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Biomedical subjects

A Calin

Publications and source records attributed to A Calin.

At least 55 records · Page 3Linked to original sources
PubMed1997

Juvenile onset ankylosing spondylitis--more girls than we thought?

OBJECTIVE: To define the sex ratio of juvenile onset ankylosing spondylitis (AS) among a large population. METHODS: Using a standard questionnaire, data were collected from 3362 subjects, members of the National Ankylosing Spondylitis Society and patients at a tertiary referral center. RESULTS: Of 3362 patients, 2461 (73%) were male; male:female sex ratio was 2.7:1. Of the total, 379 (11%) had disease onset between the ages of 5 and 16 years. Of these, 278 were boys and 101 girls, giving an overall male:female ratio, in juvenile AS, of 2.6:1. For those with onset ages 5-13 years there was a ratio of 2.1:1, while for those aged over 14 years at onset, the ratio was 3.2:1. CONCLUSION: Older published ratios, ranging from 4.5:1 to 6:1, used smaller samples, focusing only on subjects who were juveniles at the time of the study. Our data collection method, which recruits from 2 sources and includes adults with juvenile onset, attempts to avoid these methodological problems. The data suggest a higher incidence of juvenile AS among females than previously described.

Adolescent↗
PubMed1997

Socioeconomic status in ankylosing spondylitis: relationship between occupation and disease activity.

OBJECTIVE: To identify the socioeconomic status through occupation of a large cohort of patients with ankylosing spondylitis (AS) and to determine possible relationships between occupation and clinical variables. METHODS: We analyzed the employment status of 1,044 patients with AS. RESULTS: 85% of patients (890 of 1,044) were in full employment at the time of the assessment compared to 15% who were unemployed. When 50 employed patients were compared to 50 unemployed cases, the latter had increased disease activity and lower psychosocial well being. CONCLUSION: Employed patients from the higher occupational group (I), had less disease activity, and lower pain and depression than patients from the lowest occupational group (IV).

Adult↗
PubMed1997

Low dose amitriptyline in ankylosing spondylitis: a short term, double blind, placebo controlled study.

OBJECTIVE: To define the effect of low dose amitriptyline on fatigue, pain, and stiffness in patients with ankylosing spondylitis (AS). METHODS: One hundred consecutive patients with AS were randomized to receive low dose amitriptyline up to 30 mg nightly or placebo for 2 weeks. Patients were assessed by the Bath Ankylosing Spondylitis Disease Activity (BASDAI) and Functional (BASFI) Indices pre and post-treatment. RESULTS: Eighty-eight patients (44 amitriptyline, 44 placebo) completed the study. Eight (5 amitriptyline, 3 placebo) stopped treatment because of side effects (e.g., drowsiness, dryness of mouth) and 4 provided insufficient data. Compared to placebo, the patients taking amitriptyline showed significantly greater improvement in restful sleep (66 vs 20%; p < 0.001) and their disease activity scores [BASDAI amitriptyline 1.18 (23%) vs placebo 0.52 (10%); p = 0.024]. All other variables showed a trend to greater improvement by amitriptyline, although the differences were not statistically significant. CONCLUSION: (1) In a 2 week study, low dose amitriptyline significantly improved sleep in AS and was well tolerated; (2) as defined by BASDAI, there was a significant reduction in disease activity with amitriptyline; (3) compared to placebo, there was a nonsignificant trend toward improvement in function; and (4) in spite of improvement in pain, fatigue, and sleep with amitriptyline, stiffness was not increased.

Adult↗
PubMed1997

Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group.

An international working group was formed to select core sets to be used as endpoints in clinical trials in ankylosing spondylitis (AS). The results of the first steps of the selection of these core sets are described. The definition of the settings for which the core set will be intended are defined. The methods used to select the core sets were a combination of literature search, nominal group discussions, and plenary discussions. The following settings were defined: disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD)/physical therapy, and clinical record keeping. Over 110 variables used as endpoints in AS were found in the literature. The preliminary core set for DC-ART consists of physical function, pain, spinal mobility, patient global assessment, peripheral joints/entheses, x-ray spine. The selected core set for SMARD/physical therapy includes physical function, pain, spinal mobility, spinal stiffness, and patient global assessment. The core set for clinical record keeping includes all measures of the SMARD/physical therapy core set completed by peripheral joints/entheses, and acute phase reactants. Three preliminary core sets for AS have been defined. Further research will be performed to select specific measures for all domains.

Antirheumatic Agents↗
PubMed1997

Which patients with ankylosing spondylitis derive most benefit from an inpatient management program?

OBJECTIVE: To evaluate the benefit achieved from an inpatient management program by testing the hypothesis that more mobile, younger patients on their first course show the most improvement. METHODS: We assessed 236 patients over an 18 month period. Patients were assessed at the beginning and end of the course by 4 indices, 3 of which were self-administered (disease activity, functional ability, and global well being) and one administered by a trained physiotherapist (metrology). Paired t tests and ordinary least squares regression analysis were used to compare pre and postcourse results for each index. RESULTS: The wide range of disease duration (0-53 years) and disease severity [0.69-9.39 (on a 0-10 scale)] reveal that patients are from a wide spectrum of disease. Results revealed a mean improvement of 18-27% over baseline in the 4 indices. Significant predictors of greater improvement over the 2 week course were found for each index. CONCLUSION: Our results confirm the benefit of an intensive regime of inpatient physiotherapy. Although the original hypothesis cannot be accepted or rejected as the results were different for the 4 indices, the following general conclusions may be drawn: (1) there is a trend for females to improve more than males; (2) patients who have attended fewer courses tend to achieve more improvement; (3) younger patients do better than older patients; and (4) age of disease onset has little effect.

Adult↗
PubMed1996

Radiology and spondylarthritis.

Radiographs are characteristically required to define the nature of the disease process in spondylarthritis. They need rarely be repeated, except for complications or unusual manifestations of the underlying disease. To date, new techniques of radio-imaging have provided only minimal advantages, if any. (Berkowitz et al, 1991; Docherty et al, 1992; Gibbon, 1992; Ralston et al, 1992; Deyo, 1994; Jensen et al, 1994). The plain radiograph is still pivotal to our understanding of the disease.

Humans↗
PubMed1996

The Bath Ankylosing Spondylitis Patient Global Score (BAS-G).

In the absence of an ideal objective measure for assessing ankylosing spondylitis (AS), self-administered measures of disease activity (the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) and function (the Bath Ankylosing Spondylitis Functional Index, BASFI) have been developed, in addition to an objective measure of spinal mobility (the Bath Ankylosing Spondylitis Metrology Index, BASMI). However, a more global assessment is also desirable. We report on the design and validation of a global measure (the Bath Ankylosing Spondylitis Patient Global Score, BAS-G) which reflects the effect of AS on the patient's well-being. A pilot study was performed to select the most appropriate wording for BAS-G. Using 392 patients with AS, BAS-G's construct and predictive validity and test-retest reliability were assessed. Correlations between BAS-G and BASDAI/BASFI were calculated, and multiple regression was used to examine the significant correlates. The distribution of the responses covered the whole scale. As predicted, BAS-G correlated best with BASDAI (r=0.73), followed by BASFI (r=0.54). The best fitting regression equation included these scales as well as patients' gender and current age. One week and 6 month scores were significantly different (P<0.001). Construct validity was good: BAS-G correlated more strongly with each component of BASDAI and BASFI than with BASMI or with gender. Predictive validity was satisfactory: there was an improvement (mean=29%) in in-patient BAS-G scores over a 2 week treatment period (P<0.001). Test-retest reliability was excellent (1 week r=0.84, 6 months r=0.93). BAS-G correlates well with both BASDAI and BASFI, suggesting that disease activity and functional ability play a major role in patients' well-being, whereas metrology does not. The score is sensitive to change, reliable, and meets face, predictive and construct validity criteria.

Adult↗
PubMed1996

The epidemiology of spondylodiscitis in ankylosing spondylitis--a controlled study.

UNLABELLED: Spondylodiscitis is well recognized in ankylosing spondylitis (AS), but little is known about its epidemiology. We therefore reviewed 147 consecutive patients with AS using lumbar and thoracic spine radiographs. For each patient with spondylodiscitis, two age- and sex-matched controls were selected. Twelve individuals (8%) had spondylodiscitis, affecting a total of 32 disc spaces: 10 thoracic, 22 lumbar. The mean age at onset was 21 +/- 4.1 yr, significantly younger than that of the controls (28.5 +/- 10.1 yr, P = 0.004). Half of the 12 patients had multiple lesions (between two and six levels). The most common site was the lower thoracic spine with additional lumbar spine involvement. Only two of the 12 patients (17%) had symptoms localized to the lesions. Neither trauma nor infection were considered to be causes of the spondylodiscitis. IN CONCLUSION: (1) spondylodiscitis occurs in approximately 8% of patients with AS; (2) these patients have early onset of disease; (3) multiple-level lesions in the spine are not uncommon among those with spondylodiscitis; (4) lesions are usually asymptomatic.

Adult↗
PubMed1996

HLA class I associations of ankylosing spondylitis in the white population in the United Kingdom.

OBJECTIVE: To investigate the HLA class I associations of ankylosing spondylitis (AS) in the white population, with particular reference to HLA-B27 subtypes. METHODS: HLA-B27 and -B60 typing was performed in 284 white patients with AS. Allele frequencies of HLA-B27 and HLA-B60 from 5926 white bone marrow donors were used for comparison. HLA-B27 subtyping was performed by single strand conformation polymorphism (SSCP) in all HLA-B27 positive AS patients, and 154 HLA-B27 positive ethnically matched blood donors. RESULTS: The strong association of HLA-B27 and AS was confirmed (odds ratio (OR) 171, 95% confidence interval (CI) 135 to 218; p < 10(-99)). The association of HLA-B60 with AS was confirmed in HLA-B27 positive cases (OR 3.6, 95% CI 2.1 to 6.3; p < 5 x 10(-5)), and a similar association was demonstrated in HLA-B27 negative AS (OR 3.5, 95% CI 1.1 to 11.4; p < 0.05). No significant difference was observed in the frequencies of HLA-B27 allelic subtypes in patients and controls (HLA-B*2702, three of 172 patients v five of 154 controls; HLA-B*2705, 169 of 172 patients v 147 of 154 controls; HLA-B*2708, none of 172 patients v two of 154 controls), and no novel HLA-B27 alleles were detected. CONCLUSION: HLA-B27 and -B60 are associated with susceptibility to AS, but differences in HLA-B27 subtype do not affect susceptibility to AS in this white population.

Alleles↗
PubMed1996

Fatigue in ankylosing spondylitis: its prevalence and relationship to disease activity, sleep, and other factors.

OBJECTIVE: To assess the symptom of fatigue in patients with ankylosing spondylitis (AS) with regard to its prevalence and its relationship to disease activity and other factors. METHODS: A self-administered questionnaire, including visual analog scales to assess fatigue, other components of disease activity, and functional ability (the Bath AS Functional Index, BASFI) was sent to 350 patients with AS. Questionnaires were completed and returned by 295 patients (84% response rate). Statistical analyses were descriptive and predictive and included t tests, chi-squared tests, and multiple regression. RESULTS: Sixty-five percent of the patients (n = 192) described fatigue as a major symptom (F+ group) while 31% (n = 91; F- group) did not consider it to be important (4% noncommittal). Excluding fatigue, the mean of a disease activity composite score was significantly higher in the F+ group (5.26, standard deviation (SD) + or - 2.33) than in the F- cohort (3.67, SD + or - 2.09, p <0.001). The former group also had significantly worse scores on the functional index (BASFI mean 5.87, SD + or - 2.42 vs 4.29. SD + or - 2.46, p <0.001). Of the total, 55% had, on occasion, suffered fatigue without accompanying pain or stiffness. After controlling for other factors, pain (p <0.001), functional disability (BASFI, p <0.001) and stiffness (p <0.05) were significantly associated with level of fatigue. The F+ group reported more sleep disturbance, with 41 % (compared to 26% of the F- group) waking more than 3 times a night (p = 0.04). In addition, usual fatigue on waking was more common in the F+ group (71 vs 36%, p <0.001). CONCLUSION: (1) Fatigue is a major symptom in the majority of patients with AS, in particular those with more severe disease; (2) fatigue is more likely to occur with active disease but may also occur as a lone symptom. (3) those with severe fatigue function less well; and (4) the management of fatigue remains an enigma - exercise, for example, having only an equivocal effect.

Adult↗
PubMed1995

Ankylosing spondylitis: the correlation between a new metrology score and radiology.

The objective was to compare the Bath Ankylosing Spondylitis Metrology Index (BASMI) with radiology as a measure of disease outcome. Fifty-three patients, covering the entire spectrum of disease severity, were blindly and independently assessed using the BASMI (total of five standardized measurements, scoring range 0-10) and a radiology score of the four main spinal areas affected by ankylosing spondylitis (AS). BASMI correlates positively with the total radiology score (r = 0.74), while the individual BASMI scores for cervical rotation (r = 0.59), wall to tragus (r = 0.61), lumbar side flexion (r = 0.56), lumbar flexion (r = 0.68) and intermalleolar distance (r = 0.50) correlate positively with their respective radiology scores. BASMI and radiology do not relate well to each other as BASMI takes account of normal physical limitation and soft tissue involvement. In addition, although radiology scores are termed a 'gold standard', they are unreliable. Therefore, BASMI may be judged to be more important in assessing AS and become a 'gold standard' itself.

Adult↗