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  #41  
Old 01-12-2009, 08:51 PM
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Default Periodontal disease in patients with ankylosing spondylitis

The following excerpt and reference was found on the web site from the Spondylitis Association of America. New members: also note the several lengthy topics we posted in the last few years about the importance of maintaining good dental health (use the search utility) or see the FAQs for a consolidated topic.
___________________________________________

Ankylosing Spondylitis and Gum (Periodontal) Disease

A study published in the January 2009 issue of the Annals of Rheumatic Diseases examined ankylosing spondylitis patient's risk of periodontal (gum) disease. Perio.org describes periodontitis as follows: "Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed."

The study concludes that "AS patients have a significantly higher risk of PD [periodontal disease], strongly suggesting the need of a close collaboration between rheumatologists, periodontists and dental hygienists when treating AS patients."

__________________________________________________ ________


Periodontal disease in patients with ankylosing spondylitis

Nicole Pischon 1*, Tobias Pischon 2, Ensar Gülmez 1, Jörn Kröger 1, Peter Purucker 1, Bernd-Michael Kleber 1, Helga Landau 3, Paul-Georg Jost-Brinkmann 3, Peter Schlattmann 4, Jan Zernicke 5, Gerd Burmester 5, Jean-Pierre Bernimoulin 1, Frank Buttgereit 5 and Jacqueline Detert 5

1 Dept. of Periodontology, Universitätsmedizin Charité, Germany
2 Dept. of Epidemiology, German Institute of Nutrition (DIFE), Germany
3 Dept. of Orthodontics, Universitätsmedizin Charité, Germany
4 Dept. of Biometry, Universitätsmedizin Charité, Germany
5 Dept. of Rheumatology, Universitätsmedizin Charité, Germany

Objective: Ankylosing spondylitis (AS) and periodontal disease (PD) are characterized by dysregulation of the host inflammatory response, resulting in soft and hard connective tissue destruction. AS has been related to other inflammatory diseases, however, there is a paucity of data on whether AS is associated with inflammatory PD.

Methods: The association between AS and PD was examined in 48 patients with AS and 48 healthy controls, matched on age and gender. AS was diagnosed according to the modified New York criteria. Periodontal examination included probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PI) and bleeding on probing (BOP). Potential risk factors of PD such as smoking, low education, alcohol consumption, Body Mass Index (BMI), as well as chronic diseases associated with PD and AS were assessed through questionnaires.

Results: In stepwise logistic regression, including AS status, age, gender, education, smoking, alcohol consumption, and BMI, only AS status, age, and education remained significant predictors of PD. Patients with AS had a significantly 6.81-fold increased odds (95 %-CI 1.96-23.67) of PD (defined as mean attachment loss > 3 mm) compared to controls. The strength of the association was attenuated but remained statistically significant after further adjustment for plaque accumulation (odds ratio 5.48; 95 %-CI 1.37-22.00).

Conclusion: The present study shows that AS patients have a significantly higher risk of PD, strongly suggesting the need of a close collaboration between rheumatologists, periodontists and dental hygienists when treating AS patients.
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  #42  
Old 03-12-2009, 09:01 PM
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I was lucky to receive the full article and permissions from the authors to share this with you. It's a fascinating and somewhat complex article relating to the previous topic.

Now that we have many members that are in the dentistry/oral hygiene field, and are now spine patients, I'd be curious about their take on these new findings.

An excerpt:
"In conclusion, the present study suggests that patients with AS have an increased prevalence of PD (periodontal disease) compared to non-diseased controls. Although this relationship needs further investigation, it seems that health professionals should be aware of the increased prevalence of PD in AS patients as well as of the potential systemic health problems related to PD."

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File Type: pdf Bechterew Paro.pdf (104.8 KB, 4 views)
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  #43  
Old 04-27-2009, 11:48 AM
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Default Infectious spondylodiscitis

This article was sent to me recently by a UK patient and I thought I already posted it -- but I may have missed it. See below.

BTW, a funny note for the old-timers in this forum: Tracy was right about the French medical professionals...they really do have their sh** together!
______________________________________________

1: J Infect. 2008 Jun;56(6):401-12. Epub 2008 Apr 28.

Infectious spondylodiscitis.

Cottle L, Riordan T.
Department of Infection and Tropical Medicine, RoyalHallamshireHospital, Sheffield, S10 2JF, UK.
OBJECTIVES: To review the available literature on infectious spondylodiscitis and provide recommendations on management, particularly identification of the causative agent and antimicrobial therapy.

METHODS AND RESULTS: The medical literature was searched using PubMed, employing the key words discitis, disc space infection, infectious spondylodiscitis, pyogenic discitis, septic discitis and post-operative discitis. Infectious spondylodiscitis is rising in incidence and diagnosis has been facilitated by the availability of sensitive imaging techniques such as MRI. No randomized controlled studies of antimicrobial therapy were identified in this literature search and there appear to be no UK consensus guidelines on investigation and management. Comprehensive French guidelines have been published and were scrutinized for this review.

CONCLUSIONS: Unless the patient is severely unwell antimicrobial therapy should be delayed until a microbiological diagnosis is established. If initial blood cultures are negative then a CT-guided biopsy should be conducted. Tentative recommendations for antimicrobial therapy can be made based on theoretical considerations and limited data from uncontrolled studies.

PMID: 18442854 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/18442854
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  #44  
Old 06-15-2009, 06:36 PM
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Default Over Half Of People With Rheumatoid Arthritis Have Periodontitis

Hello everyone, I havne't been around the site nearly as much as I'd like, but I saw this article and wanted to share it. Hope you don't mind.

Don G.



Over Half Of People With Rheumatoid Arthritis Have Periodontitis
15 Jun 2009

Over half (56%) of people with rheumatoid arthritis (RA) also have periodontitis (a chronic inflammatory disease of the gum and surrounding ligaments and bones that hold the teeth in place), displaying fewer teeth than healthy matched controls, high prevalence of oral sites presenting dental plaque and advanced attachment loss (the extent of periodontal support that has been destroyed around a tooth) (chi square p<0.05), according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. In addition, these patients were found to have significantly higher RA disease activity and anti-CCP (cyclic citrullinated peptide) antibody levels than others with RA who did not exhibit periodontitis (r=0.84, p<0.05; r=0.78, p<0.05).

The study also showed that, after six months of anti-TNF therapy (prescribed to control RA inflammation and destruction), a statistically significant improvement in periodontal status was seen in 20 (80%) of the 25 participants (mean age 41.5+3.7 years; mean disease duration 7.2+4.8 years), suggesting that the biological therapy may also be able to modulate the inflammatory process in the periodontium (the tissues investing and supporting the teeth, including the cementum, periodontal ligament, alveolar bone, and gingival / gums).

Dr Codrina Ancuta of the Grigore T Popa University of Medicine and Pharmacy, Rehabilitation Hospital, Iasi, Romania, who led the study, said: "There is a growing body of evidence to demonstrate an association between periodontal disease and systemic conditions involving inflammatory rheumatic disease (especially RA), cardiovascular disease and diabetes. However, further cross-disciplinary research among rheumatologists and periodontologists is required to fully understand the underlying mechanisms that link RA and periodontitis, and to explore how patients can be managed more holistically using treatments such as anti-TNFs and some lifestyle approached that may simultaneously address both conditions."

The prospective observational study compared 25 consecutive RA patients receiving anti-TNFs with 25 systemically healthy individuals matched for age, gender and periodontal status at baseline and six months, assessing both groups for periodontal status (visible plaque scores, marginal bleeding scores, attachment loss, number of present teeth), and the RA patient group in terms of RA parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP antibodies, disease activity and disability scores). Statistical analysis was conducted in SPSS-14 (a statistical analysis computer programme) p<0.05.

Moderate to Severe Periodontitis may be a Risk Factor for Developing RA in Non-Smokers

A second study presented at EULAR 2009 showed that, although smoking is an established risk factor for both RA and periodontitis, non-smoking individuals with moderate to severe periodontitis may also be at a greater risk for the development of RA. Those with RA who had moderate to severe periodontitis also developed significantly higher Anti-Citrullinated Peptide Antibody (ACPA) levels than those with no-mild periodontitis.

The retrospective study identified 45 RA patients based on their hospital discharge diagnostic codes from a cohort of 6,661 participants of the Atherosclerosis Risk in Communities (ARIC) study, from whom serum was obtained at the time of a detailed periodontal assessment during the period 1996-1998. RA participant sera were assessed for ACPA and rheumatoid factor (RF) positivity using ELISA (enzyme-linked immunosorbent assay). Participants were classified as having incident RA (n=33) if their first hospital discharge code occurred after periodontitis classification.

The hazard ratio (HR) of developing RA in subjects with moderate to severe periodontitis (n=27) was found to be 2.6 (95% CI=1.0-6.4, p=0.04), compared to those with no / mild periodontitis (n=6). Among lifetime non-smokers who developed RA, the Hazard Ratio was 8.8 (95% CI=1.1-68.9, p=0.04). Periodontitis severity was not shown to be independently associated with RA incidence among current and former smokers. ACPA levels were significantly higher in participants with moderate to severe periodontitis than in those with no / mild periodontitis (222.5 Units vs. 8.4 Units, p=0.04). These findings indicate that periodontitis may be a risk factor both for the development of RA, and for the development of more severe ACPA-positive disease.

Abstract number: FRI0171 & FRI0129

Source:
Rory Berrie
European League Against Rheumatism
--------------------------------------------------------------------------------

Article URL: http://www.medicalnewstoday.com/articles/153952.php
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  #45  
Old 06-15-2009, 07:53 PM
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Default Thanks!

Don,

Thx for sharing this information. I merged it with this topic; please note the similar published findings that I posted in January and March.

I am really glad to see researchers spend time looking into systemic causes of RA. I hope this interesting work continues with a focus on the spine, as so many millions of people in this (and other countries) are burdened with these conditions.

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  #46  
Old 06-16-2009, 12:59 PM
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Harrison,

I wasn't sure where to post the article. Glad you keep us in line. I've spent too little time on this site recently and finally got my home connected to the internet/email a few months ago, but between kids, chores and a job, I don't get much on-line time. However, back pain is a motivator. and betwen kids, chores and the job, my back's been getting a work-out.

Another thing I need to read more about, (I haven't investigated this much). I volunteer with 4H, mostly poultry and there are several mycobacterial diseases they vaccinate livestock against. It seems to me if livestock have vaccines against diseases known to be caused by intracellular bugs, why isn't more effort put into investigating them in humans?

thanks,

Don
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"Compressed" L5-S1 in ~1992.
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  #47  
Old 08-16-2009, 11:00 AM
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Don, you raise a good point. If anyone has the patience to read this topic from the very beginning, they may ask the same question. At least, I hope that this long topic makes people more curious about this phenomenon.

There are some researchers working specifically on identifying the connection(s) between intracellular bugs and disease. Quite a few, actually. They are located in diagnostic labs, universities and medical practices around the world. I’ll be interviewing a few of them later this year when I start the next film. BTW: The second interview I have scheduled is with a PhD researcher who has worked in dental research for decades. I'll be discussing various topics with him, like the one you posted about the RA-Periodontitis connection.

Here’s another “unusual” case of bugs contributing to a spine problem from the UK.
__________________________________________________ _______

J Med Microbiol. 2009 Jun 18.

Vertebral osteomyelitis and discitis due to Gardnerella vaginalis.
Graham S, Howes C, Dunsmuir R, Sandoe J.

Leeds General Infirmary.

Gardnerella vaginalis (G. vaginalis) is a facultatively anaerobic gram-variable pleomorphic rod which forms part of the normal vaginal flora. (Catlin, 1992) It is most commonly associated with infection of the genital tract in women, but recognition of extravaginal G. vaginalis infection is becoming more frequent. (Catlin, 1992) We describe an unusual case of G. vaginalis vertebral osteomyelitis and discitis in a 38-year-old woman with no apparent predisposing factors.

PMID: 19541786 [PubMed - as supplied by publisher]
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  #48  
Old 08-16-2009, 11:28 AM
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Default More abstracts...

I thought I posted these a while back, but I guess not! Here are some more interesting cases.
_________________________________

Infectious spondylitis [Article in Spanish]
Pintado-García V.
Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.

Vertebral osteomyelitis or spondylodiscitis is an uncommon, mainly hematogenous, disease that usually affects adults. The incidence of this condition has steadily risen in recent years because of increases in spine surgery and nosocomial bacteremia, aging of the population, and intravenous drug addiction. Pyogenic infection due to Staphylococcus aureus is the most frequent form of the disease, but tuberculosis and brucellosis are still common causes of spondylitis in Spain.

The clinical presentation is nonspecific and the diagnosis is often delayed. Magnetic resonance imaging is the most sensitive radiologic technique for this disease. Blood cultures are often positive, but computed tomography-guided needle biopsy or surgical biopsy of the affected vertebra is sometimes required to achieve a microbiological diagnosis. Prolonged antibiotic therapy and occasionally surgery are essential for cure in most patients, and both factors have contributed to a reduction in the morbidity and mortality of the disease in recent years.

Spondylodiscitis and infectious endocarditis: a round-trip to be considered.
Calderaro D, Gualandro DM, Yu PC, Marques AC, Puig LB, Caramelli B.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.

The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course.

A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflammatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the …..

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess.
Metta H, Corti M, Brunzini R.
Unit 17, Division B, Infectious Diseases, FJ Muñiz Hospital and Santa Lucia Hospital, Buenos Aires, Argentina.

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment.

We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.
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  #49  
Old 09-09-2009, 08:15 PM
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Default Reactive Arthritis

A patient with reactive arthritis (in her case, diagnosed as Reiter’s) sent me this link. I saw this page a few years ago, but the NIH has since updated it and I read it carefully. Frankly, I was a bit surprised with the specificity of changes; however, I see it as progress: http://www.niams.nih.gov/Health_Info/Reactive_Arthritis/default.asp

Here are some excerpts from this page referenced above, but please read the full page to get all the nuggets that may be of interest to you. There's a lot there!

What Is Reactive Arthritis?

…Reactive arthritis is a form of arthritis, or joint inflammation, that occurs as a “reaction” to an infection elsewhere in the body. Inflammation is a characteristic reaction of tissues to injury or disease and is marked by swelling, redness, heat, and pain.

Besides this joint inflammation, reactive arthritis is associated with two other symptoms: redness and inflammation of the eyes (conjunctivitis) and inflammation of the urinary tract (urethritis). These symptoms may occur alone, together, or not at all.

Reactive arthritis is also known as Reiter’s syndrome, and your doctor may refer to it by yet another term, as a seronegative spondyloarthropathy.

The seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. (Examples of other disorders in this group include psoriatic arthritis, ankylosing spondylitis, and the kind of arthritis that sometimes accompanies inflammatory bowel disease.)…

…The symptoms of reactive arthritis usually last 3 to 12 months, although symptoms can return or develop into a long-term disease in a small percentage of people...

What Causes Reactive Arthritis?

Reactive arthritis typically begins about 1 to 3 weeks after infection. The bacterium most often associated with reactive arthritis is Chlamydia trachomatis, commonly known as chlamydia (pronounced kla-MID-e-a). It is usually acquired through sexual contact. Some evidence also shows that respiratory infections with Chlamydia pneumoniae may trigger reactive arthritis…

…Infections in the digestive tract that may trigger reactive arthritis include Salmonella, Shigella, Yersinia, and Campylobacter. People may become infected with these bacteria after eating or handling improperly prepared food, such as meats that are not stored at the proper temperature….
_____________________________

So there you have it -- at least for reactive arthritis: food, sexual contact or respiratory infections can lead to reactive arthritis.

I must ask you - especially the "lurkers:" How I am doing on creating my thesis so far? All I am trying here is collect the articles and research from many different researchers and organizations to assemble a logical argument.

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  #50  
Old 09-20-2009, 08:31 PM
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Adv Exp Med Biol. 2009;649:71-84. Links

Synovial and mucosal immunopathology in spondyloarthritis.
Vandooren B, Tak PP, Baeten D.

Clinical Immunology and Rheumatology, University of Amsterdam, Amsterdam, The Netherlands.

Chronic inflammation of musculoskeletal structures is the most prominent disease manifestation of SpA. More specifically, the axial disease affects the spine, the sacroiliac joints and the hips. Peripheral disease includes peripheral arthritis, with a preference for asymmetrical inflammation of joints of the lower limbs and enthesitis, which is the presence of inflammation at the sites were ligaments and tendons attach to the bone.

Additionally, SpA is often characterized by subclinical inflammation of the gut which partially resembles inflammatory bowel disease. Here, we will review the immunopathology of these different disease manifestations and relate them to clinical applications as well as emerging pathogenic concepts.
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