Although more common in women, SSc appears as strikingly more severe in men. Our results obtained through the largest worldwide database demonstrate a higher risk of severe cardiovascular involvement in men. These results raise the point of including sex in the management and the decision-making process.
Retrospective population-based survey in 2 regions of the Republic of Moldova determined the incidence of fractures at the hip, proximal humerus and distal forearm. The estimated number of such fractures nationwide for 2015 was 11,271 and is predicted to increase to 15,863 in 2050. The hip fracture rates were used to create a FRAX model to help guide decisions about treatment. Objective This paper describes the epidemiology of osteoporotic fractures in Republic of Moldova that was used to develop the country-specific fracture prediction FRAX® tool. Methods We carried out a retrospective population-based survey in 2 regions of the Republic of Moldova (Anenii Noi district and Orhei district) representing approximately 6% of the country's population. We identified hip, forearm and humerus fractures in 2011 and 2012 from hospital registers and primary care sources. Age-and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Moldova. Fracture probabilities were compared with those from neighbouring countries having FRAX models. Results The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 3911 and is predicted to increase by 60% to 6492 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures. FRAX-based probabilities were higher in Moldova than neighbouring countries (Ukraine and Romania). Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Moldavan population and help guide decisions about treatment.
ObjectivesThe purpose of the study was to investigate the relationship between disease activity, structural lesions and physical function by testing the hypothesis that the level of structural lesions contributes independently to physical impairment.MethodsFor this analysis, the database of Rheumatology Department was used and included 78 consecutive SA patients who have been observed for many years, implying that they have used NSAID’s and DMARD for progression disease, no one has used TNF blocking agents.ResultsBASFI and DFI correlated significantly (r 0.88). The correlation coefficient for mSASSS and BASFI was 0.508 and for mSASSS and DFI equal to 0.464, suggesting a moderate correlation relationship. The correlation coefficient for the relationship between BASDAI and BASFI was equal to 0.79 and for BASDAI and DFI equal to 0.69 suggesting a moderate to significant correlation. The correlation between mSASSS and BASFI or DFI was dependent on the BASDAI level.To further investigate the relationship between mSASSS and BASFI/DFI, concurrently adjusting for BASDAI and other covariates, a multivariate analysis was performed using GEE with BASFI or DFI as dependent variables, and mSASSS and BASDAI as covariates, concurrently adjusting for age, sex, duration of illness, HLA-B27 status and hip involvement.Both BASDAI and mSASSS contributed independently to the BASFI and DFI explanations with significant parameter estimates. Regression coefficients describe the independent relationship between the explanatory variables and the dependent variable: in the environment, compared to a patient with mSASSS 40, a patient with the mSASSS score 50 has a BASFI of 0.57 times greater, independent of BASDAI.All mSASSS subscripts contributed independently to the explanation of BASFI variations (p<0.001). Compared to the mSASSS model, which had the best result, the model with the total score of the syndesmofite, the number of the affected vertebral units, the number of vertebral vertebral units, and the model with the non-syndesmophitary summary score, it was deduced that the syndesmophites are in much but not exclusively responsible for explaining variations in BASFI. A model with the sindesmophites summary score (p<0.001) and the non-syndesmophyte (p=0.002) shows that both components contribute significantly to the explanation of BASFI variations. Results with DFI were similar.Using mSASSS, the syndesmophyte subservices, the affected vertebral units or vertebral vertebral units, we showed that lumbar and cervical spine involvement contributed independently and almost similarly to explaining variations in BASFI and DFI.ConclusionsThe study conducted by us demonstrates that the patient‘s physical function is not only dependent on signs and symptoms reported by the patient (activity of the disease), but also on the degree of structural lesions. Optimal AS treatment should not only include strategies aimed at removing pain, redness and fatigue, but also strategies aimed at preventing the formation and growth of syndesmofite.Disclosure of ...
BackgroundIn advanced ankylosing spondyloarthritis (AS), bone ankylosis or ossification of the involved joints can make the chest practically immobile, decrease its compliance, or even lead to intercostal muscle atrophy.ObjectivesThe purpose of the study was to evaluate chest involvement in AS by measuring toracoabdominal movements during quiet breathing, by dividing the chest and abdominal contribution to the current volume, by inductive plethysmography methods.Methods60 consecutive patients were recruited from the Rheumatology Department of the Republican Clinical Hospital. They were selected based on AS diagnosis, with no existing cardiovascular or neuromuscular diseases that would alter respiratory mechanisms and the absence of severe obesity.ResultsMonotherapy with DMARD was 27 out of 60 patients (45%) (Sulfasalazine 3 g/day) for a period of 1–48 months (mean value=19.4 (15.5) months). There were no differences in the angle of the Ct-Abd curve between patients with DMARD and DMARD-naive treatment (38.2 (14.5)o and 34.7 (19.5)o for sitting position, 49.3 (18.1)o and 47.2 (23.1)o in orthostatism, and 19.1 (15.6)o and 16.1 (14.6)o for clinostatism, p<0.05). In the baseline study, the Ct-Abd patient angle was lower than the control group in sitting position (36.3 (17.3)o and 51.5 (8.9)o, p=0.0002) in orthostatism (48.1 (20.8)o and 62.4 (12.5)o, p<0.01) or orthostatism (17.4 (15.0)o and 24.5 (9.8)op<0.05). In the entire patient group, the Ct-Abd angle correlated negatively with BASFI in all three body positions (r=−0.50, p<0.0001 in the sitting position, r=−0.36, p<0.01 in orthostatism, r=−0.47, p<0.0001 in clinostatism); did not correlate with BASDAI, BASMI, or the modified Schoeber test in either of the three body positions.In 15 AS patients who underwent repeated measurements of toracoabdominal movements while receiving their associated DMARD treatment (Methotrexate 15 mg/week and Sulfasalazine 3 g/day) 3 months after treatment, the angle of the Ct-Abd slope was significantly higher than that of the fundamental study, in all bodily positions.The Ct-Abd angle continued to increase, with increments less pronounced and reached significant value only between measurements of 3 months and 12 months. Improvements in standardised clinical signs following associated DMARD treatment followed a similar pattern, with scores at each interval significantly different from those measured in the baseline study, improvements continuing at a faster pace slowly after the third month.In the control group, the angle of the slope of the Ct-Abd curve was not different in the two measurements in any of the body positions (51.4 (8.9)o and 50.7 (9.3)o in the sitting position, 62.4 (12.4)o and 61.6 (11.8)o in orthostatism, and 24.6 (9.8)o and 24.8 (10.4)o in clinostatism, p<0.05). In orthostatism, the difference between the measurements was 0.8o (confidence interval 95%–0.9 to 2.52, upper and lower boundaries of 6.6o and 8.2o).ConclusionsThe slope of the Ct – Abd curve during quiet breathing correlates negatively with BASFI and responds s...
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