Family History Of Ankylosing Spondylitis Research Articles

P185 Does BASDAI score correlate to MRI changes in ankylosing spondylarthritis?

Abstract Background/Aims The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is routinely used subjective outcome measurement of disease activity in Ankylosing Spondylitis (AS). BASDAI > 4 is used as a criterion for commencing anti-TNF therapy. Previous studies shown BASDAI correlation with MRI has been proven to be weak. We did this study to systemically compare clinical and radiological data of patients with AS and to look for the degree of correlation between BASDAI score and MRI changes positive for spondyloarthritis in our cohort of patients. Methods A retrospective analysis of AS patients attending Leicester spondylarthritis service at University Hospitals Leicester Trust (UHL) was carried out. Clinical characteristics such as HLA-B27 status, extra-articular features, family history of AS and CRP measurement were obtained from online systems and clinic letters. Online records were reviewed to see if patients had a MRI of the sacroiliac joints along with a BASDAI score at the time of MRI. Medcalc calculator was used for statistical analysis. Results A total of 106 patients were analysed with a mean age of 45.6 +/- 11.6 years (M = 62, F = 44) with mean BASDAI of 5.0 +/- 2.5. Mean CRP was 17.01+/- 30.4 (median CRP 6.5). 61% (n = 65) were HLA-B27 positive. 70 of 106 patients had a sacroiliac MRI scan which could be reviewed to a satisfactory level to determine whether disease is present or not. Two results were statistically significant when comparing active versus no active lesions on MRI: inflammatory back pain and anti-TNF therapy (Table 1). P185 Table 1:Comparison of clinical features in patients with active versus inactive lesions on MRI sacroiliac joint.Active lesions on MRI N = 45No active lesions on MRI N = 25P valueMean BASDAI (SD)5.0 (2.6)5.4(2.6)0.5Mean ASDAS CRP (SD)2.14(1.1)2.04(0.6)0.73Mean CRP (SD) mg/l14.7(21)17.8(33)0.645.5HLA-B2731180.Uveitis1190.3Inflammatory back pain40170.03Enthesitis820.3Peripheral Arthritis670.1Dactylitis010.2Psoriasis211Inflammatory bowel disease710.1Ethnicity: Caucasian37230.2Ethnicity: Asian820.3Age45.5 (10.2)50.5(11.3)0.06M: F26:1916:90.7Anti-TNF therapy1840.03BASDAI >428150.8BASDAI <417100.8BASDAI= Bath ankylosing spondylitis disease activity index, ASDAS= Ankylosing Spondylitis disease. CRP=C-reactive protein, HLA= human leucocyte antigen. Conclusion BASDAI score did not statistically correlate with the severity of inflammation as objectively observed on MRI. Only inflammatory back pain and anti-TNF therapy correlated with MRI disease activity. There was no difference in clinical features including HLA-B27 between patients with active and inactive MRI. Thus, BASDAI as a criterion for biologic therapy may need re-considering. Disclosure N. Jain: None. S. Byravan: None. J. Stairs: None. W. Rennie: None. M. Arumugam: Other; Speaker and Conference Fee MSD, Novartis, Abbvie.

Is family history a predictor of response to tumour necrosis factor inhibitors in spondyloarthritis? A Swedish nationwide cohort study

Objective: To determine whether a family history of spondyloarthritis (SpA) is associated with clinical presentation at the start of tumour necrosis factor inhibitor (TNFi) treatment, or predictive of TNFi drug survival and treatment response in patients with SpA. Method: Family history of SpA in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated SpA (uSpA) from the Swedish Rheumatology Quality register starting a TNFi as their first biologic in 2006–2018 was assessed through national registers. Clinical characteristics at treatment start were compared by family history status. We used Cox regression to estimate hazard ratios for drug discontinuation, and analysed treatment response at 3 and 12 months with linear regression. Multiple imputation was used to address missing data. Results: We included 9608 patients. Patients with family history had an earlier age at onset and longer disease duration at TNFi treatment start, but did not differ regarding disease activity and presence of SpA manifestations. Hazard ratios for drug discontinuation were 1.08 [95% confidence interval (CI) 0.89–1.31] for AS patients with a family history of AS, 1.02 (95% CI 0.89–1.18) for PsA patients with a family history of PsA, and 1.11 (95% CI 0.85–1.45) for uSpA patients with a family history of uSpA, after adjusting for demographic, socioeconomic, and SpA-related factors. Treatment response at 3 and 12 months was similar between groups. Conclusion: Family history of SpA was not found to be associated with clinical presentation at the start of TNFi treatment, nor was it associated with drug survival or treatment response in SpA patients starting a first TNFi.

Spondyloarthritis: aspects of pathogenesis and diagnostics

Spondyloarthritis (SpA) has extremely high social importance due to patient’s risk of early disability and a persistent decline in the quality of life. The last decade has brought important knowledge on its genetic mechanisms and pathophysiological aspects, as well as diagnosis and treatment. Axial spondyloarthritis (axSpA) is characterized by a pathological tissue response to immune and mechanical triggers, predominant lesion of the axial skeleton (spine, sacroiliac joints). It is divided into ankylosing spondylitis (AS) and non-radiological axSpA. Mechanical stress is proven to affect specific localization of inflammation and tissue damage in SpA. Areas of inflammation and erosion are limited to those having increased susceptibility and unique microanatomy. It is shown that a number of genes located outside the main histocompatibility complex significantly affect susceptibility to AS. A study of genes and polymorphisms not related to HLA-B27 revealed different pathogenesis mechanisms in various ethnic groups and formed a new understanding of AS pathogenesis and treatment. A family history of AS or anterior uveitis is useful to detect axSpA, as it is associated with the carrier of genetic marker HLA-B27. Researchers are strongly focused on studying AS patients» autoantibodies, where antibodies to CD74 are of the greatest diagnostic value. An imbalanced microbiome can trigger SpA development. Approximately 50 % of all SpA patients have microscopic signs of intestinal inflammation. The development and use of highly sensitive imaging methods in the future will lead to improved approaches for axSpA classification and more precise disease prognosis and therapeutic decisions. 18-fluorodeoxyglucose positron emission tomography is a sensitive method to determine syndesmophytes and sacroiliac joints in axSpA patients.

Characterization of ankylosing spondylitis in Upper Egypt

Objective: To explore the features of ankylosing spondylitis (AS) in Upper Egypt which has been under estimated in this area known for its lower socioeconomic status (SES). Methods: Seventy patients with a definite diagnosis of AS were prospectively evaluated. Information about human leukocyte antigen (HLA-B27) status, pattern of axial and peripheral involvement, inflammatory markers, extra axial features and axial radiographic findings together with other demographic variables were recorded. Bath AS disease activity and functional status (BASDAI and BASFI) were also assessed. Results: The mean age at onset was 24.9 ± 7.5 years and at diagnosis was 35.46 ± 12.1 years, with a diagnostic delay of 9.9 years on average. The male to female ratio was 2.9:1. HLA-B27 was positive in 38 of 51 patients (74.5%). Eighteen patients (25.7%) had a family history of AS. Peripheral arthritis was present in 14 patients (20%). Anterior uveitis was present in 5 patients (7.1%). The mean radiographic sacroiliitis grade was 2.42 ± 0.59. Lumbar syndesmophytes were present in 45 patients (64.3%) and bamboo spine was present in 13 (18.6%). Thirty (42.9%) patients had radiographic hip abnormalities, of whom 6 had received hip replacement surgery. Of 65 patients examined by bone densitometry, osteoporosis was diagnosed in 26 patients (40%). The mean BASDIA and BASFI were 4.8 ± 1.18 and 5.4 ± 1.5, respectively. Axial radiographic damage was significantly greater in men (P >0.001). Only 6 patients (8.6%) were aware of the nature of the disease and were maintained on regular treatment. Conclusion: The characteristics of AS in Upper Egypt were revealed. Noticeable radiographic damage with a high BASFI and BASDAI indicated a more severe disease than that reported in other Middle Eastern populations with a higher SES.

Prevalence of HLA-B27 in Moroccan healthy subjects and patients with ankylosing spondylitis and mapping construction of several factors influencing AS diagnosis by using multiple correspondence analysis.

The aim of the present study was to determine the prevalence of human leukocyte antigen HLA-B27 in Moroccan healthy controls and in patients with ankylosing spondylitis (AS), and to analyze the correlation between HLA-B27 and AS in Moroccan patients. The prevalence of HLA-B27 was determined by evaluating the number of HLA-B27-positive samples in 128 healthy subjects and in 53 patients diagnosed with AS according to the ESSG and AMOR criteria. HLA-B27 was determined by the polymerase chain reaction using sequence-specific primers. Multivariate analysis of our data (HLA-B27, age, sex, and family history) for AS and healthy controls was performed by multiple correspondence analysis (MCA). The frequency of HLA-B27 was significantly greater in AS patients (45.3 %) than in healthy controls (4.7 %) [p < 0.0001, OR 16.8, and CI 95 % (5.83-51.03)]. In addition, HLA-B27 was more common in male patients than in female ones (p < 0.05). 100 % of the AS patients reported a family history of AS, whereas only 20 % of the healthy controls reported a family history of AS. The graphical interpretation of MCA showed a significant relation between the presence of HLA-B27 and AS. This study strengthens the link between HLA-B27 and AS and represents a very valuable informative diagnostic tool, especially in regard to male patients who have a family history of AS.

Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis.

The variability of demographic, social, genetic, and clinical factors might influence the time between the onset of symptoms and the diagnosis [diagnostic delay (DD)] of ankylosing spondylitis (AS) in different geographic areas. Different clinical manifestations in men and women affected by AS might indicate a possible role of gender in DD. The aim of the present study was to investigate the influence of demographic, social, genetic, and clinical factors on DD and the differences of DD between men and women related to the presence of different demographic, social, clinical, and genetic parameters in an Italian cohort of primary AS patients. A total of 135 Italian primary AS patients (45 female and 90 male, 27.9 ± 0.89 years old at onset) were studied. The DD, gender, education and work (manual or non-manual) levels, and type of first clinical presentation (inflammatory back pain, arthritis, enthesitis) at onset, family history of AS, and HLA B27 presence were analyzed. The DD (8.744 mean ±0.6869) was significantly higher in men (p = 0.0023), in axial presentation (p = 0.0021), and in manual work (even if with low significance, p = 0.047). The lower DD in women in comparison to that in men was likely related to higher education (p = 0.0045) and work (p = 0.0186) levels, peripheral involvement (p = 0.0009), and HLA B27 positivity (p = 0.0231). DD was higher in AS patients: male, employed in manual jobs, and with axial symptoms at onset. In men, DD seemed to be negatively influenced by lower level of education and work, axial clinical presentation, and HLA B27.

AB0735 Diagnostic Delay Worsens Mobility and Work Disability in Ankylosing Spondylitis

BackgroundDiagnostic delay (DD) in Ankylosing Spondylitis (AS) remains a challenge, averaging 8.6 years1. Chronic back pain comprises 2.6million GP consultations per year, of which 5% have AS2. Identifying this “needle...

OP0262-PARE What is the Knowledge Level that Ankylosing Spondylitis Patients Have About their Own Disease?

BackgroundPatient’s knowledge about his or her own disease is critical for an acceptable management and improved quality of life. Aspects such as symptoms, treatment, diagnosis, etc. should be known to...

Ankylosing spondylitis in three Sub‐Saharan populations: HLA‐B*27 and HLA‐B*14 contribution

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease affecting predominantly the axial skeleton and sacroiliac joints, of unknown etiology and strongly associated with human leukocyte antigen (HLA)-B27 (1). The clinical presentation of AS in Sub-Saharan populations is rare (2) due to the very low frequency in Africans of the most important genetic predisposing condition for the development of AS, HLA-B27 antigen, comparing to Europeans or North Americans. However, the influence of HLA markers other than B27, like other HLA-B alleles, has not been investigated thoroughly in these regions. We previously conducted two studies in the Togolese and Zambian population that showed genetic evidence for implication of HLA-B*1403 in AS (3, 4). This allele was found in 50% of the AS patients from Togo and absent in healthy controls, whereas two of the three AS patients from Zambia were B*14:03 positive and none of the healthy controls had this allele. Here, 14 cases of AS were diagnosed over a 2-year period in the University Hospital Yalgado Ouedraogo of Ouagadougou (Burkina Faso, Africa) according to the New York criteria (5). We also selected 27 controls matched for sex, age and ethnic origin. None of the patients or the controls showed other types of spondyloarthropathies (SpA) (reactive arthritis, arthritis associated to human immunodeficiency virus, psoriasic arthritis or undetermined SpA). A sample of peripheral blood per subject was taken in the University Hospital Yalgado Ouedraogo using PAXgene Blood DNA Tubes (Qiagen, Valencia, CA) for blood collection and stabilization. DNA purification and HLA-B genotyping with the HLA-SSO Typing Kit (Tepnel Lifecodes, Stanford, CT) was performed at the Histocompatibility Unit of the Hospital Universitario Central de Asturias, Oviedo, Spain. We analyzed the HLA-B alleles’ distribution between AS patients and controls from Burkina Faso. One finding was the presence of B*14:03 in two of the 14 AS patients (14.3%) and its absence in the 27 controls. We also found that the presence of B*27:05 was increased in AS patients compared with controls (50% vs 3.7%, P = 0.001, OR = 26). To date, we have described 25 AS patients from Sub-Saharan populations (n = 3, 8 and 14 from Zambia, Togo and Burkina Faso, respectively), and we have compared the HLA-B alleles distribution to healthy subjects (n = 204; 92 Zambians, 85 Togoleses and 27 from Burkina Faso), all of them without other types of SpA. Although the distribution of each HLA-B allele (B*27:05 and B*14:03 ) was distinctive, we concluded that the influence of HLA-B alleles in AS is homogenous in all populations studied (B*14:03+B*27:05 ) (Table 1). In this regard, we take into account the three AS Sub-Saharan populations and showed that the frequency of HLA-B*14:03 or HLA-B*27:05 alleles was significantly increased in AS patients compared to healthy controls (32% vs 0.2%, P = 5.65 × 10−16, OR = 191.5) (Table 1). It has been argued that the AS in Sub-Saharan populations seems to represent a subgroup of the disease (2). The disease has a similar clinical presentation compared to Western Europe and North America, but according to several studies the AS patients are older at onset of the disease, the most of them lack extra-articular manifestations and many affected subjects do not have a family history of AS (2). To date, we have analyzed 25 AS cases in Sub-Saharan populations and the average age at the beginning of the disease was 26 years, similar to the other parts of the world. Moreover, the most important issue for assuming that AS in African is a subgroup of the disease was that the most of Sub-Saharan African patients were HLA-B27 negative, and this subtype was rare in black Africans (2). However, we showed that the influence of HLA class I allotypes is homogeneous in all populations studied, suggesting a common mechanism of predisposition to AS. The pathogenic behavior of B*14:03 and B*27:05 may be related to a common feature, taking on that in both cases they are involved in the disease mechanism. The objective of future studies should be evaluate features compatibles with the association of B*14:03 and B*27:05 with AS. Accordingly, results inconsistent with a pathogenic role of misfolding or free surface-expressed heavy chain have been described (6), showing relevance of peptide binding as a important purpose of study for searching common features between B*14:03 and B*27:05. Structural studies have also been reported in order to shed light on the causes of association of these alleles with AS (7, 8). It has been observed that alloreactive cytotoxic T-lymphocyte may be generated against cells expressing B*14:02 (not associated with AS) that cross-react with HLAB27 molecules, suggesting that many shared ligands adopt antigenically similar conformations when bound to different

Spectrum of ankylosing spondylitis in Portugal. Development of BASDAI, BASFI, BASMI and mSASSS reference centile charts

The availability of population-specific normative data regarding disease severity measures is essential for patient assessment. The goals of the current study were to characterize the pattern of ankylosing spondylitis (AS) in Portuguese patients and to develop reference centile charts for BASDAI, BASFI, BASMI and mSASSS, the most widely used assessment tools in AS. AS cases were recruited from hospital outpatient clinics, with AS defined according to the modified New York criteria. Demographic and clinical data were recorded. All radiographs were evaluated by two independent experienced readers. Centile charts for BASDAI, BASFI, BASMI and mSASSS were constructed for both genders, using generalized linear models and regression models with duration of disease as independent variable. A total of 369 patients (62.3% male, mean ± (SD) age 45.4 ± 13.2years, mean ± (SD) disease duration 11.4 ± 10.5years, 70.7% B27-positive) were included. Family history of AS in a first-degree relative was reported in 17.6% of the cases. Regarding clinical disease pattern, at the time of assessment 42.3% had axial disease, 2.4% peripheral disease, 40.9% mixed disease and 7.1% isolated enthesopatic disease. Anterior uveitis (33.6%) was the most common extra-articular manifestation. The centile charts suggest that females reported greater disease activity and more functional impairment than males but had lower BASMI and mSASSS scores. Data collected through this study provided a demographic and clinical profile of patients with AS in Portugal. The development of centile charts constitutes a useful tool to assess the change of disease pattern over time and in response to therapeutic interventions.

Ankylosing spondylitis in sub-Saharan Africa

Ankylosing spondylitis (AS) represents a chronic inflammatory bone disease of the axial skeleton that manifests as chronic back pain and progressive stiffness of the spine. It characteristically affects young adults...

Pattern of ankylosing spondylitis in an Iranian population of 98 patients

The prevalence and pattern of ankylosing spondylitis (AS) can vary from country to country, according to genetic and environmental factors. This study aims to analyze the patterns of disease in a population of Iranian patients with AS. We performed a prospective study (2002–2007) analyzing 98 patients with diagnosis of AS according to the modified New York criteria. Selected patients underwent complete clinical (initial symptom, axial and peripheral involvement, heel enthesitis, extra-articular manifestations) and radiological (sacroiliac, lumbar, thoracic, and cervical spine) investigations, and these data were compared with sex, age at onset, and HLA-B27. There was predominance of men (71.4%), adult onset (>16 years, 90.8%), and positive HLA-B27 (73.4%). Family history of AS was noted in 14.3% of the patients. The predominant initial symptoms were inflammatory low back pain (44.2%). Radiological findings included syndesmophytes in 34.7% and “bamboo spine” in 16.3% of patients. Acute anterior uveitis was noted in 44.9% of patients. Male sex was associated with involvement of shoulder (P = 0.001). Female sex and juvenile-onset AS were associated with extra-articular involvement. Positive HLA-B27 was associated with hip involvement (P = 0.042) and adult-onset AS (P = 0.035). Analysis of the patterns of disease in this population of 98 southern Iranian patients with AS revealed that female sex and juvenile-onset AS were associated with extensive extra-axial involvement; and HLA-B27 was associated with hip involvement.

Pattern of ankylosing spondylitis in an Iranian population of 98 patients

The prevalence and pattern of ankylosing spondylitis (AS) can vary from country to country, according to genetic and environmental factors. This study aims to analyze the patterns of disease in a population of Iranian patients with AS. We performed a prospective study (2002-2007) analyzing 98 patients with diagnosis of AS according to the modified New York criteria. Selected patients underwent complete clinical (initial symptom, axial and peripheral involvement, heel enthesitis, extra-articular manifestations) and radiological (sacroiliac, lumbar, thoracic, and cervical spine) investigations, and these data were compared with sex, age at onset, and HLA-B27. There was predominance of men (71.4%), adult onset (>16 years, 90.8%), and positive HLA-B27 (73.4%). Family history of AS was noted in 14.3% of the patients. The predominant initial symptoms were inflammatory low back pain (44.2%). Radiological findings included syndesmophytes in 34.7% and "bamboo spine" in 16.3% of patients. Acute anterior uveitis was noted in 44.9% of patients. Male sex was associated with involvement of shoulder (P = 0.001). Female sex and juvenile-onset AS were associated with extra-articular involvement. Positive HLA-B27 was associated with hip involvement (P = 0.042) and adult-onset AS (P = 0.035). Analysis of the patterns of disease in this population of 98 southern Iranian patients with AS revealed that female sex and juvenile-onset AS were associated with extensive extra-axial involvement; and HLA-B27 was associated with hip involvement.

Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech Republic

The aim of the study was to evaluate factors that influence health status and work disability in patients with ankylosing spondylitis (AS) in the Czech Republic. Data were collected in a retrospective fashion directly from patients with AS using mailed questionnaires containing questions regarding sociodemographic characteristics of patients, the course of their disease, therapy, rehabilitation, quality of life, and ability to work. HAQ-DI (Health Assessment Questionnaire-Disability Index) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) were also included in the questionnaires; 1,008 questionnaires were suitable for further statistical analysis. The average age +/- SD of patients was 50.2 +/- 10.7 years, the average symptom duration was 23.0 +/- 11.6 years. Mean time from first symptoms to diagnosis was 9.1 years. Full disability had been awarded to 303 patients (30%) at some point of their disease. Twenty seven percent of patients reported receiving full disability pension for 10 or more years. Four hundred fifty six subjects (45%) were currently or had been previously receiving partial disability pension. Receiving disability pension was more frequent among men (64%) compared to women (56%) (P = 0.012), despite the fact that women had higher BASDAI (P < 0.001) and HAQ-DI (P = 0.004) scores. Patients with a family history of AS had higher BASDAI and HAQ-DI scores (P = 0.001 and P = 0.008, respectively) compared to patients without a family history of AS. BASDAI and HAQ-DI scores correlated with age and duration of illness, younger patients and those with shorter disease duration had lower values. Fifty eight percent of patients reported a BASDAI score > or =4 (current cutoff value for initiation of biological therapy), but only 1% of patients were treated by anti TNF alpha agents within the last year. Seven hundred ninety one patients underwent spa treatment in the previous year; 96% of them experienced improvement of their health condition.

Long‐term outcome and prognostic factors in enthesitis‐related arthritis: A case–control study

To compare the clinical, functional, and radiographic outcomes in patients with enthesitis-related arthritis (ERA) with those in patients with other subtypes of juvenile idiopathic arthritis (JIA) and healthy controls, and to determine genetic markers, patient characteristics, and early disease variables that predict the development of remission, sacroiliitis, and physical limitations in ERA. Fifty-five children with ERA who were first admitted to Rikshospitalet Medical Center between 1980 and 1985 were studied. Patients with oligoarthritis or polyarthritis who were admitted during the same period (n = 55) and individuals from a national population registry (n = 55) were matched for sex and age and used as controls. Health status was assessed after a median of 15.3 years of disease (range 11.7-21.9 years) and, in some patients, was reassessed after a median of 23.0 years (range 19.7-29.4 years) of disease, by use of the 36-item Short Form health survey and the Health Assessment Questionnaire. Clinical and radiographic examinations were performed at the 15-year followup visit. Variables relating to the onset of disease were retrospectively obtained by chart review. HLA alleles were determined by genotyping and serologic testing. Patients with ERA had lower levels of physical functioning, poorer physical health, and more bodily pain compared with patients with oligoarthritis or polyarthritis (after a median of 15.3 and a median of 23.0 years) and normal controls (after a median of 15.3 years). Among patients with ERA, remission occurred in 44%, sacroiliitis was observed in 35%, and reduced spinal flexion was observed in 75%. Predictors of failure to attain disease remission included the following: ankylosing spondylitis (AS) in a first-degree relative, the presence of HLA-DRB1*08, and ankle arthritis within the first 6 months. HLA-DPB1*02 was a protective factor, whereas a persistently elevated erythrocyte sedimentation rate (ESR), and hip arthritis within the first 6 months were risk factors for sacroiliitis. Female sex, a family history of AS, and high numbers of affected joints within the first 6 months predicted poor physical health status after 23 years. Male sex was associated with reduced anterior flexion of the spine. In this study, patients with ERA had poorer physical outcomes compared with patients with oligoarticular or polyarticular JIA and controls from the general population. A family history of related diseases, sex, the presence of HLA-DRB1*08, the absence of HLA-DPB1*02, a persistently elevated ESR, early hip or ankle arthritis, and high numbers of affected joints were predictors of an unfavorable outcome.

Risk factors for functional limitations in patients with long‐standing ankylosing spondylitis

To identify risk factors for functional limitations in patients with ankylosing spondylitis (AS) of at least 20 years' duration. Patients with AS for > or =20 years were enrolled in the cross-sectional component of the Prospective Study of Outcomes in AS. All patients had clinical evaluations and completed questionnaires on functional limitations and potential risk factors. Functional limitations were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI; score range 0-100, higher scores indicate more limitations) and the Health Assessment Questionnaire for the Spondylarthropathies (HAQS). Risk factors included demographic characteristics, duration of AS, smoking status, number of comorbid medical conditions, recalled level of recreational activity in teens and twenties, occupational physical activity throughout life (rated 1 = little, 2 = moderate, 3 = heavy, and weighted by the number of years in each job), and history of AS in a first-degree relative. The 326 patients (74% men) had a mean +/- SD age of 55.0 +/- 10.7 years, a mean duration of AS symptoms of 31.7 +/- 10.2 years, and a mean BASFI score of 40.7 +/- 25.6. BASFI scores increased with higher lifetime occupational physical activity (r = 0.31; P < 0.0001), the number of comorbid conditions (r = 0.25; P < 0.0001), and the duration of AS (r = 0.12; P = 0.04). BASFI scores were higher among current smokers compared with former/nonsmokers (55.5 versus 38.9; P = 0.0002), and among nonwhites compared with whites (49.9 versus 39.3; P = 0.02). In multivariable analyses, lifetime occupational physical activity, current smoking, education level, number of comorbid conditions, and family history were significantly associated with BASFI scores. The same risk factors were associated with the HAQS. Functional limitations in patients with AS for >/=20 years are greater among those with a history of more physically demanding jobs, more comorbid conditions, and among smokers, and are less severe among those with higher levels of education and a family history of AS.

Review: restricted dietary salt intake can reduce blood pressure but does not reduce death or cardiovascular morbidity

OBJECTIVE: To investigate prevalence and gender distribution in parents of children with ankylosing spondylitis (AS). METHODS: Family history of AS (parents, uncles, and aunts), maternal age at delivery, and consecutive...