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published_or_final_version / Social Work / Master / Master of Social Work

The MHC class I allele, HLA-B27, is strongly associated with a group of inflammatory arthritic conditions collectively known as spondyloarthropathies (SpA). Ankylosing spondylitis (AS) shows the strongest association with 90-95 % of patients being HLA-B27 positive. The relationship between HLA-B27 and SpA has been known for over 30 years, however despite ongoing research, the reason for this association has not yet been elucidated. In more recent years, research has focused on intrinsic properties of the HLA-B27 allele, in particular its propensity to misfold, forming homodimers. It has been proposed that these homodimers could be associated with the disease process through the activation of an ER stress response known as the unfolded protein response (UPR), or through aberrant recognition at the cell surface. We have investigated whether the expression of HLA-B27 is associated with the activation of the UPR. We have studied the expression of BiP, and the cleavage of XBP1 and ATF6 using stable and transiently expressing cell lines. We have also investigated the formation of non-B27 homodimers using a human cell line stably expressing HLA-B8, and finally we have studied the expression of homodimers in exosomes, small immunomodulatory vesicles released from numerous cell types. The results presented here lead us to conclude that in vitro studies of the UPR are complicated, prone to a number of technical issues, and may therefore not be appropriate for gaining information that would be of significant use when comparing to the real disease scenario. Our data suggest that non-B27 dimers may be strongly influenced by both the overexpression of MHC class I heavy chains and also the redox environment within the cell. We have isolated a novel fully folded, beta-2m-associated, MHC class I homodimer in exosomes and have detected a novel HLA-A and HLA-B mixed heavy chain dimer. Our results suggest that these dimers form through interactions between the cysteine residues in the cytoplasmic tail and that these dimers form in exosomes because they contain lower levels of the important antioxidant glutathione when compared to whole cells. Together, these results define a new MHC class I structure present on exosomes at significant levels, which could potentially influence immune recognition by both antigen-specific T cell receptors and NK family receptors. The data also poses questions about whether these novel structures, when they involve HLA-B27, could influence the pathogenesis of spondyloarthropathies.

The Major Histocompatibility Complex (MHC) is a genomic region in chromosome 6 which has been consistently found to be associated with the risk of developing virtually all common autoimmune diseases. Although its importance in disease pathogenesis has been known for decades, efforts to disentangle the roles of the classical human leukocyte antigens (HLA) and other variants responsible for the susceptibility to disease have often met with limited success, owing to the complex structure and extreme heterogeneity of the region. In this thesis, I interrogate the MHC for association with three common autoimmune diseases, ankylosing spondylitis, psoriasis and multiple sclerosis, with the aim of confirming the previously-reported associations and of identifying novel ones. To do so, I employ a systematic, joint analysis of single nucleotide polymorphism (SNP) and HLA allele data, in a logistic regression framework, using a recently developed algorithm to predict the HLA alleles for samples where such information is unavailable. To ensure the reliability of the analysis, I apply stringent quality control procedures and integrate over the uncertainty of the HLA allele predictions. Moreover, I resolve the haplotype phase of individuals from the HapMap project to create reliable reference panels, used in both HLA prediction and in quality control procedures. By directly testing HLA subtypes for association with the disease, the power to detect such associations is increased. I present the results of the analysis on the three disease phenotypes and discuss the evidence for important novel findings amongst both SNPs and HLA alleles in two of the diseases. In the final part of this thesis, I introduce a novel, model-based approach to detect inconsistencies in the data and show how it can be used to flag problematic SNPs which conventional quality control procedures may fail to identify.

Introdução: Baixas concentrações séricas de esclerostina foram descritas em pacientes com Espondilite Anquilosante (EA). No entanto, não existem dados sobre a importância deste inibidor da via de sinalização Wnt em pacientes com EA durante o tratamento com anti fator de necrose tumoral alfa (TNFa). Objetivos: Avaliar longitudinalmente os níveis séricos de esclerostina e sua associação com inflamação e densidade mineral óssea (DMO) em pacientes com EA em tratamento com anti-TNFa. Métodos: Trinta pacientes com EA em atividade foram avaliados no início, 6 e 12 meses, após terapia anti-TNFa em relação aos parâmetros clínicos (BASDAI, BASFI, BASMI e ASQoL), marcadores inflamatórios e dano radiológico basal (mSASSS). Trinta indivíduos saudáveis pareados por idade e sexo constituíram o grupo controle. As análises laboratoriais de esclerostina e da ligação de esclerostina ao receptor LRP6 e a DMO foram realizadas nos pacientes nos mesmos períodos de avaliação e comparadas aos controles. Resultados: Na avaliação inicial, pacientes com EA apresentavam menores concentrações séricas de esclerostina [60,5 (32,7) vs. 96,7 (52,9) pmol/l,P=0,002] e níveis similares de ligação de esclerostina ao receptor LRP6 (P=0,387) em relação aos controles. Foi observado melhora do BASDAI, BASFI, BASMI, ASQoL comparando tempo basal vs. 6 vs. 12 meses (P<0,01). Concomitantemente, observou-se um aumento gradual da DMO da coluna lombar (P<0,001) e no início do estudo os pacientes apresentavam uma correlação positiva entre avaliação radiológica basal (mSASSS) e a DMO da coluna lombar (r=0,468, P<0,01). Foi observada também uma redução dos marcadores inflamatórios comparando tempo basal vs. 6 vs. 12 meses (P<0,01). Os níveis de esclerostina aumentaram progressivamente após o tratamento com anti-TNFa [60,5 (32,7) vs. 67,1 (31,9) vs. 72,7 (32,3) pmol/l, P<0,001]. Entretanto, após 12 meses de terapia anti-TNFa as concentrações séricas de esclerostina permaneceram significativamente mais baixos em relação os controles [72,7 (32,3) vs. 96,7 (52,9) pmol/l, P=0,038]. Além disso, aos 12 meses, os níveis séricos de esclerostina ficaram mais baixos nos 10 pacientes que ainda apresentavam proteína C reativa elevada (PCR=5mg/l), comparados aos pacientes que apresentaram normalização dos níveis de PCR (P=0,004). Interessantemente, estes 10 pacientes com inflamação persistente já apresentavam concentrações séricas mais baixas de esclerostina quando comparados aos demais pacientes (P=0,023) antes do tratamento com anti- TNFa. A análise de regressão logística demonstrou que os pacientes com EA com níveis baixos de esclerostina apresentam um risco aumentado de apresentar PCR alta após 12 meses de tratamento (odds ratio = 7,43, 95% IC 1,23-45,01, P=0,020) quando comparados aos pacientes com níveis altos de esclerostina no tempo basal. Conclusão: Concentrações persistentemente baixas de esclerostina estão associados a inflamação contínua em pacientes com EA tratados com terapia anti-TNFa. / Introduction: Sclerostin levels have been reported to be low in ankylosing spondylitis (AS), but there is no data regarding the possible role of this Wnt inhibitor during anti tumor necrosis factor alpha (TNFa) therapy. Objectives: The present study longitudinally evaluated sclerostin levels, inflammatory markers and bone mineral density (BMD) in AS patients under anti-TNFa therapy. Methods: Thirty active AS patients were assessed at baseline, 6 and 12 months after anti-TNFa therapy regarding clinical parameters (BASDAI, BASFI, BASMI and ASQoL), inflammatory markers, BMD and baseline radiographic damage (mSASSS). Thirty age- and sex-matched healthy individuals comprised the control group. Patients\' sclerostin levels, sclerostin binding LRP6 and BMD were evaluated at the same time points and compared to controls. Results: At baseline, AS patients had lower sclerostin levels [60.5 (32.7) vs. 96.7 (52.9) pmol/l, P=0.002] and comparable sclerostin binding to LRP6 (P=0.387) than controls. Improvement of BASDAI, BASFI, BASMI, ASQoL was observed at baseline vs. 6 vs. 12 months (P<0.01). Concomitantly, a gradual increase in spine BMD (P<0.001) and a positive correlation between baseline mSASSS and spine BMD was found (r=0.468, P<0.01). Inflammatory parameters reduction was observed comparing baseline vs. 6 vs. 12 months (P<0.01). Sclerostin levels progressively increased [60.5 (32.7) vs. 67.1 (31.9) vs. 72.7 (32.3) pmol/l, P<0.001] after anti-TNFa treatment. At 12 months, the sclerostin levels remained significantly lower in patients compared to controls [72.7 (32.3) vs. 96.70 (52.85) pmol/l, P=0.038]. Moreover, sclerostin serum levels at 12 months were lower in the 10 patients with high CRP (=5mg/l) compared to the other 20 patients with normal CRP (P=0.004). Of note, these 10 patients with persistent inflammation also had lower sclerostin serum levels at baseline compared to the other patients (P=0.023). Univariate logistic regression analysis demonstrated that AS patients with lower sclerostin serum levels had an increased risk to have high CRP at 12 months (odds ratio=7.43, 95% CI 1.23-45.01, P=0.020) than those with higher sclerostin values. Conclusion: Persistent low sclerostin levels may underlie continuous inflammation in AS patients under anti-TNFa therapy.

Objetivo: investigar a capacidade osteoclastogênica de células mononucleares do sangue periférico (PBMCs) de pacientes do sexo masculino com espondilite anquilosante (EA), comparando com indivíduos saudáveis e determinar a relação da osteoclastogênese com parâmetros clínicos e laboratoriais. Métodos: células mononucleares do sangue periférico de 85 pacientes com espondilite anquilosante e 59 controles saudáveis (CT) foram marcadas para avaliar a presença de células CD16 positivas (precursores de osteoclastos). As PBMCs foram mantidas, in vitro, por 21 dias para indução da diferenciação em osteoclastos e avaliação da apoptose destas células. Os níveis séricos do ligante do receptor ativador de fator nuclear kB (RANKL), osteoprotegerina (OPG), telopeptídeo C-terminal do colágeno tipo I (CTX) e propeptídeo Nterminal do procolágeno tipo I (P1NP) foram também avaliados. Resultados: PBMCs de pacientes com EA apresentaram menor porcentagem de células CD16 positivas (25,06 ± 8,59 vs. 28,59 ± 10,20%; p = 0,026) e originaram menor número de osteoclastos comparados aos controles saudáveis (647,7 ± 669,4 vs. 764,4 ± 561,9 OC/poço; p = 0,014). A porcentagem de osteoclastos em apoptose foi menos frequente nos pacientes com EA versus CT (31,8 ± 32,5 vs. 44,5 ± 34,3%; p = 0,007). Menores relações RANKL/OPG e CTX/P1NP foram observadas nos pacientes com EA em relação aos CT (0,05 ± 0,03 vs. 0,07 ± 0,07; p = 0,046 e 0,008 ± 0,003 vs. 0,010 ± 0,003; p < 0,001, respectivamente). Pacientes com EA em uso de terapia de anti-inflamatório não-hormonal (AINH) não apresentaram diferença associada ao número de osteoclastos gerados e à porcentagem de células CD16 positivas comparados aos CT (p > 0,05). Entretanto, pacientes com EA em uso de terapia com inibidor de TNFalfa (iTNFalfa) demonstraram menor número de osteoclastos gerados comparados aos indivíduos saudáveis (582,51 ± 717,56 vs. 764,43 ± 561,9 OC/poço; p = 0,047). Observou-se uma correlação negativa entre número de osteoclastos gerados a partir de PBMC de pacientes com EA e duração de doença (R = -0,220, p = 0,043). Conclusões: os presentes resultados demonstraram que monócitos de pacientes com EA apresentam uma menor capacidade em gerar osteoclastos comparados a indivíduos saudáveis, e que a osteoclastogênese esteve correlacionada negativamente à duração de doença. Estes dados sugerem que os osteoclastos possuem um papel importante na fisiopatologia da doença óssea nos pacientes com EA / Objective: the aim of this study was to investigate if the osteoclastogenic capacity of PBMCs is different in AS patients compared to controls and the relationship between osteoclastogenesis and clinical/laboratory parameters. Methods: PBMCs from 85 male ankylosing spondylitis (AS) patients and 59 controls were tested for CD16+ cells and induced to differentiate into osteoclasts over 3 weeks in vitro. Serum levels of RANKL, osteoprotegerin (OPG), C-terminal telopeptide of type I collagen (CTX) and N-terminal propeptide of type 1 collagen (P1NP) were also evaluated. Results: PBMCs from AS patients had fewer CD16+ cells (25.06 ± 8.59 vs. 28.59 ± 10.20%; p = 0.026) and produced fewer osteoclasts (647.7 ± 669.4 vs. 764.4 ± 561.9 OC/well; p = 0.014) compared to controls. Apoptosis occurred less frequently in osteoclasts obtained from AS patients than in osteoclasts from the controls (31.8 ± 32.5 vs. 44.5 ± 34.3%; p = 0.007). A lower RANKL/OPG and CTX/P1NP were observed in AS patients compared to controls (0.05 ± 0.03 vs. 0.07 ± 0.07; p = 0.046 e 0.008 ± 0.003 vs. 0.010 ± 0.003; p < 0.001, respectively). AS patients taking NSAIDs presented no difference regarding the number of OCs produced and the percentage of CD16+ cells compared to controls (p > 0.05). However, patients taking TNFalpha inhibitors (TNFi) presented lower OC numbers than controls (582.51 ± 717.56 vs. 764.43 ± 561.9 OC/well; p = 0.047). A negative correlation was demonstrated between the number of osteoclasts generated from PBMCs of AS patients and disease duration (R = -0.220, p = 0.043). Conclusion: monocytes from male AS patients display a lower capacity to generate osteoclasts in vitro compared to cells from controls. Osteoclastogenesis was negatively correlated with disease duration. This finding supports the idea that osteoclasts play a role in the physiopathology of bone disease in AS patients

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2018-02-07T18:29:25Z No. of bitstreams: 1 ulissescamargo_tese.pdf: 700757 bytes, checksum: 68231dab9197a8717320c0e887f2b2f6 (MD5) / Made available in DSpace on 2018-02-07T18:29:25Z (GMT). No. of bitstreams: 1 ulissescamargo_tese.pdf: 700757 bytes, checksum: 68231dab9197a8717320c0e887f2b2f6 (MD5) Previous issue date: 2016-09-22 / Introduction. The spondyloarthritis encomprises a group of diseases strongly associated with HLA-B*27 gene. It has been proposed that genes not belonging to the major histocompatibility complex human influence the genesis of these diseases especially in patients HLA-B*27 negative. Objectives. The aim of this study was to test the hypothesis that the antigens of the ABO, Secretor and Lewis histo-blood systems are associated with spondyloarthritis, especially ankylosing spondylitis (AS). Material and methods. Three hundred and ninety-four patients with clinical suspicion of spondyloarthritis sent for identification of HLA-B*27 gene were analyzed. One hundred and nineteen (30.2%) had confirmed the diagnosis of spondyloarthritis according to the ASAS criteria. The remaining 275 (69.8%) were used as controls. The identification of HLA-B*27 gene was performed using the PCR-SSOP method. The identification of the antigens of the ABO, Secretor and Lewis histo-blood systems was performed using hemagglutination and PCR-RFLP methods. The exact Fisher's test, the chi-square, and the values of Odds Ratio (OR) and Confidence Interval set at 95% were calculated using the GraphPad INSTAT software, accepting the error of 5%. Results. No statistically significant differences were observed in the frequency of antigenic profiles of ABO (χ2: 1.152; p = 0.764; GL: 3), Secreto (χ2: 0.779; p = 0.377; GL: 1) and Lewis (χ2: 1.853; p = 0.396; GL: 2) histo-blood groups between patients and controls. The Lea antigen was more frequent in patients with AS compared to controls (OR: 1.833; 95% CI: 1025- 3284, p = 0.053). This antigen was strongly associated with AS in HLA-B*27 negative patients compared to controls (OR: 4.469; 95% CI: 1931-10342; p = 0.0007). This association remained only in males in the absence of HLA-B*27 gene (OR: 6.880; 95% CI: 1852-25564; p = 0.004). Conclusions. AS is associated to the Lea antigen in HLAB* 27 negative male patients. / Introdução. As espondiloartrites compreendem um grupo de doenças fortemente associadas ao gene HLA-B*27. Tem sido proposto que genes não pertencentes ao complexo principal de histocompatibilidade humano influenciam a gênese destas doenças especialmente nos pacientes HLA-B*27 negativos. Objetivos. O objetivo deste estudo foi testar a hipótese de que os antígenos dos sistemas histo-sanguíneos ABO, Secretor e Lewis estão associados à espondiloartrites, especialmente a espondilite anquilosante (EA). Material e método. Foram analisados 394 pacientes com suspeita clínica de espondiloartrites encaminhados para identificação do gene HLA-B*27. Cento e dezenove (30,2%) tiveram o diagnóstico de espondiloartrite confirmado de acordo com os critérios ASAS. Os 275 (69,8%) restantes compuseram o grupo controle. A identificação do gene HLA-B*27 foi realizada com o uso do método PCR-SSOP. A caracterização dos antígenos dos sistemas histo-sanguíneos ABO, Secretor e Lewis foi realizada com o uso dos métodos hemaglutinação e PCR-RFLP. O teste exato de Fisher, o qui-quadrado, os valores de Odds Ratio (OR) e do intervalo de confiança a 95% foram calculados com o uso do software GraphPad Instat, aceitando o erro de 5%. Resultados. Não foram observadas diferenças estatisticamente significantes nas frequências dos perfis antigênicos dos sistemas histo-sanguíneos ABO (χ2: 1.152; p=0,764; GL: 3), Secretor (χ2: 0.779; p=0,377; GL: 1) e Lewis (χ2: 1.853; p=0,396; GL: 2) de pacientes e controles. Foi observada maior frequência do antígeno Lea em pacientes com EA, comparados aos controles (OR: 1.833; IC 95%: 1.025 – 3.284; p=0,053). Este antígeno mostrou-se fortemente associado à EA em pacientes HLA-B*27 negativos comparados aos controles (OR: 4.469; IC 95%: 1.931 – 10.342; p=0,0007). Esta associação se manteve apenas no gênero masculino na ausência do gene HLA-B*27 (OR: 6.880; IC 95%: 1.852 – 25.564; p = 0,004). Conclusões. A EA está associada ao antígeno Lea nos pacientes masculinos HLA-B*27 negativos.

Introdução: Baixas concentrações séricas de esclerostina foram descritas em pacientes com Espondilite Anquilosante (EA). No entanto, não existem dados sobre a importância deste inibidor da via de sinalização Wnt em pacientes com EA durante o tratamento com anti fator de necrose tumoral alfa (TNFa). Objetivos: Avaliar longitudinalmente os níveis séricos de esclerostina e sua associação com inflamação e densidade mineral óssea (DMO) em pacientes com EA em tratamento com anti-TNFa. Métodos: Trinta pacientes com EA em atividade foram avaliados no início, 6 e 12 meses, após terapia anti-TNFa em relação aos parâmetros clínicos (BASDAI, BASFI, BASMI e ASQoL), marcadores inflamatórios e dano radiológico basal (mSASSS). Trinta indivíduos saudáveis pareados por idade e sexo constituíram o grupo controle. As análises laboratoriais de esclerostina e da ligação de esclerostina ao receptor LRP6 e a DMO foram realizadas nos pacientes nos mesmos períodos de avaliação e comparadas aos controles. Resultados: Na avaliação inicial, pacientes com EA apresentavam menores concentrações séricas de esclerostina [60,5 (32,7) vs. 96,7 (52,9) pmol/l,P=0,002] e níveis similares de ligação de esclerostina ao receptor LRP6 (P=0,387) em relação aos controles. Foi observado melhora do BASDAI, BASFI, BASMI, ASQoL comparando tempo basal vs. 6 vs. 12 meses (P<0,01). Concomitantemente, observou-se um aumento gradual da DMO da coluna lombar (P<0,001) e no início do estudo os pacientes apresentavam uma correlação positiva entre avaliação radiológica basal (mSASSS) e a DMO da coluna lombar (r=0,468, P<0,01). Foi observada também uma redução dos marcadores inflamatórios comparando tempo basal vs. 6 vs. 12 meses (P<0,01). Os níveis de esclerostina aumentaram progressivamente após o tratamento com anti-TNFa [60,5 (32,7) vs. 67,1 (31,9) vs. 72,7 (32,3) pmol/l, P<0,001]. Entretanto, após 12 meses de terapia anti-TNFa as concentrações séricas de esclerostina permaneceram significativamente mais baixos em relação os controles [72,7 (32,3) vs. 96,7 (52,9) pmol/l, P=0,038]. Além disso, aos 12 meses, os níveis séricos de esclerostina ficaram mais baixos nos 10 pacientes que ainda apresentavam proteína C reativa elevada (PCR=5mg/l), comparados aos pacientes que apresentaram normalização dos níveis de PCR (P=0,004). Interessantemente, estes 10 pacientes com inflamação persistente já apresentavam concentrações séricas mais baixas de esclerostina quando comparados aos demais pacientes (P=0,023) antes do tratamento com anti- TNFa. A análise de regressão logística demonstrou que os pacientes com EA com níveis baixos de esclerostina apresentam um risco aumentado de apresentar PCR alta após 12 meses de tratamento (odds ratio = 7,43, 95% IC 1,23-45,01, P=0,020) quando comparados aos pacientes com níveis altos de esclerostina no tempo basal. Conclusão: Concentrações persistentemente baixas de esclerostina estão associados a inflamação contínua em pacientes com EA tratados com terapia anti-TNFa. / Introduction: Sclerostin levels have been reported to be low in ankylosing spondylitis (AS), but there is no data regarding the possible role of this Wnt inhibitor during anti tumor necrosis factor alpha (TNFa) therapy. Objectives: The present study longitudinally evaluated sclerostin levels, inflammatory markers and bone mineral density (BMD) in AS patients under anti-TNFa therapy. Methods: Thirty active AS patients were assessed at baseline, 6 and 12 months after anti-TNFa therapy regarding clinical parameters (BASDAI, BASFI, BASMI and ASQoL), inflammatory markers, BMD and baseline radiographic damage (mSASSS). Thirty age- and sex-matched healthy individuals comprised the control group. Patients\' sclerostin levels, sclerostin binding LRP6 and BMD were evaluated at the same time points and compared to controls. Results: At baseline, AS patients had lower sclerostin levels [60.5 (32.7) vs. 96.7 (52.9) pmol/l, P=0.002] and comparable sclerostin binding to LRP6 (P=0.387) than controls. Improvement of BASDAI, BASFI, BASMI, ASQoL was observed at baseline vs. 6 vs. 12 months (P<0.01). Concomitantly, a gradual increase in spine BMD (P<0.001) and a positive correlation between baseline mSASSS and spine BMD was found (r=0.468, P<0.01). Inflammatory parameters reduction was observed comparing baseline vs. 6 vs. 12 months (P<0.01). Sclerostin levels progressively increased [60.5 (32.7) vs. 67.1 (31.9) vs. 72.7 (32.3) pmol/l, P<0.001] after anti-TNFa treatment. At 12 months, the sclerostin levels remained significantly lower in patients compared to controls [72.7 (32.3) vs. 96.70 (52.85) pmol/l, P=0.038]. Moreover, sclerostin serum levels at 12 months were lower in the 10 patients with high CRP (=5mg/l) compared to the other 20 patients with normal CRP (P=0.004). Of note, these 10 patients with persistent inflammation also had lower sclerostin serum levels at baseline compared to the other patients (P=0.023). Univariate logistic regression analysis demonstrated that AS patients with lower sclerostin serum levels had an increased risk to have high CRP at 12 months (odds ratio=7.43, 95% CI 1.23-45.01, P=0.020) than those with higher sclerostin values. Conclusion: Persistent low sclerostin levels may underlie continuous inflammation in AS patients under anti-TNFa therapy.

Hensikt: Å kartlegge hvilken kunnskap norske pasienter med ankyloserende spondylitt har om sykdommen og i hvilken grad deres tiltro til egen mestringsevne påvirker deres helserelaterte livskvalitet.Metode: Tverrsnittstudie i form av en spørreundersøkelse for å kartlegge og beskrive deltagernes kunnskap om sykdommen og hvordan denne kunnskapen påvirker deres livssituasjon. Studien ble gjennomført på 150 pasienter i forbindelse med deres deltagelse på en behandlingsreise til utlandet.Resultat: Pasientene var mest fornøyde med den informasjonen de fikk fra spesialist i revmatologi og fysioterapeut. De anga også medpasienter som en viktig kilde til informasjon. Deltagelse i mestringskurs og informasjon fra sykepleier var de informasjonskildene færrest respondenter var fornøyde med. Respondentene hadde mest kunnskap om sykdommens symptomer og trening, mens kunnskap om medikamenter og hjelpemidler/tiltak for tilrettelegging hjemme og på arbeidsplassen var de temaer de hadde minst kunnskap om. De som var mest fornøyde med den kunnskapen de hadde om sykdommen, hadde en signifikant bedre tiltro til at de kunne påvirke sine smerter og sykdomssymptomer.Konklusjon: Kunnskap om sykdommen bidrar positivt til å påvirke pasientenes helserelaterte livskvalitet. Læring gjennom utveksling av kunnskap og erfaringer med andre i samme situasjon, synes å være en riktig og positiv måte å tilrettelegge pasientundervisningen på. Målgruppen bør imidlertid kartlegges, slik at undervisningen kan tilpasses deltagernes utdannelsesnivå. Likeledes bør helsepersonellets roller og funksjoner avklares og tydelig defineres. / Aims: This study sought to explore the knowledge Norwegian patients with ankylosing spondylitishave about the disease and to what extent belief in their own capacity to master the disease affectshealth-related quality of life.Methods: We used questionnaires to explore and describe participants’ knowledge about ankylosingspondylitis. The questionnaires also assessed how this knowledge affected participants’ lifesituations. The study included 150 patients who participated in a rehabilitation programme abroad.Results: The patients were most satisfied with information provided by rheumatologists andphysiotherapists. They also considered fellow patients as an important source of information. Lesssatisfactory was information provided by nurses and courses in disease mastery. Respondents werevery knowledgeable about disease symptoms and physical exercise. However, they described theirknowledge about medication and appliances designed for use at home or in the workplace as limited.The patients who were most satisfied with their knowledge about the disease had a significantlybetter belief in their ability to cope with pain and disease-related symptoms.Conclusions: Knowledge about their disease contributed positively to patients’ health-related qualityof life. Sharing knowledge and personal experience with others who are in similar situationsenhances learning and appears to be a useful and positive way of providing patient education.However, adapting training to the educational background of participants will require carefulassessment of the target group. Similarly, the roles and domains of health care professionals requireclear definitio / <p>ISBN 978-91-85721-82-5</p>

Title: Comparison of educational and compensation exercise programmes for ankylosing spondylitis patients Objective: The objective of the research was to determine the effect of two educational and compensation exercise programmes on the mobility of the axial system, the functional status and disease activity (including inflammatory process activity) in individuals with ankylosing spondylitis. Methods: The research group included men and women (average age of 35.42 ± 7.15 years), all out-patients of the Institute of Rheumatology in Prague. This characteristic sample (n ═ 38) consisted of respondents who were randomised into three groups: The first experimental group (n ═ 13) attended an educational and compensation exercise programme in a group setting in a gym (twice a week) and an educational and compensation exercise programme in the form of a group exercise in a pool - hydrokinesiotherapy (once a week); the second experimental group (n ═ 13) attended the same educational and compensation exercise programme in a group setting in a gym (twice a week); the control group educational and compensation exercise programme in a group setting in a gym (twice a week) received no exercise intervention but its members were allowed to use "passive" physiotherapeutic procedures (e.g. hydrotherapy or...