Introduction: Patient education is an important part of the management of rheumatic and musculoskeletal diseases. Given that patients with diverse diseases do not have the same needs, it is crucial to assess the educational requirements of targeted groups to provide tailored educational interventions. The aim of our study was to assess educational needs of a large cohort of patients with different rheumatic and musculoskeletal diseases attending a health facility in Austria. Methods: We assessed educational needs, via an online survey of patients with fibromyalgia (FMS), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) recruited from an Austrian health-care facility, using the Austrian version of the Educational Needs Assessment Tool (OENAT). Results: For our sample of 603 patients, AS (62%), RA (15%), and FMS (24%), there were no educational need differences for the domains of movements, disease process, and self-help measures. Patients with FMS had less need for pain management education and greater need for education about feelings, than other disease groups. Patients with RA had a greater need for education related to treatments than other groups, and patients with AS had a greater need for treatment education than patients with FMS. Patients with AS reported greater need for support system education than other patient groups. Conclusion: Educational needs vary by disease groups, suggesting that health-care professionals should assess disease-specific needs for education to provide optimal assistance in disease management for patients.

Background: The aim of this cross-sectional study was to investigate potential associations between periodontal inflamed surface area (PISA) and tooth loss with disease-related parameters in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: Patients who attended the Department of Nephrology and Rheumatology, University Medical Centre Goettingen, Germany, were included. The oral examination comprised the detection of the number of remaining teeth and periodontal condition based on staging and grading matrix. Based on periodontal pockets with positive bleeding on probing, the periodontal inflamed surface area (PISA) was determined. Disease related parameters were extracted from the patients’ records. Results: In total, 101 (RA) and 32 participants (AS) were included. Patients with RA had 22.85 ± 4.26 and AS patients 24.34 ± 5.47 remaining teeth (p < 0.01). Periodontitis stage III and IV was present in 91% (RA) and 81.2% (AS) of patients (p = 0.04). Associations between PISA and disease-related parameters were not found in both groups (p > 0.05). In RA, a higher age (p < 0.01), C-reactive protein (p = 0.02), disease activity (p < 0.01) and prednisolone intake (p < 0.01) were associated with fewer remaining teeth. In AS, a higher age (p = 0.02) and increased Bath Ankylosing Spondylitis Metrology Index (p = 0.02) were associated with a lower number of remaining teeth. Conclusions: Tooth loss is associated with disease activity, especially in RA individuals. Dental care to prevent tooth loss might be recommendable to positively influence oral health condition and disease activity in RA and SA patients.

Ankylosing Spondylitis (AS) and Chronic Pain Syndrome (CPS) can be treated in many different ways. I found a problem in the balance of healing modalities surrounding diagnosis and care of illness and disease. This struggle is not singular to AS and CPS, but universal to physical and mental concerns. Some effective treatments and therapies are not recognized as such or are just beginning to become so. The scope of my work reflects on the course of my life. It was heavily influenced by the way my medical care was managed from an early age and how it evolved over the years. Through my educational program, I examined the necessity to bridge the gap between treatment paradigms and to expand on a broader, more inclusive, healing rubric. This rubric includes a broader emphasis on skill-based and complementary and alternative medicines. The viability to incorporate holistic health therapies earlier in life is explored through my use of the Scholarly Personal Narrative (SPN) qualitative research method. I chose this methodology because scientific fact could be argued either way for one therapeutic approach over another. By incorporating lived experience through SPN the union and cohesion necessary in all healing modalities, and their positive aspects, can be seen. The truth becomes self-evident. The results of this examination showed awareness earlier in life toward alternative and holistic treatments being paramount. Parents and educators lack information concerning modern therapeutic approaches. It also showed each situation will vary, but choice in treatment for ailments and illness of all kinds is not only viable, but highly recommended and researched. Access issues such as health insurance remain obstacles with some treatments and therapies, while others are a matter of cost prohibition, such as nutrition therapies. The implications of my work indicate a need for earlier incorporation of holistic healing programs and skill based therapies alongside perpetuated medical models in early childhood development and education. In conclusion, awareness towards medical concerns and how we as a society treat them can be improved upon by systemically incorporating less harmful therapies earlier in life. Fostering relations between medical providers, care providers and educators for students' wellbeing should be the foreground of any educational policy. Educators and parents alike should be made aware of and take advantage of effective skill-based treatments before a physical or mental condition surfaces or medication only approaches are authoritatively recommended. Integrating programs that build strong mental resilience and focus on youth development and education can reduce the necessity for more invasive treatments or medications should an ailment or illness develop.

Name of diploma thesis: Physical activity and body composition in patients with ankylosing spondylitis Prepared by: Bc. Lucie Srovnalíková Supervisor: PhDr. Andrea Levitová, Ph.D. Target: The findings the size of physical activity and body composition in the groups of patients with ankylosing spondylitis with different duration of disease and subsequent comparison of the size of physical activity with selected health recommendations for a healthy population. Methods: The sample consists of participants (10 women and 36 men, n = 46, 42.8 ± 11.3 years old) with clinically diagnosed disease ankylosing spondylitis who have been outpatiently visiting Rheumatology institute in Prague. The sample was divided into three groups according to the duration of disease (1st group 0-6 years, 2nd group 7 -14 years, 3rd group 3-15 years). Accelerometer ActiGraph GT3X was used for determine the size of weekly physical activity. Bioelectrical impedance using a BIA 2000 was used to assess the body composition. Results: From the perspective of the physical activity health recommendations all three groups met health recommendation for minimum amount of moderate-intensity physical activity throughout the week (150 minutes). Neither group, however, did not meet health recommendation for minimum average daily number of...

Objetivo: Avaliar a função testicular em pacientes do sexo masculino com espondilite anquilosante (EA). Métodos: Vinte pacientes com EA e vinte e quatro adultos masculinos saudáveis foram avaliados quanto às características demográficas, exame urológico, ultrassonografia testicular, avaliações dos espermatozóides, anticorpo anti-espermatozóide e perfil hormonal. Critérios de seleção foram: período de pelo menos 3 meses sem o uso de sulfasalazina e metotrexato e nunca terem usado agentes biológicos ou imunossupressores. As avaliações da EA incluíram investigações clínica e laboratorial. Resultados: A mediana da idade atual foi similar no grupo controle e EA (p=0,175). A freqüência de varicocele foi significantemente maior nos pacientes com EA em comparação com os controles (40% vs 8%, p=0,027). A mediana das formas normais de espermatozóides foi similar em pacientes com EA versus controles [17,25 (2-32,5) vs. 22,5 (1,5-45)%, p=0,215], assim como os outros parâmetros dos espermatozóides (p>0,05). Em contraste, a mediana das formas normais de espermatozóides foi significantemente menor em pacientes com EA com varicocele versus aqueles sem varicocele [13,5 (2-27) vs. 22 (10-32,5)%, p=0,049]. Reforçando esse achado, não foi observada nenhuma diferença nesse parâmetro comparando pacientes com EA e controles sem varicocele (p=0,670). Além disso, outros fatores relevantes para a disfunção testicular (anticorpo anti-espermatozóide, hormônios, marcadores inflamatórios e escores da EA) foram comparáveis em pacientes com e sem varicocele (p>0,05). Conclusão: Nós identificamos uma freqüência alta de varicocele em pacientes com EA associada a anormalidades espermáticas, contudo sem associação com tratamento, anticorpos anti-espermatozóides, alterações hormonais ou parâmetros da doença. A exclusão desses fatores sugere que a varicocele pode ser a responsável pela disfunção testicular em pacientes com EA e não o processo da doença ou a autoimunidade. Investigação da varicocele deve ser sempre realizada em pacientes com EA e problemas de fertilidade / Objective: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls. Methods: 20 AS patients were compared to 24 male healthy subjects in regard to demographic data, urologic examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments. Results: Demographic data were similar in AS and controls (p=0.175). Varicocele was significantly more frequently found in AS patients than in controls (40% vs. 8%, p=0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and controls (p>0.05). In contrast, the median of normal sperm forms was significantly lower in AS patients with versus those without varicocele [13.5 (2-27) vs. 22 (10-32.5) %, p=0.049] whereas no difference in sperm morphology was observed comparing AS patients and controls without varicocele (p=0.670). Comparison of AS patients with and without varicocele showed that anti-sperm antibodies, hormones, inflammatory markers and disease activity scores did not contribute to the impaired sperm morphology observed in AS patients with varicocele. Conclusion: An increased frequency of varicocele was found in AS patients associated with sperm abnormalities, but independent of therapy, anti-sperm antibodies, hormonal alterations or disease parameters. The exclusion of these factors suggests that varicocele may underlie testicular dysfunction in AS patients and not the disease process or autoimmunity. Investigation for varicocele should be done in AS patients with fertility problems

Objetivo: Avaliar a função testicular em pacientes do sexo masculino com espondilite anquilosante (EA). Métodos: Vinte pacientes com EA e vinte e quatro adultos masculinos saudáveis foram avaliados quanto às características demográficas, exame urológico, ultrassonografia testicular, avaliações dos espermatozóides, anticorpo anti-espermatozóide e perfil hormonal. Critérios de seleção foram: período de pelo menos 3 meses sem o uso de sulfasalazina e metotrexato e nunca terem usado agentes biológicos ou imunossupressores. As avaliações da EA incluíram investigações clínica e laboratorial. Resultados: A mediana da idade atual foi similar no grupo controle e EA (p=0,175). A freqüência de varicocele foi significantemente maior nos pacientes com EA em comparação com os controles (40% vs 8%, p=0,027). A mediana das formas normais de espermatozóides foi similar em pacientes com EA versus controles [17,25 (2-32,5) vs. 22,5 (1,5-45)%, p=0,215], assim como os outros parâmetros dos espermatozóides (p>0,05). Em contraste, a mediana das formas normais de espermatozóides foi significantemente menor em pacientes com EA com varicocele versus aqueles sem varicocele [13,5 (2-27) vs. 22 (10-32,5)%, p=0,049]. Reforçando esse achado, não foi observada nenhuma diferença nesse parâmetro comparando pacientes com EA e controles sem varicocele (p=0,670). Além disso, outros fatores relevantes para a disfunção testicular (anticorpo anti-espermatozóide, hormônios, marcadores inflamatórios e escores da EA) foram comparáveis em pacientes com e sem varicocele (p>0,05). Conclusão: Nós identificamos uma freqüência alta de varicocele em pacientes com EA associada a anormalidades espermáticas, contudo sem associação com tratamento, anticorpos anti-espermatozóides, alterações hormonais ou parâmetros da doença. A exclusão desses fatores sugere que a varicocele pode ser a responsável pela disfunção testicular em pacientes com EA e não o processo da doença ou a autoimunidade. Investigação da varicocele deve ser sempre realizada em pacientes com EA e problemas de fertilidade / Objective: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls. Methods: 20 AS patients were compared to 24 male healthy subjects in regard to demographic data, urologic examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments. Results: Demographic data were similar in AS and controls (p=0.175). Varicocele was significantly more frequently found in AS patients than in controls (40% vs. 8%, p=0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and controls (p>0.05). In contrast, the median of normal sperm forms was significantly lower in AS patients with versus those without varicocele [13.5 (2-27) vs. 22 (10-32.5) %, p=0.049] whereas no difference in sperm morphology was observed comparing AS patients and controls without varicocele (p=0.670). Comparison of AS patients with and without varicocele showed that anti-sperm antibodies, hormones, inflammatory markers and disease activity scores did not contribute to the impaired sperm morphology observed in AS patients with varicocele. Conclusion: An increased frequency of varicocele was found in AS patients associated with sperm abnormalities, but independent of therapy, anti-sperm antibodies, hormonal alterations or disease parameters. The exclusion of these factors suggests that varicocele may underlie testicular dysfunction in AS patients and not the disease process or autoimmunity. Investigation for varicocele should be done in AS patients with fertility problems

The inflammatory arthritis Ankylosing Spondylitis (AS) is linked to the human leucocyte antigen HLA-B27. HLA-B27 is thought to drive AS because it misfolds during assembly in the endoplasmic reticulum (ER), inducing ER cell stress. Modulating HLA-B27 folding in the ER is therefore a therapeutic target pathway. The recent discovery of polymorphisms in the ER-resident peptidase ERAP1 that can impact on HLA-B27 and AS, makes ERAP1 one such target. Exosomes are small, typically 50-200 nm sized particles, formed in the endosomal recycling pathway, which can be released into the extracellular environment. Exosomes have a wide range of biological activities depending on the cell type of origin, and on the delivered cargo, which can include bio-active proteins, lipids, mRNA and miRNA. There is interest in the use of exosomes as drug delivery agents. Here, exosomes were studied as a delivery agent to modulate ERAP1, as a potential therapeutic tool for the treatment of AS. Exosomes, isolated from cell lines including CEM and Jurkat (T cell lineage), Jesthom (B cell lineage), U937 (monocyte lineage) and the epithelial HeLa cell line, were characterized by nanoparticle tracking analysis, flow cytometry and immunoblotting using markers including CD9, CD63, CD81 and TSG101. Differential expression of these markers in the immune cell lines indicated the complexity of defining exosomes. EVs were then tested using cell penetrating peptides, electroporation, lipid transfection and sonication for their ability to load FITC-siRNA or FITC-antibody as cargo. Significantly, post-loading RNase A or trypsin incubation demonstrated that many techniques do not lead to efficient cargo loading of exosomes. Sonication proved the most effective technique, with up to 30% efficiency. Loading of exosomes with ERAP1-targetted siRNA did not however lead to notable ERAP1 inhibition. The data indicates that external loading of exosomes with cargo remains a significant challenge in developing exosomes as therapeutic tools.

Made available in DSpace on 2014-12-17T14:13:47Z (GMT). No. of bitstreams: 1 ElianeMS_DISSERT.pdf: 1308169 bytes, checksum: b8d50e23c9e0ac50c9a3012fb88a87b4 (MD5) Previous issue date: 2010-04-20 / Universidade Estadual do Rio Grande do Norte / The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, leading to limitation of spine mobility and functional disability. Physical therapy, especially exercise, is an important part in your treatment. The Global Postural Reeducation(GPR),a method that uses stretching based on evaluation of muscular chains, with significant interference in postural changes may be a complementary alternative for the treatment of this disease. The aim was to evaluate the effects of Global Postural Reeducation (GPR) in patients with Ankylosing Spondylitis (AS) and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n = 22) and a control group (n = 16). Both groups were treated over four months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were: pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire - Spondyloarthropathies - HAQ-S), quality of life (Medical Outcome Study Short Form 36 Healthy Survey-SF-36), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index - BASDAI). Statistical analysis was used with a significance level of p < 0.05. There was a statistically significant difference for all the parameters analyzed between pre and post-treatment in both groups. In the inter-group comparison the GPR group showed a statistically significant improvement in morning stiffness (p = 0.01), spine mobility parameters, except finger-floor distance (p = 0.11), in chest expansion (p = 0.02), and in the physical aspect component of the SF-36 (p = 0.00).Finally, we observed that this sample of patients with AS ,treatment with RPG 60 seems to have a better response in some clinical measures, than the conventional self stretching performed in groups. Further studies are needed to further evaluate this therapeutic alternative in the EA / A Espondilite Anquilosante (EA) ? uma doen?a inflamat?ria cr?nica que acomete principalmente o esqueleto axial, levando ? limita??o da mobilidade da coluna e incapacidade funcional. A fisioterapia, particularmente a cinesioterapia, ? parte importante no seu tratamento. A Reeduca??o Postural Global (RPG), um m?todo que utiliza alongamento baseado em avalia??o de cadeias musculares, com interfer?ncia importante nas altera??es posturais, poder? ser uma alternativa complementar no tratamento dessa doen?a. O objetivo deste estudo foi avaliar os efeitos da RPG individual em pacientes com EA e comparar com um programa de auto alongamento convencional e exerc?cios respirat?rios, feitos em grupo. Trata-se de um estudo intervencional controlado, totalizando 38 pacientes com EA, divididos em dois grupos, tratados durante quatro meses: o grupo RPG (n=22) e o grupo controle (n=16). O grupo RPG realizou posturas de alongamento das cadeias musculares e o grupo controle realizou auto- alongamento convencional e exerc?cios respirat?rios em grupo. As vari?veis analisadas foram: intensidade da dor, dura??o da rigidez matinal, mobilidade da coluna, expansibilidade tor?cica, atividade da doen?a (Bath Ankylosing Spondylitis Disease Activity ?ndex-BASDAI), capacidade funcional (Health Assessment Questionnaire- Spondyloarthropathies-HAQ-S) e qualidade de vida (Medical Outcome Study Short Form 36 Healthy Survey-SF-36). Para a an?lise dos dados foi utilizada um n?vel de signific?ncia de p < 0.05. Os resultados mostraram que houve uma diferen?a estatisticamente significante, em todos os par?metros analisados, em ambos os grupos entre o pr? e p?s- tratamento. xiv Em compara??o ao grupo controle, o grupo RPG mostrou melhora estatisticamente significante na rigidez matinal (p=0.01), nos par?metros da mobilidade da coluna (exceto dist?ncia dedo-ch?o (p=0.11)), na expansibilidade tor?cica (p=0.02) e no componente Aspecto F?sico do SF-36 (p=0.00). Ao final, observamos que, nesta amostra de pacientes com EA, o tratamento com RPG parece ter uma resposta melhor em algumas medidas cl?nicas, do que o auto- alongamento convencional, realizado em grupo. Outros estudos s?o necess?rios para melhor avaliar esta alternativa terap?utica na EA

The number of rheumatic diseases has been increasing in Europe. It is estimated that currently up to a quarter of Europeans suffer from some type of rheumatism. Rheumatoid arthritis and Bechterew's disease (ankylosing spondylitis) are chronic diseases manifested by pain, stiffness, inflammation of joints and the back. The theoretical section is divided into two parts; the first part defines rheumatoid arthritis and Bechterew's disease from the health point of view. The second part is devoted to the social area that is often neglected. The aim of the practical section of the thesis is to reveal how rheumatoid arthritis differs from Bechterew's disease in terms of the use of social assistance, as well as employability or participation in social life. For the data collection, qualitative research methods and interviewing techniques were used. The addressed respondents were patients of rheumatology consulting rooms of the Medipont Plus Ltd., who were divided into two groups ? patients with rheumatoid arthritis and those with Bechterew's disease. The research has shown that persons suffering form rheumatoid arthritis are more likely to get a disability pension than those with Bechterew's disease and they also more often use social contributions, most frequently the extra benefits for people with disabilities ? ZTP cards. This is related to a lower work capability in patients with rheumatoid arthritis compared to those with Bechterew's disease. The research results are influenced by the age of the respondents, the length of the illness, the difference in the roles of men and women and last but not least, by personality characteristics. The research has proved that patients suffering from rheumatic diseases as well as those suffering from Bechterew's disease and undergoing biological treatment are more self-sufficient due to this modern treatment. It has also been found that the respondents who are not fully self-sufficient are not informed about the possibilities to get social benefits and contributions and do not know where to get this information. The thesis could provide an impetus for the strategy when rheumatic diseases are not considered only a medical issue, because these diseases significantly influence the lives of the people affected and thus become a serious psychosocial issue.

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