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...
BackgroundOsteoporosis is a disease which is frequently asymptomatic until fragility fractures occur. The study of risk factors in osteoporosis is continuously developing, considering that there is a tremendous geoghraphic variety in osteoporosis occurrence. We present the results of an epidemiological study of fragility fracture cases in Republic of Moldova, trying to underlie differences in fragility fracture epidemiology, based on residence region, and possibly lifestyle factors, in a female population.ObjectivesThe purpose of the study was to determine the incidence and prevalence of fragility fractures in women, with comparison of epidemiological indexes between urban and rural areas in Republic of Moldova.MethodsApproximately 6% of the state population was included in the study. Data regarding peripheral fragility fracture cases was collected from all specialised and primary medical institutions from the defined area. Fragility fractures of proximal humerus, distal forearm, proximal femur and distal calf, in women aged over 40 years old were collected. Using population statistics provided by the National Bureau of Statistics, epidemiological indexes regarding fracture incidence and prevalence were derived, with further comparison of derived epidemiological indexes for urban and rural areas, as well as separate epidemiological indexes for the four fracture regions.ResultsA general incidence of 1033.4 peripheral fragility fractures per 1 00 000 female population >40 years was determined, with a significantly higher incidence in urban areas (1216.7 vs 980.1, p<0.05). The incidence of proximal humerus fracture was 149 per 1 00 000 female population >40 years, with a small, but significantly higher incidence in urban areas (159.5 vs 145.9, p<0,05). The incidence of distal forearm fractures was 393.4 per 1 00 000 population >40 years, significantly higher in urban areas (528.5 vs 354.1, p<0,05). The incidence of proximal femur fracture was 208.5 per 1 00 000 population >40 years, significantly higher in urban areas (227.9 vs 202.9, p<0,05). The incidence of distal calf fractures was 282.5 per 1 00 000 population >40 years, with a small, but significantly higher incidence in urban areas (300.7 vs 277.2, p<0,05).ConclusionsThere was an overall higher incidence of fragility fractures in the urban female population compared to the rural one, with a similar relationship in all four fracture groups. The association between urban residence and increased incidence of fragility fractures in women, could be attributed to a less active physical lifestyle (known risk factor in osteoporosis) in urban areas. Distal forearm fractures showed a greater prevalence both in urban and in rural areas, compared to other fracture types. Moreover, the incidence difference between urban and rural areas was most prevalent in the distal forearm fracture group. The latter observation was not determined in a similar study in men, in the same population and period of time.Disclosure of InterestNone declared
BackgroundInflammatory joint disease is a burden to the patient and society, due to medical costs and the impact it has on the health-related quality of life. Functional status plays a significant role in quality of life impairment.ObjectivesTo study and compare functional status changes between different inflammatory joint diseases and degenerative joint disease.Methods1500 patients with inflammatory joint disease and 400 patients with degenerative joint disease were included in this study. In the first group, 645 (43.0%) were diagnosed with rheumatoid arthritis, 330 (22.0%) - psoriatic arthritis, 100 (6.7%) - ankylosing spondylitis, 200 (13.3%) - axial spondyloarthritis, 135 (9.0%) - gout, 20 (1.3%) - other crystal arthritis, 45 (3.0%) - early arthritis and 25 (1.7%) with other arthritis. Physical exam with functional status was assessment were performed. Descriptive statistics and Mann-Whitney U tests were used to compare the study groups, as well as the subgroups within the inflammatory disease group.ResultsBoth groups were comparable according to sex, with a predominance of female sex (χ2 = 86.4 and 30.74 respectively, p<0.001), and no difference in sex distribution (mean ranks of U test – 950.98 and 967.44, p = 0.524). Mean age was significantly lower in the inflammatory joint disease group (44.76 vs 60.19, p<0.001). The Mann-Whitney U test showed a significantly greater mean rank in the inflammatory disease group (999.07 vs 790.66, p<0.001), suggesting an overall higher functional class, and thus worse functional status in the inflammatory joint disease group. Further analysis using the same method, between subgroups in the inflammatory joint disease group, showed a higher mean rank (worse functional status) in patients with rheumatoid arthritis, when compared with psoriatic arthritis (501.95 vs 460.73, p<0.05) and early arthritis (352.24 and 248.83, p<0.001). Psoriatic arthritis showed a higher mean rank, compared to axial spondyloarthritis (282.88 vs 254.97 p<0.05) and early arthritis (193.34 vs 148.83, p<0.01). Gout patients showed a higher mean rank (worse functional status), when compared to rheumatoid arthritis (453.65 vs 377.28, p<0.001), psoriatic arthritis (281.33 vs 213.23, p<0.001), ankylosing spondylitis (127.07 vs 105.75, p<0.05), axial spondyloarthritis (184.67 vs 156.75, p<0.01) and early arthritis (101.70 vs 56.89, p<0.001), thus making it the subgroup associated with the poorest functional status. Ankylosing spondylitis showed a higher mean rank, when compared to psoriatic arthritis (238.13 vs 208.64, p<0.05), axial spondyloarthritis (151.75 vs 129.88, p<0.05) and early arthritis (81.63 vs 53.83, p<0.001). Axial spondyloarthritis and other crystalline arthritis subgroups both showed higher mean ranks compared to early arthritis (130.0 vs 91.89 and 43.2 vs 28.56 respectively, p<0.01), making early arthritis the subgroup associated with the best functional status. No significant differences were found when comparing rheumatoid arthritis with ankylosing spondylitis, axial spondyloarthritis and...
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