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Scientific Abstracts
Objectives: To investigate whether women with spondyloarthritis, pyuria and a
negative urine culture have a urogenital infectious process triggering the disease
or an inflammatory process secondary to the spondyloarthritis.
Methods: We investigate in a cross-sectional descriptive study, urinary free
symptoms women with a clinical diagnosis of spondyloarthritis according to
ASAS-2010 classification criteria presenting with leukocyturia and a positive
leukocyte esterase were evaluated in the Urogynecology service in our hospital
to perform a cystoscopy and colposcopy with samples for culture and cytology
(cervical and urethral).
Results: We studied 38 patients with a mean age of 49 (±12) with a clinical
diagnosis of undifferentiated spondyloarthritis in 19, psoriatic arthritis in 10,
ankylosing spondylitis in 6 and inflammatory bowel disease on 3. Twenty-six
patients were colposcopy evaluated and in only one patient a florid vaginosis was
found. Cervical cultures were positive for Chlamydia Trachomatis in 6 patients,
E. Coli in 6, Staphylococcus spp y Bacillus in 3 each, Gardnerrella vaginalis,
Klebsiella and Pseudomona in 1 patient each. Urethral cultures were positive for
Chlamydia trachomatis in 12 patients, E. coli in 8, Lactobacilli, Psesudomana,
Staphylococcus 4 patients each and Enterococci in 3 patients. The most common
cystoscopic findings were increased vasculature in 19 patients, metaplasia in 13,
trabeculae in 10, superficial hemorrahage in 5 and urethral stricture in 3. In three
patients increased vasculature, petechiae and hemorrhagic points were reported
Conclusions: Patients with spondyloarthritis and asymptomatic positive leukocyte
esterase can present Chlamydia trachomatis in culture of urethra and/or cervix.
Patients who do not have positive culture presented cystoscopic inflammatory
changes, which suggests an inflammatory process independent of bacteria.
[1] Carter J.D., Hudson A.P. Reactive Arthritis: Clinical aspects and medical
management. Rheum Dis Clin N Am 35(2009) p21-44
[2] Carter J.D. Reactive Arthritis: defined etiologies, emerging, pathophysiology,
and unresolved treatment. Infect Dis Clin N Am 20(2006) p827-847
[3] Lange U., Berliner M., Ludwig M., Shiefer H.G. and Et all. Ankylosing sponyilitis
and infections of the female urogenital tract. Rheumatol Int 17(1998) p181-184
[4] Mohammad-Bagher O. and Eley A.R., Is the role of Chlamydia Trachomatis
underestimated in patients with suspected Reactive Arthritis?. International
Journal Of Rheumatic Disease 13(2010)
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.5678
M. Calis 1 , E. Sonbahar 1 , H. Talay Calis 2 , C. Yazici 3 , F. Ulku Demir 4 , S. Mistik 5 .
Department of Physical Medicine and Rehabilitation, Erciyes University Medical
School; 2 Pyhsical Medicine and Rehabilitation Clinics, Kayseri Training and
Research Hospital; 3 Department of Biochemistry, Erciyes University Medical
School; 4 Physical Medicine and Rehabilitation Clinics, Kayseri Training and
Research Hospital; 5 Department of Family Medicine, Erciyes University Medical
School, Kayseri, Turkey
Background: Recently, studies are focused on finding the relation between
Natriuretric Peptide and the immune system.
Objectives: The aim of the present study is assessing the role of serum levels
of natriuretic peptides and the correlation of oxidative stress in patients with
ankylosing spondylitis
Methods: This study has been carried out in patients with ankylosing spondylitis
(AS). 45 patients with AS and 20 healthy controls were enrolled. Serum levels
of pro atrial natriuretic peptide (proANP), brain natriuretic peptide (BNP), N
terminal pro C type natriuretic peptide (NTproCNP) who were from natriuretic
peptide (NP) family and myeloperoxidase (MPO) activity, serum levels of total
lipid hydroperoxides (LHP), neopterin, total oxidant status (TOS), total antioxidant
status (TAOS), tumour necrosis factor alpha (TNF-α), advanced oxidation protein
products (AOPP) and thiol levels were assayed.
Results: There was no significant difference in neopterin, TNF-α, TOS, TAOS,
proANP and NTproCNP concentration between patients with AS and healthy
controls. ESR, CRP, AOPP, MPO, LHP and BNP levels were significantly higher
in patients with AS than in controls. Thiol, albumin levels were significantly lower
in patients with AS than in controls. There was statistically significant difference
between acut phase response markers, ESR and CRP levels of active group and
inactive group. AOPP and MPO levels were significantly higher in active group
than in inactive group and control group. LHP and thiol levels were statistically
significant different in active and inactive group than in control group. NTproCNP,
AOPP and LHP levels were significantly higher in patients who were active status
than in remission status. Thiol, albumin levels were significantly lower in patients
who were active status than in remission status. Serum AOPP levels correlated
with BASDAI and BASFI scores, CRP and ESR levels in patients with AS.
Conclusions: These results indicate that serum AOPP and proANP levels may
reflect clinical activity of disease and may be helpful for monitoring patients with
AS. The higher levels of MPO activity showed us enhanced production of ROS by
activated neutrophils play a role in the pathogenesis of AS patients. It is thought
that NPs related to the oxidative stres in patients with AS and may play an
important role of the pathogenesis.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.1064
P. Cetin, I. Sari, M. Birlik, F. Onen, N. Akkoc. Rheumatology, Dokuz Eylul
University School of Medicine, Izmir, Turkey
Background: Recognition of inflammatory back pain (IBP) is central to early
diagnosis of ankylosing spondylitis (AS), as well as to that of axial spondyloarthritis
(AxSpA), which has been introduced as a more inclusive term to make early
diagnosis of AS possible in the absence of radiographic sacroiliitis. While AxSpA
is a hot topic for practicing rheumatologists, it is not yet known to what extent the
recent knowledge accumulated in this field has been communicated to the other
Objectives: To assess the level of awareness of features of IBP and AxSpA
among physicians, who are frequently consulted first by patients with low back
pain, and also the referral and management behavior of those specialties in
patients with IBP and AxSpA.
Methods: Trained interviewers using a structured questionnaire performed face
to face interviews with a total of 403 physicians, from six different regions
of Turkey, which included orthopedists (n:202), family physicians (n:102), and
neurosurgeons (n:99). In the first part of the interview, physicians were asked to
tell the topics they question when interviewing patients with back pain. Then they
were shown 10 questions relevant for inflammatory back pain, and asked to rank
them, from 1 to 10, with 1 having the highest importance. In the second part
of the interview they were asked, which laboratory tests and imaging modalities
they order, when assessing patients with back pain. They were also asked if they
would order any of the tests displayed to them when they think the patient has
inflammatory back pain. In the next part of the interview the physicians’ familiarity
with the concept of AxSpA and their referral patterns and management strategies
in this group of patients were evaluated.
Results: The duration of back pain was the most frequent topic questioned by the
physicians (68%). Other domains, such as the effect of activity and night/morning
pain, which are relevant for diagnosing IBP were asked by only a small proportion
of physicians, (15% and 14%, respectively). Duration of back pain was ranked as
having the highest importance (mean rank: 2.5) and the history of NSAID use
with the least importance (6.9). The majority of physicians stated that they don’t
request blood tests (64%) when evaluating patients with low back pain and they
refer 24% of their patients. Suspicion of a rheumatologic disease is the reason for
referral in 15% of those cases. The great majority of physicians (89%) expressed
that they can make distinction between mechanical and inflammatory pain. When
asked what tests they would order if the patient has IBP; the answers given
were CRP (85%), ESR (72%), pelvic X ray (1%), MRI (9%) and HLA-B27 (10%).
However when it is asked in multichoice format, then the corresponding figures
changed dramatically: 97%, 92%, 80%, 75% and 32%, respectively. About half
of the interviewed physicians admitted that they were not aware of the concept
Conclusions: There is a great need, at least in Turkey, to increase awareness of
the concept of AxSpA and its main clinical features among specialists who are
likely to be the first physicians consulted by patients with back pain.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.4838
A. Hartavi 1 , G. Alayli 1 , H. Alacam 2 , A. Bilgici 1 , D. Durmus 1 , A. Bedir 2 ,
O. Kuru 1 . 1 Physical Medicine and Rehabilitation; 2 Biochemistry, Ondokuz Mayis
University Medical Faculty, Samsun, Turkey
Background: Ankylosing spondylitis (AS) is chronic inflammatory disease of
spine and sacroiliac joints. It clinically presents with extraarticular involvement and
entesitis along with axial and peripheral involvement. Recent studies demonstrated
that adipocytokines released from white adipose tissue contribute to inflammation
and tissue damage. Apelin is produced in a variety of tissues, and is also shown
to be a new adipokine secreted from the adipocytes and is present in plasma.
Objectives: Although there are studies assessing the relation between AS
and serum adipocytokines, there is almost no study investigating this relation
in terms of apelin. Thus, in our study we aimed to investigate serum apelin
level, association with clinical and laboratory parameters, disease activity and
radiographical damage in AS patients.
Methods: Eighty-five AS patients (M/F=63/22) (mean age 36.70±10.99 years)
followed up in Ondokuz Mayıs University Medicine Faculty Physical Medicine
and Rehabilitation (Rheumatology) Department, 79 RA patients (M/F =11/68)
(mean age 47.97±13.69 years) and 76 healthy controls (M/F =41/35) (mean
age 37.40±13.40 years) were enrolled in the study. Bath Ankylosing Spondylitis
Disease Activity Index (BASDAI) was used for disease activity, Bath Ankylosing
Spondylitis Functional Index (BASFI) for functionality, Bath Ankylosing Spondylitis
Metrology Index (BASMI) for spinal movement, Modified Stoke Ankylosing
Scientific Abstracts
Spondylitis Score System (mSASSS) for radiological damage, and Short Form-36
(SF-36) for quality of life assessment. Apelin and TNF-α levels were determined
by ELISA method.
Results: Apelin levels of AS (2.94±0.81) and RA (3.25±0.90) patients were
statistically higher than healthy controls (2.38±0.77) (p<0.05) and apelin levels
of AS patients were statistically lower than RA patients (p=0.049). Statistically
significant difference was found between three groups in terms of TNF- α level.
While TNF-α levels of RA and AS patients were significantly higher than healthy
controls (p<0.05), there was no statistically difference between AS and RA
patients (p>0.05). Quality of life scores of AS patients except social function
were lower than healthy controls. A positive correlation was found between apelin
and TNF- α levels (p=0.002, r=0.33). While there was a negative correlation
between apelin and BASDAI, BASFI, ESR and CRP, there was no correlation
with m-SASSS and BASMI. There was positive correlation between apelin and
physical function, physical role and pain parameters of quality of life.
Conclusions: We found serum apelin levels higher in AS and RA patients
comparing to healthy controls. We couldn’t find any correlation between apelin
and radiological progression in AS patients. Nevertheless, there was a negative
correlation between apelin and clinical and laboratory measurements that show
disease activity. By these findings, we concluded that serum apelin level increases
at disease course of AS, it may be a marker of clinical activity rather than new
bone formation.
[1] Xie H, Yuan LQ, Luo XH, et al.Apelin suppresses apoptosis of human
osteoblasts. Apoptosis 2007;12:247–254.
[2] Daviaud D, Boucher J, Gesta S, et al. TNFalpha up-regulates apelin expression
in human and mouse adipose tissue. FASEB J 2006;20:1528–1530.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.2310
D. Durmus 1 , G. Sarisoy 2 , G. Alayli 1 , H. Kesmen 1 , A. Bilgici 1 , O. Kuru 1 .
Physical Medicine and Rehabilitation; 2 Psychiatry, Ondokuz Mayis University
Medical Faculty, Samsun, Turkey
Objectives: This study was intended to identify general psychiatric symptoms
in patients with ankylosing spondylitis (AS) and to determine the distribution of
these psychiatric symptoms by degree of disease activity.
Methods: One hundred sixty volunteers, 80 AS patients and 80 healthy
controls, matched in terms of age, gender, education and job, were included.
Spinal pain by visual analogue scale (pain VAS-rest), disease activity by Bath
Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity
by Bath Ankylosing Spondylitis Functional Index (BASFI), and quality of life
by short form-36 (SF-36) were assessed in patients. Psychiatric symptoms
were measured using the Symptom Checklist-90-R, Beck Depression Inventory,
State–Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and Rosenberg SelfEsteem Scale. Correlations were determined between BASDAI, BASFI scores
and psychiatric scale scores.
Results: In addition to symptoms of depression, anxiety, decreased quality of
life and sleep impairment in AS patients, we also determined that less studied
symptoms such as somatization, obsession, compulsion, anger–hostility, paranoid
ideation, psychoticism, and low self-esteem were also more frequent compared
to the healthy controls. Some symptoms were also more prevalent in AS patients
with high disease activity compared to patients with low disease activity. In
AS patients, while there was positive correlation between disease activity and
psychiatric symptoms, there was negative correlation between functional capacity
and psychiatric symptoms.
Conclusions: Depressive, anxious and sleep impairment symptoms are not the
only ones seen in AS patients; other psychiatric symptoms are also common.
Further studies are needed to investigate the frequency and causes of these
symptoms. As seen in patients with a progressive course and lower functional
capacity, more psychiatric symptoms develop in patients with more severe
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.5156
O. Kucuksahin 1 , A. Ateş 2 , M. Törüner 3 , N. Türkçapar 2 , A. Şahin 4 , M. Turgay 2 ,
G. Kınıklı 2 , H. Çetinkaya 3 , N. Düzgün 2 . 1 Rheumatology, Yıldırım Beyazıt
University; 2 Rheumatology; 3 Gastroenterology, Ankara University, Ankara;
Rheumatology, Cumhuriyet University, Sivas, Turkey
Background: The most extraintestinal finding of inflammatory bowel diseases
is musculoskeletal involvement. “Enteropathic arthritis” has been described
as an inflammatory arthritis that gastrointestinal system plays a role in its
pathogenesis and occuring with inflammatory bowel disease. Arthritis associated
with inflammatory bowel disease effects peripheral and axial joints.
Objectives: The aim of this study is to evaluate the frequency of spondyloarthropathy and ankylosing spondylitis in inflammatory bowel diseases.
Methods: 319 patients with inflammatory bowel disease following-up at Ankara
University medical faculty gastroenterology department were included in the
study. Modified New York criteria and ASAS classification criteria were used
for ankylosing spondylitis. European spondyloarthropathy study group (ESSG)
criteria were used for enteropathic arthritis group. Descriptive statistical data for
continuos variables were presented as median (min–max), % and frequencies
were used for categorical variables to summarize of the results of the study.
Results: The mean age of the patients was as follows; 40.08±12.7 years in
Crohn’s disease (CD), 40.0.8±12.4 years in ulcerative colitis (UK). Of the CD
patients, 88 (46.3%) was male, 102 (53.7%) was female. 68 (52.7%) male, and
61 (47.3%) female was found in UK patients. HLA-B27 positivity was measured
36 (18.9%) in CD, and 27 (20.9) % in UK. The frequency of entesopathy was
observed 32 (24.8%) in UK and 57 (30%) in CD. Anterior uveitis was found 5
(2.6%) in CD and 4 (3.1%) in UK. Of the patients, 55 (28.9%) CD patients and
29 (22.5%) UK patients had active smoking history. Positive family history was
described 39 (20.5%) in CD and 23 (17.8%) in UK patients. AS was found 26
(13.7%) in CD and 10 (7.8%) in UK. In over all inflammatory bowel disease
patients, the frequency of peripeheral arthritis was 49 (15.4%), AS was 36 (11.3)
%, and SpA was 61 (19.1%).
Conclusions: The bowel can be affected different manifestations in IBD. In
particular, musculoskeletal involvement may be the first findings of the disease.
The frequency of AS was found as 11.3% and SpA was found 19.1% according
to our single center experience.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.5709
P. Drivelegka 1 , N. Papachrysos 2 , I.F. Petersson 3 , A. Bremander 4,5 ,
L.T. Jacobsson 1 . 1 Department of Rheumatology and Inflammation Research,
Sahlgrenska Academy at University of Gothenburg; 2 Department of
Gastroenterology, Sahlgrenska University Hospital/Östra, Gothenburg;
Department of Orthopedics, Department of Clinical Sciences; 4 Department of
Clinical Sciences, Section of Rheumatology, Lund University, Lund; 5 Research
and Development Centre, Spenshult Hospital of Rheumatic Diseases, Halmstad,
Background: Inflammatory Bowel Disease associated arthropathy (IBD-aA) can
cause impaired function but the level of activity limitations in comparison with
other subgroups of spondyloarthritis (SpA) is unknown. Furthermore, data on the
association of IBD-aA with the severity of bowel disease is limited.
Objectives: To compare disease severity as measured by patient reported
outcome (PROMs): 1) in patients with IBD-aA with peripheral and axial musculoskeletal manifestations to those in Ankylosing Spondylitis (AS) and Psoriatic
Arthritis (PsA) respectively, 2) by severity of IBD-aA reflected by whether second
line treatment had be given.
Methods: The SpA Scania cohort consists of all the subjects aged 15 years or
older in the Skåne region (1.2 million inhabitants in southern Sweden) having
recieved a diagnosis of any type of Spondyloarthritis during 2003-2007 at primary
or specialised care visits (N=5771) recorded in the Skåne Health Care Register
(SHCR). This included patients with Ankylosing Spondylitis (26%), Undiffentiated
Spondyloarthritis (22%), Psoriatic Arthritis (39%) and IBD-aA (2.3%). A postal
questionnaire was sent in 2009 to all the subjects aged 15 years or older including
questions on PROMs with an overall response rate of 58%. Of the 65 patients
with IBD-aA responding to the questionnaire a structured review of medical
records verified both IBD and arthritis in 80% (N=52), from whom questionnaire
data was used in the present analyses. The occurrence of axial or peripheral
musculoskeletal disease and given second line therapy (surgery or treatment with
TNF-inhibitor for IBD) were retrieved through the medical record review.
Results: Fifty-two patients records were analysed (17 men, mean age 39.8).
Patients with axial IBD-aA (N=23) had comparable values for BASDAI (4.8 vs 4.0,
p=0.19) and BASFI (4.1 vs 3.4, p=0.44) to AS patients (N=711). Patients with
peripheral IBD-aA (N=44) had comparable values for global health (numeric rating
scale) (4.5 vs 4.1, p=0.51) compared to PsA patients (N=1225). Severe bowel
disease, defined as the need of anti-TNFa therapy or surgery, was observed in
52% (n=27) of the patients with IBD-aA. Perceived health according to PROMs
was similar in the patients with and without severe IBD (BASDAI: 5.1 vs 4.9
p=0.71, BASFI: 4.5 vs 3.3 p=0.13, global health: 4.8 vs 4.2 p=0.29).
Conclusions: Patients with IBD-aA tend to have worse perceived health
compared to patients with AS and PsA. This warrants further and larger studies
of this subgroup of SpA.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.4558
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