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- Bengtsson, Karin, et al.
(author)
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Cardiac conduction disturbances in patients with ankylosing spondylitis : results from a 5-year follow-up cohort study
- 2019
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In: RMD Open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 5:2
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Journal article (peer-reviewed)abstract
- Objectives: To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up.Methods: In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks.Results: Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up.Conclusions: The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.
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| 2. |
- Deminger, Anna, 1973
(author)
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A prospective chohort study on bone formation and bone loss in ankylosing spondylitis
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background and objectives: Patients with ankylosing spondylitis (AS) have an increased risk of bone loss with development of osteoporosis and vertebral fractures (VFs) but also spinal new bone formation with growth of bony spurs (syndesmophytes) between the vertebrae. Measurements of spinal bone mineral density (BMD) by the routine method dual-energy x-ray absorptiometry (DXA) in anteroposterior (AP) projection can be difficult to interpret due to the spinal new bone formation. The general aims of this thesis were to study the development of bone loss and new bone formation over 5 years in patients with AS and to assess factors associated with the changes. Methods: The studies included in this thesis are based on a cohort of patients with AS according to the modified New York criteria recruited from three rheumatology clinics in western Sweden. Patients completed the same protocol at baseline and at the 5-year follow-up with assessment of BMD with DXA at the hip (femoral neck, total hip), the spine (AP, lateral) and total radius and spinal radiographs for grading of AS related spinal alterations and VFs. A group of men were randomized in an age-adjusted algorithm to undergo high-resolution peripheral quantitative computed tomography (HRpQCT) at the ultra-distal radius and tibia for assessment of volumetric BMD (vBMD), cortical area and microarchitecture. Serum hepatocyte growth factor (s-HGF) was analyzed with enzyme-linked immunosorbent assay (ELISA) in the total cohort. Results: Over 5 years, there were significant decreases in femoral neck BMD and tibia vBMD. Decreases were associated with signs of inflammation. In contrast, BMD at the total hip and the spine AP and lateral projections increased. Use of bisphosphonates was associated with increases in BMD at all measured sites except tibia. Use of tumor necrosis factor inhibitors (TNFi) was associated with increases in BMD at AP spine and tibia. Only three patients developed new VFs. AS related spinal alterations increased significantly with higher increases in men compared to women. New predictors identified for spinal radiographic progression were obesity in both sexes and use of bisphosphonates and impaired mobility in women. Among previously known predictors, baseline AS related spinal alterations was shared by sexes, whereas baseline elevated CRP and smoking were predictors in men. The biomarker s-HGF was identified as a novel independent predictor of spinal radiographic progression in men. Conclusion: The studies in this thesis suggest that the best site to assess bone loss in patients with longstanding AS is at the femoral neck and that inflammation has a negative impact on bone loss and development of AS related spinal alterations and thus is an important treatment target. The studies give further reasons to counsel the patients to stop smoking and to encourage obese patients to weight loss. Treatments with bisphosphonates and TNFi had a positive impact on BMD. Further studies are suggested regarding the role of bisphosphonates in relation to spinal radiographic progression and whether s-HGF can be useful as a predictor for spinal radiographic progression.
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| 3. |
- Klingberg, Eva, et al.
(author)
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A distinct gut microbiota composition in patients with ankylosing spondylitis is associated with increased levels of fecal calprotectin
- 2019
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In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 21:1
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Journal article (peer-reviewed)abstract
- Background Ankylosing spondylitis (AS) shares many characteristics with inflammatory bowel disease (IBD). Intestinal microbiota most likely plays an important role in the development of IBDs and may also be involved in the pathogenesis of AS. We aimed to define and compare the fecal microbiota composition in patients with AS, ulcerative colitis (UC), and healthy controls (HC) and to determine relationships between fecal microbiota, fecal calprotectin, and disease-related variables in AS. Methods Fecal microbiota composition was assessed with GA-map (TM) Dysbiosis Test (Genetic Analysis, Oslo, Norway), which also reports the degree of deviation of the microbiota composition compared with a healthy control population, a Dysbiosis Index (DI) score 1-5. The AS patients were assessed with questionnaires, back mobility tests, fecal calprotectin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results Totally, 150 patients with AS (55% men, median age 55.5 years, median BASDAI 3.2), 18 patients with UC (56% men, median age 30.5 years), and 17 HC (65% men, median age 22 years) were included. Principal component analysis showed highly separate clustering of fecal microbiota from the patients with AS, UC, and HC. Compared with HC, fecal microbiota in AS was characterized by a higher abundance of Proteobacteria, Enterobacteriaceae, Bacilli, Streptococcus species, and Actinobacteria, but lower abundance of Bacteroides and Lachnospiraceae. Further, fecal microbiota composition differed between patients with normal (<= 50 mg/kg, n = 57) and increased (>= 200 mg/kg, n = 36) fecal calprotectin. Patients with increased fecal calprotectin had lower abundance of bacteria with anti-inflammatory properties such as Faecalibacterium prausnitzii and Clostridium and higher abundance of the genus Streptococcus. No association was found between the fecal microbiota composition and HLAB27 status, disease activity, function, or medication. Dysbiosis (defined as DI >= 3) was found in 87% of AS patients. Conclusions Patients with AS have a distinct fecal microbiota signature, which is linked to fecal calprotectin levels, a marker of intestinal inflammation, but not to other clinical parameters. These findings suggest a local interplay between intestinal microbiota and gut inflammation in AS.
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