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At least 1,261 records · Page 70Linked to original sources
PubMed2000

Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study.

The aim of the study was to evaluate the efficacy of methotrexate treatment in patients with ankylosing spondylitis in a 3-year open trial. Seventeen patients, 14 men and three women (mean age 32.7+/-8.9 years), suffering from ankylosing spondylitis and non-responders to treatment with sulphasalazine, were enrolled in our study. Sixteen of them were evaluable at the end of the study. Methotrexate (7.5-10 mg/week) was administered for 3 years. Efficacy was evaluated on the basis of clinical and laboratory variables, radiographic signs of disease progression and daily dosage of indomethacin. We obtained a good and relatively prompt clinical response except for peripheral arthritis and iridocyclitis; in fact, after 3 months of methotrexate treatment a significant amelioration of the following parameters was observed: visual analogue scale for the evaluation of both night pain and general well-being, Shober's test, occiput-wall distance, fingertip to floor, erythrocyte sedimentation rate, C-reactive protein level and daily dose of indomethacin. A further improvement was obtained during the subsequent period. Radiographs of the spine and sacroiliac joints did not show any signs of disease progression. Side-effects were a transitory elevation of transaminases (four cases) and slight hypogammaglobulinaemia (one case). Methotrexate treatment may be useful in ankylosing spondylitis, but a combined treatment might be indicated for patients with peripheral arthritis.

Adult↗
PubMed2003

The jet ski open-book pelvic fracture: diagnosis with multidetector CT.

A 10-year-old girl sustained a traumatic open-book pelvic fracture from a straddle injury in a jet ski accident. Plain films and computed tomography both demonstrated diastasis of the symphysis pubis and bilateral widening of the sacroiliac joints. The open-book fracture resulted from the patient's striking the steering column of the watercraft during a deceleration accident. The unusual cause of this injury is of clinical interest because with increasing popularity of personal watercraft and changes in the design of these vehicles, the incidence and prevalence of this type of injury may increase in the future.

Journal Article↗
PubMed2000

Probing for genes in seronegative spondyloarthropathy.

Seronegative spondyloarthropathies are a group of disorders characterized by inflammation of the spine, sacroiliac joints, and peripheral arthritis along with various characteristic extra-articular features. Their pathogenesis and immunogenetics have not yet been fully elucidated. Ankylosing Spondylitis (AS) is probably the best studied of these disease. It has now been 27 years since the association of human leukocyte antigen (HLA) B27 and AS has been demonstrated. Since then, a plethora of association studies and linkage studies unequivocally demonstrate that genetic determinants within or near the major histocompatible complex (MHC) are critical to the etiology of AS. Surprisingly though, the total MHC contribution to AS has been estimated at only 30%. In this review, we highlight the genetic basis of AS as the prototypical chronic axial arthritis, and discuss the rationale and approach in searching for non-HLA linked genes.

Diseases in Twins↗
PubMed2004

Imaging in spondyloarthropathies.

Seronegative spondyloarthropathies comprise a group of inflammatory arthritides, which consists of ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter's syndrome), enteropathic arthritis, and undifferentiated spondyloarthropathy. All of them share common laboratory, clinical, and imaging findings, with characteristic involvement of the sacroiliac joints, spine, and, to various degrees, peripheral joints. For many years, conventional radiography was the mainstay for definitive diagnosis of sacroiliitis and for follow-up of the anatomic changes in the spine, peripheral joints, and entheses. Conventional radiographs remain the imaging investigation of choice; however, they are unable to detect early inflammatory changes of sacroiliitis, which are important for establishing a diagnosis without delay. Other imaging modalities, such as computed tomography, bone scintigraphy, magnetic resonance imaging, and ultrasonography have improved the capabilities of detecting early disease and became useful adjuncts to plain films. In addition, they also have enabled more accurate detection of pathology at various anatomic sites of the musculoskeletal system predominantly involved in spondyloarthropathies. This article will review and highlight the role of each of these modalities in the assessment of the axial and peripheral skeleton in seronegative spondyloarthropathies.

Diagnostic Imaging↗
PubMed2006

The role of nonsteroidal anti-inflammatory medications and exercise in the treatment of ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic rheumatic disease that primarily affects the sacroiliac joints and spine. Even with the development of tumor necrosis factor-alpha inhibitors, which have revolutionized the treatment of this disease, the combination of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and a life-long exercise program still form the first step in its management. Multiple clinical trials have addressed the efficacy and safety of both nonselective and selective NSAIDs. Gastrointestinal toxicity remains their major side effect, with increased concern about the potential of cardiovascular toxicity, especially with the selective cyclooxygenase-2 inhibitors. A specific set of recommendations has been proposed for the management of AS.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Biomarkers in spondyloarthritis.

In spondyloarthritis, in particular ankylosing spondylitis (AS), a need exists for clinically meaningful biomarkers, both for diagnosis and prognosis. Earlier diagnosis has become an imperative since the advent of biologic therapy, which has proved effective in controlling axial inflammation. Presently, however, there are no biomarkers that reliably distinguish inflammatory back pain from the far more prevalent mechanical back pain. The target sites in AS--sacroiliac joints and the spine--are relatively inaccessible to the investigator and clinician, so defining markers associated with or predictive of axial inflammation remains an important goal. Cytokines, metalloproteinases, and cartilage catabolic products are all candidates for the important role of biomarker in spondyloarthritis.

Biomarkers↗
PubMed1975

External fixation of the pelvic girdle with a trapezoid compression frame.

The compression obtained with external anchorage in the anterior and posterior part of the pelvic girdle has been studied with a measuring device in the sacroiliac joint and and the symphysis of a specimen pelvis. Two models of external frames were tested, in both of which anchorage to the pelvic bone was brought about with 3 pins inserted in the iliac crests. The results were best with a trapezoid frame and bar exerting a compressive force on the pelvic girdle. When mounted with an inclination of 70 degrees to the long axis of the body, the frame exerted considerable compression on the posterior part of the pelvic girdle. This mounting afforded good stability of the detached hemipelvis. The trapezoid compression frame is recommended as an alternative to conventional methods of treating unstable fractures and dislocations of the pelvic girdle.

Adult↗
PubMed1985

Fracture of the transverse process of the fifth lumbar vertebra.

Fracture of the transverse process of the fifth lumbar vertebra is caused by traction through the iliolumbar ligament by the vertically and proximally or medially dislocated hemipelvis. This fracture is therefore associated with the vertical shearing force of Malgaigne's fracture-dislocation of the pelvis or the lateral crush fracture-dislocation of the pelvis. In the absence of evidence on a radiograph of a fracture through the sacroiliac area or dislocation or subluxation of the sacroiliac joint, the fracture of the transverse process of the fifth lumbar vertebra may be the only radiological evidence for posterior instability of the ipsilateral hemipelvis.

Adult↗
PubMed1996

Volume changes within the true pelvis during disruption of the pelvic ring--where does the haemorrhage go?

Fractures of the pelvis are not only common but are very varied in their complexity. They represent 3% of all fractures (1), they account for 1 in every 1000 surgical admissions and are the third most commonly encountered injury in motor vehicle accident fatalities (2). However, only a small percentage of all pelvic fractures are associated with major disruption of the pelvic ring (3). Life threatening haemorrhage is a frequent complication of major pelvic fractures (1, 4) and haemorrhage is the leading cause of death in these patients (5, 6). It was believed that fracture and subsequent displacement of the ring greatly increased pelvic volume. However, clinical practice seemed to indicate that this might not be true. This study aimed to assess the change in pelvic volume which occurs in severely displaced pelvic fractures. A model of the bony pelvis was designed to permit extreme displacements of the symphyseal and sacroiliac joints. The volume of a polythene balloon placed within the true pelvis was measured as an indication of true pelvic volume. Our finding was that the increase in the volume of the true pelvis which occurs in a fracture with massive diastasis is much smaller than previously assumed.

Fractures, Bone↗
PubMed1989

Cortical pelvic strains with varying size hemiarthroplasty in vitro.

Four human pelves were dissected of soft tissues and instrumented with rosette strain gages. The pelves were left intact (not separated at the pubic symphysis or sacroiliac joints) although each of the eight hemipelves was tested separately. The pelves were loaded to simulate single leg stance with use of a wire mesh cemented to the wing of the ilium, representing the abductor muscles. Loading was carried out with the intact hip joint and 1 mm undersized, correct sized, and 1 mm oversized hemiarthroplasty. The correct sized component produced a strain pattern closet to normal. The oversized component was associated with an increase in strain at the medial acetabular dome.

Acetabulum↗
PubMedDate not supplied

Mechanical and textural properties of pelvic trabecular bone.

So far, virtually nothing is known about the mechanical properties of pelvic trabecular bone. In this study, several techniques have been used to establish some insight in these properties. Dual-energy quantitative computer tomography (DEQCT) was used to look at the distribution of bone densities throughout the pelvic bone and nondestructive mechanical testing was used to obtain Young's moduli and Poisson's ratios in three orthogonal directions for cubic specimens of pelvic trabecular bone. The same specimens were then used for stereological measurements to obtain volume fractions and the spatial orientations of the mean intercept lengths. The combined data on the mechanical tests and the stereological measurements made it possible to calculate Young's moduli and Poisson's ratios for the specimens' principal material axes. DEQCT showed that bone densities within a pelvic bone are significantly higher in the superior part of the acetabulum, extending to the sacroiliac joint area and, secondly, in the area of the pubic symphysis. Volume fractions found for the specimens did not exceed 20%. This may be considered rather low when compared to values reported in the literature for trabecular bone of femoral or tibial origin, but the values do lie in the same range as vertebral trabecular bone. With the volume fraction as its primary predictor, values of Young's moduli were also low. For most specimens these values were not higher than 100 MPa, with an occasional peak of 250 MPa. Looking at the ratio of the highest and lowest Young's modulus or at the components of the fabric tensor, it can be concluded that pelvic trabecular bone is not highly anisotropic. On an average, Poisson's ratio was found to be closer to 0.2 rather than 0.3, which is in accordance with other studies on Poisson's ratio of trabecular bone.

Acetabulum↗
PubMed1990

A wider spectrum of spondyloarthropathies.

As in other diseases of undetermined etiology, the diagnosis of ankylosing spondylitis (AS) and related spondyloarthropathies (SpA) is based on clinical and roentgenographic features. The current criteria for diagnosis of some of these diseases are too restricted, and do not recognize the existence of a much wider disease spectrum. For example, radiographically detected sacroiliitis is extremely frequent in AS, but may not be an obligate manifestation, especially in early or atypical forms of the disease. Arthritis involving the axial skeleton, including the sacroiliac joints, can be present in some patients without evidence of erosive disease roentgenographically. The disease spectrum of Reiter's syndrome has also been broadened considerably, and "incomplete" forms of Reiter's syndrome are observed much more commonly than the classical triad of arthritis, conjunctivitis, and urethritis. The term "B27-associated reactive arthritis" has been used in recent years to refer to SpA following enteric or urogenital infections, and the disease spectrum includes the clinical picture of typical Reiter's syndrome. The clinical spectrum of psoriatic SpA has been better clarified. Some of the less well defined B27-associated clinical syndromes include seronegative oligoarthritis, polyarthritis, or dactylitis ("sausagelike" toes) of the lower extremities, and heel pain caused by calcaneal (and tarsal) periostitis. These and other undifferentiated SpA have been ignored in previous epidemiological studies because of the inadequacy of the existing classification criteria. The European Spondylarthropathy Study Group (ESSG) has completed a study aimed at developing preliminary classification criteria for the whole group of SpA patients, with the specific intention of encompassing patients with undifferentiated SpA.

Arthritis↗
PubMed1991

Ankylosing spondylitis in nonhuman primates: the drill and the siamang.

Nonhuman primates are known to be susceptible to many of the arthritides that afflict humans. Psoriatic like spondyloarthropathies have been reported in gorillas and skeletal hyperostosis in gibbons, rhesus monkeys, and gorillas, and additional cases of both of these conditions occurring in drills (baboons) are noted in this report. One western lowland gorilla and two rhesus monkeys with clinical features consistent with ankylosing spondylitis have been documented previously. Two additional nonhuman primate species with radiographic evidence of ankylosing spondylitis are described. A siamang (gibbon) and two drills (baboons) with the classic radiographic features of ankylosing spondylitis, namely a bamboo spine and sacroiliac joint fusion, are reported.

Animals↗
PubMed1992

Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter.

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155 unselected cases of lower ureteral calculi. The average stone size was 9.6 mm (range 5-23 mm). One hundred forty-three patients had stones located below the lower margin of the sacroiliac joint. These patients were placed in a supine position. The stones were visualized radiologically without use of a ureteral catheter in 78 percent of the patients; in 22 percent a ureteral catheter was inserted prior to ESWL to aid in stone localization. In 145 patients (94%) treatment was completed in one session; 10 patients (6%) required two sessions. Of the patients, 38 percent were free of stones one day after ESWL; 97 percent became stone free within three months, and only 3 patients required endoscopic manipulation, after ESWL. Twelve patients had stones in the midureter overlying the sacroileum. They were placed in the prone position, and the calculi were visualized with the aid of a ureteral catheter. All these patients became free of stones one month after treatment. There were no significant treatment-related complications except for bacteremia in 1 case. In view of the remarkable efficacy, negligible complication rate, and shorter hospital stay as compared to ureteroscopic stone manipulations, we recommend high energy ESWL as the primary monotherapy of mid and lower ureteral stones.

Adolescent↗
PubMed1995

Oblique abdominal muscle activity in standing and in sitting on hard and soft seats.

The activity of the oblique abdominal muscles was investigated with the trunk in unconstrained, symmetrical and static postures. Electromyographic recordings in six healthy subjects revealed that in all subjects the activity of both the internal and the external obliques is significantly higher in unconstrained standing than in supine posture. Activity of the internal oblique was higher than that of the external oblique abdominal. The sacrospinal, gluteus maximus and biceps femoris muscles showed practically no activity in unconstrained erect posture. During unconstrained sitting both oblique abdominals are active. In most subjects the activity of the oblique abdominals was significantly smaller when sitting on a soft car seat than when sitting on an office chair with a hard seat. The possibility is discussed that contraction of the oblique abdominals in unconstrained standing and sitting may help in stabilizing the basis of the spine and particularly the sacroiliac joints. During standing and sitting the oblique abdominal muscles apparently have a significant role in sustaining gravity loads. RELEVANCE: Back pain and pelvic pain are often experienced in prolonged standing and sitting postures. In these postures the oblique abdominals are shown to be active. The present study gains clinical significance by the studies showing relatively small oblique abdominal muscle strength in patients with low back pain. A soft seat may be helpful in treatment and prevention, because it substitutes oblique abdominal muscle activity.

Journal Article↗
PubMed1991

Decreasing gastrointestinal morbidity with the use of small bowel contrast during treatment planning for pelvic irradiation.

Small bowel tolerance is a major dose-limiting factor in treating the pelvis with radiation therapy (RT). The use of small bowel contrast during RT simulation is one technique used to localize the bowel and identify the treatment plan that would exclude the greatest volume. To determine the influence of treatment planning with oral contrast on gastrointestinal injury, acute and chronic small bowel morbidity was analyzed in 115 patients with endometrial and rectal carcinoma who received postoperative radiation therapy at the Fox Chase Cancer Center. Mean and median time of follow-up were 31 and 27 months, respectively. Acute diarrhea was seen in 82% of the patient population. Ten percent of patients experienced major complications requiring hospitalization. Ninety-three percent of patients simulated without contrast experienced side effects compared to 77% of patients simulated with contrast (p = .026). There was an increased incidence of chronic complications in patients who were not simulated with contrast dye (50% vs 23%, p = .014). Median duration of minor side effects was 4 months for patients planned without oral contrast and 1 month for patients who had contrast at the time of simulation (p = .036). The superior aspect of the treatment field was determined to be at a more inferior location in patients simulated with contrast, thereby excluding small bowel from treatment. Seventy-four percent of patients simulated without contrast had the upper border of the field placed at the superior aspect of the sacroiliac joint or above, compared to only 40% of patients planned with oral contrast (p = .002). This study has demonstrated decreased complications (both overall and chronic) as well as a change in the location of the treatment field with the use of small bowel contrast. Multivariate analysis revealed that both the use of oral contrast (p = .026) and a lower superior border of the treatment field (p = .007) were predictive for fewer sequelae to RT, indicating that planning with contrast leads to changes in the technical delivery of RT other than field placement (e.g., block placement). The reduced incidence and duration of small bowel morbidity may be in part caused by alterations of the treatment plan made when the small bowel is visualized at the time of simulation. It is therefore recommended that oral small bowel contrast be used during treatment planning for pelvic irradiation.

Adult↗
PubMed1989

Inflammatory disorders of the vertebral column: seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis.

A variety of inflammatory disorders may involve the spine and sacroiliac joint. Of these, the seronegative spondyloarthropathies (consisting principally of ankylosing spondylitis, psoriasis, Reiter's syndrome, and certain intestinal diseases), adult-onset rheumatoid arthritis, and juvenile chronic arthritis are particularly important. The imaging abnormalities accompanying these disorders, supplemented with some clinical and pathologic data, are the subject of this review.

Arthritis, Juvenile↗
PubMed2005

What diagnostic tests are useful for low back pain?

Low back pain (LBP) is a common problem that poses some interesting and difficult diagnostic problems. It is typically benign and self-limited, but it is occasionally the presenting symptom of serious systemic disease. The general diagnostic approach to low back pain is to check for 'red flags' in the history and physical that suggest the presence of malignancy, infection or spondyloarthridites, and for neurological compromise that could indicate that surgery is required (cauda equina syndrome) or may be beneficial (such as herniated discs or spinal stenosis that have not improved with conservative care). In the absence of these features, imaging is of limited value. Recent research has begun to evaluate subgroups with 'non-specific' low back pain that seem to benefit from specific interventions such as median branch or sacroiliac joint injections, manipulation, or specific exercises, but these require further investigation and validation.

Diagnosis, Differential↗