Which factors really influence the course of ankylosing spondylitis?
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Aged↗
Biomedical subjects
A Falkenbach
Publications and source records attributed to A Falkenbach.
Interleukin-6 serum concentration in ankylosing spondylitis: a reliable predictor of disease progression in the subsequent year?
The aim of the present study was to evaluate whether in ankylosing spondylitis (AS), interleukin-6 (IL-6) is a reliable predictor of changes in mobility in the subsequent year. Of 261 AS patients who had been enrolled in a previous study, 128 returned for treatment at our health centre after 1 year (+/-3 months). The variables for mobility after 1 year (II) were compared with the findings of the previous year (I). Differences in parameters for mobility were related to the serum concentration of IL-6 in the previous year. Relation between serum concentration of IL-6 and difference (II-I) in occiput-to-wall distance (Spearman's rank correlation coefficient r(s), P value) was 0.02, 0.82; chin-chest distance -0.09, 0.31; cervical rotation -0.08, 0.39; chest expansion 0.05, 0.54; finger-floor distance -0.02, 0.84; Ott sign (flexibility of the thoracic spine) -0.11, 0.22; Schober sign 0.01, 0.94. After 1 year there was a significant improvement in cervical rotation in patients with low IL-6 serum concentration (lower quartile), but not in those with high levels of IL-6 (upper quartile). No further difference was seen between patients with high or low levels of IL-6. The present data suggest that the serum concentration of IL-6 does not allow a prediction of disease progression in the subsequent year.
Cervical Vertebrae↗
Radon progeny activity in sweat following radon exposure in a warm and humid environment.
The objective was to evaluate whether activity of radon progenies can be detected in sweat following speleotherapeutic radon exposure (40 kBq/m3) in a warm (38 degrees C) and humid (relative humidity > 70%) environment. A group of 11 male patients with spondyloarthropathy (n = 6) or non-inflammatory rheumatic diseases (n = 5) underwent a 1-h treatment in the gallery of the Gasteiner Heilstollen, and 20 min after leaving the treatment area radon progeny activity was measured in sweat by utilizing a special filter set. The results suggest that radon is discharged with sweat, causing a significant activity of radon and radon progenies on the skin. This finding may be important from a clinical point of view, since specialists experienced in radon therapy have repeatedly emphasized the importance of the degree of radioactivity on the skin for the effectiveness of treatment. It has even been claimed that the skin is the major target for radon therapy, possibly because of the influence on Langerhans' cell function.
Fever↗
Speleotherapeutic radon exposure of a child suffering from juvenile chronic arthritis.
OBJECTIVE: Should a child be exposed to radon for therapeutic purposes? CASE REPORT: We report on a 7-year-old boy with juvenile chronic arthritis who experienced good pain relief after therapeutic radon exposure. DISCUSSION: Controversy exists whether children should be exposed to radon for therapeutic purposes. Benefit and risk of therapeutic radon exposure should be discussed more objectively and not emotionally.
Arthritis, Juvenile↗
[Use of conventional and unconventional therapies among patients with ankylosing spondylitis].
OBJECTIVE: A large share of rheumatism patients who are treated by rheumatologists use unconventional therapies additionally. What is the frequency in patients with ankylosing spondylitis who present for treatment at a radon spa? PATIENTS: 75 patients with ankylosing spondylitis presenting for treatment at the Gasteiner Heilstollen Hospital agreed to participate in the study (6 refused). DESIGN: In an open interview a research assistant asked the patients to name all interventions which they have used for the treatment of ankylosing spondylitis. RESULTS: Unconventional therapies (beside treatment at the Gasteiner Heilstollen) were used by 39 patients. Most frequently cited were acupuncture (15x), diet (8x), herbal therapy (7x), and homeopathy (6x). In total 40 different forms of unconventional therapies were mentioned. All patients claimed to have used at least two conventional therapies. CONCLUSION: Patients presenting for treatment at a radon spa claim to have used conventional therapies more frequently than unconventional forms of treatment.
Acupuncture Therapy↗
[Dynamics of radon decay product activity in saliva following therapeutic radon exposure].
Radon decay product activity was measured in saliva of 10 male patients 20-30 min after a 1-hour radon exposure in the gallery of the Gasteiner Heilstollen (radon activity 36.2 kBq/m(3), radon progeny activity 20.3 kBq/m(3)). In 1 patient showing relatively high activity (75th percentile) measurements were continued until 65 min after exposure. Patients were asked to collect about 2 ml of saliva in the mouth and produce it on a filter. After drying the filter at 300 degrees C, radon progeny activity was measured. Activity (median) at 20-30 min after leaving the treatment area was 4.5 Bq (25th percentile 1 Bq; 75th percentile 21 Bq). In the patient who underwent additional measurements the activity showed a further increase up to 29 Bq (35 min after radon exposure) before it continuously decreased to a very low activity (1-3 Bq) at 65 min after exposure. The results show that a significantly increased radon decay product activity is found in saliva after speleotherapeutic radon exposure. Maximum values were observed 35 min after radon exposure. Radon decay product activity almost disappeared after about 1 h.
Complementary Therapies↗
Unconventional medicine in Central Europe: a misuse of public health insurance?
OBJECTIVE: To scrutinize the presumption maintained by critics that patients seeking medical treatment at a health resort may be more motivated by the prospect of a pleasant sojourn paid for by health insurance than by the impairment caused by a disease. DESIGN: Variables for mobility (occiput-to-wall distance, cervical rotation, chest expansion, thoracic flexion, lumbar flexion, and finger-to-floor distance) and C-reactive protein were determined in 181 patients (male 134, female 47; age 52.4 +/- SEM 0.8 years) with ankylosing spondylitis (AS) whose costs were covered by their health insurance (group A) and in 77 AS patients (male 66, female 11; age 51.6 +/- 1.2 years) who paid their own costs (group B). SUBJECTS: A group of 258 patients with AS presenting for 3- or 4-week speleotherapeutic radon treatment at the Gasteiner Heilstollen Hospital, a medical institution located at Badgastein in the Austrian Alps. RESULTS: After Bonferroni correction for multiple calculations no significant difference was seen between the two groups. CONCLUSIONS: The results suggest that patients presenting for medical treatment at a health resort suffer a like degree of disease impairment, whether they pay their own costs or not. There was no evidence that seeking treatment at a health resort may be an attempt by patients to misuse the health insurance for "sponsored" holidays.
C-Reactive Protein↗
[Effect of a positive family history on the prognosis in patient with Bechterew disease].
The objective of the present study was to evaluate whether the patients with a family history of ankylosing spondylitis might have a milder course of the disease than patients with a negative family history. We investigated a group of 197 patients with ankylosing spondylitis who had been suffering from symptoms of the disease for > or = 20 years. After exclusion of the patients with a history, or current evidence of colitis or urethritis, the remaining 148 patients with ankylosing spondylitis (none with psoriasis) were divided into 2 groups on the basis of a positive (25 patients) or a negative (123 patients) family history of ankylosing spondylitis. The variables of mobility were compared. Furthermore, the present height was compared with the former (maximum) height. All variables measured in the present study showed slightly better results in the patients with a positive family history, but the differences were not significant. The decrease of height was slightly larger in patients with a positive family history. Evidently, a positive family history does not appear to give a reliable prediction of the long-term prognosis in Austrian and German patients with ankylosing spondylitis.
Adult↗
In ankylosing spondylitis serum interleukin-6 correlates with the degree of mobility restriction, but not with short-term changes in the variables for mobility.
The aim of this study was to evaluate whether the serum concentration of interleukin-6 (IL-6) reflects disease activity in ankylosing spondylitis (AS). A group of 271 AS patients were enrolled in the study, 261 of whom completed the entire protocol (201 males, 60 females, median age of 53 years). Serum IL-6 was measured three times (I, baseline; II, after 10-12 days; III, after 17-24 days) during a 3- or 4-week treatment at the health resort. At the same times, the variables for mobility were measured, and the patients were asked to assess their complaints (score) in a self-styled questionnaire. The serum concentration of IL-6 correlated with the measurements of occiput-to-wall distance, cervical rotation, finger-floor distance and Schober sign, and with morning pain at all three evaluations. Comparisons between changes in IL-6 and changes in the variables (measures of mobility, scores of the questionnaires) did not reveal significant correlations. Present data would suggest that in AS the serum concentration of IL-6 indicates the degree of mobility restriction resulting from previous disease progression, but is not a reliable marker of current disease activity.
Arthralgia↗
UVB radiation and its role in the treatment of postmenopausal women with osteoporosis.
In humans, the serum concentration of parathyroid hormone (PTH) is higher in winter than in summer. The increase of PTH can be suppressed by oral vitamin D supplements, which is considered beneficial to those with osteoporosis. The present study investigates whether this effect can also be achieved by serial ultraviolet (UV) irradiation of the skin. In total, 34 women suffering from postmenopausal osteoporosis were included in the open trial. In late winter, 20 patients were irradiated with a spectrum containing UVB, eight times over a period of 4 weeks. The serum concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D], PTH, osteocalcin, alkaline phosphatase (AP), calcium and phosphorus were measured before the first, and 2 days after the last, dose of radiation. The data were compared to the controls (n = 14, no UV exposure), who were evaluated once at the start of the study and then again 4 weeks later. After UV irradiation the level of 25(OH)D was increased, whilst that of PTH remained unchanged. The serum level of osteocalcin decreased in the control group, but did not change in the group of women who had been exposed to UV radiation. The present study of osteoporotic women does not confirm previous findings in studies of healthy volunteers i.e. that PTH can be suppressed by exposure to UVB radiation in winter. Further studies are required to specify whether there are subgroups of osteoporotic people who may benefit from exposure to UVB radiation during winter.
Adult↗
Course in massage therapy for medical students.
Massage courses for medical students have been held at Frankfurt University Medical School since 1987. To evaluate the motives for participation and to record possible changes in the attitude towards massage therapy, the students were asked to fill out a standardized questionnaire in 1990, 1993 and 1995/96. The results show that the motive for participation and the attitude towards massage therapy remained widely unchanged during these years. Summarizing all data (n = 199) the motives for participation were: (1) to practise massage therapy (86%), (2) to be better able to (later) prescribe massage therapy (66%), (3) to improve palpation skills (75%), (4) to do 'something practical' (56%), and (5) to (later) practise massage therapy as a medical doctor (23%). On average, the proportion of theory and practical instruction of 1:3.2 was considered suitable.
Adult↗
Unchanged response to stimulation of pituitary hormone release after serial UV irradiation in men.
A group of 24 healthy young men were evaluated before and after serial suberythematous ultraviolet (UV) radiation: group I, control (no irradiation); groups II and III, 12 radiations in 4 weeks with two different spectra (both containing UV-B). Before the first and 2 days after the last exposure all the volunteers were given an intravenous injection of thyrotropin releasing hormone (TRH, protirelin 0.2 mg) and luteinizing hormone releasing hormone (LH-RH, gonadorelin 0.1 mg). The serum concentrations of TSH, follicle stimulating hormone, LH and prolactin were measured at 0, 20, 30, 45 and 60 min by radioimmunoassay. Neither basal nor stimulated levels of the pituitary hormones showed significant changes after UV radiation. The results showed that exposure to suberythematous doses of UV did not influence the regulation of pituitary hormones in these healthy individuals.
Adult↗
Travel to sunny countries is associated with changes in immunological parameters.
Under laboratory conditions, various studies have shown that changes in immunological parameters must be expected after exposure to ultraviolet (UV) light. The objective of the present study was to evaluate, whether such changes can also be revealed after a vacation to a sunny country without prior adaptation to ultraviolet radiation. In 32 volunteers white blood cells, lymphocyte subpopulations, sIL2-R, sCD14, immunoglobulins and complement factor C3 were determined before and after a vacation in a country with abundant sunshine during winter. The subjects received relevant doses of UVB as confirmed by questionnaires, UVB-dosimetry and the significant increase of 25-hydroxyvitamin D. After vacation, there was a significant decrease of the CD4/8 ratio and the serum concentration of IgG. The serum concentration of sIL2-R, sCD14, IgA and C3 was increased after the journey. Sunshine exposure without prior adaptation may be responsible for significant alterations in the immune system in association with a vacation during winter.
Adaptation, Physiological↗
Raynaud's phenomenon in vibration syndrome: the impact of cold feet on skin temperature and vasomotion of the hand after immersion in cold water.
Patients with vibration syndrome, suffering from Raynaud's phenomenon, are sensitive to cold. Rewarming time, after local cooling, is delayed. The present study evaluated whether rewarming of the hand after cooling is influenced by the temperature of the feet. In five Japanese patients (former forest workers) with vibration syndrome, suffering from Raynaud's phenomenon, and in five healthy controls, temperature changes of the hand after cooling were registered under the two test situations (on different days) with the feet immersed in water of 35 degrees C or 20 degrees C, respectively. In both patients and controls (in both groups, in four of five cases) rewarming of the hand after cooling was faster when the feet were immersed in cold water, compared with when the feet were immersed in warm water. In this test situation, the systemic thermoregulative counterreaction appears to be more important for rewarming of the hand after cooling than a possible synchronous passive reaction accompanying warming of the feet. A deliberate training of the systemic counterreaction may prove beneficial for patients with Raynaud's phenomenon.
Adult↗
[Specific and aspecific sports activities of patients with Bechterew's disease].
Regular physical exercise is a major positive influence for the course of ankylosing spondylitis. By means of a standardized questionnaire, a total of 118 patients (78 male, 40 female) with ankylosing spondylitis were asked about their regular physical activity. The patients' mean age was 47 years, and they have been suffering from the symptoms of the disease for (a mean) 17 years. Twenty-nine percent of the patients practice disease-specific exercises daily. Thirty-nine percent have not received any instructions about the optimal exercises in the previous 5 years. Most information had been given by the physiotherapist at home or at the health resort. Non-specific physical exercises are practiced by half of the patients. Lack of time and lack of motivation are the major factors preventing the patients from greater activity. Deficient mobility was claimed by 37 of the 118 patients to prevent them from practicing sports. Better information, and hence motivation, of the patients are suggested by our findings as the most useful way to foster wider use of physical exercise.
Adult↗
[Hypertrophic osteoarthropathy as indicator for bronchial carcinoma].
Clubbing of the fingers and periosteal bone formation are the typical signs of hypertrophic osteoarthropathy, which mostly is a secondary manifestation of an underlying disease. Reporting a case of hypertrophic osteoarthropathy in association with bronchial carcinoma, we stress the importance of an extensive diagnostic evaluation with chest X-ray as a first step.
Adenocarcinoma↗
[Differential diagnostic significance of complex values of gas exchange during submaximal physical effort in patients with emphysema and pulmonary fibrosis].
The aim of this study was to clarify a) whether the behaviour of functional dead space ratio (VD/VE), alveolo-arterial difference of oxygen tensions (AaDO2) and the venous admixture ratio (QVA/Qt) differed at rest and during submaximal exercise, between patients with pulmonary emphysema and interstitial pulmonary fibrosis as well as from the respective findings in healthy controls, and b) whether a differentiation between these two diseases could be achieved by investigations of complex pulmonary gas exchange. Eleven patients with pulmonary fibrosis (F), which had been diagnosed by pulmonary biopsies, 11 patients with pulmonary emphysema (E) and 11 healthy controls (C) were subjected to conventional pulmonary function tests (PFTs: spirometry, bodyplethysmography, DCO) immediately followed by examinations of pulmonary gas exchange conducted at rest and during an incremental submaximal cycle spiroergometry (ERGO). With normal PFTs for C, vital capacity was diminished in F and the 1" timed vital capacity (FEV1) as well as Tiffeneau's index were reduced in E, while air way resistance and functional residual capacity were augmented in the latter group. In all patients the CO-diffusing capacity was lower compared to C, however, without differences between F and E. In both E and F, the arterial O2 tension were lower at rest as well as during ERGO when compared to C, whereas VD/VE, QVA/Qt and AaDO2 as well as the specific ventilation for O2 were higher, respectively. Alveolar ventilation was similar in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗