Concept Of SpA Research Articles

Exploring the unifying concept of spondyloarthritis: a latent class analysis of the REGISPONSER registry.

The aim of our study was to identify the potential distinct phenotypes within a broad SpA population. We conducted a cross-sectional study using the REGISPONSER registry, which has data from 31 specialist centres in Spain, including patients with SpA who have fulfilled the ESSG criteria. A latent class analysis (LCA) was performed to identify the latent classes underlying SpA according to a set of predefined clinical and radiographic features, independently of expert opinion. In a population of 2319 SpA patients, a five-classes LCA model yielded the best fit. Classes named 'Axial with spine involvement' and 'Axial with isolated SI joint involvement' showed a primarily axial SpA phenotype defined by inflammatory back pain and high HLA-B27 prevalence. Patients in class 'Axial + peripheral' showed a similar distribution of manifest variables to previous classes but also had a higher likelihood of peripheral involvement (peripheral arthritis/dactylitis) and enthesitis, therefore representing a mixed (axial and peripheral) subtype. Classes 'Peripheral + psoriasis' and 'Axial + peripheral + psoriasis' were indicative of peripheral SpA (and/or PsA) with high likelihood of psoriasis, peripheral involvement, dactylitis, nail disease, and low HLA-B27 prevalence, while class 'Axial + peripheral + psoriasis' also exhibited increased probability of axial involvement both clinically and radiologically. The identification of five latent classes in the REGISPONSER registry with significant overlap between axial and peripheral phenotypes is concordant with a unifying concept of SpA. Psoriasis and related features (nail disease and dactylitis) influenced the phenotype of both axial and peripheral manifestations.

Health and its significance in the modern concept of wellness and spa

The aim of the study is to present selected issues related to health that are significant in the modern concept of wellness and spa.
 The World Health Organization has adopted the so-called positive definition of health, which encompasses it as a state of complete physical, mental, and social well-being, rather than merely the absence of disease or infirmity. Wellness is one of the contemporary approaches to health related to quality of life and actions for health (aspiring towards wellness). On the other hand, spa is an idea of a holistic approach to health, where the harmony of mind and body is to be ensured through the use of relaxing, cosmetic, and biological renewal treatments, often involving water. Spa centers combine relaxation with the care for psychophysical health. The purpose of these centers is to improve health, well-being, and appearance. These aspects are extremely important in the holistic understanding of health.

Why Inhibition of IL-23 Lacked Efficacy in Ankylosing Spondylitis.

The term spondyloarthritis pertains to both axial and peripheral arthritis including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), which is strongly linked to psoriasis and also the arthritis associated with inflammatory bowel disease. The argument supporting the role for IL-23 across the spectrum of SpA comes from 4 sources. First, genome wide associated studies (GWAS) have shown that all the aforementioned disorders exhibit IL-23R pathway SNPs, whereas HLA-B27 is not linked to all of these diseases-hence the IL-23 pathway represents the common genetic denominator. Secondly, experimental animal models have demonstrated a pivotal role for the IL-23/IL-17 axis in SpA related arthropathy that initially manifests as enthesitis, but also synovitis and axial inflammation and also associated aortic root and cutaneous inflammation. Thirdly, the emergent immunology of the human enthesis also supports the presence of IL-23 producing myeloid cells, not just at the enthesis but in other SpA associated sites including skin and gut. Finally, drugs that target the IL-23 pathway show excellent efficacy for skin disease, efficacy for IBD and also in peripheral arthropathy associated with SpA. The apparent failure of IL-23 blockade in the AS which is effectively a spinal polyenthesitis but evidence for efficacy of IL-23 inhibition for peripheral enthesitis in PsA and preliminary suggestions for benefit in axial PsA, raises many questions. Key amongst these is whether spinal inflammation may exhibit entheseal IL-17A production independent of IL-23 but peripheral enthesitis is largely dependent on IL-23 driven IL-17 production. Furthermore, IL-23 blocking strategies in animal models may prevent experimental SpA evolution but not prevent established disease, perhaps pointing towards a role for IL-23 in innate immune disease initiation whereas persistent disease is dependent on memory T-cell responses that drive IL-17A production independently of IL-23, but this needs further study. Furthermore, IL-12/23 posology in inflammatory bowel disease is substantially higher than that used in AS trials which merits consideration. Therefore, the IL-23 pathway is centrally involved in the SpA concept but the nuances and intricacies in axial inflammation that suggest non-response to IL-23 antagonism await formal definition. The absence of comparative immunology between the different skeletal sites renders explanations purely hypothetical at this juncture.

Global-Environmental System Architecture with IoT×GIS: 5D WORLD MAP SYSTEM

The 5D World Map System, the Mathematical Model of Meaning technique (MMM) and their applications create new analytical system environments with the SPA concept (Sensing, Processing and Actuation) for the "Global Knowledge Sharing, Analysis and Visualization". 5D World Map System is a knowledge sharing, analysis and visualization system for realizing Global-Environmental Analysis with the integration of various environmental phenomena. We have proposed the 5D World Map System to collect and facilitate various social and natural-environmental information resources, which are characteristics of infrastructure, disaster, traffic, water and energy supply. The collaborative research activities are promising for approaching to the global architecture of a multi-visualized knowledge analysis and sharing system "5D World Map System," applied to "environmental data analysis and visualization. The basic dimensional space of this system consists of a temporal (1st dimension), spatial (2nd, 3rd and 4th dimensions) and semantic dimensions (5th dimension, representing a large-scale and multiple-dimensional semantic space that is based on our semantic associative computing model (MMM: The Mathematical Model of Meaning)). This system is effective to make a progress of "global-environmental analysis" with cyber-physical system integration for detecting and analyzing natural and social environmental phenomena. The 5D World Map System is globally utilized as a Global Environmental Semantic Computing System for SDGs 9, 11, 14, United-Nations-ESCAP.

Repositioning of Spa Premises into The Context of Islamic Built Environment and Muslim Friendly Attributes

Spas have become increasingly popular and have emerged as important profit centers for hotels. However, the uniqueness of this market has been largely overlooked in term of Shari’ah compliant to cater to Muslim needs. Therefore, the purpose of this study is to the repositioning of spa typologies, spatial organization and social interaction in the context of Islamic built environment. A survey was administered at 4 case studies of different spas typologies in Kuala Lumpur and Selangor to identify the new dimensions of Muslim-friendly spa concept. Cluster analysis was then applied to classify spa premises into different groups based on the typologies, services and spatial organization. Finally, the importance analysis was performed according to the groups to determine significant Shari’ah compliant or Muslim-friendly elements. Based on the finding, the spa that follows the Shari'ah compliance brings remuneration and advance the excellence of spa by implementing space organization of spa, which is considering security, privacy, also a segregation gender in space including the spa design component. It is crucial that Malaysia takes concrete steps to develop Islamic or Shari’ah compliant tourism internationally. This research is intended to provide further information on the understanding, practice, features, and requirements for Muslim-friendly spa which will help to boost Malaysia’s potential to become as one of the prominent destinations for Islamic or Shari’ah compliant tourism.

Measuring the Effects of Forest SPA Programme in Urban Parks Using Active Imagination

Abstract Nature has been shown to be beneficial to our overall health and well-being. We are all connected to nature and it is important to maintain this vital connection for our health and well-being. Spending time outside in nature or urban parks has been shown to positively affect a person’s emotions and improve their sense of well-being. Access to nature balances circadian rhythms, lowers blood pressure, reduces stress and increases absorption of Vitamin D. Increasingly, evidence demonstrates that contactwith the living world around us is an important part of healing and recovery. The natural world’s role in human well-being is an essential, yet often forgotten, aspect of healthcare. Of particular importance are the benefits one can derive through interaction with natural environments. Reincorporating the natural world is practiced to move healthcare toward being more “green”. Spiritual well-being is enhanced through the experience of greater interconnections, and it occurs when interacting with the natural world. One study examined the physiological and psychological responses to real forest landscapes as well as the therapeutic uses of forests relative to urban environments. Lower levels of the stress hormone cortisol have been reported in adults subsequent to performing the same mental activities in a garden setting vs. an indoor classroom. A separate study involving over 11,000 adults from Denmark showed that living more than 1 km away from green space (forests, parks, beaches, lakes) were 42 percent more likely to report high stress and had the worst scores on evaluations of general health, vitality, mental health and bodily pain The landscape itself offers retreat from daily routine. The aim of our research was to measure the effects of Forest SPA programs on attendants’ well-being. Research has been organized in cooperation between Health college Belgrade and Medical SPA Association of Serbia. There were fourteen participants taking part in the research. Prior to Forest SPA program all participants, 14 students on specialization in Medical Wellness were invited to half-an-hour active imagination (mandala drawing) workshop. Drawing Mandala is a meditation in motion, dreaming with open eyes, and during the process of active imagination the unconscious self is active and not passive like in dreams. Using the data and research methodology from Henderson’s Empirical Study of the Healing Nature of Artistic Expression we designed our investigation. After 90 minutes of Forest SPA program in selected Urban park, participants were invited to draw mandala to describe how they feel at that moment. Several participants (8 of them) attended a 90-minute City SPA program with Tibetan bowls vibration massage. At the end of the SPA program they were invited to draw mandala. Analyzing symbols and colors, number of symbols and their relationship in presented mandalas we can realize the effects of the Forest SPA programs in urban parks on achieving better emotional balance and enhancing individualization process in participants. Our pilot research of Active imagination (by drawing mandalas) revealed that it can be used as a part of Forest SPA program as ART therapy and at the same time as an instrument for individual approach to the client of Forest SPA program as a medical SPA concept.

The Emergence of Islamic Spa Concept

The onset of having a place for women to rejuvenate and refresh their body, mind and soul after a hectic day at work is amazing. Muslim women nowadays are more open to the idea of operating and visiting spa to get the benefits and advantages offered. However, as the awareness of implementing Islamic teaching as a way of life is increasing, spa operators and entrepreneurs are now taking the challenges to open an Islamic concept spa. The emergence of great numbers of Muslimah spa in Malaysia attracts the attention of the researcher to propose the elements that considered following the Shariah law and can be implemented in the present and in the future. There is not enough study about Islamic spa as spa and wellness services is a new scope to be focused in Muslim friendly hospitality services. This paper is an attempt to get the attention of spa operators and organisation to participate in this project and produce reliable resources in promoting Muslim friendly spa in the future

10-4 Shumadian forest hammam as a medical SPA concept

10-4 Shumadian forest hammam as a medical SPA concept

Skin, Inflammation and Sulfurous Waters: What is Known, What is Believed

One could argue that balneotherapy and mud therapy would have not lasted 2,000 years or so If they were not effective. No doubt a long history cannot be taken per se as scientific proof of efficacy. Some empiricism is still present in the field: the concept of spa itself is quite confounding, whereas spring waters are used for leisure purposes but also for non-acute patient therapy and late phases of clinical recovery. These confounding elements ultimately feed the opinion of those who aprioristically reject any potential beneficial effect of balneotherapy: instead, it should at least generate questions that deserve scientific answers. Clinical practices sequentially integrating pharmacological therapy with those natural principles for which a sufficient scientific demonstration is available, would probably cut the costs of public health, generating widespread advantages for the community. Recently, it has become evident that mineral waters may have intrinsic pharmacological properties. Of the numerous salts dissolved in thermal waters that might show pharmacological properties, for certain hydrogen sulfide (H2S) contained in sulfurous waters is the one that has obtained greater scientific attention, to which should be added the extensive scientific effort recently dedicated to H2S as a cellular gasotransmitter, independently from its natural sources. Dermatology and cosmetics are among the most studied applications of sulfurous waters, around which, however, some empiricism still confounds opinions: we therefore considered that a state-of-the-art focus on this topic might be timely and useful for future studies.

FRI0440 Referral patterns and diagnosis of patients with axial spondyloarthritis: results of an international survey

BackgroundAppropriate identification and referral of patients with symptoms suggestive of axial spondyloarthritis (axSpA) can facilitate earlier diagnosis and management. Understanding current referral practices used by primary care and other health-care...

Classification criteria for psoriatic arthritis and ankylosing spondylitis/axial spondyloarthritis

The concept of spondyloarthritides (or spondyloarthropathies, SpAs) that comprises a group of interrelated disorders has been recognised since the early 1970s. While the European Spondyloarthropathy Study Group (ESSG) criteria and the Amor criteria have been developed to embrace the entire group of SpAs, new criteria for psoriatic arthritis have been developed recently. The Classification of Psoriatic Arthritis (CASPAR) study, a large one of more than 1000 patients, led to a new set of validated classification criteria for psoriatic arthritis. Since their publication in 2006 the CASPAR criteria are widely used in clinical studies. In ankylosing spondylitis, the 1984 modified New York criteria have been used widely in clinical studies and daily practice but are not applicable in early disease when the characteristic radiographical signs of sacroiliitis are not visible but active sacroiliitis is readily detectable by magnetic resonance imaging (MRI). This led to the concept of axial SpA that includes patients with and without radiographical damage; candidate criteria for axial SpA were developed based on proposals for a structured diagnostic approach. These criteria were validated in the Assessment of Spondyloarthritis International Society (ASAS) study on new classification criteria for axial SpA, a large international prospective study. In this new criteria, sacroiliitis showing up on MRI has been given as much weight as sacroiliitis on radiographs, thereby also identifying patients with early axial SpA. Both the CASPAR and the ASAS criteria for axial SpA are likely to be of use as diagnostic criteria.

Treatment of ankylosing spondylitis and extra-articular manifestations in everyday rheumatology practice

The SpAs are a group of overlapping, chronic, inflammatory rheumatic diseases including AS, a chronic inflammatory disease primarily affecting the SI joints. In addition to inflammatory back pain, AS patients are also more likely to experience extra-articular manifestations belonging to the SpA concept which can affect the eyes, the gastrointestinal tract and the skin and other related inflammatory conditions. This review focuses on current progress in treatment options in SpA with special emphasis on extra-articular features. TNF inhibition has demonstrated effectiveness in the treatment of AS symptoms and all currently available anti-TNF agents appear to have similar efficacy. However, the efficacy of anti-TNF agents varies in the treatment of extra-articular manifestations and comorbidities. Analyses of trials of anti-TNF agents in patients with AS have revealed significant reductions in the incidence of flares of uveitis and IBD with infliximab and adalimumab (uveitis only) treatment but not with etanercept. All three anti-TNF agents (infliximab, adalimumab, etanercept) have demonstrated efficacy in psoriasis (not associated with AS). When evaluating as to which agent to use in the treatment of AS, an important consideration is the overall well-being of the patient. This should include any additional inflammatory burden that manifests in other parts of the body, which may currently be subclinical. Based on current evidence, among TNF inhibitors, the monoclonal antibodies (infliximab and adalimumab) are more appropriate than etanercept if extra-articular manifestations or comorbid conditions are present or suspected. To date, infliximab appears to be the best studied agent with a wide spectrum of proven efficacy.

Incorporating a Medical Spa into a Physician-Run Practice

The age-old spa concept is no less valuable today than it was during the time of Julius Caesar. Over the centuries, there have been many iterations of the concept of the spa. The most recent is the medical spa, which has become the fastest-growing segment of the spa industry. Many physicians including dermatologists wish to incorporate a medical spa into their practices. This article discusses the key elements that should be considered to make this venture successful.

Microdamage and altered vascularity at the enthesis–bone interface provides an anatomic explanation for bone involvement in the HLA–B27–associated spondylarthritides and allied disorders

To describe the basis for entheseal-associated bone disease in the spondylarthritides, by analyzing microanatomic and histopathologic relationships between soft tissue, bone cortex, and adjacent trabeculae. Serial sections from 52 entheses were examined; these entheses encompassed small and large insertions in the upper limb (n = 21), lower limb (n = 27), and spine (n = 4) from 60 cadavers. Enthesis microdamage (fissuring) as well as vascular and reparative changes were evaluated. Contact radiographs were used to ascertain the relationship between entheses and the trabecular network. At virtually all fibrocartilaginous entheses, the deep cortical boundary was extremely thin (typically 50-600 microm) or indistinguishable, and 96% of entheses had small holes in the cortical shell (typically 100-400 microm wide). Such regions were frequent sites of bone formation and renewal (96%) and microdamage (31%); these changes were more common in the lower limb. The presence of blood vessels near holes in the cortical shell was common; in 85% of attachments, blood vessels were present on the soft tissue side of the enthesis. Highly orientated trabeculae were more obvious in the lower limb than the upper limb (59% versus 29%). The trabecular network supporting the cortical shell is an integral part of the enthesis, transferring load to an extensive skeletal region. In many cases, tendons/ligaments are anchored directly to such networks. This functional integration is associated with microdamage and repair at the hard tissue-soft tissue interface. These findings have implications for understanding bone involvement in SpA and for the SpA concept in general, especially the hypothesis that enthesis-bone architecture may be important in disease initiation.

Restoring The Homestead's Historic Spa

Health Fitness Dynamics, a spa consulting firm, helped to restore the historic Homestead Spa in Hot Springs, Virginia. As part of the reconstruction effort HFD decided to modernize the spa's concept by allowing coed use of facilities. While the building was gutted, the spa remained open by moving some facilities to nearby guest rooms. Key to the building program was a concept that allowed treatment rooms to be used by groups or individuals, as needed, by opening or closing doors. HFD also conducted pre-opening training to introduce the new facility and new treatment concepts to the three dozen spa employees, many of whom had been on staff for well over a decade. Employees responded favorably, with a result of favorable guest comments and financial results that exceeded management's expectations.

Course of gut inflammation in spondylarthropathies and therapeutic consequences

Gut inflammation plays a crucial role in the pathogenesis of spondylarthropathies (SpA) since ileocolonoscopic studies have demonstrated the presence of gut inflammation in different forms of this concept: in ankylosing spondylitis (AS) (60%), in enterogenic (90%) and urogenital reactive arthritis (20%), in undifferentiated SpA (65%), in the pauciarticular and axial forms of psoriatic arthritis (16%), in late onset pauciarticular juvenile chronic arthritis (80%) and in acute anterior uveitis (66%). The strong relationship between gut and joint inflammation was demonstrated by performing a second ileocolonoscopy: remission of the joint inflammation was always connected with a disappearance of gut inflammation, whereas persistence of locomotor inflammation was mostly associated with the persistence of gut inflammation. During further evolution 20% of the non-ankylosing spondylitis SpA patients can develop AS. About 6% of the total group SpA patients, in whom inflammatory bowel disease (IBD) was excluded, developed Crohn's disease 5 to 9 years later. All these patients initially presented with gut inflammation, which indicates that this finding has prognostic value. The high prevalence of evolution to IBD in SpA patients confirms the thesis that both disease entities bear common pathogenic mechanisms, and confirms the place of IBD in the concept of SPA. Sulphasalazine (SASP), a successful drug in the treatment of IBD, has demonstrated its effectiveness in the treatment of SpA. The beneficial effect of the drug in this disease entity could be due to its anti-inflammatory effect on the gut wall, by normalizing its permeability and by preventing the entrance of antigens through the defective gut wall. However, SASP could not prevent the evolution to IBD.