Observation on the Therapeutic Effect of Heatclearing and Dampness-eliminating Dredging Collaterals Combined with Papaya Antirheumatic Pills on Treatment of Damp-heat Obstructive Ankylosing Spondylitis

Objective:Therapeutic effect of heatclearing and dampness-eliminating dredging collaterals combined with papaya antirheumatic pills on treatment of damp-heat obstructive ankylosing spondylitis.Methods:A total of 200 patients with ankylosing spondylitis who were treated in our hospital from January 2018 to October 2019 were selected as the research objects and randomly divided into 2 groups,each with 100 patients.The control group was treated with leflunomide+papaya antirheumatic pills,and the observation group was treated with self-drafted recipe of heat-clearing and dampness-eliminating,the curative effect,visual analogue score(VAS),barthel AS function index(BASFI)score,biochemical indicators and adverse reactions between the two groups were compared.Results:After 12 weeks of treatment,the efficacy of the observation group was higher than that of the control group.The pain score,BASFI score,and biochemical index were lower than those of the control group,and the differences were statistically significant(P<0.05);There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Heat-clearing and dampnesseliminating dredging collaterals combined with papaya antirheumatic pills is effective in the treatment of damp-heat obstructive ankylosing spondylitis,which is beneficial to reduce the degree of pain and inflammation of the affected area,helps patients remain active,and improves activities of daily living.

Ankylosing spondylitis coexisting with Clonorchis sinensis infection: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune responses.Numerous studies have investigated links between AS and various infections-bacterial,viral,fungal,and other microorganism infections.However,limited attention has been given to the association between AS and Clonorchis sinensis(C.sinensis)infection.CASE SUMMARY A 27-year-old male with a 10-yr history of AS presented to our hospital with inflammatory lower back pain as the primary manifestation.Ten years ago,the patient had achieved a stable condition after treatment with biological agents.However,he experienced a recurrence of lumbosacral pain with an unexplained cause 10 d before hospital admission.A lumbosacral magnetic resonance imaging(MRI)scan revealed bone marrow edema in the left sacroiliac joint,and laboratory indicators were elevated.Moreover,the presence of C.sinensis eggs was detected in the stool.The patient was prescribed praziquantel,resulting in the disap-pearance of C.sinensis eggs in subsequent routine stool tests and relief from lumbosacral pain.A follow-up MRI scan performed after 4 months revealed a reduction in bone marrow edema around the left sacroiliac joint.CONCLUSION C.sinensis infections could potentially trigger the exacerbation of AS.Clinicians should pay attention to investigating the presence of infections.INTRODUCTION Ankylosing spondylitis(AS)is a chronic inflammatory and rheumatic disease resulting from an imbalance between innate and acquired immune responses[1].While it can affect any part of the spine,its primary symptoms are persistent back pain and stiffness in the lower back and pelvis.The prevalence of AS per 10000 individuals is 23.8 in Europe,31.9 in North America,16.7 in Asia,10.2 in Latin America,and 7.4 in Africa[2].Infections commonly occur in the first 3 months and may act as potential triggers for the first symptoms of AS,often manifesting as gastrointestinal,urinary tract,and respiratory infections of microbiological origin[3,4].Clonorchis sinensis(C.sinensis)infection is a severe parasitic disease affecting millions globally,especially prevalent in China,South Korea,the Far East of Russia,and Vietnam,with an estimated 15 million cases[5].Transmission occurs through the consumption of undercooked freshwater fish containing metacercariae.Adult C.sinensis parasites then establish themselves within the human hepatobiliary system[6].C.sinensis infection triggers the activation of sphingosine 1-phosphate receptor 2,leading to the injury and fibrosis of the hepatobiliary[7].Recent research in a rat model found that C.sinensis infection increases the risk of hepatocellular carcinoma by stimulating hepatic progenitor cell proliferation[8].Complications of C.sinensis infection include cholestasis,cholangitis,biliary system fibrosis,and in severe cases,the development of cholangiocarcinoma[9].Consequently,the primary preventive measure is to abstain from consuming raw or undercooked freshwater fish.Praziquantel is the recommended and effective treatment for this infection[10].While there is existing literature on the coexistence of AS and parasitic infections,there is limited research specifically addressing the simultaneous presence of AS and C.sinensis infection.This case report details a rare scenario of AS coexisting with C.sinensis infection,underscoring the potential impact of C.sinensis infection on AS disease activity.

Hounsfield units in assessing bone mineral density in ankylosing spondylitis patients with cervical fracture-dislocation

BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.

Effects of serum inflammatory factors,health index and disease activity scores on ankylosing spondylitis patients with sleep disorder

BACKGROUND Patients with ankylosing spondylitis(AS)frequently suffer from comorbid sleep disorders,exacerbating the burden of the disease and affecting their quality of life.AIM To investigate the clinical significance of serum inflammatory factors,health index and disease activity scores in patients with AS complicated by sleep disorders.METHODS A total of 106 AS patients with comorbid sleep disorders were included in the study.The patients were grouped into the desirable and undesirable prognosis groups in accordance with their clinical outcomes.The serum levels of inflammatory factors,including C-reactive protein,erythrocyte sedimentation rate,interleukin(IL)-6,tumour necrosis factor-αand IL-1β,were measured.Disease activity scores,such as the Bath AS functional index,Bath AS disease activity index,Bath AS metrology index and AS disease activity score,were assessed.The health index was obtained through the Short Form-36 questionnaire.RESULTS The study found significant associations amongst serum inflammatory factors,health index and disease activity scores in AS patients with comorbid sleep disorders.Positive correlations were found between serum inflammatory factors and disease activity scores,indicating the influence of heightened systemic inflammation on disease severity and functional impairment.Conversely,negative correlations were found between disease activity scores and health index parameters,highlighting the effect of disease activity on various aspects of healthrelated quality of life.Logistic regression analysis further confirmed the predictive value of these factors on patient outcomes,underscoring their potential utility in risk assessment and prognostication.CONCLUSION The findings demonstrate the intricate interplay amongst disease activity,systemic inflammation and patientreported health outcomes in AS patients complicated by sleep disorders.The results emphasise the need for comprehensive care strategies that address the diverse needs and challenges faced by these patients and underscore the potential relevance of serum inflammatory factors,health index and disease activity scores as prognostic markers in this patient population.

Research Progress in the Treatment of New Bone Formation of Ankylosing Spondylitis

Ankylosing spondylitis(AS)has a very high disability rate.How to effectively inhibit the formation of new bones has become a difficult point in clinical treatment.In recent years,research has shown that different treatment plans can have an impact on inhibiting new bone formation.In this paper,the different effects of new bone formation in the treatment of AS with traditional Chinese and Western medicine are systematically listed.

Three kinds of TNF alpha antagonists in the treatment of ankylosing spondylitis

Objective:To study the three kinds of TNF alpha blockers treatment of ankylosing spondylitis the clinical effect, in order to select the best treatment plan, improve the level of clinical diagnosis and treatment.Method: Choose 2014-2016 in our hospital treatment of 99 cases of ankylosing spondylitis patients as the research object, the average is divided into three groups, each group of 33 cases, infliximab (Remicade, respectively adopt, in accordance with the heap, Ada wood treatment, observe the changes on the relevant index after treatment.Results: After treatment in the morning stiffness time, VAS score, BASDAI, ASDAS, blood sedimentation, c-reactive protein, MPV, propagated, PLT on indicators such as improved to some extent;On the morning stiffness time, in accordance with the heap single resistance group had the greatest reduction;ASDAS infliximab (Remicade, with single set to drop on the most obvious;VAS score and BASDAI is Ada wood sheet resistance group had the greatest reduction. On the propagated, according to the heap single resistance group had the greatest reduction;PLT, blood sedimentation, infliximab (Remicade, c-reactive protein in single resistance group had the greatest reduction;MPV is Ada wood sheet resistance group had the greatest reduction. Conclusion: The three kinds of TNF alpha antagonists' treatment of ankylosing spondylitis on clinical symptoms, signs and laboratory tests were different, each have advantages and disadvantages.

High-dose thalidomide increases the risk of peripheral neuropathy in the treatment of ankylosing spondylitis

Thalidomide is an effective drug for the treatment of ankylosing spondylitis but might induce peripheral neuropathy. This major adverse reaction has attracted much concern. The current study aimed to observe the incidence of thalidomide-induced peripheral neuropathy among an- kylosing spondylitis patients for 1 year after treatment. In this study, 207 ankylosing spondylitis cases received thalidomide treatment, while 116 ankylosing spondylitis cases received other treat- ments. Results showed that the incidence of thalidomide-induced peripheral neuropathy in the thalidomide group was higher than that in the non-thalidomide group. There was no significant difference in the incidence of neuropathy between the 〈 6 months medication and 〉 6 months medication groups. There were no differences in the mean age, gender, or daily dose between the two groups. The incidence of peripheral neuropathy among patients receiving 25, 50, 75, or 100 mg thalidomide per day was 4.6%, 8.5%, 17.1%, 21.7%, respectively. The incidence was significantly different between the groups receiving 25 mg and 100 mg thalidomide. In conclu- sion, thalidomide can induce peripheral neuropathy within 1 year after treatment of ankylosing spondylitis; however, age and gender have no obvious impact on the incidence of peripheral neuropathy. The incidence of peripheral neuropathy is associated with increasing daily doses of thalidomide.

Clinical significance and prognostic value of tumor necrosis factor-α and dickkopf related protein-1 in ankylosing spondylitis

BACKGROUND Ankylosing spondylitis(AS)frequently occurs in people aged 30-45 years,and its prevalence is generally believed to be between 0.1%and 1.4%globally.At present,the“gold standard”for diagnosis of AS requires the provision of pelvic X-rays,which makes it more difficult to perform in population-based epidemiological studies.Therefore,the identification of serological indicators related to the diagnosis,treatment,and prognosis of AS patients is of great significance.AIM To analyze the therapeutic,diagnostic significance and prognostic value of dickkopf-related protein-1(DKK-1)and tumor necrosis factor-α(TNF-α)in AS.METHODS A total of 113 patients with active AS were selected as the research group,and 100 healthy subjects who underwent physical examination were selected as the control group.The levels of DKK-1 and TNF-α in peripheral blood in the two groups were compared.The diagnostic and predictive values of DKK-1 and TNF-α for AS were analyzed with ROC curves,and the factors influencing AS recurrence were analyzed with COX regression.RESULTS Before treatment,the research group showed lower DKK-1 levels but higher TNF-αlevels than the control group(both aP<0.05).In the research group,DKK-1 was up-regulated and TNF-αwas down-regulated after 12 wk of treatment(aP<0.05).The area under the curve,sensitivity and specificity of DKK-1 combined with TNF-αfor diagnosing AS were 0.934,82.30%and 97.00%,respectively.Before treatment,the area under the curve,cutoff value,sensitivity and specificity of DKK-1 for predicting the curative effect were 0.825,68.42 pg/mL,73.68%and 80.00%,respectively,and those of TNF-αwere 0.863,32.79 ng/L,92.11%and 77.33%,respectively.DKK-1 and TNF-αlevels after treatment were closely related to the curative effect(aP<0.05).C-reactive protein,the Bath Ankylosing Spondylitis Disease Activity Index,DKK-1,and TNF-αwere risk factors for AS recurrence(aP<0.05).CONCLUSION DKK-1 and TNF-αare effective in the diagnosis and treatment of AS and are risk factors for its recurrence.In addition,DKK-1 may be a potential target for the diagnosis of AS.

Research progress on the regulation mechanism of non-coding RNA on ankylosing spondylitis

Ankylosing spondylitis(AS)is a chronic progressive inflammatory immune disease,which mainly affects the spine and sacroiliac joints,with a high rate of late disability.At present,because the pathogenesis of the disease is not clear,its treatment targets are not clear,and there is no consensus on intervention measures.Therefore,further exploration of the mechanism of the disease has certain guiding significance for clinical application.At the same time,non-coding RNA can regulate protein translation,participate in the physiological and pathological changes of AS,and is closely related to the progress of AS.Its internal mechanism and potential targets are worthy of in-depth study.This article summarizes the research progress of non-coding RNA involved in AS through the regulation of bone metabolism,inflammation,cell death and autophagy,in order to provide a theoretical basis for exploring potential clinical diagnostic markers and therapeutic targets of AS.

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.

Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis:A case report

BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.

Clinical Research on Alleviating Pain for Patients with Ankylosing Spondylitis and Their Active Function by Acupuncture with Chinese Medicine Fuming and Steaming

OBJECTIVE: To investigate clinical effect of acupuncture combined with TCM fumigation on pain and active function improvement in patients with ankylosing spondylitis. METHODS: 42 patients with ankylosing spondylitis were selected in hospital from October 2016 to October 2017, who were randomly divided into 2 groups by number table method. 21 patients received conventional treatment as control group. 21 patients combined with acupuncture, TCM fumigation treatment as observation group. Clinical indicators, activity function, pain scores were evaluated before and after treatment. RESULTS: Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score, BASFI score, VAS score after treatment decreased in two groups compared with before treatment(P<0.05). Chest mobility, lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion after treatment increased in two groups compared with before treatment(P<0.05). Refers to distance, morning stiffness time, rump length after treatment reduced in two groups compared with before treatment(P<0.05). Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score, BASFI score, VAS score in observation group were lower than control group after treatment(P<0.05). Chest mobility, lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion in observation group were higher than control group after treatment(P<0.05). Refers to distance, rump length in observation group were smaller than control group after treatment(P<0.05). Morning stiffness time in observation group was less than control group after treatment(P<0.05). CONCLUSIONS: Acupuncture combined with TCM fumigation can significantly improve pain and active function in patients with ankylosing spondylitis, which is worthy of clinical promotion.

Advances in Research of Ankylosing Spondylitis with Inflammatory Bowel Disease

This paper reviews the advances in research of co-pathogenesis and clinical treatment of ankylosing spondylitis(AS)and inflammatory bowel disease(IBD),in order to offer ideal therapeutic effects for comorbid patients and to provide new ideas for clinical practice.

Ankylosing Spondylitis in a West African Hospital

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.

Comparison of ankylosing spondylitis treatment efficacy between distal and proximal point acupuncture combined with drug treatment: a randomized controlled study

Background:Multiple meta-analyses have found that acupuncture combined with drug treatment can effectively improve the efficacy of clinical treatment for ankylosing spondylitis.The efficacy of acupuncture is based on nearby action and/or remote action,and there have been very few studies comparing the efficacy of these two actions in the treatment of active ankylosing spondylitis.Therefore,we designed this study to observe the clinical efficacy of different acupuncture methods combined with drug treatment for ankylosing spondylitis.Methods:Sixty patients with active ankylosing spondylitis were randomized into a test group and a control group.In addition to basic treatment with nonsteroidal anti-inflammatory drugs and empirical formula of Chinese medicine named heat-clearing,Yin-nourishing,and dehumidifying pills,the test group mainly adopted distal point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the nine acupoints,including Houxi(SI3),Shugu(BL65),Siguan(LI4),Quchi(LI11),Yanglingquan(GB34),Shenmai(BL62),Sanyinjiao(SP6),Taixi(KI3),and Zusanli(ST36),for five consecutive days per week(two days of rest per week)for two consecutive weeks.The control group mainly adopted proximal and local point acupuncture with needles manipulated once every 10 minutes and retained for 30 minutes at each of the six acupoints,including Jiaji(EX-B2),Dazhui(DU14),Tianzhu(BL10),Dachangshu(BL25),Shenshu(BL23),and Yaoyangguan(DU3),for five consecutive days per week(two days of rest per week)for two consecutive weeks.Changes between pretreatment and posttreatment ankylosing spondylitis disease activity score,McGill score,and Bath score were evaluated.Results:Ankylosing spondylitis,McGill,and Bath score were lower in both groups with a more significant drop in the test group.After the treatments were discontinued,ankylosing spondylitis,McGill,and Bath scores were lower for the test group compared to those immediately after the two-week treatment.For the control group,ankylosing spondylitis and McGill scores were higher compared to those immediately after the two-week treatment but lower than the pretreatment scores;the Bath score was lower compared to that immediately after the two-week treatment.The differences between the two groups were statistically significant(P<0.05).Conclusion:Though both distal point and proximal point acupuncture combined with drug treatment can improve disease symptoms in patients with ankylosing spondylitis,the distal acupoint group had higher and longer-lasting clinical efficacy.

A review of the treatment of ankylosing spondylitis from liver and kidney

Ankylosing spondytitis is a kind of arthropathy of rheumatic immune disease. The pathogenesis of ankylosing spondytitis is not very ctear in current medicat research. Because of the recurrence of the disease and the prolongation of the disease, the quality of tife of the patients has been seriously affected. Traditional Chinese medicine has tong known its etiotogy and pathogenesis, and it is very effective in ctinicat treatment. Based on the theory of traditional Chinese medicine and modern physicians' understanding of its etiotogy and pathogenesis, and starting from the function and characteristics of tiver and kidney, this paper explores the basis of treating ankylosing spondytitis from tiver and kidney, with a view to providing new ideas for the ctinicat treatment of ankylosing spondytitis.

Lung parenchymal changes in patients with ankylosing spondylitis

AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT). METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53 males to 25 females who were followed up for 3.88 (1-22) years on average. neumonia and tuberculosis were excluded. In a detailed examination of lung HRCT findings, we investigated the presence of parenchymal micronodules,parenchymal bands, subpleural bands, interlobular and intralobular septal thickening, irregularity of interfaces,ground glass opacity, consolidation, mosaic pattern,bronchial wall thickening, bronchial dilatation, tracheal dilatation, pleural thickening, emphysema, thoracic cage asymmetry, honeycomb appearance, structural distortion, apical fibrosis and other additional findings.RESULTS: In detailed HRCT evaluations, lung parenchymal changes were found in 46 (59%) of all patients. We found parenchymal bands in 21 (27%) cases, interlobular septal thickening in 9 (12%), emphysema in 9 (12%), apical fibrosis in 8 (10%), ground-glass opacities in 7 (9%), parenchymal micronodules in 5 (6%), irregularity in interfaces in 3 (4%), bronchial dilatation in 3 (4%), mosaic pattern in 2 (3%), pleural thickening in 2 (3%), consolidation in 1 (1%), bronchial wall thick ening in 1 (1%) and a subpleural band in 1 (1%) case. Furthermore, we detected subsegmental atelectasis in 2 patients and a cavitary lesion in 1 patient. CONCLUSION: Our study had the highest number of AS cases of all previous studies in evaluating lung paren chymal changes. The rate of lung parenchymal changes was slightly lower than that reported in recent literature.

Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

The Total Hip Arthroplasty in Ankylosing Spondylitis

Objectives: The assessment of the radio clinical results of sixty one total hip arthroplasties was performed among young and active patients, with follow-up for ankylosing spondylitis, in order to evaluate the effect of surgery on the quality of life of these patients. Methods: For the functional improvement of the patients, we relied on the scores of Devane, Harris and that of Postel Merle d’Aubeigné. The radiological analysis was based on the coxometry. Results: The study confirms the notable functional gain and consequently the improvement of the quality of life of the patients. However, the longevity of the implants remains difficult to envisage due to our limited and insufficient hindsight. Conclusion: The total hip arthroplasty transforms the life of the young patients’ carriers of the disabling coxitis on the stiffening spondylarthritis, by getting them the laziness and the mobility wished for.

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.