blood gases, pH and HCO 3 were initially analyzed (t 0) and, during HD, at 30 min (t 0.5), 1 hr (t 1) and 4 hrs (t 4). At t 0 , a statistically significant difference was observed for PO 2 (CON: 84.7±3.60, COPD: 72.19±4.92; p<0.001). For the first hr, PO 2 decreased, and at t 1 , oxygen was required for 6 COPD subjects. By t 4 , there was no significant difference in PO 2 between groups. The alveolar-arterial gradient (ΔA-a) remained different between groups (P<0.001, all times), with increasing ΔA-a for both groups up to t 1 and decreasing over the remaining 3 hr. For both groups, at t 4 , ΔA-a was higher than at t 0 (p<0.001). For PCO 2 , both groups demonstrated increases from t 0 to t 1 (p=0.0004), with COPD having PCO 2 higher than CON at t 0.5 and t 1 (p<0.05 for both); by t 4 , PCO 2 levels decreased to nearly the same as at t 0. Over the 4 hr treatment, HCO 3 and pH increased significantly for both groups; however no significant difference was observed between COPD and CON. Markedly increased ΔA-a is observed during HD in some COPD patients. COPD patients retain more CO 2. However, the effect of HCO 3 leads to mild metabolic alkalosis at t 4 .

The alveolar-arterial oxygen gradient (DeltaA-a) provides a useful assessment of ventilation/perfusion (V/Q) abnormalities. The objectives of the present study were to: (i) examine the correlation between the DeltaA-a and the pneumonia severity index (PSI); and (ii) determine whether these measures were comparable in predicting clinical outcomes. The present study was conducted at a 750-bed teaching hospital. It examined a retrospective cohort of 255 patients with community acquired pneumonia (CAP) over a 2 year period. Association between the CAP and DeltaA-a was investigated by regression models and correlation, as well as two logistic models for subjects bifurcated by low-risk/moderate-to-high risk. The decision levels (DL) for both PSI and DeltaA-a were then compared as predictors of both length of stay (LOS) and survival. The correlation between PSI and DeltaA-a was strong (rho = 0.76; P < 0.0001) and was best modelled by a curvilinear relationship. Both logistic models indicated a strong association (P < 0.001) between DeltaA-a and PSI and yielded an optimal DL for the DeltaA-a of < 89 mmHg. Inter-test agreement of DeltaA-a with PSI was 76.9% (kappa = 0.60; 95% confidence interval 0.47-0.72; P < 0.0001). At < 89 mmHg, the odds ratios for LOS were similar to those at PSI = 90 in predicting LOS in the range 3-7 days, inclusive. There was no significant difference in the ability of DeltaA-a and PSI to predict survival for either the low- or high-risk group (P = 0.363 and P = 0.951, respectively). The DeltaA-a correlates well with PSI and performs comparably in predicting two major outcomes in subjects hospitalized with CAP.

BackgroundClassic ankylosing spondylitis (AS) with radiographic sacroiliitis has long been considered to be more common in men than women. But this difference has gradually decreased with increasing recognition of this condition in women so that the more recent data suggest a range of 2:1 to 1.2:1 ratio in favor of men [1].ObjectivesTo document greater disease recognition in women during the last 30 years in Switzerland as reflected by AS patient membership in the Swiss Ankylosing Spondylitis Society (SVMB) since its foundation in 1978 [2].MethodsWe reviewed the Society's quarterly newsletters that have kept record since 1980 not only of the number of members, but also the percentage of males and females AS patients. We calculated yearly AS patient membership and also change in the male/female patient ratio (M:F).ResultsThere has been a progressive decline in the M:F ratios since 1980 as shown in the Figure. There were 44 female forming 28% of the patient population, with a M:F ratio of 2.57 in 1980. At the end of 2016, there are 1731 females forming 49% of the total number of patients, and the M:F ratio is now 1.03.ConclusionsAS is now being recognized as often in females as in males, as reflected in the membership of SVMB over the last 36 years. There can be various reasons for this observation, one of them being the availability of better imaging tools to recognize AS/axial spondyloarthritis (axSpA), especially among women whose disease is clinically and radiologically less pronounced and is therefore often overlooked [2]. For example, the use of MRI (for early detection of spinal inflammation) and the ASAS criteria have resulted in >50% females in a German cohort of patients with nonradiographic axSpA [3]. SVMB has played a major role in achieving greater disease recognition in Switzerland by increasing disease awareness and educating patients and their families, the general public, the governing bodies and the allied health professionals about AS, and by interacting closely with rheumatologists. Other possible factors influencing our data include: women outliving men, forming a little greater percentage of the general population, and possibly more likely to join patient self-help groups and societies, We did not investigate any gender difference in disease severity and clinical presentation. In conclusion, AS/axSpA almost equally afflicts men and women in Switzerland.References Khan MA. Accomplishments of Heinz Baumberger PhD: a remarkable patients with ankylosing spondylitis for 72 years. Clin Rheumatol. 2016;35(6):1637–41.Khan M.A. Ankylosing Spondylitis - Axial Spondylitis. Professional Communications Inc. 2016. pp. 1–333.Rudwaleit M, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum. 2009;60:717–27. Disclosure of InterestNone declared

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