Objective. To determine the association between urolithiasis and syndesmophyte formation and the effect of urolithiasis on ankylosing spondylitis (AS) disease activity. Methods. In a longitudinal cohort of 504 patients with AS, we conducted an analysis of all patients with AS who have a history of urolithiasis. All patients met the modified New York criteria for AS. Demographics, clinical characteristics, extraarticular features, and comorbidities are systematically recorded in the database. We compared disease activity, functional indices, medical therapy and radiographic damage between AS patients with (Uro+) and without urolithiasis (Uro–) using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Results. Thirty-eight patients with AS (7.5%) had a history of urolithiasis in our cohort. Seventy-six patients with AS who did not have urolithiasis, matched for age, sex, and ethnicity, were selected as controls. Patients who were Uro+ were more likely to have more functional disability, based on the Bath AS Functional Index (BASFI; mean 5.3 vs 3.6 in control group, p = 0.003). Trends were noted in the Uro+ group toward higher Bath AS Disease Activity Index (BASDAI; mean 4.9 vs 4.0, p = 0.09), more peripheral joint involvement (p = 0.075), and higher frequency of biologic therapy (p = 0.09). No significant difference was detected in mSASSS or the Bath AS Metrology Index (BASMI). Significant association with diabetes mellitus (DM; p = 0.016) and Crohn’s disease (p = 0.006) was noted in the Uro+ group. Conclusion. Although there is no acceleration of syndesmophyte formation or spinal mobility restriction, more functional disability was detected in the urolithiasis group. The higher risk with concomitant DM or Crohn’s disease should alert clinicians to these comorbidities in Uro+ patients with AS.
Objective. To investigate the features of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) in a Canadian cohort of 639 patients with AS and 73 patients with nr-axSpA. Methods. Clinical and laboratory data were compared for patients with AS and nr-axSpA enrolled in a longitudinal SpA cohort. Results. The proportion of male patients was higher in AS than in nr-axSpA (76.2% vs 47.9%; p < 0.0001). There was no difference in the presence of HLA-B27 between AS (78.9%) and nr-axSpA (72.5%) patients, nor in age at the time of diagnosis, although AS patients were younger at the time of symptom onset (23.9 yrs vs 26.4 yrs; p = 0.03). Disease duration at the time of last clinic visit was longer for AS than for nr-axSpA patients (17.7 yrs vs 12.1 yrs; p = 0.0002). Acute-phase reactants were higher in AS than in nr-axSpA (C-reactive protein 11.4 vs 5.2, p < 0.0001; erythrocyte sedimentation rate 13.7 vs 9.9, p = 0.02). The Bath Ankylosing Spondylitis Metrology Index was higher in patients with AS (2.84 vs 1.35, p < 0.0001). Conclusion. Patients with nr-axSpA were more likely to be female and to have lower inflammatory markers than patients with AS. When restricted to female patients only, acute-phase reactants did not differ significantly between AS and nr-axSpA. The evidence provides indirect support for the concept that nr-axSpA may represent an early form of AS, but that also has features of a distinct disease entity with significant burden of symptoms.
Objective. To evaluate the effect of pregnancy on ankylosing spondylitis (AS). Methods. Our study aimed to determine the severity of back pain and stiffness pre-, during, and postpartum in patients with AS and controls, and corresponding extraarticular symptoms. Results. Nineteen female patients with AS (35 pregnancies) and 33 controls (77 pregnancies) were studied. Improvement in pain was reported in 51% of AS patients, predominantly in the first trimester, with significant improvement in pain than stiffness. In both groups, pain worsened in later stages, likely secondary to biomechanical loading. Postpartum pain scores in AS returned to prepartum levels in general. Conclusion. Pregnancy does not substantially aggravate disease activity or severity in AS.
BACKGROUND AND AIM: A growing body of evidence indicates that prenatal exposure to fluoride is neurotoxic to child development. However, epidemiologic research examining fluoride's effect on autism spectrum disorder (ASD) is lacking. Our aim was to examine the association of prenatal fluoride exposure with ASD-like behaviors in a sample of preschool aged children living in regions with fluoridated and non-fluoridated community water. METHODS: We analyzed 502 mother-child pairs from the Maternal-Infant Research on Environmental Chemicals (MIREC), a prospective multicentered Canadian birth cohort, with available data on prenatal fluoride exposure, ASD-like behaviors, and covariates. We measured fluoride exposure by averaging maternal urinary fluoride adjusted for specific gravity (MUFsg) across three trimesters. We assessed children's ASD-like behaviors at 3-4 years of age using the parent-reported Social Responsiveness Scale-2 (SRS-2) Preschool Form, with higher scores indicating more behavioral symptomology. Covariate adjusted linear and quantile regression models were used to estimate the difference in the relationship between MUFsg and SRS-2 conditional mean and quantile subscale T-scores, respectively. We adjusted all regression models for baseline maternal age, second-hand smoke, marital status, parity, child sex, study site, and the HOME score that was assessed at child follow-up visit. RESULTS:Mean MUFsg concentration was 0.53 mg/L (SD=0.38), and mean SRS-2 Total T-score was 45.3 (SD=6.2). In multiple linear regression, a 1 mg/L increase in MUFsg concentration was not statistically associated with SRS-2 Total T-score (β=0.12; 95% CI, -1.36, 1.60; P=0.87). Likewise, we observed no statistical association for all other SRS-2 subscale T-scores. In quantile regression, there was no statistical association between MUFsg and SRS-2 Total T-score across percentiles: 0.1, 0.3, 0.5, 0.7 and 0.9. Effect modification by sex was not observed. CONCLUSIONS:In this Canadian cohort, we found no evidence of a statistical association between prenatal fluoride exposure and ASD-like behaviors among preschool aged children. KEYWORDS: biomarkers of exposure, children's environmental health, epidemiology, fluoride, neurodevelopmental outcomes
Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring.We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes.Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020.Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English.We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses.Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes.Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation.In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.
Objective. To identify soluble biomarkers associated with response to therapy with tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA). Methods. The study was conducted at a PsA clinic where patients are assessed every 6 months, and serum samples are collected and stored once a year at the time of clinical assessment. Forty patients with active PsA who gave serum samples prior to treatment with TNFi and after at least 3 months of therapy were identified. Patients were classified as TNFi responders if tender joint count was < 3, swollen joint count was 0, and Psoriasis Area and Severity Index score was < 4 at the time the second sample was collected. The following biomarkers were tested by ELISA: TNF superfamily 14, matrix metalloprotease-3 (MMP-3), receptor activator of nuclear factor kappa-B ligand, osteoprotegerin, cartilage oligomeric matrix protein (COMP), CPII, C2C and C1-2C, CS-846, and highly sensitive C-reactive protein. Paired t tests and logistic regression was used for statistical analyses. Results. After a mean treatment duration of 11 months with TNFi (etanercept 28 patients, adalimumab 6, golimumab 4, infliximab 2), 29 patients were classified as TNFi responders. Baseline level of MMP-3 was independently associated with responder status (OR 1.067 for each 1-unit increase, p = 0.045). A reduction in MMP-3 levels with therapy increased the odds of achieving response (OR 1.213 for each 1-unit change, p = 0.030), whereas a reduction in COMP decreased the odds (OR 0.587, for each 100-unit increase, p = 0.039). None of the other biomarkers was associated with response. Conclusion. Baseline as well as reduction in serum MMP-3 and increase in serum COMP are independently associated with response to TNFi therapy in patients with PsA.
