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At least 19 recordsLinked to original sources
PubMedDate not supplied

Pyogenic spondylitis and early tuberculous spondylitis in children: differential diagnosis with standard radiographs and computed tomography.

In a study of 23 patients, axial computed tomography (CT) was the most valuable modality to differentiate between early tuberculous (10 patients) and pyogenic spondylitis (13 patients). Tuberculous spondylitis showed large erosions with calcification, whereas pyogenic spondylitis showed multiple small well-defined erosions, mostly without calcification. Both groups had large or small paravertebral soft tissue swelling, with accompanying calcification, in six of the 10 patients with tuberculous spondylitis and in only one patient with pyogenic spondylitis. Tuberculous spondylitis showed larger intraspinal extradural abscesses, with calcification in 50% of cases, whereas pyogenic spondylitis demonstrated no calcification.

Child↗
PubMed2002

Assessment of functional ability in younger and older patients with ankylosing spondylitis: performance of the bath ankylosing spondylitis functional index.

OBJECTIVE: To determine whether the Bath Ankylosing Spondylitis Functional Index (BASFI) is applicable in older patients with ankylosing spondylitis and whether it shows major differences between younger and older patients with ankylosing spondylitis. DESIGN: BASFI total scores and every BASFI item of 202 patients with ankylosing spondylitis aged >or=60 yr (group A) and 267 patients with ankylosing spondylitis aged <or=40 yr (group B) were calculated. The results were compared with the results of the Health Assessment Questionnaire for the Spondyloarthropathies. RESULTS: The BASFI scores had a median of 4.2 in group A and 2.6 in group B. Marked differences between the age groups were found for every item of the BASFI. Internal consistency was high in both groups. The Spearman correlation coefficient between BASFI and the Health Assessment Questionnaire for the Spondyloarthropathies was rs(A) = 0.83 in group A and rs(B) = 0.78 in group B. CONCLUSION: The data suggest that the BASFI is also applicable to older patients experiencing AS. There is a significant difference in the BASFI score between younger and older patients with ankylosing spondylitis.

Activities of Daily Living↗
PubMed1978

Ankylosing spondylitis and inflammatory bowel disease. II. Prevalence of peripheral arthritis, sacroiliitis, and ankylosing spondylitis in patients suffering from inflammatory bowel disease.

To establish the prevalence of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis in patients with inflammatory bowel disease, 58 consecutive patients suffering from ulcerative colitis (UC) and 51 with Crohn's disease (CD) underwent a detailed rheumatological examination. In addition, all patients were screened for the presence of the antigen HLA B27. Peripheral arthritis was found in 14 (8 UC, 6 CD) patients (12.8%); radiographic sacroiliitis was diagnosed in 11 (5 UC, 6 CD) (10.1%), of whom 10 were asymptomatic; and ankylosing spondylitis was diagnosed in 2 UC and 2 CD patients (3.7%). 18.9% of the UC and 3.9% of the CD patients were HLA B27 positive. One of the 11 patients with radiographic sacroiliitis and 2 of the 4 with ankylosing spondylitis had the HLA B27 antigen. Peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis are apparently frequent manifestations in patients suffering from inflammatory bowel disease. Asymptomatic radiographic sacroiliitis in these patients appears to differ from idiopathic ankylosing spondylitis, both clinically and genetically. Evaluation of subjective rheumatological complaints, necessary for a confident diagnosis of ankylosing spondylitis, according to the New York criteria is difficult during a flare-up of the inflammatory bowel process, as was shown in 4 CD cases with marked limitation of lumbovertebral function and chest expansion, but no radiological abnormalities of the SI joints.

Adult↗
PubMed1990

[Sex influence on the cardiac complication of ankylosing spondylitis--analysis of 95 cases of ankylosing spondylitis including our case].

Ankylosing spondylitis is apparently rare among Japanese and it is known that this disease is commoner in males than in females. The male to female ratio among general ankylosing spondylitis is 4.5:1. The cardiac conduction abnormalities, aortic insufficiency and mitral insufficiency are sometimes associated with this disease. We analysed the influence of sex on the development of these cardiac complications using 95 reported cases of ankylosing spondylitis including our case. Among the ankylosing spondylitis patients who were accompanied with cardiac complication, 99% were male. This frequency is significantly high compared with that found in general ankylosing spondylitis (p less than 0.0001). The cardiac complication associated with this disease seems to be characteristic for males. This sex difference is useful for differential diagnosis from various diseases which accompany these cardiac complications. The mechanism of sex influence on the cardiac complication of ankylosing spondylitis was also discussed.

Adolescent↗
PubMed1999

A comparative study of the usefulness of the Bath Ankylosing Spondylitis Functional Index and the Dougados Functional Index in the assessment of ankylosing spondylitis.

To determine whether the Bath Ankylosing Spondylitis Functional Index (BASFI, score 0-10) or Dougados Functional Index (DFI, score 0-40) is superior in measuring physical function in ankylosing spondylitis (AS) we studied 191 consecutive outpatients with AS in the Netherlands, France, and Belgium. The participating centers are secondary and tertiary referral centers. The external criterion for disease activity (DA) was: both patient and physician assessment of disease activity on a visual analog scale (VAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The external criterion for damage was 2 radiological scores of the spine; BASRI-s (Bath Ankylosing Spondylitis Radiology Index-spine) and a modified SASSS (Stoke Ankylosing Spondylitis Spine Score). Median scores for BASFI and DFI were 2.5 (range 0-10) and 8.5 (range 0-35), respectively. Spearman correlation coefficient between both indexes was 0.89. The average correlation with disease activity variables was 0.42 for BASFI and 0.41 for DFI. For both BASFI and DFI the correlation with BASRI-s was 0.42 and with SASSS 0.36. When distinguishing between patients with high and low disease activity, sensitivity for both indexes was between 76 and 94%, while specificity was between 66 and 87% for all 3 DA measures. Average misclassification between BASFI, DFI and DA was 23 and 27%, respectively. Both BASFI and DFI correlate equally well with disease activity and damage.

Adolescent↗
PubMed1998

Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?

OBJECTIVE: In 1971 McEwen and colleagues suggested that the radiological changes of classic ankylosing spondylitis (AS), and the changes of the spondylitis associated with inflammatory bowel disease differ in several respects from the radiological features of psoriatic and reactive spondylitis. The findings of this study have never been confirmed. The aim of this study was to replicate the McEwen study comparing films blinded to diagnostic group. METHODS: The study population comprised 91 patients with classic AS, 15 patients with regional enteritis, 16 patients with ulcerative colitis, five patients with sexually acquired reactive arthritis, two with post-dysenteric arthritis, and 34 with psoriatic arthritis. Blinded reading of spinal radiographs was undertaken, scoring for severity, symmetry, paravertebral ossification, size of syndesmophytes, ligamentous calcification, squaring, discitis, pseudofractures, zygoapophyseal joint involvement, and complete ankylosis. RESULTS: Comparison of the four groups--classic, enteropathic, psoriatic, and reactive AS--showed differences with respect to symmetry of sacroiliitis, symmetry of lumbar spinal involvement, and frequency and size of syndesmophytes. Zygoapophyseal joint involvement was more frequent in the lumbar spine in classic and enteropathic spondylitis but no between group differences were found with respect to symphisitis, squaring, apophyseal joint involvement and ligamentous calcification in the lumbar spine, and other areas. CONCLUSIONS: Some of the radiological differences described by McEwen et al, notably the asymmetry, the less severe changes, and the distinctive syndesmophytes in psoriasis, have been confirmed. A number of phypotheses are proposed to explain these differences including biomechanical, biochemical, and genetic factors.

Adolescent↗
PubMed1985

Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York criteria in patients with a positive clinical history screening test for ankylosing spondylitis.

The modified New York criteria for the diagnosis of ankylosing spondylitis were evaluated and compared to the older criteria in 151 patients, referred to hospital because of low back pain and who had a positive clinical history screening test for ankylosing spondylitis and in 31 controls with non-inflammatory back pain. Radiological examination of the sacro-iliac joints showed sacro-iliitis in 124 (82%) from the 151 with inflammatory back pain. In 110 (72%) of those patients a diagnosis of definite ankylosing spondylitis according to the classical New York criteria could be made and they had a prevalence of HLA-B27 of 84%. Application of the modified New York scheme increased the number of patients meeting the criteria for definite ankylosing spondylitis to all 124 patients with sacro-iliitis, and 82% of this group carried HLA-B27. The classical New York criteria of 'limitation of the lumbar spine in three directions' and of 'limitation of chest expansion' appeared to reflect disease duration rather than help in the initial diagnosis.

Adolescent↗
PubMed2003

Spondylitis association of America: the member-directed, nonprofit health organization addressing the needs of ankylosing spondylitis patients.

Ankylosing spondylitis (AS) involves a spinal arthritis that affects young adults, with an onset usually between 17 and 35 years of age. Although historically underdiagnosed, AS strikes at least 1 million Americans. Enhancing the quality of lives of AS patients in the United States is one of the goals of the Spondylitis Association of America (SAA). To this end, the SAA strives to expand the knowledge and resources available for AS patients and for health professionals. This article explores how the SAA addresses the needs of patients living with spondylitis. This article explains that through its effective collaborations, the SAA dedicates itself to the eradication of AS and related diseases through education, advocacy, awareness, and research.

Humans↗
PubMed1999

Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument?

OBJECTIVE: Disease activity has been defined using a self-administered instrument, focusing on fatigue, axial pain, peripheral pain, enthesopathy and morning stiffness [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. This validated instrument is simple and takes 40 s to complete, but whether the index is an accurate expression of the component parts, or whether additional weighting would enhance its efficacy, is unclear. METHODS: Four hundred and seventy-three patients with ankylosing spondylitis received placebo or active non-steroidal anti-inflammatory drug (NSAID) for 6 weeks, and changes between entry and completion were captured by BASDAI and the individual components. Principle component analysis (PCA) was used to explore the best combinations of variables in decreasing order of explained total dispersion and to assess whether a single sum (or algebraic expression) best defined disease activity status. RESULTS: At entry, the correlation between BASDAI and the first axis was 0.99, 0.11 with the second, and zero thereafter. Data at study end and relating to change revealed a 100% correlation (R = 1) between the first axis and the sum, with zero for the remainder. CONCLUSIONS: The data support BASDAI as being a valid and appropriate composite to define disease activity in ankylosing spondylitis. Developed as a simple sum of its components, BASDAI has excellent content validity.

Aged↗
PubMedDate not supplied

Translation, cross-cultural adaptation, and validation of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Dougados Functional Index (DFI) in a Spanish speaking population with spondyloarthropathies.

OBJECTIVES: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure disease activity and functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Spanish language. METHODS: The BASDAI, BASFI, and DFI questionnaires were translated into Spanish by three independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Spanish were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Spanish versions were made. The Spanish versions were administered to 61 ambulatory patients with AS and to 80 patients with undifferentiated spondyloarthropathy for validation purposes. Reliability and responsiveness were measured in 28 patients participating in a physiotherapy program. RESULTS: Reliability showed an acceptable 24-hour test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.68, 95% CI: 0.29-0.85; BASDAI ICC: 0.74, 95% CI: 0.52-0.88 and DFI ICC: 0.87, 95% CI: 0.73-0.94. The construct validity of the instruments was evaluated, and BASDAI was correlated with disease activity measured by the total enthesis count (rs: 0.34); general well being in the last week (rs: 0.7); spinal pain (rs: 0.53) and duration of morning stiffness (rs: 0.64). BASFI correlated with Schöber's test (rs: -0.4); occipital-wall distance (rs: 0.38) and thoracic expansion (rs: -0.3). DFI correlated with Schöber's test (rs: -0.36); occipital-wall distance (rs: 0.29) and chest expansion (rs: -0.3). The correlation among DFI and BASFI was rs: 0.83. All instruments showed clinical responsiveness in the physiotherapy program (baseline and end of program; mean +/- SD): BASDAI: 6.25 +/- 1.97 and 3.07 +/- 2.04 (p = 0.0001); BASFI: 5.68 +/- 2.29 and 2.88 +/- 1.77 (p = 0.0001); DFI: 16 +/- 7.6 and 8.0 +/- 5.5 (p = 0.001) with effect sizes and standardized effect sizes > 1. CONCLUSIONS: The Mexican Spanish versions of the BASDAI, BASFI, and DFI showed adequate reliability, validity and responsiveness to clinical change. These instruments can be used in the clinical evaluation of Spanish-speaking patients with AS.

Activities of Daily Living↗
PubMed1983

[Destructive cervical spondylitis. An unusual initial manifestation of ankylosing spondylitis].

Erosions of vertebral bodies and intervertebral discs are usually considered as late manifestations of ankylosing spondylitis. Yet they may occur early and indeed constitute the first sign of the disease. This is illustrated by the case reported here, where a 19-year-old woman with an 18-months diagnosis of ankylosing spondylitis was found to have severe destructive lesions of the 6th cervical vertebra without discal lesion nor cervical ankylosis. Surgical biopsy excluded a tumoral or infectious process. Spinal fusion (C4-C7) was performed, and cervical pain was completely relieved with non-steroidal anti-inflammatory drugs.

Adult↗
PubMed2004

Responsiveness and discriminative capacity of the assessments in ankylosing spondylitis disease-controlling antirheumatic therapy core set and other outcome measures in a trial of etanercept in ankylosing spondylitis.

OBJECTIVE: To investigate the responsiveness and discriminative capacity, and the relationship between both, of instruments selected for the disease-controlling antirheumatic therapy (DC-ART) core set by the Assessments in Ankylosing Spondylitis Working Group (ASAS). METHODS: Responsiveness and discriminative capacity of different measures reflecting disease activity and function, either included in the ASAS DC-ART core set or not, were evaluated in a randomized controlled clinical trial comparing etanercept with placebo in patients with ankylosing spondylitis. Guyatt's method was used as the primary analysis for responsiveness, and Student's t-test for discriminative capacity. RESULTS: At day 28 of therapy, almost all measures indicated moderate to large responsiveness in the etanercept group (Guyatt 0.60-3.11). Some scales of the Short Form 36 (general health, mental component summary, and role emotional), the modified Schober's test, and the Fatigue Severity Scale were not responsive. The results were similar if analyzed at day 112 of therapy. Peripheral joint counts, joint scores, and occiput-to-wall distance could not be evaluated due to a floor effect. In general, the relation between responsiveness and discriminative capacity was strong: Measures that demonstrated high responsiveness also showed high between-group t values. CONCLUSION: Measures included in the ASAS DC-ART core set, except modified Schober's test, have good responsiveness and good discriminatory capacity. Some measures could not be evaluated due to a floor effect.

Antirheumatic Agents↗
PubMedDate not supplied

[Pyogenic spondylitis in the interarticular portion of the vertebral arch. Case report on primary dorsal spondylitis].

The manifestation of a pyogenic spondylitis only in the dorsal part of a spinal segment is very rare and causes even more diagnostic problems than the typically anterior located spondylitis. We are reporting on a patient with known isthmic spondylolisthesis who developed the inflammatory process primarily in the intervertebral joint and in the interarticular portion. For a few months the cause of his complaints was thought to be due to spondylolisthesis till radiological adn laboratory methods lead to the correct diagnosis and adequate therapy.

Abscess↗
PubMed1999

Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis.

To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group. The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue. For each instrument the members were asked to judge if the instrument was feasible and relevant. If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list. These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set. This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping. The response rate to the questionnaire was 72%. For each domain one or more instruments were selected, except for Entheses and Fatigue. The chosen instruments were similar for the 3 above settings. Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility. For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research. It is recommended to use these instruments in all research projects in AS.

Antirheumatic Agents↗
PubMed2000

The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index.

OBJECTIVE: To develop a simple but reproducible radiological scoring system for the hip in ankylosing spondylitis (AS). METHODS: A consensus approach was used to develop a grading system whereby hip radiographs of 470 patients with AS were scored from 0 to 4 (normal, suspicious, mild, moderate, and severe), producing the Bath Ankylosing Spondylitis Radiology Hip Index ( BASRI-hip or BASRI-h). The system was designed to be specific for AS radiographic change at the hip and includes circumferential joint space narrowing, osteophytes, erosions, and protrusio acetabulae. This score can then be added to the BASRI-spine, forming the grading system BASRI-total, scored 2-16. Radiographs of 134 patients were used to test reproducibility. Blinded radiographs of 100 non-AS patients were included randomly to assess disease specificity. Sensitivity to change was determined using 438 radiographs from 122 patients, over 219 time intervals. RESULTS: Inter and intraobserver variation for the right and left hip showed 83-84% and 94-96% complete agreement, respectively. Disease specificity was 0.76. If non-AS patients with a total hip replacement were excluded, disease specificity was 0.83. Sensitivity to change became apparent at one year (p < 0.001). Grading the hips using a single radiograph takes seconds. CONCLUSION: BASRI-h is a reliable method for grading hip radiographic change in AS. It is disease-specific, sensitive to change, simple to use, and rapid to perform.

Female↗
PubMed2001

[Differences between tuberculous spondylitis and brucellar spondylitis].

OBJECTIVE: To identify potential differences in the clinical and laboratory characteristics between tuberculous spondylitis (TS) and brucellar spondylitis (BS). PATIENTS AND METHODS: Retrospective study of patients with TS and BS diagnosed in our hospital between january 1992 and december 1998. RESULTS: TS was diagnosed in 17 patients and BS in 10 patients. In our series, a higher delay in the diagnosis (27.9 +/- 24.6 vs. 16 +/- 5.6 weeks, p = 0.02) was found in TS. There was a higher frequency, but without stadistic significance, of immunosuppression, one or several paravertebral or epidural abscesses, spinal cord compression, anemia and an elevated erythrocyte sedimentation rate in TS, and a higher frequency of fever/febricule and residual vertebral pain in BS. Lumbar location was the most frequent in both groups (58.8% in TS and 70% in BS). CONCLUSIONS: It is possible that there were some differences in the clinical and laboratory characteristics between TS and BS which may be an aid in the differential diagnosis of both entities and orient the empirical treatment in these cases without a definitive microbiological diagnosis or while awaiting the diagnostic confirmation.

Adolescent↗
PubMed1975

[Differentiation of spondylitis ankylopoietica and spondylitis hyperostotica].

Changes in the bodies of vertebrae in ancylopoetic spondylitis (Bekhterev's disease) and in hyperostotic spondylitis (Forestier's disease) may be very similar, in particular as regards the ancylotic connection of the bodies of the vertebrae and syndesmophytes. In the differential diagnosis the following differences are important: Syndesmophytes in Bekhterev's disease are symetrical and continuous, there is ossification of the intervertebral discs, and ancylosis affects always sacroiliac, intervertebral and costovertebral joints. In hyperostotic spondylosis the sclerotic syndesmophytes bulge in a lateral direction, mainly to the right. The inveretebral discs do not ossify, the sacroilliac and other above mentioned joints are not affected.

Aged↗
PubMed2002

Measuring disability in ankylosing spondylitis: comparison of bath ankylosing spondylitis functional index with revised Leeds Disability Questionnaire.

OBJECTIVE: Disability has been identified as a core outcome measure in ankylosing spondylitis (AS). The Dougados Functional Index (DFI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) have been selected as core measures of function in this disease. However, neither of these instruments has undergone rigorous psychometric testing. METHODS: The psychometric properties of 2 measures of disability, the BASFI and the revised Leeds Disability Questionnaire (RLDQ), were compared in a cohort of 208 outpatients with AS. Rasch analysis was used to examine the properties of each measure and to compare them on a common scale. Test-retest was assessed in a cohort of 149 subjects who completed each instrument twice over an interval of 2 weeks. RESULTS: Both instruments gave an even spread of scores across the study group, but BASFI responses were positively skewed and RLDQ responses negatively skewed. There was a highly significant difference between perceived severity groups for both instruments (Kruskal-Wallis chi-squared: RLDQ, 75.1; BASFI, 80.4; both p < 0.0001). Both instruments gave acceptable test-retest scores (RLDQ ICC = 0.95, 95% CI 0.93-0.97; BASFI ICC = 0.94, 95% CI 0.92-0.96). Both instruments were found to be unidimensional according to the Rasch model, but the BASFI had more items displaying differential item functioning. Category disordering was apparent with the BASFI but not the RLDQ. However, both instruments displayed disordered item thresholds. Neither instrument can be used as an interval measure. Both measures had "towers" of thresholds whereby several thresholds were marking the same point on the underlying disability construct. This was particularly notable in the case of the BASFI. CONCLUSION: Both the BASFI and RLDQ provide a unidimensional measure of function in AS that is in accord with patient perception of disease severity. Neither instrument can be used as an interval measure. Changing the way that the instruments are scored, for example by collapsing categories, may improve their performance.

Activities of Daily Living↗