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R. Michael Küster - One of the best experts on this subject based on the ideXlab platform.
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The efficacy and safety of intraarticular corticosteroid therapy for Coxitis in juvenile rheumatoid arthritis.
Arthritis and rheumatism, 2002Co-Authors: Jasper Neidel, Martina Boehnke, R. Michael KüsterAbstract:Objective To study the efficacy and safety of intraarticular triamcinolone hexacetonide (IATH) for the treatment of Coxitis in patients with juvenile rheumatoid arthritis (JRA). Methods Fifty consecutive patients with JRA and Coxitis were studied prospectively. Forty-eight children received IATH in 67 arthritic hips. The remaining 2 children exhibited 3 cases of femoral head necrosis (FHN) at the initial assessment and were only followed up; both were receiving long-term systemic steroids. After a minimum of 2 years, the study was concluded with a final evaluation that included magnetic resonance imaging. Results In 39 of 67 hip joints (58%), remission of the Coxitis for a period of 2 years was obtained through a single administration of IATH, while another 12 hip joints showed remission of Coxitis after repeated TH injections (total remission rate 76%). We observed 2 patients with FHN following IATH. Both of these children were receiving long-term systemic steroids. During the period between onset of JRA and screening assessment for this study, the children exhibited 2.4 cases of FHN per 100 patient-years, while 1.5 cases of FHN per 100 patient-years were observed between IATH treatment and final followup. All 5 observed cases of FHN occurred among the 20 children who received long-term systemic steroids, while no necrosis occurred in the 30 children who did not receive systemic corticosteroids (P = 0.009 by Fisher's exact test). Conclusion IATH for juvenile rheumatoid Coxitis was an effective treatment that did not increase the rate of FHN. Systemic steroids, however (or their covariable, severity of JRA), may increase the risk of FHN in JRA.
Jasper Neidel - One of the best experts on this subject based on the ideXlab platform.
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The efficacy and safety of intraarticular corticosteroid therapy for Coxitis in juvenile rheumatoid arthritis.
Arthritis and rheumatism, 2002Co-Authors: Jasper Neidel, Martina Boehnke, R. Michael KüsterAbstract:Objective To study the efficacy and safety of intraarticular triamcinolone hexacetonide (IATH) for the treatment of Coxitis in patients with juvenile rheumatoid arthritis (JRA). Methods Fifty consecutive patients with JRA and Coxitis were studied prospectively. Forty-eight children received IATH in 67 arthritic hips. The remaining 2 children exhibited 3 cases of femoral head necrosis (FHN) at the initial assessment and were only followed up; both were receiving long-term systemic steroids. After a minimum of 2 years, the study was concluded with a final evaluation that included magnetic resonance imaging. Results In 39 of 67 hip joints (58%), remission of the Coxitis for a period of 2 years was obtained through a single administration of IATH, while another 12 hip joints showed remission of Coxitis after repeated TH injections (total remission rate 76%). We observed 2 patients with FHN following IATH. Both of these children were receiving long-term systemic steroids. During the period between onset of JRA and screening assessment for this study, the children exhibited 2.4 cases of FHN per 100 patient-years, while 1.5 cases of FHN per 100 patient-years were observed between IATH treatment and final followup. All 5 observed cases of FHN occurred among the 20 children who received long-term systemic steroids, while no necrosis occurred in the 30 children who did not receive systemic corticosteroids (P = 0.009 by Fisher's exact test). Conclusion IATH for juvenile rheumatoid Coxitis was an effective treatment that did not increase the rate of FHN. Systemic steroids, however (or their covariable, severity of JRA), may increase the risk of FHN in JRA.
Sh. F. Erdes - One of the best experts on this subject based on the ideXlab platform.
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Features of Coxitis treatment in patients with ankylosing spondylitis
IMA-PRESS LLC, 2018Co-Authors: E. M. Agafonova, T. V. Dubinina, A. B. Dyomina, D. G. Rumyantseva, Sh. F. ErdesAbstract:The hip joint damage (HJD) Coxitis is a characteristic manifestation of ankylosing spondylitis (AS). Treatment policy for Coxitis in this disease has not been worked out today. There are a few studies evaluating the efficacy of tumor necrosis factor-α (IFN-α ) inhibitors in these patients. Coxitis treatment with disease-modifying antirheumatic drugs (DMARDs) is under study.The paper describes three clinical cases of patients with AS and Coxitis, in two of whom combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and IFN-α inhibitors produced a fairly rapid positive effect in reducing inflammatory changes in HJD as evidenced by magnetic resonance imaging; moreover, there was no x-ray progression. It can be assumed that there is a so-called window of opportunity when no irreversible structural changes in HJD occur during timely initiated therapy with biological agents (BAs).Our findings suggest that further investigations are needed to clarify the effects of DMARD and combination therapy using DMARD and BAs in combination with NSAIDs
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DIAGNOSIS AND TREATMENT OF Coxitis IN PATIENTS WITH ANKYLOSING SPONDYLITIS
IMA-PRESS LLC, 2018Co-Authors: E. M. Agafonova, T. V. Dubinina, Sh. F. ErdesAbstract:The review analyzes the foreign and Russian literature published in the past 30 years and devoted to the diagnosis and treatment of Coxitis in ankylosing spondylitis (AS). The results of previous works have revealed the high rate of hip joint injury (HJI) in AS, but it is still unclear which diagnostic technique is the most sensitive for the early detection of Coxitis. The latter has been shown to serve as one of the predictors of early disability in patients. The most studied treatment for Coxitis is now HJI endoprosthesis, for which indications and contraindications have been clearly developed, while the question of drug therapy remains open
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DIAGNOSIS OF Coxitis IN ANKYLOSING SPONDYLOSIS
IMA-PRESS LLC, 2016Co-Authors: T. V. Dubinina, A. B. Dyomina, A. V. Smirnov, Sh. F. ErdesAbstract:Coxitis is one of the characteristic clinical manifestations of ankylosing spondylitis (AS). Hip joint (HJ) damage in AS is regarded as a poor prognostic factor and the early detection of Coxitis is of great importance, as timely adequate therapy may reduce the risk of irreversible HJ changes. Coxitis may be diagnosed clinically and using different imaging techniques, each of which can characterize different aspects of damage of these joints. The lecture considers the clinical and instrumental diagnosis of Coxitis in AS
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METHOTREXATE IN THE TREATMENT OF Coxitis IN EARLY SPONDYLOARTHRITIS: ARE THERE PROSPECTS?
IMA-PRESS LLC, 2015Co-Authors: T. V. Dubinina, A. B. Demina, Sh. F. ErdesAbstract:Hip joint injury, Coxitis, is a characteristic manifestation of ankylosing spondylitis. Coxitis therapy has not been elaborated so far. There are few publications on the efficacy of tumor necrosis factor-α inhibitors. Alternative pharmacotherapies, including use of methotrexate, have not fully been studied. The study describes clinical cases of Coxitis treated in patients with early spondyloarthritis
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Coxitis IN ANKYLOSING SPONDYLITIS: COMPARISON OF CLINICAL MANIFESTATIONS WITH ULTRASOUND STUDY DATA
IMA-PRESS LLC, 2014Co-Authors: M. V. Podryadnova, R. M. Balabanova, M. M. Urumova, Sh. F. ErdesAbstract:Objective: to compare the clinical manifestations of Coxitis with the data of HJ ultrasound study (USS) on inpatient samples.Subjects and methods. This cross-sectional study enrolled 220 AS patients meeting the modified 1984 New York criteria who had been consecutively admitted to the clinic of the V.A. Nasonova Research Institute of Rheumatology in 2012–2013. A specially designed schedule was filled out for each patient. Disease activity was measured by the BASDAI and ASDAS and functional status was assessed by the BASFI. Coxitis was diagnosed on the basis of clinical signs, such as HJ pain and/or movement limitations on patient admission to the clinic. All the patients underwent HJ USS.Results. The clinical signs of Coxitis were found in 162 (73.6%) patients. In 107 (66%) of them, pain intensity recorded by the digital rating scale if only in one joint was 4 scores or higher. The patients with and without the clinical signs of Coxitis were matched for age and disease duration. However, in Coxitis, high disease activity was detected significantly more frequently and BASFI scores were also significantly higher. USS indicated that 119 (54%) patients had joint effusion. HJ effusion was found in 104 (63%) of the 162 patients with clinically manifest Coxitis; and among the119 patients with USS verified Coxitis, 87% were seen to have clinical signs of joint injury and 104 (47%) patients had both clinical and ultrasound signs of HJ injury simultaneously. USS revealed no signs of synovitis in 58 patients with the clinical signs of HJ lesion.Conclusion. Among the patients with AS, the rate of Coxitis runs to 51%. The patients with Coxitis have higher disease activity and more pronounced functional impairments than those without HJ injury. Coxitis causes considerably diminished working ability. In a number of cases, USS allows, when the clinical manifestations are similar, a differential diagnosis between synovitis and enthesitis located in this area. It is necessary to conduct additional studies to specify the upper limit of the normal range for the neck-capsular distance that is to be kept in mind when diagnosing Coxitis by USS
S. Erdes - One of the best experts on this subject based on the ideXlab platform.
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THU0252 The rate of us verified hip involvement in patients with ankylosing spondylitis
THURSDAY 14 JUNE 2018, 2018Co-Authors: E. M. Agafonova, T. Dubinina, A. Dyomina, O. Rumyantseva, S. ErdesAbstract:Background Hip joint (HJ) involvement is one of the most common extra-axial manifestations of ankylosing spondylitis (AS). Objectives To correlate clinical manifestations of Coxitis with the ultra-sound findings in AS patients. Methods 224 consecutive AS patients (mean age 33,2±14,2 y) meeting 1984 modified N-Y criteria and hospitalised in V.A. Nasonova Research Institute of Rheumatology with hip pain were evaluated. Patients’ mean age at the onset of the disease was 26,3±20,3 y., 93% of them were HLA-B27-positive. Median AS duration was 57 [12–444] months, the BASDAI score was 5,7±3,1. The diagnosis of Coxitis was based on clinical signs and symptoms, such as inguinal pain and/or limitation in the range of hip motion (ROM) at the time of patients’ admission to the clinic. All patients (regardless current complaints) were subjected to ultrasound (US) examination of the HJ (Sono Diagnost 360 (Philips)) using linear (7,5 MHz) and convex (5,0 MHz) transducers. A neck capsular pattern (NCP – the distance between the signals from inner surface of the femoral neck and the joint capsule) more than 7 mm was used as the US criterion, verifying the clinical diagnosis of Coxitis. Results The US criterion of Coxitis was found in 119 (53%) out of 224 patients, and two groups of pts were analysed based on NCP values with 7 mm threshold. Conclusions US criterion of Coxitis, i..e, increased NCP, was found in 53% of patients with clinical AS manifestations. Patients with US-confirmed Coxitis demonstrate more active disease with greater functional impairment and longer history of AS, as compared to AS population without US signs of hip involvement. Disclosure of Interest None declared
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AB0715 Correlation of Clinical Symptoms and Instrumental Findings in as Coxitis
Annals of the Rheumatic Diseases, 2016Co-Authors: S. Erdes, T. Dubinina, O. Rumyantseva, A. Starkova, M. Podryadnova, S. Krasnenko, A. Demina, M. Urumova, E. AgafonovaAbstract:Background Involvement of the hip joint (Coxitis) is one of distinctive manifestations of ankylosing spondylitis (AS), resulting total hip arthroplasty in 5%>7% of cases. Objectives To correlate the clinical features of Coxitis in AS pts with radiographic and ultrasonographic findings. Methods A total of 63 patients (mean age 31,7±12,7 years) with a diagnosis of AS (at the modified New York criteria 1984), having of pain in the hip joints, sequentially admitted for treatment at the clinic. Mean age of disease onset was 30,8±9,6 y. Hip pain was scored using VAS 100 mm. Coxitis was established on the basis of clinical symptoms - the presence of pain and/or limitation of motion in the hip joints at the time of admission of the patient to the clinic. Pelvic radiographs were taken in all pts to determine the severity of hip involvement using BASRI hip scale, and ultrasound examination was made using Sono Diagnost 360 (Philips) with linear (7,5 MHz) and convex (5,0 MHz) transducers. Joint effusion was set when the distance between the signals from the joint capsule and the inner part of the femoral neck was more than 7 mm. Results Synovitis on ultrasonography found in 53 (81%) pts out of 61. Pts were grouped into 2 arms based on radiologic findings, i.e. Group with radiographic signs of Coxitis and Group without radiographic abnormalities. Two groups comparison data are presented in the Table Conclusions Ultrasound allows hip joint to clarify the cause of pain with similar clinical and radiographic manifestations, localized in this area, as well as to determine if the patient has synovitis in the early stages of the Coxitis. Patients with radiological Coxitis have a longer duration of the disease, severe functional disorders of the index BASFI, with the defeat of the peripheral joints is less common. Disclosure of Interest None declared
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AB0779 Should Ultrasound Coxitis Criteria in Ankylosing Spondylitis be Reviewed
Annals of the Rheumatic Diseases, 2015Co-Authors: M. Podryadnova, T. Dubinina, M. Urumova, R. Balabanova, S. ErdesAbstract:Background Hip joints are the most commonly affected part of locomotor system in ankylosing spondylitis (AS) patients, imposing serious functional limitations. Hip joints involvement is diagnosed in 56% of AS patients in Russia, being the cause of 7% total hip replacement surgeries. Objectives To study ultrasound features of AS Coxitis in hospitalized patients. Methods The study included 220 consecutive AS patients (criteria 1984), hospitalized to V. A. Nasonova Research Institute of Rheumatology during the period 2012-13 yy. Mean patients9 age was 36,3±10,2. Mean age at disease onset - -30,6±11,0 y. 82% of patients were HLA-B27-positive, disease activity by BASDAI - 4,5±2,1, ASDAS - 3,3±1,2. Functional BASFI index was 4,4±2,6. All patients were subjected to routine clinical examination. Hip joints ultrasound examination was performed with Sono Diagnost 360 (Philips) using linear (7,5 MHz) and convex (5,0 MHz) transducers. Transudation in the joint space was registered when the distance between signals from the capsule and medial aspect of femoral neck was ≥7 mm [1]. Results Transudation in the joint space based on established US ≥7 mm distance was found in 119 (54%) patients, 104 (83%) out of them also had clinical signs and symptoms of Coxitis (pain and functional limitations). Patients9 clinical data of both subgroups – with and without US Coxitis criteria - are presented in the Table. Both subgroups were comparable by demographic parameters. Higher disease activity, CRP levels and BASFI scores (i.e. functional impairment) are evident in patients with US diagnosed transudation. 15 patients with US symptoms of sinoviitis had no clinical manifestations of Coxitis. In these patients the capsular-neck distance did not exceed 8 mm. Conclusions Clinical manifestations accompany US-diagnosed Coxitis only when capsular-neck distance is ≥8 mm. More studies are warranted to establish upper limit of the normal US-measured distance between the capsule and femoral neck for US final diagnosis of Coxitis. References Koski J.M., Antilla P.J., Isomaki H.A. Ultrasonography of the adult hip joint. Scand. J. Rheumatol., 1989, 18, 113-119. Disclosure of Interest None declared
Josep M Viver - One of the best experts on this subject based on the ideXlab platform.
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Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea.
Digestive diseases and sciences, 2001Co-Authors: Fernando Fernández-bañares, Antonio Salas, Maria Esteve, Jorge C Espinos, T M Forné, J Martín-comin, Josep M ViverAbstract:Bile acid malabsorption (BAM) has been described in patients with collagenous colitis. There are no similar studies in lymphocytic colitis. The possibility that BAM might not necessarily be part of the microscopic colitis process and that both entities could simply be concomitant has not been evaluated. Our aim was to assess the frequency and severity of BAM in patients with microscopic colitis as well as in patients with previously unexplained functional chronic diarrhea. Likewise, we wanted to investigate the effect of cholestyramine on the induction and maintenance of remission of these conditions. A [75Se]HCAT abdominal retention test was performed in 26 patients with collagenous colitis, 25 with lymphocytic colitis, and 32 with previously unexplained functional chronic diarrhea. Patients with microscopic colitis who had BAM as well as a subgroup of eight collagenous colitis patients without BAM received treatment with cholestyramine. All patients with previously unexplained chronic diarrhea who had BAM were treated with cholestyramine. Twenty-two (43.1%) patients with microscopic colitis and 24 (75%) patients with previously unexplained functional chronic diarrhea presented with BAM. The frequency of BAM was higher in lymphocytic colitis than in collagenous colitis (60% vs 27%; P = 0.025). Cholestyramine induced clinical remission in 19 of 22 patients with microscopic colitis and BAM, none of eight patients with collagenous colitis without BAM, and all patients with previously unexplained chronic diarrhea and BAM. In conclusion, BAM seems to be common in patients with microscopic colitis-mainly in lymphocytic colitis-and in those with previously unexplained functional chronic diarrhea, suggesting that idiopathic BAM and microscopic colitis are often concomitant conditions. In this setting, cholestyramine seems to be highly effective in stopping diarrhea.
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original contributionsincidence of collagenous and lymphocytic colitis a 5 year population based study
The American Journal of Gastroenterology, 1999Co-Authors: Fernando Fernandezbanares, Antonio Salas, Maria Esteve, Jorge C Espinos, Montserrat Forne, Josep M ViverAbstract:Objective: The incidence of collagenous and lymphocytic colitis is not well known. We sought to assess the incidence of collagenous and lymphocytic colitis in a well-defined population during a 5-yr study period. Methods: From January 1, 1993, to December 31, 1997, all new patients diagnosed with collagenous or lymphocytic colitis living in the catchment area of the Hospital Mutua de Terrassa (Barcelona, Spain) were identified. Since 1993 all patients with chronic diarrhea were referred for a diagnostic colonoscopy. Multiple biopsy sampling of the entire colon was performed when appearance of the colonic mucosa was grossly normal. Results: Twenty-three cases of collagenous colitis and 37 of lymphocytic colitis were diagnosed. The female:male ratios were 4.75:1 and 2.7:1 for collagenous and lymphocytic colitis, respectively. The mean age at onset of symptoms was 53.4 ± 3.2 (range, 29–82) yr for collagenous colitis, and 64.3 ± 2.7 (range, 28–87) yr for lymphocytic colitis (p = 0.012). The mean annual incidence per 100,000 inhabitants based on the year of onset of symptoms was 1.1 (95% confidence interval [CI], 0.4–1.7) for collagenous colitis, and 3.1 (95% CI, 2.0–4.2) for lymphocytic colitis. A peak incidence was observed in older women in both diseases. A rate of microscopic colitis of 9.5 per 100 normal-looking colonoscopies performed in patients with chronic watery diarrhea was observed. Normal rectal biopsies were found in 43% and 8% of patients with collagenous and lymphocytic colitis, respectively. Conclusions: The incidence of lymphocytic colitis is three times higher than that of collagenous colitis. Microscopic colitis should be considered as a major possibility in the work-up of chronic diarrhea in older women.
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incidence of collagenous and lymphocytic colitis a 5 year population based study
The American Journal of Gastroenterology, 1999Co-Authors: Fernando Fernandezbanares, Antonio Salas, Maria Esteve, Jorge C Espinos, Montserrat Forne, Josep M ViverAbstract:Objective: The incidence of collagenous and lympho- cytic colitis is not well known. We sought to assess the incidence of collagenous and lymphocytic colitis in a well-defined population during a 5-yr study period. Methods: From January 1, 1993, to December 31, 1997, all new patients diagnosed with collagenous or lympho- cytic colitis living in the catchment area of the Hospital Mutua de Terrassa (Barcelona, Spain) were identified. Since 1993 all patients with chronic diarrhea were re- ferred for a diagnostic colonoscopy. Multiple biopsy sampling of the entire colon was performed when ap- pearance of the colonic mucosa was grossly normal. Results: Twenty-three cases of collagenous colitis and 37 of lymphocytic colitis were diagnosed. The female:male ratios were 4.75:1 and 2.7:1 for collagenous and lym- phocytic colitis, respectively. The mean age at onset of symptoms was 53.4 6 3.2 (range, 29 - 82) yr for collag- enous colitis, and 64.3 6 2.7 (range, 28 - 87) yr for lym- phocytic colitis (p 5 0.012). The mean annual incidence per 100,000 inhabitants based on the year of onset of symptoms was 1.1 (95% confidence interval (CI), 0.4 - 1.7) for collagenous colitis, and 3.1 (95% CI, 2.0 - 4.2) for lymphocytic colitis. A peak incidence was observed in older women in both diseases. A rate of microscopic colitis of 9.5 per 100 normal-looking colonoscopies per- formed in patients with chronic watery diarrhea was observed. Normal rectal biopsies were found in 43% and 8% of patients with collagenous and lymphocytic colitis, respectively. Conclusions: The incidence of lymphocytic colitis is three times higher than that of collagenous colitis. Microscopic colitis should be considered as a major possibility in the work-up of chronic diarrhea in older women. (Am J Gastroenterol 1999;94:418 - 423. © 1999 by Am. Coll. of Gastroenterology)
