OBJECTIVE: To observe the clinical efficacy of different acupuncture methods in the treatment of ankylosing spondylitis (AS) at different stages. METHODS: Thirty-two patients with AS were treated with acupuncture at ashi points (tendon focus), triple acupuncture method was used in the acute phase, accompanied needling method was used in the remission phase, once a day, 5 times a week for 4 weeks. The Bath ankylosing spondylitis disease activity index (BASDAI) score, Bath ankylosing spondylitis functional index (BASFI) score and TCM symptom grade quantitative standard score before and after treatment were observed, and the efficacy was evaluated. RESULTS: After treatment, the BASDAI score, BASFI score and TCM symptom grade quantitative standard score were reduced compared with those before treatment (P<0.01), the effective rate was 96.9% (31/32). CONCLUSION Different acupuncture methods in the treatment of AS at different stages could improve signs and symptoms, such as pain, activity limitation and morning stiffness.
Humans ; Spondylitis, Ankylosing/physiopathology* ; Acupuncture Therapy/methods* ; Male ; Female ; Adult ; Middle Aged ; Young Adult ; Acupuncture Points ; Treatment Outcome

This study explores the diagnosis and treatment of needle knife therapy for ankylosing spondylitis (AS) at middle and advanced stage based on the theory of meridian tendons, from a holistic perspective and syndrome differentiation. The treatment strategy includes "harmonizing yin and yang" to address root causes and "tendons-based release" to harmonize qi and blood, with the "tendons nodule points" as the core acupoint selection criterion. Based on this approach, the study systematically elaborates on two needle knife methods for AS: "governor vessel bone-piercing technique" and "below-the-umbilicus release technique", covering indications, acupoint location, and procedures. Clinical case examples are provided to enrich needle knife therapy guided by the theory of meridian tendons, offering insights for clinical and research work on AS.
Humans ; Acupuncture Points ; Acupuncture Therapy/methods* ; Meridians ; Spondylitis, Ankylosing/physiopathology* ; Tendons/physiopathology*

OBJECTIVE: To comprehensively assess the occurrence of residual symptoms in patients with axial spondyloarthritis who have successfully attained the treatment goal of low disease activity, and to conduct a thorough analysis of the related factors. METHODS: An analysis was performed on axial spondyloarthritis patients who achieved low disease activity for the first time during their visits at the Rheumatology and Immunology Department of Peking University Third Hospital, spanning from May 1, 2021, to February 29, 2024. Based on the ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP), the patients who achieved low disease activity were divided into a non-remission low disease activity group and a remission group. The occurrence of residual fatigue and pain symptoms in both groups was assessed, and binary Logistic regression analysis was used to evaluate the related factors. RESULTS: In the study, 201 patients achieved low disease activity during treatment. The gender distribution was skewed towards males, with 151 male patients (75.1%) and 50 female patients (24.9%). The median age of the patients who achieved low disease activity was 32.0 (28.0, 37.0) years, and the median disease duration was 6.7 (3.8, 11.5) years. Notably, 140 patients (69.7%) achieved low disease activity but did not experience complete remission, while 61 patients (30.3%) attained remission. A substantial proportion of the patients, 45.8%, reported residual fatigue visual analogue scale (VAS) ≥4, with a marked difference between the non-remission low disease activity group and the remission group (53.6% vs. 27.9%, P=0.001). Similarly, 24.4% of the patients had residual pain VAS ≥4, with a significant disparity between the non-remission low disease activity group and the remission group (30.0% vs. 11.5%, P=0.005). Binary Logistic regression analysis revealed that C-reactive protein levels had a notable negative influence on residual fatigue symptom (B=-0.142, P=0.008, OR=0.868), whereas ASAS-HI had a positive effect on residual fatigue (B=0.288, P < 0.001, OR=1.334). Gender was found to have a significant impact on residual pain symptoms, with females exhibiting a higher risk (B=1.135, P=0.002, OR=3.112). CONCLUSION The residual fatigue and pain symptoms are common in axial spondyloarthritis patients who have achieved low disease activity, particularly among female patients. More assessment and recognition of the residual disease burden in these patients will be needed to optimize the treatment strategies.
Humans ; Female ; Male ; Adult ; C-Reactive Protein/analysis* ; Axial Spondyloarthritis ; Fatigue/etiology* ; Severity of Illness Index ; Spondylitis, Ankylosing/physiopathology* ; Remission Induction ; Pain/etiology* ; Logistic Models

OBJECTIVE: To investigate the effect of vitamin D3 on polarization of monocyte macrophages induced by serum from patients with ankylosing spondylitis (AS). METHODS: Twenty AS naïve patients and 20 healthy controls from Wenzhou People's Hospital during January 2016 and December 2017 were enrolled. The macrophages were differentiated from THP1 cells induced by phorbol 12-myristate 13-acetate (PMA), and then co-cultured with the serum from healthy subjects (control group) or AS patients. Vitamin D3 was added in the medium mixed with serum from AS patients. Flow cytometry was used to analyze the ratio of CD68 and CD206 positive cells, and RT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase(iNOS) and arginase-1(Arg-1). RESULTS: THP1 cells could be polarized into mononuclear-macrophages with the induction of PMA. The proportion of CD206 positive cells in AS-serum group was lower than that in the control group (=9.434, <0.05), while the proportion of CD68 positive cells was higher than that in the control group (=43.920, <0.05). The proportion of CD206 positive cells in vitamin D3 group was higher than that in AS-serum group (=8.895, <0.05), while the proportion of CD68 positive cells was lower than that in AS-serum group (=9.089, <0.05). mRNA expression of Arg-1 in AS-serum group was lower than that in the control group (=8.899, <0.05), while mRNA expression of iNOS was higher than that in the control group (=3.656, <0.05). mRNA expression of Arg-1 in vitamin D3 group was higher than that in AS-serum group (=6.219, <0.05), while mRNA expression of iNOS was lower than that in AS-serum group (=5.876, <0.05). CONCLUSIONS Vitamin D3 can regulate the polarization of mononuclear macrophages for immunoregulation in patients with AS.
Adjuvants, Immunologic ; pharmacology ; Cell Differentiation ; drug effects ; Cholecalciferol ; pharmacology ; Humans ; Monocytes ; drug effects ; Spondylitis, Ankylosing ; blood ; physiopathology

BACKGROUNDPrevious studies showed that combining apparent diffusion coefficient (ADC) value with the Spondyloarthritis Research Consortium of Canada (SPARCC) index value might provide a reliable evaluation of the activity of ankylosing spondylitis (AS), and that contrast-enhanced (CE) magnetic resonance imaging (MRI) is unnecessary. However, the results were based on confirming only a small random sample. This study aimed to assess the role of CE-MRI in differentiating the disease activity of AS by comparing ADC value with a large sample.

METHODSA total of 115 patients with AS were enrolled in accordance with Bath AS Disease Activity Index and laboratory indices, and 115 patients were divided into two groups, including active group (n = 69) and inactive group (n = 46). SPARCC, ΔSI, and ADC values were obtained from the short tau inversion recovery (STIR), diffusion-weighted imaging (DWI), and CE-MRI, respectively. One-way analysis of variance and receiver operating characteristic analysis were performed for all parameters.

RESULTSThe optimal cutoff values (with sensitivity, specificity, respective area under the curve, positive likelihood ratio, and negative likelihood ratio) for the differentiation between active and inactive groups are as follows: SPARCC = 6 (72.06%, 82.61%, 0.836, 4.14, 0.34); ΔSI (%) = 153 (80.6%, 84.78%, 0.819, 5.3, 0.23); ADC value = 1.15 × 10-3 mm2/s (72.73%, 81.82%, 0.786, 4, 0.33). No statistical differences were found among the predictive values of SPARCC, ΔSI, and ADC. Multivariate analysis showed no significant difference between the combination of SPARCC and ADC values with and without ΔSI.

CONCLUSIONSUsing large sample, we concluded that the combination of STIR and DWI would play significant roles in assessing the disease activity, and CE-MRI sequence is not routinely used in imaging of AS to avoid renal fibrosis and aggravation of kidney disease.

Adolescent ; Adult ; Contrast Media ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Image Enhancement ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Spondylitis, Ankylosing ; diagnostic imaging ; physiopathology ; Young Adult

BACKGROUNDOsteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis (AS). The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS.

METHODSFifty-nine AS patients and 40 healthy controls were enrolled. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) at posterior-anterior (PA) lumbar, lateral lumbar and hip regions. Thoracic and lumbar X-rays were obtained for morphometric measurements. Clinical, biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiology Index-total (BASRI-t), erythrocyte sedimentation rate (ESR) and the C-reactive protein levels.

RESULTSOsteoporosis was present in 32% of patients and 5% of controls according to lateral vertebral BMD measurements. Fracture was present in 31% of patients. The effect of some clinical and laboratory parameters on BMD status and vertebral fractures was analyzed in the patient group. Osteoporosis in lateral lumbar DEXA was associated with higher BASMI, BASFI, BASRI-t scores and ESR level. Low hip BMD was associated with low BMI and high BASFI and BASRI-t scores. Vertebral fractures were associated with advanced age, longer disease duration, longer duration since diagnosis, higher BASMI and BASRI-t scores, higher ESR level, reduced femoral and lateral lumbar BMD. Logistic regression analysis revealed that only BASRI-t score was significantly associated with low lateral spinal BMD and BMI and BASFI score were independently associated with low hip BMD. The presence of compression fractures was independently associated with BASRI-t score and low lateral lumbar BMD.

CONCLUSIONSOsteoporosis and vertebral fractures in AS seem to be related to the extent of radiological involvement. A low lateral lumbar BMD is an important risk factor for vertebral fractures.

Absorptiometry, Photon ; Adult ; Blood Sedimentation ; Bone Density ; physiology ; C-Reactive Protein ; metabolism ; Female ; Humans ; Male ; Osteoporosis ; epidemiology ; metabolism ; Spinal Fractures ; epidemiology ; metabolism ; Spondylitis, Ankylosing ; epidemiology ; metabolism ; physiopathology

The objectives of this study were to estimate the cost-of-illness (COI) and health-related quality of life (HRQOL) in patients with ankylosing spondylitis (AS) in Korea and to evaluate the effects of socio-demographic and clinical factors on the COI and the HRQOL. Face-to-face interview surveys were taken from patients with AS at the Rheumatology Clinic of Seoul National University Hospital. Direct medical and non-medical costs, indirect costs (productivity loss due to job loss and sick leave), and deterioration of HRQOL in patients with AS were measured. Factors associated with COI and HRQOL were analyzed with multiple regression and multivariate logistic regression. A total of 191 patients with AS was enrolled in the study. The COI in patients with AS amounted to 11,646,180 Korean Won (KRW) per patient, and their HRQOL was 0.62. As functional severity worsened, the total costs increased (class I, KRW 7.7 million; class II, KRW 12.9 million; classes III & IV, KRW 25.2 million) and the HRQOL scores decreased (class I, 0.72; class II, 0.61; classes III & IV, 0.24). Functional severity is the major determinant of the COI and HRQOL in patients with AS.
Adult ; Aged ; Antibodies, Monoclonal/therapeutic use ; *Cost of Illness ; Costs and Cost Analysis ; Demography ; Female ; Humans ; Interviews as Topic ; Logistic Models ; Male ; Middle Aged ; *Quality of Life ; Republic of Korea ; Severity of Illness Index ; Spondylitis, Ankylosing/drug therapy/economics/*physiopathology ; Tertiary Care Centers

The objective of this study was to develop a Korean version of the Assessment of Spondyloarthritis International Society-Health Index/Environmental Factor (ASAS HI/EF) and to evaluate its reliability and validity in Korean patients with axial spondyloarthritis (SpA). A total of 43 patients participated. Translation and cross-cultural adaptation of the ASAS HI/EF was performed according to international standardized guidelines. We also evaluated validity by calculating correlation coefficients between the ASAS-HI/EF score and the clinical parameters. Test-retest reliability was excellent. The correlations among the mean ASAS-HI score and all tools of assessment for SpA were significant. When it came to construct validity, the ASAS HI score was correlated with nocturnal back pain, spinal pain, patients's global assessment score, the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI) and EuroQoL visual analogue scale (EQ VAS) (r = 0.353, 0.585, 0.598, 0.637, 0.690, 0.430, and -0.534). The ASAS EF score was also correlated with the patient's global assessment's score, BASDAI, BASFI, BASMI, and EQ VAS score (r = 0.375, 0.490, 0.684, 0.485, and -0.554). The Korean version of the ASAS HI/EF can be used in the clinical field to assess and evaluate the state of health of Korean axial SpA patients.
Adult ; Asian Continental Ancestry Group ; Female ; Guidelines as Topic ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Questionnaires ; Reproducibility of Results ; Republic of Korea ; *Severity of Illness Index ; Spondylitis, Ankylosing/*diagnosis/physiopathology ; Translations

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.
Cervical Vertebrae/*pathology/radiography ; Deglutition ; Deglutition Disorders/diagnosis/*etiology/physiopathology/therapy ; Esophageal Stenosis/diagnosis/*etiology/physiopathology/therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteophyte/diagnosis/*etiology/therapy ; Spondylitis, Ankylosing/*complications/diagnosis/therapy ; Tomography, X-Ray Computed ; Treatment Outcome

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.
Adult ; Age of Onset ; *Asian Continental Ancestry Group ; Female ; HLA-B27 Antigen/diagnostic use ; Humans ; Joints/pathology ; Male ; Severity of Illness Index ; Spondylitis, Ankylosing/diagnosis/*pathology/*physiopathology/*radiography