Transfusion requirements in patients with intracapsular fracture or baseline Hb level of 12 g/dL or more appear to be reduced by IV iron sucrose therapy, but there was no difference in morbidity, mortality, or length of hospital stay. The treatment is safe and hastens recovery from blood loss.

Objective. To explore the association between mobility, inflammation, and structural damage in ankylosing spondylitis (AS). Methods. Patients with AS were included in a cross-sectional study in which spinal mobility was measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI) and by the University of Có rdoba Ankylosing Spondylitis Metrology Index (UCOASMI), based on an automated motion analysis. Structural damage was measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), and activity by the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity (BASDAI). We analyzed the correlations between variables, as well as interaction by multiple linear regression models to reach a predictive equation. Results. Fifty AS patients, mainly men in their mid-40s and with moderate levels of disease activity and structural damage, were included in the study. BASMI and UCOASMI scores showed a strong correlation (r ‫؍‬ 0.89). UCOASMI scores correlated stronger than BASMI with structural damage (r ‫؍‬ 0.72 versus r ‫؍‬ 0.67) and patient's age (r ‫؍‬ 0.68 versus r ‫؍‬ 0.56). Correlations of mobility were weaker with disease activity by the ASDAS (r ‫؍‬ 0.38) and BASDAI (r ‫؍‬ 0.49), and disease duration (r ‫؍‬ 0.40). Multiple linear regression showed that factors associated to mobility by UCOASMI were age, the BASDAI, mSASSS, ASDAS (0:<2.1, 1:>2.1), and disease duration >15 years. The largest weight in the equation corresponded to the mSASSS. The association between the ASDAS and UCOASMI is dependent on disease duration. Conclusion. Mobility in AS is influenced by both structural damage and activity, but definitely also by age and disease duration. Improved mobility should be a relevant target in AS, even more prominently than activity, given its closer relation to structural damage.

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The aim of the study was to explore the influence of psychological affective states such as cheerfulness and bad mood on self-reported disease activity in patients with ankylosing spondylitis (AS) while controlling for demographic and clinical variables. Patients attending a biological therapy unit were selected for a cross-sectional study if they met the criteria for AS and were already receiving treatment. Their psychological affective state was assessed with the state version of the State-Trait Cheerfulness Inventory. Clinical variables included were patient-reported disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and acute-phase reactants. We performed univariate and multivariate analyses to verify the robustness of the relationship between psychological affective states and disease activity. We also explored whether disease activity, measured either by self-report or by acute-phase reactants, was influenced by patient's overall affective state. In the recruited 31 patients with AS, overall affective state contributed significantly to the variance in BASDAI scores, adding 21.8% to the overall R-square of the predictive power of clinical and demographic variables (combined R-square = 17%). A higher positive affective state was associated with lower values of C-reactive protein (p < 0.05). Results of a bootstrapping procedure showed that the relationship between C-reactive protein levels and BASDAI scores was mediated by overall affective state. In patients with AS, affective state can induce variability in self-reported disease activity. Patients' overall affective state can explain the relationship between acute-phase reactants and self-reported scores. These findings suggest interesting possibilities for the monitoring of disease activity in AS.

BACKGROUND: The objective of the current study was to determine whether overnight pulse oximetry in patients with amyotrophic lateral sclerosis is prognostic of the onset of awake respiratory failure and hospital admissions. METHODS: This was an observational study in a cohort of subjects with amyotrophic lateral sclerosis. The study included subjects with a baseline S pO 2 6 94% on home overnight pulse oximetry testing. Patients age 6 80 y and those with comorbidities and with poor short-term prognosis or sleep apnea were excluded. The subjects were classified as nocturnal desaturators according to percentage of sleep time with S pO 2 < 90% (T90) > 10%. RESULTS: A total of 76 subjects were included: 40 men (53%), mean 6 SD age 60 6 14.4 y, mean 6 SD body mass index 25.7 6 4.60 kg/m 2 , and spinal presentation in 63.2%. After overnight pulse oximetry, 20 subjects (26%) were classified as desaturators and 56 (74%) as non-desaturators. In the first year, the subjects with nocturnal desaturation had respiratory failure more often compared with the subjects without desaturation (35% vs 10.91%; P 5 .02) and had a higher risk of developing respiratory failure during the course of the study (hazard ratio 2.48; P 5 .030). The desaturator group also had a higher rate of 6 1 admission (40% vs 7.3%; P 5 .01) and a higher likelihood of respiratory-related hospitalization (hazard ratio 2.41; P 5 .02). Median survival was almost 1 year less if T90 > 10% was observed in the overnight pulse oximetry: 21 months versus 32 months survival if T90 was^10%. CONCLUSIONS: In subjects with amyotrophic lateral sclerosis, nocturnal desaturation conferred a higher risk of respiratory failure and poorer prognosis. Even in the absence of other clinical criteria, early pulse oximetry should be performed and the need for nocturnal ventilatory support assessed.

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