台灣僵直性脊椎炎資料庫 Ankylosing Spondylitis Databank Project in Taiwan 魏  正 宗  James Cheng-Chung Wei, M.D., Ph.D.   中山醫學大學附設醫院過敏免疫風...
AS in Taiwan <ul><li>Normal population: 23 M </li></ul><ul><li>Estimated AS prevalence: 0.2-0.4 % </li></ul><ul><li>Nation...
AS caring society in Taiwan   www.ascare.org.tw
Ankylosing Spondylitis Databank Project in Taiwan   Backgrounds / Aims <ul><li>There are still many unmet needs in the pat...
Methods <ul><li>Collected since 2003, still ongoing in CSMUH, Taichung, Taiwan. </li></ul><ul><li>Other cohorts in Taipei ...
Chinese version of Bath indices Reliability of BASDAI 、 BASFI 、 BAS-G James Cheng-Chung Wei , Ruey-Hong Wong,Jun-Huang Hua...
BASDAI 活性量表 Bath Ankylosing Spondylitis Activity Index James Cheng-Chung Wei, Ruey-Hong, Ming-Chih Chou, Hong-Shen Lee. Cl...
 
BAS-G 整體量表 Bath Ankylosing Spondylitis Patients’ Global Assessment
Physical examination  <ul><li>Finger to floors </li></ul><ul><li>Modified Schober test </li></ul><ul><li>Occipital-to-wall...
AS Tissue Bank in Taiwan <ul><li>Inflammatory markers:  Erythrocyte sedimentation rate (ESR) , Hypersensitive C-reactive p...
Results Taichung CSMUH Cohort Ankylosing Spondylitis Databank Project in Taiwan
Taiwan AS databank <ul><li>3000+ visits and samples from AS patients, including  </li></ul><ul><ul><li>1500 first-visit pa...
CSMUH cohort <ul><li>Mean age was 34.28    11.21 </li></ul><ul><li>Sex ratio (M:F) was 2.82 : 1.  </li></ul><ul><li>Disea...
Bath Indices <ul><li>Average BASDAI was 3.99    2.26,  </li></ul><ul><li>BASFI 2.13    2.17 and  </li></ul><ul><li>BAS-G...
Physical examinations Finger to floor distance, > 10 cm (%) (AS, n=820) 499 (60.85) Schober’s test, < 15cm (%) (n=818) 783...
Clinical manifestations Variables Patient number (%) History of the buttock pains and back, no. (%) 755 (93.44) History of...
HS-CRP Variable HS-CRP- p value HSCRP-  r BASDAI 0.0005 0.15117 BASFI 0.0002 * 0.16228 BAS-G 0.0001 * 0.22709
HLA-B27 in Taiwan <ul><li>91% of AS patients have HLA-B27. </li></ul><ul><li>5-9% in whole population in Taiwan </li></ul>...
 
Annals of the Rheumatic Diseases. 2009;68:1781–1786. <ul><li>Results:  </li></ul><ul><li>MMP-3/TIMP-1 alleles  showed that...
SNP vs Phenotype study
 
SNP of OPG  in AS JH Huang, JC Wei. Rheumatology 2010
 
Arthritis &rheumatism  2009;60(11),3269–79. (J. Gu and JCC Wei and Yu-Ling Wei contributed equally)
Identification of RGS1 as a Candidate Biomarker for Undifferentiated Spondylarthritis  J. Gu, JCC Wei ,Yu-Ling Wei, D. Yu....
Future works <ul><li>More works on genotype and phenothype </li></ul><ul><li>Micro-RNA studies </li></ul><ul><li>Registry ...
Conclusions  <ul><li>Our Chinese versions of the BASDAI, BASFI, and BAS-G showed good reliability, validity, and responsiv...
 
Thank you James Cheng-Chung Wei, M.D., Ph.D. [email_address] +886 975 128095 Chung Shan Medical University Hospital Chines...
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Wei as databank in taiwan 2011

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Wei as databank in taiwan 2011

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  • Dr Wei, Tsai and Chou published a highly-citated paper showing that HLA-B60 and B61 are strongly associated with B27-negative AS in Taiwan.
  • Dr Wei and colleagues in Chung Shan medical university had set up an AS databank to investigate the association of AS genotype and clinical phenotype. They had found that MMP-3/ TIMP alleles correlate to disease activity and functional index of AS.
  • They also collaborated with Prof Brown in Australia and found that IL1 gene complex was associated with AS in Taiwanese Chinese.
  • Moreover, investigators from Taiwan, China and Prof David Yu in UCLA had close collaboration to discover candidate biomarker for spondyloarthritis by microarray and rt-PCR.
  • They had found RGS1 as candidate biomarker for USpA, as well as NR4A2, IL-8…etc.
  • Wei as databank in taiwan 2011

    1. 1. 台灣僵直性脊椎炎資料庫 Ankylosing Spondylitis Databank Project in Taiwan 魏 正 宗  James Cheng-Chung Wei, M.D., Ph.D.   中山醫學大學附設醫院過敏免疫風濕科主任 Director, Division of Allergy, Immunology & Rheumatology Chung Shan Medical University Hospital, Taichung, Taiwan Chairman, Taiwan AS caring society
    2. 2. AS in Taiwan <ul><li>Normal population: 23 M </li></ul><ul><li>Estimated AS prevalence: 0.2-0.4 % </li></ul><ul><li>National Health Insurance </li></ul><ul><li>TNF blockers reimbursed for severe refractory AS </li></ul><ul><ul><li>BASDAI>6, ESR>28, CRP>1 mg/dl, B27+ </li></ul></ul><ul><li>AS caring society since 1998 </li></ul>
    3. 3. AS caring society in Taiwan www.ascare.org.tw
    4. 4. Ankylosing Spondylitis Databank Project in Taiwan Backgrounds / Aims <ul><li>There are still many unmet needs in the pathogenesis and management of AS. </li></ul><ul><li>To setup a research collaboration network in Taiwan. </li></ul><ul><li>A comprehensive AS translational database including clinical parameters and tissue samples is crucial and essential for future researches. </li></ul>
    5. 5. Methods <ul><li>Collected since 2003, still ongoing in CSMUH, Taichung, Taiwan. </li></ul><ul><li>Other cohorts in Taipei and Kaoshiung. </li></ul><ul><li>All first visit AS patients and some other SpA. </li></ul><ul><li>Comprehensive 10 pages epidemiological questionnaire </li></ul><ul><li>Psochometric validation of the Chinese version of Bath indices : Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Index (BAS-G </li></ul>
    6. 6. Chinese version of Bath indices Reliability of BASDAI 、 BASFI 、 BAS-G James Cheng-Chung Wei , Ruey-Hong Wong,Jun-Huang Huang, Chen-Tung Yu, Chung-Tei Chou, Ming-Shiou Jan, Gregory J. Tsay, Ming-Chih Chou, Hong-Shen Lee. Clin Rheumatol 2007;26:1685-1691 BASDAI BASFI BAS-G Number of items in Scale 6 10 2 Cronbach’s coefficient Alpha 0.85 0.94 0.91 ICC Test/Retest 0.93 0.92 0.94
    7. 7. BASDAI 活性量表 Bath Ankylosing Spondylitis Activity Index James Cheng-Chung Wei, Ruey-Hong, Ming-Chih Chou, Hong-Shen Lee. Clin Rheumatol (2007) 26:1685–1691
    8. 9. BAS-G 整體量表 Bath Ankylosing Spondylitis Patients’ Global Assessment
    9. 10. Physical examination <ul><li>Finger to floors </li></ul><ul><li>Modified Schober test </li></ul><ul><li>Occipital-to-wall </li></ul><ul><li>Lateral bending test </li></ul><ul><li>Shoulder and hip examination </li></ul>
    10. 11. AS Tissue Bank in Taiwan <ul><li>Inflammatory markers: Erythrocyte sedimentation rate (ESR) , Hypersensitive C-reactive protein (hs-CRP) and Immunoglobulin A (IgA) . </li></ul><ul><li>Serum were separated within 2 hours and stocked into -80 degree. </li></ul><ul><li>Peripheral blood mononuclear cells (PBMC) were separated and stored in liquid nitrogen. </li></ul><ul><li>DNA and RNA were extracted and stocked into -20 degree refrigerators. </li></ul><ul><li>HLA-B27 by PCR </li></ul><ul><li>HLA-B27subtyping by PCR-SSO methods. </li></ul><ul><li>HLA-ABC typing by lymphocytotoxicity assay. </li></ul>
    11. 12. Results Taichung CSMUH Cohort Ankylosing Spondylitis Databank Project in Taiwan
    12. 13. Taiwan AS databank <ul><li>3000+ visits and samples from AS patients, including </li></ul><ul><ul><li>1500 first-visit patients </li></ul></ul><ul><ul><li>2000+ follow up visits </li></ul></ul><ul><li>1500 DNA samples were collected. </li></ul><ul><li>130 RNA from peripheral mononuclear cell </li></ul><ul><li>Some synovial fluid, synovium, enthesis, and bone. </li></ul>
    13. 14. CSMUH cohort <ul><li>Mean age was 34.28  11.21 </li></ul><ul><li>Sex ratio (M:F) was 2.82 : 1. </li></ul><ul><li>Disease duration of 5.10  6.45 years </li></ul><ul><li>Delay diagnosis time lag was 5.91  6.64 years. </li></ul><ul><li>42.59 % patients have known family history </li></ul>JC Wei. Ankylosing spondylitis databank in Taiwan , PhD thesis, 2007
    14. 15. Bath Indices <ul><li>Average BASDAI was 3.99  2.26, </li></ul><ul><li>BASFI 2.13  2.17 and </li></ul><ul><li>BAS-G 4.27  2.82 cm in 10-cm scale. </li></ul><ul><li>61% were disease-active ( BASDAI>3 ) </li></ul><ul><li>27% were functional disabled ( BASFI>2 ) </li></ul>
    15. 16. Physical examinations Finger to floor distance, > 10 cm (%) (AS, n=820) 499 (60.85) Schober’s test, < 15cm (%) (n=818) 783 (95.72) Chest expansion test, < 5cm (%) (n=815) 532 (65.28) L’t lateral bending test, < 10cm (%) (n=812) 247 (30.42) Occiput to wall distance, > 0 cm (%) (n=814) 143 (17.57) Shoulder pain or limitation of motion (n=779) 197 (25.29)
    16. 17. Clinical manifestations Variables Patient number (%) History of the buttock pains and back, no. (%) 755 (93.44) History of peripheral arthritis, no. (%) 518 (64.43) History of uveitis, no. (%) 195 (24.19) History of psoriasis, no. (%) 112 (13.90) History of hematuria no. (%) 55 (6.86) History of oral ulcer, no. (%) (n=805) 94 (11.68) Onset symptom, no. ( peripheral arthristis / enteritis / back pain / uveitis) (%) ( 21.55 /2.96/50.56/2.54) HLA-B27 positive 91.2 % Family history of spondyloarthritis 349 (43.35)
    17. 18. HS-CRP Variable HS-CRP- p value HSCRP- r BASDAI 0.0005 0.15117 BASFI 0.0002 * 0.16228 BAS-G 0.0001 * 0.22709
    18. 19. HLA-B27 in Taiwan <ul><li>91% of AS patients have HLA-B27. </li></ul><ul><li>5-9% in whole population in Taiwan </li></ul><ul><li>HLA-B27 subtyping: 89% B2704 in Taiwan </li></ul>2704 2705 2706 2707 Total AS 108 3 0 0 111 Normal 72 4 5 3 84
    19. 21. Annals of the Rheumatic Diseases. 2009;68:1781–1786. <ul><li>Results: </li></ul><ul><li>MMP-3/TIMP-1 alleles showed that 6A/C (OR = 3.23, 95% CI 1.50 to 6.95) and 6A/T (OR = 2.55, 95% CI 1.17 to 5.54) had a significantly greater risk of AS than the 5A/T alleles. </li></ul><ul><li>MMP-3/TIMP-1 5A/T alleles had the lowest BASDAI (p = 0.02), BASFI (p = 0.05) and BAS-G (p = 0.02) among all MMP-3/TIMP-1 alleles. </li></ul>
    20. 22. SNP vs Phenotype study
    21. 24. SNP of OPG in AS JH Huang, JC Wei. Rheumatology 2010
    22. 26. Arthritis &rheumatism 2009;60(11),3269–79. (J. Gu and JCC Wei and Yu-Ling Wei contributed equally)
    23. 27. Identification of RGS1 as a Candidate Biomarker for Undifferentiated Spondylarthritis J. Gu, JCC Wei ,Yu-Ling Wei, D. Yu. Arthritis & rheumatism 2009;60(11),3269–79.
    24. 28. Future works <ul><li>More works on genotype and phenothype </li></ul><ul><li>Micro-RNA studies </li></ul><ul><li>Registry database for AS patients under TNF blockers therapy </li></ul><ul><ul><li>Focus on hepatitis B and TB </li></ul></ul><ul><li>International collaboration </li></ul><ul><li>… </li></ul>
    25. 29. Conclusions <ul><li>Our Chinese versions of the BASDAI, BASFI, and BAS-G showed good reliability, validity, and responsiveness . </li></ul><ul><li>We had established a comprehensive clinical and tissue database of AS in Taiwan. </li></ul><ul><li>This database can be used for further researches, medical practice and education. </li></ul>
    26. 31. Thank you James Cheng-Chung Wei, M.D., Ph.D. [email_address] +886 975 128095 Chung Shan Medical University Hospital Chinese Medicine Clinical Trial Center

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