The purpose of this two stage exploratory study was to investigate the psychosocial, and physical problems associated with a chronic form of arthritis, Ankylosing Spondylitis (AS), following the format of `Problem Specification' suggested by the competency-based model of coping (Goldfried and D'Zurilla, 1969). The first stage goal identified problem thoughts, feelings, and situations associated with AS, by thirteen AS sufferers, two physicians, two physical therapists, and ten significant others. The method for obtaining first stage information was an author constructed structured telephone interview. The second stage goal was the development of an author constructed survey instrument, the Inventory of Problems for Ankylosing Spondylitis (IPAS) completed by Iii individuals with AS, to identify problem frequency, and severity, both for the past twelve months, and for the total time a problem had been present. The second stage included a measure of social support, the Family Relationship Index, consisting of three scales from the Family Environmental Scales (Moos and Moos, 1986).Four areas of exploration were undertaken by this study which included: 1) Taxonomy of AS Problems - identification of AS problems 2) Frequency and Severity - how are identified problems rated and rank ordered 3) Social Support - how does social support affect responses to identified problems, and demographics 4) Demographics - how do such factors as age or gender affect responses to identified problems.The descriptive analysis confirmed that problems in the IPAS are problems experienced by the sample of AS participants. Items sorted into three categories of physical, relationship, and intrapersonal content areas were subjected to post hoc principle component analyses, yielding forty-five factors. Principle component analyses were conducted on first order factors within the three content areas yielding 13 second order orthogonal factors of AS problem themes which included work discrimination, and relationship difficulties with physicians. Significant findings were found for health ratings and second order factors `uncontrollability' and `stress'ratings of health status associated with lower levels of `uncontrollability' and `stress'. No significant results were found for social support and second order factors. The validity and reliability of the IPAS are suggested for future study, and current findings must be interpreted cautiously. Further research is recommended. / Department of Counseling Psychology and Guidance Services

N/A

Background: For effective provision of healthcare, knowledge of disease epidemiology is of paramount importance. Within Ankylosing Spondylitis (AS), however, several areas are poorly understood, including information regarding disease prevalence and natural history, and the quality of life (QoL) of patients. This thesis aimed to address these areas, specifically to: a) determine the prevalence of AS, b) identify determinants of poor QoL, and c) describe the natural history of the disease. Methods: The Scotland and Ireland Registry for Ankylosing Spondylitis (SIRAS) was used to fulfill these aims and collects clinical and patient-reported information on all AS patients seen within Scottish secondary care. AS prevalence was calculated as the number of patients, per 10,000 adults, while QoL was described using the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and factors associated with poor QoL assessed using Poisson regression. To assess the natural history of AS, the mean scores of commonly collected disease measures (including disease activity) were plotted yearly, from diagnosis. Results: The prevalence of AS was calculated to be 4.7 per 10,000. Poor QoL was associated with being retired/unemployed due to ill health, poor physical function, high disease activity, pain, fatigue, poor spinal mobility and being prescribed a biologic therapy. Regarding the natural history of AS; of the clinical measures studied, all remained relatively stable over time at the group level; however differences were demonstrated, when stratifying by gender, initial disease activity and by biologic use. Discussion/Conclusions: This study has added to the knowledge of disease in three main ways: accurate prevalence estimates aid the distribution of healthcare, the factors associated with reporting poor QoL may provide novel targets for future intervention and the reported consistency in the natural history of the disease may be used to reassure patients who present with low disease activity while initiating aggressive therapy for those with initial high activity.

No description available.

Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines. Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS. Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS. Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved.  It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS. Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist. Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.

The major histocompatibility complex (MHC) class I molecule, Human Leukocyte Antigen B27 (HLA-B27) is a strong genetic risk factor for Ankylosing Spondylitis (AS). However, the mechanism linking HLA-B27 and the development of AS is unknown. Recent studies have shown that monoclonal antibodies targeting interleukin 17A (IL-17A) are an effective therapy for many patients with AS suggesting that IL-17A secreting lymphocytes mediate the disease. Published experimental evidence suggests further a potential role for 4 specific killer cell immunoglobulin-like receptors (KIRs) in the pathogenesis of AS, namely KIR3DL1, KIR3DL2, KIR2DL5, and KIR3DS1. KIRs are immunomodulatory receptors for MHC class I molecules that are expressed by a variety of lymphocyte subsets. We hypothesize that the expression of these AS-associated KIRs differentially modulates the expression of IL-17A in HLA-B27 positive vs. negative individuals thereby affecting susceptibility to AS. To begin to address this hypothesis, the experiments described in thesis were performed to develop a set of multi-color flow cytometry panels that permit the analysis of expression of KIR3DL1, KIR3DL2, KIR2DL5, KIR3DS1 and of IL-17A by major classical and unconventional lymphocytes subsets. These panels will be used in future studies to analyze peripheral blood samples from genotyped HLA-B27 positive and negative healthy individuals as well as from AS patients and controls.

Thesis (doctoral)--Ludwig-Maximilians-Universität zu München, 1979.

任煜華. / 論文 (哲學碩士)--香港中文大學, 1999. / 參考文獻 (leaves 1-37 (4th group)) / 附中英文摘要. / Ren Yuhua. / Lun wen (zhe xue shuo shi) -- Xianggang Zhong wen da xue, 1999. / Can kao wen xian (leaves 1-37 (4th group)) / Fu Zhong Ying wen zhai yao. / 致謝 --- p.i / 論文撮要 --- p.iii / 論文撮要（英文） --- p.v / Chapter 第一章 --- 引言 --- p.1 / Chapter 第二章 --- 文獻探討：強直性脊椎炎 --- p.10 / Chapter 第三章 --- 文獻探討:婚姻、家庭、社會支持及心理健康 --- p.39 / Chapter 第四章 --- 概念架構：家庭系統與長期病 --- p.74 / Chapter 第五章 --- 研究問題與假設 --- p.96 / Chapter 第六章 --- 研究方法 --- p.104 / Chapter 第七章 --- 研究結果 --- p.124 / Chapter 第八章 --- 研究結果之討論及建議 --- p.205 / 參考書目 / 附錄：調查問卷

No description available.

No description available.