Moving instead of asking? performance-based tests and BASFI-questionnaire measure different aspects of physical function in ankylosing spondylitis

INTRODUCTION: Ankylosing Spondylitis (AS) is characterised by limitations in physical function. The Bath Ankylosing Spondylitis Functional Index (BASFI) is considered to be the gold-standard to assess physical function in AS patients. However, the BASFI questionnaire is a self-reported outcome measure and susceptible to subjective interpretation (under- or over-estimation). More objective outcome measures, like performance-based tests, could provide an objective outcome measurement for the evaluation of limitations in physical function. Therefore, the primary aim of this study was to determine the association between performance-based measures and the BASFI questionnaire. METHODS: In this cross-sectional study 126 AS patients completed the BASFI questionnaire and eight performance-based tests based on BASFI-items. Each test received three scores: one for performance (time or points) and a score for exertion and pain experienced during performance (using modified Borg-scale and VAS 0-100 mm, respectively). Linear regression analyses were used to assess the associations between the BASFI questionnaire and performance-based tests. RESULTS: The univariable association between performance and BASFI-score was moderate with a R-square of 0.31 and Beta of 0.56 (p's < 0.05). In a multivariable analysis, the association between performance, exertion and pain on the one hand and BASFI-score on the other was assessed; R-square increased to 0.54: the Beta's for exertion and pain during performance were 0.38 and 0.26, respectively; the Beta for performance decreased to 0.19 (p's < 0.05). CONCLUSIONS: This study demonstrates that alongside actual performance, patients seem to incorporate exertion and pain in their assessment of perceived physical function on the BASFI questionnaire. Performance-based tests could provide an objective outcome measurement for the evaluation of physical function and give relevant new information in addition to the BASFI questionnaire

Bone formation rather than inflammation reflects Ankylosing Spondylitis activity on PET-CT: a pilot study

INTRODUCTION: Positron Emission Tomography - Computer Tomography (PET-CT) is an interesting imaging technique to visualize Ankylosing Spondylitis (AS) activity using specific PET tracers. Previous studies have shown that the PET tracers [(18)F]FDG and [(11)C](R)PK11195 can target inflammation (synovitis) in rheumatoid arthritis (RA) and may therefore be useful in AS. Another interesting tracer for AS is [(18)F]Fluoride, which targets bone formation. In a pilot setting, the potential of PET-CT in imaging AS activity was tested using different tracers, with Magnetic Resonance Imaging (MRI) and conventional radiographs as reference. METHODS: In a stepwise approach different PET tracers were investigated. First, whole body [(18)F]FDG and [(11)C](R)PK11195 PET-CT scans were obtained of ten AS patients fulfilling the modified New York criteria. According to the BASDAI five of these patients had low and five had high disease activity. Secondly, an extra PET-CT scan using [(18)F]Fluoride was made of two additional AS patients with high disease activity. MRI scans of the total spine and sacroiliac joints were performed, and conventional radiographs of the total spine and sacroiliac joints were available for all patients. Scans and radiographs were visually scored by two observers blinded for clinical data. RESULTS: No increased [(18)F]FDG and [(11)C](R)PK11195 uptake was noticed on PET-CT scans of the first 10 patients. In contrast, MRI demonstrated a total of five bone edema lesions in three out of 10 patients. In the two additional AS patients scanned with [(18)F]Fluoride PET-CT, [(18)F]Fluoride depicted 17 regions with increased uptake in both vertebral column and sacroiliac joints. In contrast, [(18)F]FDG depicted only three lesions, with an uptake of five times lower compared to [(18)F]Fluoride, and again no [(11)C](R)PK11195 positive lesions were found. In these two patients, MRI detected nine lesions and six out of nine matched with the anatomical position of [(18)F]Fluoride uptake. Conventional radiographs showed structural bony changes in 11 out of 17 [(18)F]Fluoride PET positive lesions. CONCLUSIONS: Our PET-CT data suggest that AS activity is reflected by bone activity (formation) rather than inflammation. The results also show the potential value of PET-CT for imaging AS activity using the bone tracer [(18)F]Fluoride. In contrast to active RA, inflammation tracers [(18)F]FDG and [(11)C](R)PK11195 appeared to be less useful for AS imaging

The evolving treatment of ankylosing spondylitis

promotiedatum: 6-5-2015 � prom-id: 1286

High frequency of vertebral fractures in early spondylarthropathies

Summary We demonstrated that vertebral fractures (VF) are commonly found in early SpA. Patients with VF had lower lumbar BMD than patients without VF. VF remained frequently 'unrecognized' and untreated. VF have been associated with more back pain, reduced Qol, and increased risk of future fractures which stresses the importance of recognition also in early stage SpA. Introduction VF are a common complication of longstanding ankylosing spondylitis (AS). However, data of VF in early AS patients and in other spondylarthropathies (SpA) are scarce. Therefore we examined the prevalence of VF in early SpA patients and investigated the associations between VF and demographic and disease-related variables. Methods SpA patients were included consecutively and radiographs of the spine were made. VF were assessed according to the method of Genant et al.: fractures were defined as reduction of ≫20% of the vertebrae. Descriptive statistics, t-tests and logistic regression analyses were used to study the relationship between VF and demographic and disease-related variables, radiographic damage and BMD. Results A total of 113 early SpA patients were included with a disease duration of 7 months, a mean age of 37 years. Seventeen patients (15%) had at least one VF. Fourteen patients had one VF, three patients had two VF. Most VF were located at Th6-Th8. In patients with VF, bone mineral density (BMD) of lumbar spine was lower than BMD of patients without VF (t-test: p=0.043). Axial Psoriatic Arthritis (PsA) was significantly associated with a higher risk for VF (odds ratio [OR]: 4.62, 95% confidence interval [CI] 1.15-18.58, p=0.031). No significant associations were found with disease activity variables nor with radiographic severity. Conclusion In a group of 113 early, young SpA patients, 15% already had at least one VF. Most VF were asymptomatic, undetected by routine diagnostic procedures and located at the mid-thoracic spine. The VF were associated with low BMD of the lumbar spine and with axial PsA. © International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Formando comunidades de aprendizaje la I.E.I N°096 Emilia Barcia Boniffatti mejora los logros en las competencias matemáticas

Trabajo académicoLa siguiente monografía se basa en la información recopilada de la Institución educativa inicial N°096 Emilia Barcia Boniffatti del distrito de San Miguel, Provincia de lima Departamento de Lima. El problema identificado son los “Resultados insatisfactorios en el nivel de logro de aprendizaje en las competencias matemáticas de los estudiantes de 5 años de la I.E.I N°096 “Emilia Barcia Boniffatti”– Distrito de San Miguel, siendo las causas: Inadecuada aplicación de estrategias didácticas que dificultan el desarrollo del pensamiento matemático. Insuficiente estrategia de acompañamiento para mejorar la práctica pedagógica, Limitada aplicación de estrategias para generar un buen clima del aula. La estrategia propuesta es: Las Comunidades de Aprendizaje. Ésta tiene como compones primarios, el liderazgo equitativo, el trabajo en grupo, el crecimiento de cada profesional basado en la necesidad de sus estudiantes, la investigación y la reflexión sobre el trabajo docente como evidencia del cambio que se va suscitando en el transcurrir de la aplicación de esta nueva idea, llegando así a la transformación de la institución educativa en una gran Comunidad de Aprendizaje. Esta visión del cambio ante el problema planteado; son las diferentes soluciones posibles que se llegan a cuajar con los aportes de la comunidad participante, aprovechando las cualidades, y lo que se puede llegar a obtener bajo la influencia de nuevas fortalezas descubiertas en el diagnóstico para que los estudiantes desarrollen aún más ese conocimiento matemático tan importante en su vida diaria, usándolos para el razonamiento, la creatividad y el pensamiento crítico en la resolución de problemas matemáticos, así como la predisposición para el trabajo colaborativo entre pares o equipos para la resolución de problemas matemáticos, la práctica de valores para una buena convivencia mediante los acuerdos consensuados , ante los ritmos de aprendizaje, inteligencias múltiples y necesidades especiales de aprendizaje de sus compañeros de aula, a través del manejo de variedad de estrategias didácticas en las sesiones de clases para ello se implementará el trabajo colegiado, buscando estrategias para sistematizar el monitoreo, acompañamiento y evaluación consiguiendo implementar planes de mejora de desempeño docente personalizada y promover la práctica de valores en el aula

Objective Evaluation of Physical Functioning after Tumor Necrosis Factor Inhibitory Therapy in Patients with Ankylosing Spondylitis: A Selection of 3 Feasible Performance-based Tests

Objective.(1) To select a limited number of performance-based tests that are reliable, show improvement in physical functioning after tumor necrosis factor inhibitor (TNFi) therapy in patients with ankylosing spondylitis (AS), and generate information equivalent to the full set of tests, and (2) are feasible for use in daily clinical practice.Methods.Eight performance-based tests were evaluated. To eliminate redundant testing, the tests that showed adequate reliability, the highest standardized response mean (SRM), and the largest proportion of patients with an improved performance-based physical functioning were selected. The selected tests were combined into a new criterion for improvement in physical functioning (AS Performance-based Improvement; ASPI). The number and percentage of improved patients identified with the ASPI and identified with the full set of performance tests were compared.Results.Reliability for all tests was adequate to excellent (ICC 0.73–0.96). The tests for bending, putting on socks, and getting up from the floor had the highest SRM (0.52–0.74) and showed the largest proportion of improved patients after TNFi therapy. The combination of these 3 tests was feasible in daily clinical practice and showed improved physical functioning after TNFi therapy in 67% of the patients.Conclusion.The 3 selected tests are recommended for use in daily practice because they generate information comparable to the full set. They are reliable and feasible, and the combination of these tests showed improved physical functioning after TNFi therapy in 67% of the patients. Evaluation of physical functioning might be improved by adding these tests to other AS outcome measures.</jats:sec