51
|
Di Matteo A, Filippucci E, Cipolletta E, Musca A, Carotti M, Mashadi Mirza R, Jesus D, Martire V, Pierucci D, Di Carlo M, Salaffi F, Grassi W. Hip Involvement in Patients With Calcium Pyrophosphate Deposition Disease: Potential and Limits of Musculoskeletal Ultrasound. Arthritis Care Res (Hoboken) 2019; 71:1671-1677. [DOI: 10.1002/acr.23814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022]
|
52
|
Cipolletta E, Di Matteo A, Incorvaia A, Di Carlo M, Filippucci E, Grassi W. When chest pain is not "just" Tietze's syndrome: a case of non-Hodgkin's lymphoma. Clin Exp Rheumatol 2019; 37:714. [PMID: 30943144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
|
53
|
Macchioni P, Salvarani C, Possemato N, Gutierrez M, Grassi W, Gasparini S, Perricone C, Perrotta FM, Grembiale RD, Bruno C, Tripolino C, Govoni M, Ciancio G, Farina I, Ramonda R, Frallonardo P, Desiati F, Scarpa R, Costa L, Zabotti A, De Vita S, D’Attino RM, Gualberti G, Merolla R, di Luzio Paparatti U, Aldigeri R, Marchesoni A. Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study. J Rheumatol 2019; 46:904-911. [DOI: 10.3899/jrheum.171411] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 01/21/2023]
Abstract
Objective.The purpose of the ULISSE study was to evaluate the prevalence of clinical and ultrasonographic (US) entheseal involvement in patients with psoriatic arthritis (PsA), psoriasis, and fibromyalgia syndrome (FMS).Methods.In this cross-sectional multicenter study, patients with PsA and psoriasis (not taking systemic therapy) and FMS underwent a clinical evaluation of the entheses, and a B-mode and power Doppler examination of 6 pairs of entheses.Results.The study analyzed 140 patients with PsA, 51 with psoriasis, and 51 with FMS. Clinical and US examinations were performed in 1960 and 1680 entheses in the PsA group, and 714 and 612 entheses both in the psoriasis group and in the FMS group. In both per-patient and per-enthesis evaluation, the frequency of entheseal tenderness was higher in patients with FMS (92% of the patients and 46% of the entheses, compared with 66%/23% in the PsA group and 59%/18% in the psoriasis group). With US examination, signs of entheseal involvement were more frequent in both the per-patient and per-enthesis evaluation in PsA and psoriasis (about 90% of patients in both the PsA and psoriasis groups and 75% of patients in the FMS group had at least 1 site affected, and 54%, 41%, and 27% of the pairs of entheses in, respectively, PsA, psoriasis, and FMS patients showed at least 1 enthesis involved).Conclusion.The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.
Collapse
|
54
|
Di Matteo A, Isidori M, Corradini D, Cipolletta E, McShane A, De Angelis R, Filippucci E, Grassi W. Ultrasound in the assessment of musculoskeletal involvement in systemic lupus erythematosus: state of the art and perspectives. Lupus 2019; 28:583-590. [PMID: 30841789 DOI: 10.1177/0961203319834671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Musculoskeletal manifestations are extremely common in patients with systemic lupus erythematosus. Transient and migratory arthralgia is frequently reported even without clinical signs of joint or tendon inflammation. In less than 15% of patients, joints may be more severely affected by deforming (Jaccoud's arthropathy) and/or erosive arthropathy (Rhupus syndrome). In recent years, ultrasound has emerged as a promising imaging technique for the assessment of musculoskeletal involvement in systemic lupus erythematosus, having demonstrated the ability to detect inflammation and structural damage both at articular and periarticular level. Recent ultrasound studies have also revealed new insights into musculoskeletal involvement in patients with systemic lupus erythematosus, some of them questioning the traditional concepts of systemic lupus erythematosus arthropathy, with potential clinical, prognostic and therapeutic implications. In daily clinical practice, the use of ultrasound in the assessment of joint and tendon involvement in patients with systemic lupus erythematosus is still limited. Several methodological issues encountered in ultrasound studies evaluating musculoskeletal involvement in systemic lupus erythematosus patients need to be addressed in order to improve both the reliability and clinical usefulness of ultrasound findings. This paper reviews ultrasound studies assessing musculoskeletal involvement in patients with systemic lupus erythematosus, highlighting certainty, limits, potential applications and future perspectives of ultrasound use in systemic lupus erythematosus patients.
Collapse
|
55
|
Sebastiani M, Milazzo L, Atzeni F, Vacchi C, Manfredi A, Quartuccio L, Scirè C, Gaeta GB, Lapadula G, Armignacco O, Tavio M, D'Angelo S, Meroni P, Bazzichi L, Grassi W, Mathieu A, Mastroianni C, Sagnelli E, Santantonio T, Foppa CU, Puoti M, Sarmati L, Airò P, Epis OM, Scrivo R, Gargiulo M, Riva A, Ciancio G, Zehender G, Taliani G, Meroni L, Sollima S, Sarzi-Puttini P, Galli M. Italian consensus recommendations for the management of hepatitis C infection in patients with rheumatoid arthritis. Mod Rheumatol 2019; 29:895-902. [PMID: 30582388 DOI: 10.1080/14397595.2018.1558918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: The recent introduction of direct-acting antiviral agents (DAAs) which can eliminate Hepatitis C virus (HCV) had revolutionized the treatment of HCV infections also in a complex clinical setting such as the patients with rheumatoid arthritis (RA). HCV elimination is also opportune due to the availability of more efficient immunosuppressive drugs, whose effect on the course of HCV infection is largely unknown.Methods: Consensus process was endorsed by the Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) to review the available evidence and produce practical, hospital-wide recommendations. The consensus panel consisted of 18 infectious diseases consultants, 20 rheumatologists and one clinical epidemiologist, who used the criteria of the Oxford Centre for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations.Results: A core-set of statements about management of patients with RA and infection by HCV have been developed to help clinicians in their clinical practice.Conclusions: A screening for HCV should be performed in all RA patients and it is mandatory before starting an immunosuppressive therapy. Finally, a DAA treatment should be considered in all HCV-infected patients.Significance and InnovationsHCV antibodies should be investigated at the time of diagnosis of RA and, in any case, before starting immunosuppressive therapy with disease-modifying antirheumatic drugs (DMARDs).HCV eradication with DAA should be attempted as soon as possible, depending on patient conditions allowing a continuous oral treatment lasting 8-12 weeksConventional and biological DMARDs are allowed in patients with HCV infection, but they should be used cautiously in presence of advanced liver disease.
Collapse
|
56
|
Di Matteo A, Filippucci E, Cipolletta E, Satulu I, Hurnakova J, Lato V, De Angelis R, Horvath R, Pavelka K, Salaffi F, Grassi W. Entheseal involvement in patients with systemic lupus erythematosus: an ultrasound study. Rheumatology (Oxford) 2018; 57:1822-1829. [PMID: 29982722 DOI: 10.1093/rheumatology/key189] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives The main objective of this study is to explore the prevalence and distribution of entheseal US changes in a cohort of SLE patients, taking as controls a group including both PsA patients and healthy subjects. The secondary objective is to investigate the correlation between the US findings and the clinical and serological data in SLE patients. Methods Clinical and US assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses were performed by independent rheumatologists on 65 patients with SLE, 50 patients with PsA and 50 healthy subjects. US findings were identified according to the OMERACT definitions. In SLE patients, the correlation between the US changes and the clinical and laboratory findings was evaluated. Results US revealed one or more abnormalities in at least one enthesis in 44 out of 65 SLE patients (67.7%), 47 out of 50 PsA patients (94.0%) and 22 out of 50 healthy subjects (44.0%). In SLE patients, US findings indicating active inflammation were significantly more frequently detected than in healthy subjects (P < 0.001). The distal enthesis of the patellar tendon was the most commonly involved. The presence of power Doppler signal at the enthesis was an independent predictor of SLE disease activity (SLEDAI-2k P < 0.001, β = 0.52; musculoskeletal-BILAG P < 0.001, β = 0.56). Conclusion The burden of entheseal sonographic changes was significantly higher in SLE patients than in healthy subjects, especially as regards active inflammation. The presence of power Doppler signal at the enthesis may represent a potential biomarker of SLE disease activity.
Collapse
|
57
|
Scirè CA, Rossi C, Punzi L, Genderini A, Borghi C, Grassi W. Change gout: how to deal with this "silently-developing killer" in everyday clinical practice. Curr Med Res Opin 2018; 34:1411-1417. [PMID: 29553292 DOI: 10.1080/03007995.2018.1454896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging. REVIEW This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient's risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout. CONCLUSIONS Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.
Collapse
|
58
|
Sarzi-Puttini P, Filippucci E, Adami S, Meroni PL, Batticciotto A, Idolazzi L, De Lucia O, Talavera P, Kumke T, Grassi W. Clinical, Ultrasound, and Predictability Outcomes Following Certolizumab Pegol Treatment (with Methotrexate) in Patients with Moderate-to-Severe Rheumatoid Arthritis: 52-Week Results from the CZP-SPEED Study. Adv Ther 2018; 35:1153-1168. [PMID: 30043210 PMCID: PMC6096970 DOI: 10.1007/s12325-018-0751-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Indexed: 12/12/2022]
Abstract
Introduction To assess the impact of certolizumab pegol (CZP) treatment on clinical, patient-reported, and musculoskeletal ultrasound outcomes and to determine the treatment response time point most predictive of long-term outcomes in Italian patients with rheumatoid arthritis (RA). Methods CZP-SPEED (NCT01443364) was a 52-week, open-label, prospective, interventional, multicenter study. Biologic-naïve patients with moderate-to-severe active RA, who had failed at least one DMARD treatment, received CZP (400 mg at weeks 0, 2, and 4, then 200 mg every 2 weeks) concomitantly with methotrexate. The primary objective was to identify the time point of clinical response {decrease in 28-joint Disease Activity Score [DAS28(ESR)] ≥ 1.2} most predictive of a clinical response at week 52. Additional clinical and patient-reported outcomes were measured. Power Doppler (PD) ultrasound was used to assess synovial effusion, synovial proliferation, PD signal, cartilage damage, and bone erosion according to international guidelines. Results A total of 132 patients were enrolled and received CZP; 91/132 (69%) completed to week 52. Predicted 52-week responses for early responders (week 2 onwards) were between 65% and 70%. Rapid improvements in joint cavity widening and PD signal were observed to week 8 and maintained to week 52. Cartilage damage and bone erosion were stable over 52 weeks. No new safety signals were identified. Conclusion In Italian CZP-treated patients with moderate-to-severe RA, week 12 clinical responses may be predictive of long-term response at week 52. Rapid improvements in clinical, patient-reported, and musculoskeletal ultrasound outcomes were maintained to week 52. These data may aid rheumatologists to make earlier treatment decisions. Trial Registration ClinicalTrials.gov identifier, NCT01443364. Funding UCB Pharma. Electronic supplementary material The online version of this article (10.1007/s12325-018-0751-8) contains supplementary material, which is available to authorized users.
Collapse
|
59
|
Tardella M, Di Carlo M, Carotti M, Filippucci E, Grassi W, Salaffi F. Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis: Cut-off point definition for the presence of significant pulmonary fibrosis. Medicine (Baltimore) 2018; 97:e0566. [PMID: 29718851 PMCID: PMC6392694 DOI: 10.1097/md.0000000000010566] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings.Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD.Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD.The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.
Collapse
|
60
|
Di Matteo A, De Angelis R, Cipolletta E, Filippucci E, Grassi W. Systemic lupus erythematosus arthropathy: the sonographic perspective. Lupus 2017; 27:794-801. [PMID: 29237324 DOI: 10.1177/0961203317747716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Despite being promising, the use of ultrasound (US) in the assessment of musculoskeletal manifestations of systemic lupus erythematosus (SLE) is still limited. Literature on this topic is scarce and the spectrum and clinical relevance of US abnormalities has not yet been outlined. With this paper, we aim to explore the panel of joint and tendon US findings in a group of SLE patients. Methods Twenty-five consecutive SLE patients, with current or medical history of musculoskeletal symptoms, were studied. All patients underwent routine clinical examination and US evaluation. The US examination targeted sites clinically involved in the physical examination and/or indicated as painful in the patient's medical history. Results One or more US changes were found in all the patients. US abnormalities were detected in 85 out of the 243 scanned joints (35%), in 70 out of the 215 scanned tendons (32.6%) and in 10 out of the 41 scanned entheses (24.4%). Synovial effusion, synovial hypertrophy, "mixed" synovitis (coexistence of synovial effusion and synovial hypertrophy), joint dislocation, bone erosion, and cartilage damage were found in 9.5%, 11.5%, 14%, 3.7%, 2.1%, and 4.5% of the scanned joints, respectively. Tenosynovitis, tendon dislocation, tendon tear, tendon thinning, and tendinitis/peritendinitis were detected in 17.7%, 8.4%, 0.9%, 4.2%, and 4.7% of the scanned tendons, respectively. Power Doppler signal, hypoechogenicity, thickening, enthesophytes, calcifications, and bone erosions were detected at the entheseal level in 12.2%, 9.8%, 12.2%, 7.3%, 7.3%, and in 0% of the scanned entheses, respectively. Conclusions This study revealed an unexpectedly wide heterogeneity of US pathologic findings in the joints and tendons of patients with SLE. A broad spectrum of US changes also involving anatomic structures not considered in previous investigations, including entheses and tendons with no synovial sheath, was detected. These preliminary results suggest that US is able to identify several US "patterns" whose clinical, prognostic, and pathogenetic significance is still to be defined.
Collapse
|
61
|
Galli M, Antinori S, Atzeni F, Meroni L, Riva A, Scirè C, Adorni F, Quartuccio L, Sebastiani M, Airò P, Bazzichi L, Cristini F, Del Bono V, Manfredi A, Viapiana O, De Rosa F, Favalli E, Petrelli E, Salvarani C, Govoni M, Corcione S, Scrivo R, Sarmati L, Lazzarin A, Grassi W, Mastroianni C, Gaeta GB, Ferraccioli G, Cutolo M, De Vita S, Lapadula G, Matucci-Cerinic M, Armignacco O, Sarzi-Puttini P. Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis. Clin Exp Rheumatol 2017; 35:1018-1028. [PMID: 29185961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/19/2017] [Indexed: 06/07/2023]
Abstract
Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group).
Collapse
|
62
|
Sebastiani M, Atzeni F, Milazzo L, Quartuccio L, Scirè C, Gaeta GB, Lapadula G, Armignacco O, Tavio M, Olivieri I, Meroni P, Bazzichi L, Grassi W, Mathieu A, Mastroianni C, Sagnelli E, Santantonio T, Uberti Foppa C, Puoti M, Sarmati L, Airò P, Epis OM, Scrivo R, Gargiulo M, Riva A, Manfredi A, Ciancio G, Zehender G, Taliani G, Meroni L, Sollima S, Sarzi-Puttini P, Galli M. Italian consensus Guidelines for the management of hepatitis B virus infections in patients with rheumatoid arthritis. Joint Bone Spine 2017; 84:525-530. [DOI: 10.1016/j.jbspin.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/04/2017] [Indexed: 01/05/2023]
|
63
|
Zardi EM, Di Geso L, Afeltra A, Zardi DM, Giorgi C, Salaffi F, Carotti M, Gutierrez M, Filippucci E, Grassi W. An ultrasound automated method for non-invasive assessment of carotid artery pulse wave velocity. J Investig Med 2017; 66:973-979. [PMID: 28866633 DOI: 10.1136/jim-2017-000430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 12/29/2022]
Abstract
To validate the clinical applicability and feasibility of an automated ultrasound (US) method in measuring the arterial stiffness of patients with chronic inflammatory rheumatic diseases, comparing automated measurements performed by a rheumatologist without experience in vascular sonography with those obtained by a sonographer experienced in vascular US, using a standardized manual method. Twenty subjects affected by different chronic inflammatory rheumatic disorders were consecutively recruited. For each patient, the arterial stiffness of both common carotids was manually calculated. Subsequently, the measure of the pulse wave velocity (PWV) was obtained using an US device called Radio Frequency - Quality Arterial Stiffness (RF-QAS), provided by the same US system (ie, My Lab 70 XVG, Esaote SpA, Genoa, Italy) equipped with a 4-13 MHz linear probe. The reliability comparison between the two US methods was calculated using the intraclass correlation coefficient (ICC). ICC between the values obtained with the two methods for calculating the arterial stiffness resulted 0.789. A significant positive correlation between the two methods was also established with Pearson's (r=0.62, p<0.0001) and Spearman's analysis (r=0.66, p=0.001). A significant performance comparison was seen using Bland-Altman plot. The acquisition of the arterial stiffness parameter with the automated method required about 2 min for each patient. Clinical applicability of this US automated method to assess PWV at common carotid level by a rheumatologist is reliable and feasible in comparison with a conventional manual method.
Collapse
|
64
|
Möller I, Janta I, Backhaus M, Ohrndorf S, Bong DA, Martinoli C, Filippucci E, Sconfienza LM, Terslev L, Damjanov N, Hammer HB, Sudol-Szopinska I, Grassi W, Balint P, Bruyn GAW, D'Agostino MA, Hollander D, Siddle HJ, Supp G, Schmidt WA, Iagnocco A, Koski J, Kane D, Fodor D, Bruns A, Mandl P, Kaeley GS, Micu M, Ho C, Vlad V, Chávez-López M, Filippou G, Cerón CE, Nestorova R, Quintero M, Wakefield R, Carmona L, Naredo E. The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 2017; 76:1974-1979. [PMID: 28814430 DOI: 10.1136/annrheumdis-2017-211585] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/24/2017] [Accepted: 07/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature coupled with technological developments in US imaging has necessitated an update of these guidelines. OBJECTIVES To update the existing MSUS guidelines in rheumatology as well as to extend their scope to other anatomic structures relevant for rheumatology. METHODS The project consisted of the following steps: (1) a systematic literature review of MSUS evaluable structures; (2) a Delphi survey among rheumatologist and radiologist experts in MSUS to select MS and non-MS anatomic structures evaluable by US that are relevant to rheumatology, to select abnormalities evaluable by US and to prioritise these pathologies for rheumatology and (3) a nominal group technique to achieve consensus on the US scanning procedures and to produce an electronic illustrated manual (ie, App of these procedures). RESULTS Structures from nine MS and non-MS areas (ie, shoulder, elbow, wrist and hand, hip, knee, ankle and foot, peripheral nerves, salivary glands and vessels) were selected for MSUS in rheumatic and musculoskeletal diseases (RMD) and their detailed scanning procedures (ie, patient position, probe placement, scanning method and bony/other landmarks) were used to produce the App. In addition, US evaluable abnormalities present in RMD for each anatomic structure and their relevance for rheumatology were agreed on by the MSUS experts. CONCLUSIONS This task force has produced a consensus-based comprehensive and practical framework on standardised procedures for MSUS imaging in rheumatology.
Collapse
|
65
|
D'Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, Filippucci E, Grassi W, Iagnocco A, Jousse-Joulin S, Kane D, Naredo E, Schmidt W, Szkudlarek M, Conaghan PG, Wakefield RJ. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce -Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 2017; 3:e000428. [PMID: 28948983 PMCID: PMC5597799 DOI: 10.1136/rmdopen-2016-000428] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/04/2017] [Accepted: 04/24/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To develop a consensus-based ultrasound (US) definition and quantification system for synovitis in rheumatoid arthritis (RA). METHODS A multistep, iterative approach was used to: (1) evaluate the baseline agreement on defining and scoring synovitis according to the usual practice of different sonographers, using both grey-scale (GS) (synovial hypertrophy (SH) and effusion) and power Doppler (PD), by reading static images and scanning patients with RA and (2) evaluate the influence of both the definition and acquisition technique on reliability followed by a Delphi exercise to obtain consensus definitions for synovitis, elementary components and scoring system. RESULTS Baseline reliability was highly variable but better for static than dynamic images that were directly acquired and immediately scored. Using static images, intrareader and inter-reader reliability for scoring PD were excellent for both binary and semiquantitative (SQ) grading but GS showed greater variability for both scoring systems (κ ranges: -0.05 to 1 and 0.59 to 0.92, respectively). In patient-based exercise, both intraobserver and interobserver reliability were variable and the mean κ coefficients did not reach 0.50 for any of the components. The second step resulted in refinement of the preliminary Outcome Measures in Rheumatology synovitis definition by including the presence of both hypoechoic SH and PD signal and the development of a SQ severity score, depending on both the amount of PD and the volume and appearance of SH. CONCLUSION A multistep consensus-based process has produced a standardised US definition and quantification system for RA synovitis including combined and individual SH and PD components. Further evaluation is required to understand its performance before application in clinical trials.
Collapse
|
66
|
Di Matteo A, Filippucci E, Salaffi F, Carotti M, Carboni D, Di Donato E, Grassi W. Diagnostic accuracy of musculoskeletal ultrasound and conventional radiography in the assessment of the wrist triangular fibrocartilage complex in patients with definite diagnosis of calcium pyrophosphate dihydrate deposition disease. Clin Exp Rheumatol 2017; 35:647-652. [PMID: 28339356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the diagnostic accuracy of musculoskeletal ultrasound (MSUS) and x-ray in evaluating wrist triangular fibrocartilage complex (TFCC) in patients with calcium pyrophosphate dihydrate deposition disease (CPPD) and to investigate the agreement between the extent of the calcium pyrophosphate dihydrate (CPP) crystal deposits assessed by MSUS and the radiographic findings. METHODS We enrolled 84 patients: 36 patients with "definite" CPPD and 48 controls. The Ryan and McCarty diagnostic criteria were used. A rheumatologist performed bilateral MSUS examinations of the TFCC in all patients, assessing both the presence and absence of CCP crystals deposits and their extent (0-3; 0: absent; 1: 1-2 spots; 2: more than two spots covering <50% of the volume of the structure; 3: deposits covering >50% of the volume of the structure). A radiologist evaluated the presence/absence of x-ray calcifications at TFCC level in both groups. RESULTS MSUS and x-ray sensitivity was 77.8% and 76.4%, respectively, whereas MSUS and x-ray specificity was 90.6% and 96.9%, respectively. Total agreement between MSUS and radiographic findings indicative of calcifications at TFCC level was 88.7%. CONCLUSIONS This study supports the diagnostic accuracy of MSUS and x-ray in evaluating TFCC crystal deposits in patients with CPPD. Sensitivity and specificity of MSUS and x-ray resulted comparable. The highest MSUS score of the extent of the deposits correlated better with x-ray findings.
Collapse
|
67
|
Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Maddali Bongi S, Di Munno O, Nuti R, Manzini C, Ferri C, Bogliolo L, Mathieu A, Cantatore F, Del Puente A, Muratore M, Grassi W, Frediani B, Saviola G, Delvino P, Mirone L, Ferraccioli G, Tripi G, Piazza I, Gatti D. Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study. Reumatismo 2017; 69:30-39. [DOI: 10.4081/reumatismo.2017.922] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022] Open
Abstract
Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.
Collapse
|
68
|
Okano T, Filippucci E, Di Carlo M, Draghessi A, Carotti M, Salaffi F, Wright G, Grassi W. Ultrasonographic evaluation of joint damage in knee osteoarthritis: feature-specific comparisons with conventional radiography. Rheumatology (Oxford) 2016; 55:2040-2049. [DOI: 10.1093/rheumatology/kew304] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/13/2016] [Indexed: 01/07/2023] Open
|
69
|
D'Agostino MA, Terslev L, Wakefield R, Østergaard M, Balint P, Naredo E, Iagnocco A, Backhaus M, Grassi W, Emery P. Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission. Ann Rheum Dis 2016; 75:1902-1908. [PMID: 27553213 DOI: 10.1136/annrheumdis-2016-209646] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/31/2016] [Indexed: 12/25/2022]
Abstract
The absence of specific guidance on how to use ultrasound (US) to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of US in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to European League against Rheumatism (EULAR) imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely five novel algorithms, which identify when US could be used. They are designed to aid diagnosis, to inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs.
Collapse
|
70
|
Di Matteo A, Satulu I, Di Carlo M, Lato V, Filippucci E, Grassi W. Entheseal involvement in systemic lupus erythematosus: are we missing something? Lupus 2016; 26:320-328. [PMID: 27496900 DOI: 10.1177/0961203316662723] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Continuing the research initiated in patients with inflammatory arthritis, recent studies have shown the potential role of musculoskeletal ultrasound (MSUS) in the evaluation of clinical and subclinical lupus synovitis. The inflammatory process in SLE is traditionally considered to be localized at synovial tissue areas while enthesis is not included among the possible targets of the disease. Patients and methods Entheses included in the Glasgow Ultrasound Enthesitis Scoring System were scanned in a cohort of 20 SLE patients serving as disease controls in an MSUS study aimed at assessing enthesitis in patients with psoriatic arthritis. We describe in detail four cases with unexpected and unequivocal expressions of MSUS enthesitis according to the OMERACT definition. Three out of four patients had no predisposing factors for enthesopathy. Case no. 2 was treated with a variable-dose prednisone regimen. Results In the four cases MSUS examination revealed relevant grey-scale and power Doppler abnormalities at the entheseal level, most commonly at the distal insertion of the patellar tendon. Signs of clinical enthesitis were detected in only one patient. Conclusions This case series shows for the first time the presence of clearly evident MSUS findings indicative of enthesitis in four out of 20 SLE patients (20%), raising the hypothesis that enthesis could be a missing target in the clinical evaluation of SLE patients. Our case series justifies further investigations for a better evaluation of the prevalence, characteristics and clinical relevance of entheseal involvement in SLE.
Collapse
|
71
|
Vreju FA, Filippucci E, Gutierrez M, Di Geso L, Ciapetti A, Ciurea ME, Salaffi F, Grassi W. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clin Exp Rheumatol 2016; 34:673-678. [PMID: 27192221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The main aim of this study was to investigate the relationship between ultrasound (US) findings indicative of joint inflammation and US features characterising bone erosions at joint level in patients with rheumatoid arthritis (RA) in clinical remission. METHODS Twenty-four consecutive patients with RA in clinical remission according to EULAR criteria (DAS28<2.6) underwent a complete clinical assessment. An experienced sonographer blind to the clinical data performed the US examinations to detect and score signs of joint inflammation and bone erosions from second to fifth metacarpophalangeal (MCP) joints of both hands. All joints were scanned both on dorsal and volar aspects. The second and fifth MCP joints were scanned also in lateral aspects. RESULTS The patients were mainly female (79.2%), with a mean age of 63.2 years ±12.3 standard deviation (SD) and a mean disease duration of 114.5 months ±53.9 SD. Half of the patients were rheumatoid factor positive and 45.8% were anti-citrullinated protein antibody positive. A total of 192 MCP joints and 480 aspects were assessed. Of these joints, 105 (54.7%) were found inflamed by grey-scale US, 57 (29.7%) were power Doppler (PD) positive, and bone erosions were detected in 42 (21.7%) joints. PD signal was found in 30 (53.6%) of the 56 eroded aspects and in only 41 (9.7%) out of the 424 aspects without bone erosions. Both the GS and PD mean scores were statistically higher in the joints with US bone erosions compared to those without erosions. CONCLUSIONS A higher prevalence of PD signal was found in the joints where bone erosions were detected. This is the first study providing evidence supporting the association between US bone erosions and the persistence of subclinical inflammation in RA patients in clinical remission.
Collapse
|
72
|
Hurnakova J, Di Matteo A, Salaffi F, Carotti M, Cipolletta E, Draghessi A, Di Donato E, Di Carlo M, Lato V, Pavelka K, Filippucci E, Grassi W. SAT0547 Ultrasound Assessment of Cartilage Damage at Metacarpal Head Level in Rheumatoid Arthritis and Osteoarthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
73
|
De Angelis R, Di Donato E, Grassi W. FRI0297 A Quantitative Videocapillaroscopic Study about The Main Categories of The “Scleroderma Pattern” and Their Correlation with The Clinical Features of Systemic Sclerosis (SSC). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
74
|
Sarzi-Puttini P, Filippucci E, Adami S, Meroni P, Talavera P, Kumke T, Grassi W. THU0151 Multicenter, Open-Label Study To Evaluate The Predictability of Disease Control at Week 52 Based on Early Response To Certolizumab Pegol (in Combination with Methotrexate) in Italian Patients with Moderate To Severe Rheumatoid Arthritis: The CZP-Speed Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
75
|
De Angelis R, Di Donato E, Grassi W. SAT0224 Nailfold Videocapillaroscopic Findings in Undifferentiated Connective Tissue Disease (UCTD) and Their Relationship with Raynaud's Phenomenon (RP). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
76
|
Di Matteo A, Satulu I, Di Carlo M, Lato V, Draghessi A, Di Donato E, Hurnakova J, Filippucci E, Grassi W. SAT0552 Musculoskeletal Ultrasound (MSUS) Showing Entheseal Involvement in Patients with Systemic Lupus Erythematosus (SLE): Something Unexpected. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
77
|
Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol 2015; 11:1131-46. [DOI: 10.1586/1744666x.2015.1075395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
78
|
Smolen JS, Wollenhaupt J, Gomez-Reino JJ, Grassi W, Gaillez C, Poncet C, Le Bars M, Westhovens R. Attainment and characteristics of clinical remission according to the new ACR-EULAR criteria in abatacept-treated patients with early rheumatoid arthritis: new analyses from the Abatacept study to Gauge Remission and joint damage progression in methotrexate (MTX)-naive patients with Early Erosive rheumatoid arthritis (AGREE). Arthritis Res Ther 2015; 17:157. [PMID: 26063454 PMCID: PMC4494702 DOI: 10.1186/s13075-015-0671-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/02/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION This study evaluated various remission criteria in abatacept plus methotrexate (MTX)-treated patients with early rheumatoid arthritis (RA). We aimed to investigate the time to, and sustainability of, remission, and to evaluate the relationship between remission, function and structure. METHODS Post hoc analyses were performed from the 12-month, double-blind period of the Abatacept study to Gauge Remission and joint damage progression in methotrexate (MTX)-naive patients with Early Erosive rheumatoid arthritis (AGREE) in patients with early RA (≤2 years) and poor prognostic factors, comparing abatacept plus MTX (n = 210) versus MTX alone (n = 209). RESULTS At month 12, Disease Activity Score 28, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index and Boolean remission rates were, for abatacept plus MTX versus MTX alone: 47.6 % versus 27.3 %, 33.3 % versus 12.4 %, 34.3 % versus 16.3 %, and 23.8 % versus 5.7 %, respectively. Cumulative probability demonstrated higher proportions achieving first remission and first sustained remission for abatacept plus MTX versus MTX alone (e.g., 23.3 % [95 % confidence interval (CI): 17.6, 29.1] vs 12.9 % [8.4, 17.5] for first SDAI remission over 0-6 months). For patients in SDAI remission at month 3, mean Health Assessment Questionnaire-Disability Index at month 12 was 0.20 versus 0.50 for abatacept plus MTX versus MTX alone. Mean changes in radiographic score from baseline to month 12 were minimal for patients in SDAI remission at month 3 in both groups, while less structural damage progression was seen, 0.75 versus 1.35, respectively, for abatacept plus MTX versus MTX alone for patients with moderate/high disease activity at month 3 (adjusted mean treatment difference: -0.60 [95 % CI: -1.11, -0.09; P < 0.05]). CONCLUSIONS High proportions of abatacept plus MTX-treated patients achieved stringent remission criteria. Remission was associated with long-term functional benefit; dissociation was seen between clinical and structural outcomes for abatacept. These findings highlight the impact of reaching stringent remission targets early, on physical function and structural damage, in MTX-naïve biologic-treated patients. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00122382. Registered 19 July 2005.
Collapse
|
79
|
Okano T, Filippucci E, Draghessi A, Di Carlo M, Carotti M, Salaffi F, Wright G, Grassi W. SAT0593 Ultrasonographic Evaluation of Joint Damage in Knee Osteoarthritis: A Comparison with Conventional Radiography. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
80
|
Di Donato E, De Angelis R, Salaffi F, Grassi W. FRI0584 Inter-Observer Agreement in the Quantitative Assessment of the Nailfold Capillaroscopic Findings in Systemic Sclerosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
81
|
Pereira DF, Gutierrez M, de Buosi ALP, Ferreira FBMD, Draghessi A, Grassi W, Natour J, Furtado RNV. Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings? Clin Rheumatol 2015; 34:1975-9. [PMID: 25956957 DOI: 10.1007/s10067-015-2964-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/12/2015] [Accepted: 04/28/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study is addressed to determine if there is a correlation between intra-articular power Doppler (PD) and pain symptoms in patients with rheumatoid arthritis (RA). METHODS A cross-sectional study of patients with established RA was rolled out. Seventy-two patients with chronic swelling at metacarpophalangeal (MCP) joints were consecutively enrolled in the study and divided into two groups (painful and painless). In the painful group, the inclusion criteria were pain in the visual analog scale (VAS), from 0 to 10 cm, of at least 4 cm and 0 in the painless group. All two to five MCP joints, bilaterally, were scanned by ultrasound (US) searching for intra-articular PD presence. Any value of p < 0.05 was considered significant. RESULTS Patients in the painful group had longer morning stiffness, worse 28-joint disease activity score (DAS 28), and health assessment questionnaire (HAQ) indexes. There were no association between pain and gray scale (GS) synovitis, odds ratio (OR) = 0.9 (0.6-1.2), p = 0.485; and pain and intra-articular PD, OR = 0.8 (0.6-1.2), p = 0.244. CONCLUSION Intra-articular PD was not correlated with pain symptom in this study.
Collapse
|
82
|
Westhovens R, Robles M, Ximenes AC, Wollenhaupt J, Durez P, Gomez-Reino J, Grassi W, Haraoui B, Shergy W, Park SH, Genant H, Peterfy C, Becker JC, Murthy B. Maintenance of remission following 2 years of standard treatment then dose reduction with abatacept in patients with early rheumatoid arthritis and poor prognosis. Ann Rheum Dis 2014; 74:564-8. [PMID: 25550337 PMCID: PMC4345907 DOI: 10.1136/annrheumdis-2014-206149] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate maintenance of response while reducing intravenous abatacept dose from ~10 mg/kg to ~5 mg/kg in patients with early rheumatoid arthritis (RA) who achieved disease activity score (DAS)28 (erythrocyte sedimentation rate, ESR) <2.6. METHODS This 1-year, multinational, randomised, double-blind substudy evaluated the efficacy and safety of ~10 mg/kg and ~5 mg/kg abatacept in patients with early RA with poor prognosis who had reached DAS28 (ESR) <2.6 at year 2 of the AGREE study. The primary outcome was time to disease relapse (defined as additional disease-modifying antirheumatic drugs, ≥2 courses high-dose steroids, return to open-label abatacept ~10 mg/kg, or DAS28 (C reactive protein) ≥3.2 at two consecutive visits). RESULTS 108 patients were randomised (~10 mg/kg, n=58; ~5 mg/kg, n=50). Three and five patients, respectively, discontinued, and four per group returned to open-label abatacept. Relapse over time and the proportion of patients relapsing were similar in both groups (31% (~10 mg/kg) vs 34% (~5 mg/kg); HR: 0.87 (95% CI 0.45 to 1.69)). Mean steady-state trough serum concentration for the ~10 mg/kg group was 20.3-24.1 µg/mL, compared with 8.8-12.0 µg/mL for the ~5 mg/kg group. CONCLUSIONS This exploratory study suggests that abatacept dose reduction may be an option in patients with poor prognosis early RA who achieve DAS28 (ESR) <2.6 after ≥1 year on abatacept (~10 mg/kg). TRIAL REGISTRATION NUMBER NCT00989235.
Collapse
|
83
|
Giacomelli R, Gorla R, Trotta F, Tirri R, Grassi W, Bazzichi L, Galeazzi M, Matucci-Cerinic M, Scarpa R, Cantini F, Gerli R, Lapadula G, Sinigaglia L, Ferraccioli G, Olivieri I, Ruscitti P, Sarzi-Puttini P. Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study. Rheumatology (Oxford) 2014; 54:792-7. [DOI: 10.1093/rheumatology/keu398] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Indexed: 11/12/2022] Open
|
84
|
Tămaş MM, Filippucci E, Becciolini A, Gutierrez M, Di Geso L, Bonfiglioli K, Voulgari PV, Salaffi F, Grassi W. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford) 2014; 53:1100-7. [PMID: 24501246 DOI: 10.1093/rheumatology/ket484] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and distribution of bone erosions detectable by US in patients with early RA (ERA) in comparison with long-standing RA (LSRA), other erosive diseases and healthy controls. METHODS Thirty patients with ERA and 80 patients with LSRA were consecutively recruited. Thirty patients with PsA, 15 with primary OA, 10 with gout and 20 healthy subjects were included as controls. Bone erosions were investigated at the following anatomical sites: the second and fifth metacarpal heads, the ulnar head and the first and fifth metatarsal heads, bilaterally. Dorsal, volar and lateral aspects were explored on longitudinal and transverse views. RESULTS At least one US bone erosion was found in 20 (66.7%) of 30 patients with ERA and in 10 (33%) of them it was found on the fifth metatarsal head. Bone erosions were most frequently found on the lateral quadrants of all scanned anatomical sites. If the second and fifth metacarpal heads and the fifth metatarsal head were scanned, an erosive disease could be found in 60% of ERA patients. The first metatarsal head was most frequently involved in the disease control group. CONCLUSION This study found a high percentage of ERA patients with US bone erosions, with the fifth metatarsal head and the lateral aspects the most frequently involved site and quadrants. US scanning for bone erosions on a few target joints was found feasible and provided information not obtainable with clinical examination.
Collapse
|
85
|
Spadaro A, Lubrano E, Marchesoni A, Cauli A, Cantini F, Carotti M, D'Angelo S, Grassi W, Lapadula G, Macchioni P, Mathieu A, Punzi L, Ramonda R, Salaffi F, Salvarani C, Scarpa R, Olivieri I. The adherence to ASAS classification criteria and to ASAS recommendations for the use of anti-TNH-alpha agents in axial spondyloarthritis. Clin Exp Rheumatol 2014; 32:465-470. [PMID: 24850468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/20/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the adherence of practicing rheumatologists, before and after an educational project, to Assessment of SpondyloArthritis international Society (ASAS) classification criteria and to ASAS recommendations for the use of anti-tumor necrosis factor (TNF)-alpha agents in patients with axial spondyloarthritis (SpA). METHODS The project involved 53 rheumatologists attending 2 educational meetings on an update of SpA. Each meeting included interactive sessions on 1) clinical cases, 2) clinimetric evaluation, including ASAS core set for daily practice and 3) imaging. Diagnostic and therapeutic approach of each participant was tested using short clinical cases, obtained from real-life rheumatology settings, at the beginning and at the end of this educational project. Each case for diagnostic (n=10) or therapeutic purpose (n=10) had 10 possible choices. Each participant gave a score from 0 (total disagreement) to 10 (total agreement) for each choice. RESULTS At baseline, the rheumatologists had an excellent agreement with ASAS classification criteria for axial SpA and anti-TNF-alpha treatment according to ASAS recommendations with a further significant improvement after the educational programme. In axial SpA cases with acute anterior uveitis (AU) or Crohn's disease, anti-TNF-alpha treatment was indicated mainly as monoclonal anti-TNF antibody. In presence of elevated levels of CRP, anti-TNF option has been considered useful. CONCLUSIONS Practicing rheumatologists had a satisfying adherence to ASAS classification criteria and to ASAS recommendations for the use of anti-TNF-alpha agents for patients with axial SpA. Extra-articular manifestations and other variables might play a role in the decision-process of the management of axial SpA.
Collapse
|
86
|
Salvarani C, Grassi W, Spadaro A, Grembiale R, Govoni M, Ramonda R, Marchesoni A, Scarpa R, De Vita S, Saragaglia V, Merolla R, di Luzio Paparatti U, Olivieri I. SAT0387 Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Italian Patients with Psoriatic Arthritis, Psoriasis and Fibromyalgia –The ULISSE Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
87
|
Gutierrez M, Okano T, Salaffi F, Bruno A, Filippucci E, Grassi W. AB0081 Sub-Clinical Carotid Atherosclerosis in Patients with Gout. Preliminary Results. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
88
|
De Angelis R, Salaffi F, Di Donato E, Muti S, Grassi W. FRI0498 A Quantitative Videocapillaroscopic Study about the Relationship of Avascular Areas with the Clinical Characteristics and Disease Severity in Patients with Systemic Sclerosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
89
|
Pereira D, de Buosi A, Ferreira F, Draghessi A, Riveros M, Grassi W, Natour J, Furtado R. AB0283 Articular Pain is Correlated with Ultrasound Power Doppler Findings? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
90
|
Gutierrez M, Pineda C, Navarro C, Salaffi F, Hernandez C, Ventura L, Carotti M, Grassi W. SAT0326 Validity of Ultrasound in the Assessment of Pulmonary Fibrosis in Systemic Sclerosis: Correlation with High Resolution Computed Tomography, Pulmonary Function Test and Histological Findings. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
91
|
Šenolt L, Grassi W, Szodoray P. Laboratory biomarkers or imaging in the diagnostics of rheumatoid arthritis? BMC Med 2014; 12:49. [PMID: 24642071 PMCID: PMC3984686 DOI: 10.1186/1741-7015-12-49] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/10/2014] [Indexed: 12/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is a common autoimmune disease in which a heterogeneous course and different pathogenic mechanisms are implicated in chronic inflammation and joint destruction. Despite the diagnostic contribution of anti-citrullinated protein/peptide antibodies (ACPAs) and rheumatoid factors, about one-third of RA patients remain seronegative. ACPAs belong to a heterogeneous family of autoantibodies targeting citrullinated proteins, including myelin-basic protein, several histone proteins, filaggrin and fibrin, fibrinogen or vimentin. In addition to ACPAs, antibodies directed against other post-translationally modified-carbamylated proteins (anti-CarP) were detected in up to 30% of ACPA-negative patients. Using phage display technology, further autoantibodies were recently discovered as candidate biomarkers for seronegative RA patients. Furthermore, in clinical practice, ultrasound may reveal subclinical synovitis and radiographically undetected bone erosions. To improve diagnostic certainty in undifferentiated arthritis and seronegative patients, ultrasound imaging and several new biomarkers may help to identify at risk patients and those with early disease. In this commentary we summarize recent advances in joint ultrasound and future potential of serological biomarkers to improve diagnosis of RA.
Collapse
|
92
|
Aydın SZ, Filippucci E, Atagündüz P, Yavuz Ş, Grassi W, Direskeneli H. Sonographic measurement of Achilles tendon thickness in seronegative spondyloarthropathies. Eur J Rheumatol 2014; 1:7-10. [PMID: 27708863 DOI: 10.5152/eurjrheum.2014.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/16/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To define the best cut-off value for identifying Achilles tendon thickening using ultrasound (US) in patients with spondyloarthropathies (SpA) and to assess its diagnostic utility in comparison with different cut-off values used in the literature. MATERIAL AND METHODS One-hundred and one subjects (55 SpA patients and 46 age and body mass index ((BMI)-matched healthy controls (HC)) were investigated. US was performed using a MyLab70 US system (Esaote Biomedica, Genoa, Italy) with a linear probe (6-18 MHz). Three images per Achilles enthesis were stored and the antero-posterior thickness of the enthesis was measured at the level of the Achilles tendon deeper margin insertion into the calcaneal bone on the longitudinal median scan. The best cut-off value for each gender was determined by ROC curve analysis and compared to the other cut-off values in the literature: 1) 5.29 mm for both genders, and 2) 5.5 mm for females and 6.2 mm for males. The number of measurements exceeding the cut-off values as well as sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values were calculated. RESULTS A significant difference was observed for Achilles enthesis thickness between genders (mean±SD: 4.6±0.7 mm in males vs. 4.0±0.8 mm in females, p<0.00) and between SpA patients and HC (mean±SD: 4.4±0.8 mm in SpA patients vs. 4.0±0.8 mm in HC, p<0.001). The ROC curve analysis revealed the best cut-off value to be 3.7 mm for females and 4.8 mm for males (SE: 43-70%, SP: 59-85%, PPV: 66-79%, NPV: 54-63%). Previously reported cut-off values were found to have high SP (91-98%) but very low SE (2-11%). CONCLUSION Achilles tendon thickness differs between genders; thus, it is crucial to refer to normal values that are specific for gender. High cut-off values, as previously suggested, showed very low SE in the current study. When Achilles enthesis thickening is used for the purpose of screening enthesitis in SpA patients, a lower cut-off value has a higher SE with slightly worse SP, PPV and NPVs.
Collapse
|
93
|
Dougados M, Devauchelle-Pensec V, Ferlet JF, Jousse-Joulin S, D’Agostino MA, Backhaus M, Bentin J, Chalès G, Chary-Valckenaere I, Conaghan P, Etchepare F, Gaudin P, Grassi W, van der Heijde D, Mariette X, Naredo E, Szkudlarek M, Wakefield R, Saraux A. SAT0408 Both clinical and ultrasonographic evaluation of synovitis are relevant to predict subsequent radiological deterioration in rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
94
|
Iannone F, Ferraccioli G, Ferri C, Galeazzi M, Gerli R, Giacomelli R, Grassi W, Gorla R, Govoni M, Marchesoni A, Punzi L, Sarzi-Puttini P, Triolo G, Lapadula G. AB0465 Etanercept therapy in rheumatoid arthritis patients with moderate or severe disease activity. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
95
|
Filippucci E, Di Geso L, Girolimetti R, Grassi W. Ultrasound in crystal-related arthritis. Clin Exp Rheumatol 2014; 32:S42-S47. [PMID: 24528621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/11/2013] [Indexed: 06/03/2023]
Abstract
In the last decade, an increasing number of rheumatologists have been using ultrasound (US) for assessing patients with gout and calcium pyrophosphate deposition (CPPD) disease. The high reflectivity of the crystalline aggregates and the ability of US to detect even minimal crystal deposits explain the high sensitivity of this imaging technique. Furthermore, the peculiar distribution within the target tissues results in the generation of typical US patterns and explains the excellent specificity of some US findings. The large spectrum of US findings and their wide combination generate different scenarios in different patients and also in the same subject. Such a high variety impaired the standardisation of the definitions of each US finding. This review presents the main US findings indicative of crystal deposits, discusses the available evidence supporting the use of US in patients with gout and CPPD disease, and provides a research agenda to guide further investigations. The combined US examination of the target tissues and the clinically involved sites represents the key issue to obtain the best compromise between accuracy and feasibility, in the daily US assessment of patients with crystal-related arthropathies. Moreover, the US guided aspiration of synovial fluid may enhance the possibility to reach a crystal-proven diagnosis, making US a complementary tool, not in contrast, with microscopy, which rests the current gold standard. Finally, even if at moment other US findings are not included among the typical ones for crystal-related arthropathies, it is possible that in the future, thanks to continuous technological advances, we will be able to identify other specific patterns of pathology.
Collapse
|
96
|
Grassi W, Filippucci E. A brief history of ultrasound in rheumatology: where we were. Clin Exp Rheumatol 2014; 32:S3-S6. [PMID: 24529080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
Ultrasonography in the '70s was a well-known and widely used method within several medical specialties but not in rheumatology. Initial development of the field was led by radiologists who mainly investigated the potential of ultrasound in the assessment of large joints. In the late '80s, the first studies supporting the role of ultrasound in the detection of soft tissue changes and bone erosions in the hands of patients with rheumatoid arthritis were published. In the '90s, the dramatic improvement of spatial resolution due to the new generation high frequency probes opened up new avenues for the exploration of otherwise undetectable anatomical details. Ultrasound research during this period was enhanced by the growing use of colour Doppler and power Doppler and by the first prototypes of three dimensional ultrasound. Over the last 10 years, the buzz words in ultrasound research in rheumatology have been standardisation, early diagnosis and therapy monitoring.
Collapse
|
97
|
Gutierrez M, Di Geso L, Salaffi F, Carotti M, Girolimetti R, De Angelis R, Filippucci E, Grassi W. Ultrasound Detection of Cartilage Calcification at Knee Level in Calcium Pyrophosphate Deposition Disease. Arthritis Care Res (Hoboken) 2013; 66:69-73. [DOI: 10.1002/acr.22190] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 09/24/2013] [Indexed: 11/07/2022]
|
98
|
Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G. The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford) 2013; 53:367-73. [DOI: 10.1093/rheumatology/ket356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
99
|
Gutiérrez M, Di Geso L, Rovisco J, Di Carlo M, Ariani A, Filippucci E, Grassi W. Ultrasound learning curve in gout: a disease-oriented training program. Arthritis Care Res (Hoboken) 2013; 65:1265-74. [PMID: 23509029 DOI: 10.1002/acr.22009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 02/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe the learning curve of rheumatologists with limited experience using ultrasound (US) attending an intensive disease-oriented training program focusing on the skills required to obtain and interpret US signs of monosodium urate (MSU) crystal deposits in joint and periarticular tissues. METHODS Three investigators participated in a 7-day training program involving 12 men with gout. The agreement between the expert and beginners was calculated in 4 sessions involving 8 patients with gout. The US assessment was performed at the second and third metacarpophalangeal joints, knee, tibiotalar and first metatarsophalangeal joints, second and third finger flexors, quadriceps and patellar posterior tibialis, peroneus longus and brevis, and Achilles tendons. The presence or absence of synovial fluid/synovial hypertrophy, double contour sign, intra- or periarticular and intratendinous tophi, bursitis, bone erosions, and tendon tears was recorded. RESULTS A total of 416 anatomic sites were studied. Kappa values and overall agreement percentages of qualitative assessments of US gout findings at the end of the exercise both showed moderate to excellent agreement, while in the first session they showed poor/fair agreement. At the end of the training session, sensitivity, specificity, and capability of the beginners were also improved. CONCLUSION After 1 week of the disease-oriented training program, rheumatologists with limited experience in US were satisfactorily able to detect and interpret the main US signs indicative of MSU crystal deposits at different tissues in patients with gout.
Collapse
|
100
|
Salaffi F, Carotti M, Ciapetti A, Ariani A, Gasparini S, Grassi W. Validity of a computer-assisted manual segmentation software to quantify wrist erosion volume using computed tomography scans in rheumatoid arthritis. BMC Musculoskelet Disord 2013; 14:265. [PMID: 24028158 PMCID: PMC3848730 DOI: 10.1186/1471-2474-14-265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/03/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To investigate the performance of conventional radiography (CR) for the detection of bone erosions of wrist in rheumatoid arthritis (RA) using multidetector computed tomography (CT) as the reference method and to evaluate the validity of a computer-assisted manual segmentation (outlining) technique to quantify erosion volume on CT scans. METHODS Twenty five RA patients and six controls underwent CT and radiographic evaluation of the dominant wrist on the same day. CT was performed by using a 64 GE light Speed VCT power. Wrists images were evaluated separately and scored for the presence of erosions according to the Outcome Measures in Rheumatology Rheumatoid Arthritis MRI Scoring System (RAMRIS) and the Sharp/van der Heijde scoring method. Measurements of bone erosion volumes were obtained using OsiriX medical imaging software. The mean value of the volumes of the CT bone erosions detected at two readings was used to calculate inter-rater agreement. RESULTS The overall sensitivity, specificity and accuracy of radiography for detecting erosions were 25.5%, 98.3% and 70.1%, respectively. Using computer-assisted manual segmentation (outlining) technique, erosion volume on CT measurements per subject was ranged from 0.001 cm³ to 2.01 cm³. Spearman's RAMRIS score of each wrist bones in all subjects (n = 25) were correlated with the total erosion volume on CT (p < 0.0001), with the ratio between erosion volume and the corresponding bone volume on a percentage basis (p < 0.0001). The total Sharp/van der Heijde erosion score of the all wrist bones was correlate with the RAMRIS score (p = 0.008). The intraclass correlation coefficients (ICC) for manual segmentation showed high agreement (ICC = 0.901). CONCLUSIONS Considering CT as the reference method, CR showed very low sensitivity. A close correlation with CT erosion volumes supports the OMERACT RAMRIS erosion score as a semiquantitative measure of joint damage in RA. Although the computer-assisted manual segmentation can be beneficial for diagnostic decision in cross-sectional CT examinations of the wrist in RA, this technique will require further evaluation in terms of responsiveness.
Collapse
|