Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study

OBJECTIVE: To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. METHODS: Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. RESULTS: The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist's diagnosis as well as with the classification criteria was found. CONCLUSION: These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations

Results of the worldwide, cross-sectional ASAS-PerSpA study

Objectives: To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. Methods: Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. Results: A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%). Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). Conclusion: These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.publishersversionpublishe

A cluster analysis in the worldwide ASAS-PerSpA study

Objective To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. Methods Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. Results The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist € s diagnosis as well as with the classification criteria was found. Conclusion These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.publishersversionpublishe

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Objectives To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. Methods Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. Results A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%). Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). Conclusion These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.Pathophysiology and treatment of rheumatic disease

Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study

Objective To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. Methods Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. Results The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist's diagnosis as well as with the classification criteria was found. Conclusion These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.Pathophysiology and treatment of rheumatic disease

Enhancement of Transmission Capacity in Deregualted Power System-an Overview

In this paper review of few pioneer for transmission planning in deregulated environment is been studied and most critical observations are marked. Expansion planning of approaches may be different and it depend upon the type of market is been used for making deregulated environment. Two models are very much possible one is fully adopted in UK and other in US. The two models are discussed in a great detail in literature. Broadly speaking there are only two transmission planning approaches are possible deterministic and non deterministic

Utilization of Co-Fired Blended Ash and Chopped Basalt Fiber in the Development of Sustainable Mortar

Excessive consumption of cement in construction materials has resulted in a negative impact on the environment. This leads to the need of finding an alternative binder as a sustainable construction material. Different wastes that are rich in aluminosilicates have proved to be a valuable material for alkali-activated product development, which contains zero cement. Alkali-activated products are claimed to be sustainable and cost-effective. In the present study, alkali-activated reinforced masonry mortar was developed using locally available industrial waste (co-fired blended ash—CBA). Appropriate mortar design is one of the key challenges as connections between two structural elements play a significant role in building construction. The mortar designed with suitable fiber reinforcement shall significantly help to enhance the fresh, mechanical, durability, and dynamic properties. Chopped basalt fibers (CBFs) obtained from basalt rock are one of the eco-efficient fibers applied as a reinforcing material. The present study checked the feasibility of novel industrial waste-co-fired blended ash (CBA) in the development of alkali-activated masonry mortar and reinforced alkali-activated mortar. In view of sustainable construction material design, the study elaborated the application of chopped basalt fibers (CBFs) in alkali-activated mortar design. The mortar cubes were cast and tested for various properties with varying percentages of chopped basalt fibers (0.5%, 1%, and 1.5%). The results suggest that developed mortars were able to achieve higher compressive strength (10–18 MPa) and flexural strength (3–3.5 MPa). Further, based on the properties of developed alkali-activated reinforced mortar, masonry prisms were cast and evaluated for the bond strengths (flexural and shear) of masonry. The optimum properties of alkali-activated mortar were found for the mix design of alkali activator to solid ratio of 0.40 and 0.5% CBF percentage. Application of CBF in CBA alkali-activated reinforced masonry mortar proved to be an efficient construction material with no cement

Utilization of Co-Fired Blended Ash and Chopped Basalt Fiber in the Development of Sustainable Mortar

Excessive consumption of cement in construction materials has resulted in a negative impact on the environment. This leads to the need of finding an alternative binder as a sustainable construction material. Different wastes that are rich in aluminosilicates have proved to be a valuable material for alkali-activated product development, which contains zero cement. Alkali-activated products are claimed to be sustainable and cost-effective. In the present study, alkali-activated reinforced masonry mortar was developed using locally available industrial waste (co-fired blended ash—CBA). Appropriate mortar design is one of the key challenges as connections between two structural elements play a significant role in building construction. The mortar designed with suitable fiber reinforcement shall significantly help to enhance the fresh, mechanical, durability, and dynamic properties. Chopped basalt fibers (CBFs) obtained from basalt rock are one of the eco-efficient fibers applied as a reinforcing material. The present study checked the feasibility of novel industrial waste-co-fired blended ash (CBA) in the development of alkali-activated masonry mortar and reinforced alkali-activated mortar. In view of sustainable construction material design, the study elaborated the application of chopped basalt fibers (CBFs) in alkali-activated mortar design. The mortar cubes were cast and tested for various properties with varying percentages of chopped basalt fibers (0.5%, 1%, and 1.5%). The results suggest that developed mortars were able to achieve higher compressive strength (10–18 MPa) and flexural strength (3–3.5 MPa). Further, based on the properties of developed alkali-activated reinforced mortar, masonry prisms were cast and evaluated for the bond strengths (flexural and shear) of masonry. The optimum properties of alkali-activated mortar were found for the mix design of alkali activator to solid ratio of 0.40 and 0.5% CBF percentage. Application of CBF in CBA alkali-activated reinforced masonry mortar proved to be an efficient construction material with no cement