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Sherlock JP, Cua DJ. Interleukin-23 in perspective. Rheumatology (Oxford) 2021; 60:iv1-iv3. [PMID: 34668016 PMCID: PMC8527240 DOI: 10.1093/rheumatology/keab461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jonathan P Sherlock
- Janssen Research & Development, Spring House, PA, USA.,Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Daniel J Cua
- Janssen Research & Development, Spring House, PA, USA
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Datta A, Chakraborty U, Kumar S, Chandra A. Immunopathogenesis of spondyloarthropathies – Concept of major histocompatibility locus-I-opathy. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_295_20] [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] Open
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3
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Macía-Villa C, De Miguel E. Updating the use of the Madrid Sonographic Enthesis Index (MASEI): a systematic review of the literature. Rheumatology (Oxford) 2020; 59:1031-1040. [PMID: 31750519 DOI: 10.1093/rheumatology/kez356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/17/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the literature to evaluate the use of the enthesis ultrasound Madrid Sonographic Entesis Index (MASEI) from its publication. METHODS A systematic search of MEDLINE, EMBASE, and Cochrane Central Register databases was performed. The search strategy was constructed to identify publications containing terms related to enthesis and ultrasound. The only applied filter was studies conducted in humans. One reviewer systematically screened the search. A second reviewer verified the selection. The data extraction was focused on study characteristics, including population and components of the OMERACT filter. RESULTS Sixty-eight of the 1581 identified studies had used MASEI, including 41 (60%) abstracts and 27 (40%) articles. Of the 27 articles, MASEI was mainly used for spondyloarthritis and related diseases in 12 (44%) articles, followed by both psoriatic arthritis and rheumatoid arthritis in five (19%) articles; however, it was also used in diseases such as Behçet disease, FM, familiar Mediterranean fever, SS, crystal arthropathies and systemic sclerosis. The feasibility of MASEI was reported in three (11%) articles, and the reliability in 12 (44%) with good to excellent values. No article evaluated the responsiveness to treatment. The construct validity of MASEI was assessed using biomarkers in seven (26%) articles, clinical examination in 13 (48%) and imaging procedures (only X-rays) in two (7%). The discriminative validity was assessed in 16 (59%) articles, not only in SpAs. CONCLUSION MASEI is a feasible, reliable and valid ultrasound score for the study of enthesis in spondyloarthritis, psoriatic arthritis and other diseases.
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Affiliation(s)
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
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Bertolini E, Macchioni P, Rizzello F, Salice M, Vukatana G, Sandri G, Bertani A, Ciancio G, Govoni M, Zelante A, Malavolta N, Beltrami M, Salvarani C. Ultrasonographic and clinical assessment of peripheral enthesitis and arthritis in an Italian cohort of inflammatory bowel disease patients. Semin Arthritis Rheum 2020; 50:436-443. [PMID: 32061429 DOI: 10.1016/j.semarthrit.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/08/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023]
Abstract
AIMS To evaluate the prevalence of clinical and ultrasonographic musculoskeletal involvement in Italian patients with inflammatory bowel disease (IBD). METHODS In this cross-sectional multicenter study, 148 consecutive patients with IBD were evaluated by a gastroenterologist and a rheumatologist. All patients underwent a B-mode and power Doppler ultrasonographic examination of 6 pairs of entheses and of knee and ankle joints. RESULTS A positive history for at least one musculoskeletal manifestation was reported by 40.5% of patients, more frequently in ulcerative colitis (UC) (p = 0.033). Inflammatory back pain was reported by 13.5% of patients, and a past history of peripheral arthritis by 14.9%, entheseal inflammation by 14.2% and dactylitis by 2.7%. At clinical examination, arthritis was observed in 19.6% of patients and enthesitis in 33%. Oligoarthritis and enthesitis at clinical examination were more frequently observed in UC than in Crohn disease (CD). 37.8% of total IBD patients fulfilled ASAS classification criteria for axial and/or peripheral spondyloarthritis, 8.1% ASAS classification criteria for axial spondyloarthritis, and 29.7% ASAS classification criteria for peripheral spondyloarthritis. With ultrasonographic examination, signs of entheseal involvement were observed in 87.8% of patients, while at power Doppler, ≥1 abnormality was observed in 27.1%. ASAS+ patients compared to those ASAS- had a significantly higher frequency at ultrasonography of acute entheseal abnormalities, power Doppler entheseal positivity and joint involvement. These abnormalities at ultrasonography were also observed in 34%, 13% and 12% of ASAS- patients. CONCLUSIONS Musculoskeletal manifestations occur frequently in patients with IBD. Ultrasonographic entheseal and joint involvement were also observed in asymptomatic patients.
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Affiliation(s)
- Elena Bertolini
- Medicina Gastroenterologica e, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Fernando Rizzello
- Dipartimento di Medicina Interna e Gastroenterologia e, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Marco Salice
- Dipartimento di Medicina Interna e Gastroenterologia e, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Gentiana Vukatana
- Reumatologia, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Gilda Sandri
- Reumatologia e, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy
| | - Angela Bertani
- Gastroenterologia, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy
| | - Giovanni Ciancio
- Reumatologia, Azienda Ospedaliero-Universitaria S. Anna di Ferrara (Cona) e Università di Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Reumatologia, Azienda Ospedaliero-Universitaria S. Anna di Ferrara (Cona) e Università di Ferrara, Ferrara, Italy
| | - Angelo Zelante
- Gastroenterologia, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Nazzarena Malavolta
- Reumatologia, Università di Bologna-Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Marina Beltrami
- Medicina Gastroenterologica e, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Reumatologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Reumatologia e, Azienda Ospedaliero-Unversitaria di Modena e Università di Modena e Reggio Emilia, Modena, Italy.
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5
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Qian Y, Chen B, Sheng X, Peng Y. The LMP2 CfoI polymorphism is associated with ankylosing spondylitis (AS) risk but not with acute anterior uveitis (AAU): A meta-analysis. Medicine (Baltimore) 2019; 98:e17804. [PMID: 31702633 PMCID: PMC6855618 DOI: 10.1097/md.0000000000017804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/10/2019] [Accepted: 10/06/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is one of the most common chronic inflammatory disorders affecting the sacroiliac joints, spine, and peripheral joints. Apart from HLA-B27, the LMP2 gene has been shown to play a role in the pathogenesis of AS as well as AAU in AS. However, genetic associations between LMP2 CfoI polymorphism and AS and AAU were inconclusive. We aimed to investigate the correlation of LMP2 CfoI polymorphism and AS and AAU using meta-analysis. METHODS An exhaustive search was conducted using the PubMed, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) electronic databases. The strength association was assessed by crude ORs with 95% CI. RESULTS Eight eligible records with 449 AS patients and 317 healthy controls were included in the present study. The allelic model of the LMP2 CfoI polymorphism is associated with AS risk (OR = 0.60, 95%CI = [0.32, 1.11], P = .003). A stratified analysis based on ethnicity has shown that the allelic model of LMP2 CfoI was associated with AS in the Caucasian population (OR = 0.72, 95%CI = [0.55, 0.93], P = .01) but not in the Asian population (P > .05). Furthermore, no association was detected between LMP2 CfoI polymorphism and AS complication (AAU). CONCLUSION Our combined results revealed that the allelic model of LMP2 CfoI might be a protective factor for AS in the Caucasian population. Nevertheless, future studies on different ethnicities with larger sample sizes are needed to obtain a more convincing result.
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Sánchez Barrancos IM, Manso García S, Lozano Gago P, Hernández Rodríguez T, Conangla Ferrín L, Ruiz Serrano AL, González Santisteban R. [Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (2): Muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures]. Aten Primaria 2019; 51:105-117. [PMID: 30591207 PMCID: PMC6837044 DOI: 10.1016/j.aprim.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022] Open
Abstract
This article is a continuation of the review initiated in the previous issue about the usefulness of musculoskeletal point of care ultrasound in Primary Care, completing the scenarios of muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures.
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Affiliation(s)
- Ignacio Manuel Sánchez Barrancos
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Consultorio Local de Membrilla, Centro de Salud Manzanares 2, Gerencia de Atención Integrada de Manzanares, Ciudad Real, España.
| | | | - Pedro Lozano Gago
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Departamento de Salud Alicante -San Joan, Centro de Salud Mutxamel, Alicante, España
| | - Trinidad Hernández Rodríguez
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Sector Sanitario Alcañiz, Centro de Salud Andorral, Terue, España
| | - Laura Conangla Ferrín
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; EAP Badalona2. Centre Dalt La Villa. Badalona. Barcelona, España
| | - Antonio Lorenzo Ruiz Serrano
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 3, Gerencia de Atención Integrada de Ciudad Real, Ciudad Real, España
| | - Roberto González Santisteban
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Comarca Interior de Osakidetza, Consultorio de Ayala (Luyando-Respladiza), Álava, España
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Watad A, Bridgewood C, Russell T, Marzo-Ortega H, Cuthbert R, McGonagle D. The Early Phases of Ankylosing Spondylitis: Emerging Insights From Clinical and Basic Science. Front Immunol 2018; 9:2668. [PMID: 30505307 PMCID: PMC6250731 DOI: 10.3389/fimmu.2018.02668] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
In our paper, we discuss how the early phases of ankylosing spondylitis (AS) are linked to peri-firbocartilagenous osteitis in the sacroiliac joint and entheseal bone related anchoring sites. This skeletal proclivity is linked to an abnormal immunological response to skeletal biomechanical stress and associated microdamage. A key event in the early stages of AS appears to be the association with subclinical Crohn's-like colitis with this gut inflammation being pivotal to the osteitis reaction. Whether this osteitis is consequent to non-specific intestinal innate immune activation or adaptive immune responses against specific microbiotal or self-antigens is unknown. Recurrent iritis is an HLA-B27 associated feature that may predate AS and pursues a course independent of joint involvement, and points toward the pivotal role of organ specific immunology over generalized systemic immune responses in disease expression. Human genetics and animal model studies strongly incriminate the IL23/17 axis and TNF-α in disease pathogenesis. Preliminary work shows a strong convergence of innate immune cells including type 3 innate lymphoid-cells (ILC3) and γδ T-cells in skin, gut, entheseal, and eye inflammation. Despite the HLA-B27 association, the role of adaptive immunity, especially CD8+ T-cells mediated responses remains unproven and alternative theories have been proposed. The emerging non-dependence of axial inflammation on IL-23 but dependence on IL-17A is an unexpected new twist that awaits full explanation. In this mini-review, we discuss the key events in the early stages of human AS from clinical and basic science aspects, which could be crucial for attempted disease prevention studies in at risk subjects.
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Affiliation(s)
- Abdulla Watad
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Tobias Russell
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Richard Cuthbert
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
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Elalouf O, Bakirci Ureyen S, Touma Z, Anderson M, Kaeley GS, Aydin SZ, Eder L. Psoriatic Arthritis Sonographic Enthesitis Instruments: A Systematic Review of the Literature. J Rheumatol 2018; 46:43-56. [DOI: 10.3899/jrheum.171466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
Objective.As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA).Methods.A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondyloarthritis (SpA) or PsA. Data extraction focused on the properties of the sonographic enthesitis instruments used in each study following components of the Outcome Measures in Rheumatology (OMERACT) filter: feasibility, test-retest reliability, construct validity as related to clinical assessment of enthesitis, biomarkers of inflammation and imaging of enthesitis by other modalities, discriminative validity, and responsiveness to treatment.Results.Fifty-one of 310 identified manuscripts were included. Only 1 scoring instrument of enthesitis was specifically developed and validated in patients with PsA. Only 18 (35%) of the studies involved patients with PsA, while the remaining studies focused on SpA. In PsA, construct validity was assessed using biomarkers and clinical examination in 1 (2%) and 11 (21.5%) of the studies, respectively, whereas no studies used imaging for the same purpose. Only 2 (4%) of the studies assessed discriminative validity in PsA. Responsiveness to treatment was assessed in 7 studies, none of which included patients with PsA.Conclusion.Although sonographic enthesitis scoring instruments have been developed for SpA, only a few have been validated in PsA. None of them passed the OMERACT filter in patients with PsA. Additional research is required before endorsing a specific instrument for the assessment of enthesitis in patients with PsA.
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9
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Ruyssen-Witrand A, Jamard B, Cantagrel A, Nigon D, Loeuille D, Degboe Y, Constantin A. Relationships between ultrasound enthesitis, disease activity and axial radiographic structural changes in patients with early spondyloarthritis: data from DESIR cohort. RMD Open 2017; 3:e000482. [PMID: 28955496 PMCID: PMC5604709 DOI: 10.1136/rmdopen-2017-000482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022] Open
Abstract
Background To search for association between ultrasound (US) enthesis abnormalities and disease activity, spine and sacro-iliac joints (SIJ) MRI inflammatory lesions and spine structural changes in a cohort of patients suspected for axial spondyloarthritis (SpA). Methods Patients: Of 708 patients included in the DESIR(Devenir des Spondyloarthrites Indifférenciées Récentes) cohort, 402 had an US enthesis assessment and were selected for this study. Imaging: Achilles, lateral epicondyles, superior patellar ligament, inferior patellar ligament entheses were systematically US scanned and abnormalities were summed in US structural and power Doppler (PDUS) scores. Spine radiographs, SIJ and spine MRI scans were centrally scored modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), presence of MRI sacro-iliitis, Spondyloarthritis Research Consortium of Canada and Berlin scores. Analysis: The associations between the US structural/PDUS scores and disease activity, C reactive protein (CRP), MRI SIJ and spine inflammatory lesions and mSASSS were tested by Spearman's correlation tests. Results Among the 402 patients included (median age: 33.5 years, males: 48.5%), 55% had US enthesis structural abnormalities while 14% had PDUS abnormalities. There was no association between US scores and Bath Ankylosing Spondylitis Disease Activity Index, CRP or inflammatory lesions on SIJ and spine MRI. There was a correlation between US structural and PDUS scores and the mSASSS (respectively, r=0.151, p=0.005; r=0.143, p=0.007). The proportion of patients with syndesmophytes was higher in the case of US enthesophytes (26% of syndesmophytes vs 6% in the absence of US enthesophytes, p<0.0001). Conclusion While the US abnormalities do not seem to be a helpful tool for monitoring disease activity in axial SpA, US enthesophytes, strongly associated with axial syndesmophytes, might be a marker of interest for disease severity. Trial registration number NCT01648907, date of registration : 20 July 2012.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Inserm UMR1027, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Bénédicte Jamard
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | - Alain Cantagrel
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
| | - Delphine Nigon
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | | | | | - Arnaud Constantin
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
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10
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Juanola X, Loza Santamaría E, Cordero-Coma M. Description and Prevalence of Spondyloarthritis in Patients with Anterior Uveitis. Ophthalmology 2016; 123:1632-1636. [DOI: 10.1016/j.ophtha.2016.03.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/25/2022] Open
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11
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Mindfulness and Diagnostic Acumen. Ophthalmology 2016; 123:1630-1631. [PMID: 27450813 DOI: 10.1016/j.ophtha.2016.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/22/2022] Open
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12
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Rosenbaum JT. Evolving "Diagnostic" Criteria for Axial Spondyloarthritis in the Context of Anterior Uveitis. Ocul Immunol Inflamm 2016; 24:445-9. [PMID: 27070270 DOI: 10.3109/09273948.2016.1158277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anterior uveitis is far more common than intermediate, posterior or panuveitis. About 50% of patients with acute anterior uveitis are HLA B27+. Those who are HLA B27+ are highly likely to have associated back, joint, or tendon disease. The majority of patients with acute anterior uveitis and inflammatory low back pain are suffering from axial spondyloarthritis and radiographic evidence for abnormal sacroiliac joints is not required to make this diagnosis. Received 12 October 2015; revised 31 January 2016; accepted 16 February 2016; published online 12 April 2016.
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Affiliation(s)
- James T Rosenbaum
- a Casey Eye Institute , Oregon Health & Science University , Portland , Oregon , USA.,b Legacy Devers Eye Institute , Portland , Oregon , USA
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13
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Karreman MC, Weel AEAM, van der Ven M, Vis M, Tchetverikov I, Nijsten TEC, Wakkee M, Hazes JMW, Luime JJ. Prevalence of Psoriatic Arthritis in Primary Care Patients With Psoriasis. Arthritis Rheumatol 2016; 68:924-31. [DOI: 10.1002/art.39530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/24/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Marijn Vis
- Erasmus University Medical Centre; Rotterdam The Netherlands
| | | | | | - Marlies Wakkee
- Erasmus University Medical Centre; Rotterdam The Netherlands
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14
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General applications of ultrasound in rheumatology: why we need it in our daily practice. J Clin Rheumatol 2015; 21:133-43. [PMID: 25807093 DOI: 10.1097/rhu.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound (US) is a noninvasive imaging technique that continues to gain interest among rheumatologists because of its undoubted utility for the assessment of a wide range of abnormalities in rheumatic diseases. It also has a great potential to be used at the time of consultation as an extension of the clinical examination.Current data demonstrate that the standard clinical approach could result in an insensitive assessment of some the different aspects of the various rheumatic diseases for which US has become a feasible and effective imaging modality that allows early detection of anatomical changes, careful guidance for the aspiration and/or local treatment, and short- and long-term therapy monitoring at the joint, tendon, enthesis, nail, and skin levels. The spectrum of pathological conditions for which US plays a crucial role continues to increase over time and includes rheumatoid arthritis, spondyloarthropathies, osteoarthritis, crystal-related arthropathies, connective tissue disorders, and vasculitis.It is expected that the inclusion of more longitudinal studies with a larger number of patients and more rigorous methodological approach will undoubtedly provide a better understanding of the significance of the abnormal US findings detected in order to provide the proper diagnostic and/or therapeutic approaches. In this article, we analyze the current potential applications of US in rheumatology and discuss the evidence supporting its use in the daily rheumatologic practice.
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Abstract
The spondyloarthropathies comprise ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis (PsA) and arthritis associated with inflammatory bowel disease. In this Perspectives article, we describe how Behçet disease and several clinically distinct spondyloarthropathies-all associated with MHC class I (MHC-I) alleles such as HLA-B(*)51, HLA-C(*)0602 and HLA-B(*)27 and epistatic ERAP-1 interactions-have a shared immunopathogenetic basis. As a unifying concept, we propose that barrier dysfunction in environmentally exposed organs such as the skin, and aberrant innate immune reactions at sites of mechanical stress, can often trigger secondary adaptive immune CD8(+) T-cell responses with prominent neutrophilic inflammation that culminate in exacerbation and recurrence of these diseases. Of note, these 'MHC-I-opathies' show a differential immunopathology, probably reflecting antigenic differences within target tissues: HLA-B(*)51 is linked to ocular and mucocutaneous disease but not gut involvement, and HLA-C(*)0602 is linked to type I psoriasis but not scalp or nail disease.
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16
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Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Odeh M. Entheseal involvement in systemic disorders. Clin Rheumatol 2015; 34:2001-10. [PMID: 26354427 DOI: 10.1007/s10067-015-3068-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/30/2015] [Indexed: 12/11/2022]
Abstract
The objective of this study is to review the data on entheseal involvement in systemic disorders. A Pubmed search utilizing the indexing terms "enthesis" and "enthesitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. A number of cadaver-based studies, as well as studies using ultrasonography and magnetic resonance imaging, have detailed new distinct aspects of enthesis physiology and pathology in a variety of rheumatic and non-rheumatic systemic disorders. Major progress has been done in characterization of separate components of the enthesis organ, imaging of entheses, elaboration of the role and features of entheseal disease in spondyloarthropathies, juvenile idiopathic arthritis, osteoarthritis, familial Mediterranean fever, hyperuricemia, and other systemic conditions. The knowledge acquired and summarized herein shows that entheses can be affected in various ways in variety of medical disorders with different pathogenesis. Better understanding of the risk factors, mechanisms and natural history of enthesopathies is warranted. The current progress in the understanding of entheseal involvement in systemic disorders represents just the first step in resolving the entheses-related enigmas.
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Affiliation(s)
- Gleb Slobodin
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Doron Rimar
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Majed Odeh
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Kilic E, Kilic G, Akgul O, Ozgocmen S. Presence of enthesopathy demonstrated with ultrasonography in systemic sclerosis. Mod Rheumatol 2015; 25:731-6. [DOI: 10.3109/14397595.2015.1019962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Insights Into Uveitis in Association With Spondyloarthritis From a Large Patient Survey. J Clin Rheumatol 2014; 20:141-5. [DOI: 10.1097/rhu.0000000000000087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Arend CF. Role of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy: an early finding in the diagnosis of spondyloarthritis and an under-recognized cause of posterior shoulder pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:557-561. [PMID: 24658935 DOI: 10.7863/ultra.33.4.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The acromial origin of the deltoid is a target structure of ankylosing spondylitis and related spondyloarthritis, which are often overlooked and underdiagnosed as causes of posterior shoulder pain. The objective of this article is to review the roles of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy and their importance for optimizing management in individuals with posterior shoulder pain. Adequate awareness of such enthesopathy as a potential manifestation of inflammatory rheumatic disorders is critical for early diagnosis of spondyloarthritis.
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Affiliation(s)
- Carlos Frederico Arend
- Radimagem Diagnóstico por Imagem, Cristóvão Colombo 1691, 90560-004 Porto Alegre-RS, Brazil.
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21
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Enthesitis in psoriatic arthritis. Semin Arthritis Rheum 2013; 43:325-34. [DOI: 10.1016/j.semarthrit.2013.04.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 04/01/2013] [Accepted: 04/11/2013] [Indexed: 12/18/2022]
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22
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Paramarta JE, van der Leij C, Gofita I, Yeremenko N, van de Sande MG, de Hair MJ, Tak PP, Maas M, Baeten D. Peripheral joint inflammation in early onset spondyloarthritis is not specifically related to enthesitis. Ann Rheum Dis 2013; 73:735-40. [DOI: 10.1136/annrheumdis-2012-203155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Mera-Varela A, Ferreiro-Iglesias A, Perez-Pampin E, Porto-Silva M, Gómez-Reino JJ, Gonzalez A. Ultrasonographic assessment of enthesitis in HLA-B27 positive patients with rheumatoid arthritis, a matched case-only study. PLoS One 2013; 8:e58616. [PMID: 23505543 PMCID: PMC3591382 DOI: 10.1371/journal.pone.0058616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/05/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction HLA-B27 has a modifier effect on the phenotype of multiple diseases, both associated and non-associated with it. Among these effects, an increased frequency of clinical enthesitis in patients with Rheumatoid Arthritis (RA) has been reported but never explored again. We aimed to replicate this study with a sensitive and quantitative assessment of enthesitis by using standardized ultrasonography (US). Methods The Madrid Sonography Enthesitis Index (MASEI) was applied to the US assessment of 41 HLA-B27 positive and 41 matched HLA-B27 negative patients with longstanding RA. Clinical characteristics including explorations aimed to evaluate spondyloarthrtitis and laboratory tests were also done. Results A significant degree of abnormalities in the entheses of the patients with RA were found, but the MASEI values, and each of its components including the Doppler signal, were similar in HLA-B27 positive and negative patients. An increase of the MASEI scores with age was identified. Differences in two clinical features were found: a lower prevalence of rheumatoid factor and a more common story of low back pain in the HLA-B27 positive patients than in the negative. The latter was accompanied by radiographic sacroiliitis in two HLA-B27 positive patients. No other differences were detected. Conclusion We have found that HLA-B27 positive patients with RA do not have more enthesitis as assessed with US than the patients lacking this HLA allele. However, HLA-B27 could be shaping the RA phenotype towards RF seronegativity and axial involvement.
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Affiliation(s)
- Antonio Mera-Varela
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Aida Ferreiro-Iglesias
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Eva Perez-Pampin
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Marisol Porto-Silva
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan J. Gómez-Reino
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Gonzalez
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- * E-mail:
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McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 2013; 64:1625-40. [PMID: 23111854 DOI: 10.1002/acr.21836] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther 2011; 13:R188. [PMID: 22093457 PMCID: PMC3334637 DOI: 10.1186/ar3516] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/06/2011] [Accepted: 11/17/2011] [Indexed: 02/07/2023] Open
Abstract
Introduction An increasing number of studies have applied ultrasound to the evaluation of entheses in spondyloarthritis patients. However, no clear agreement exists on the definition of enthesitis, on the number and choice of entheses to examine and on ultrasound technique, which may all affect the results of the examination. The objectives of this study were to first determine the level of homogeneity in the ultrasound definitions for the principal lesions of enthesitis in the published literature and second, to evaluate the metric properties of ultrasound for detecting enthesitis according to the OMERACT filter. Methods Search was performed in PUBMED and EMBASE. Both grey-scale and Doppler definitions of enthesitis, including describing features of enthesitis, were collected and metrological qualities of studies were assessed. Results After selection, 48 articles were analyzed. The definition of ultrasound enthesitis and elementary features varied among authors. Grey-scale enthesitis was characterized by increasing thickness (94% of studies), hypoechogenicity (83%), enthesophytes (69%), erosions (67%), calcifications (52%), associated bursitis (46%) and cortical irregularities (29%). Only 46% of studies reported the use of Doppler. High discrepancies were observed on frequency, type of probe and Doppler mode used. Face and content validity were the most frequently evaluated criteria (43%) followed by reliability (29%) and responsiveness (19%). Conclusions Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Consensus on elementary lesions and standardization of exam is needed to determine the ultrasound definition of enthesitis in grey-scale and in Doppler for future applications.
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Affiliation(s)
- Frédérique Gandjbakhch
- Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, APHP, 83 Boulevard de l’hôpital 75013 Paris, France
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Gutierrez M, Luccioli F, Salaffi F, Bartoloni E, Bertolazzi C, Bini V, Filipucci E, Grassi W, Gerli R. Ultrasound revealing subclinical enthesopathy at the greater trochanter level in patients with spondyloarthritis. Clin Rheumatol 2011; 31:463-8. [PMID: 22015936 DOI: 10.1007/s10067-011-1875-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/31/2011] [Accepted: 10/10/2011] [Indexed: 01/20/2023]
Abstract
This study was conducted to determine the prevalence of subclinical entheseal involvement at the greater trochanter level by ultrasound in patients with spondyloarthritis. Forty-six patients with spondyloarthritis and 46 healthy age- and sex-matched controls were studied. All patients with no clinical evidence of enthesopathy at the greater trochanter underwent an ultrasound examination. The following three entheses were scanned bilaterally: anterior insertion of gluteus minimus, anterior insertion of gluteus medius, and posterior insertion of gluteus medius. Ultrasound findings of enthesopathy were thickening, calcifications, bone erosions, enthesophytes, bursitis, and power Doppler signal. A total of 276 entheses were evaluated in spondyloarthritis patients. In 112 out of 276 (40.5%), grayscale ultrasound found enthesopathy. The enthesis with the highest number of signs of enthesopathy was the anterior insertion of gluteus medius (46/276) (16%), followed by posterior insertion of gluteus medius (37/276) (13.4%) and anterior insertion of gluteus minimus (29/276) (10.5%). In the healthy population, ultrasound found entesopathy in 80 out of 276 (29%) entheseal sites (p < 0.0001). Posterior insertion of gluteus medius enthesis was the more frequently involved (34/276) (12.3%), followed by anterior insertion of gluteus medius (24/276) (8.6%) and anterior insertion of gluteus minimus (22/276) (7.9%). Power Doppler was found more frequently in patients with spondyloarthritis compared with healthy controls (1% vs 0%). Our results show a higher prevalence of subclinical enthesopathy at the greater trochanter level in patients with spondyloarthritis than in age- and sex-matched healthy controls.
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Affiliation(s)
- Marwin Gutierrez
- Clinica Reumatologica, Università Politecnica delle Marche, Ospedale A. Murri, Via dei Colli, 52, 60035 Iesi, Ancona, Italy.
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Abstract
Spondyloarthritis is a group of several related but phenotypically distinct disorders: psoriatic arthritis, arthritis related to inflammatory bowel disease, reactive arthritis, a subgroup of juvenile idiopathic arthritis, and ankylosing spondylitis (the prototypic and best studied subtype). The past decade yielded major advances in the recognition of spondyloarthritis as an entity, the classification of the disease, and understanding of the genetic and pathophysiological mechanisms of disease-related inflammation and tissue damage. In parallel, new clinical and imaging outcomes have allowed the assessment of various therapeutic modalities. Blockers of tumour necrosis factor are a major therapeutic advance, but the exact roles of physiotherapy, and treatment with non-steroidal anti-inflammatory drugs and other biological treatments are unknown. The major challenges with direct relevance for clinical practice for the next decade are the development of techniques for early diagnosis, therapeutic modulation of structural damage, and, ultimately, induction of long-term, drug-free remission.
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Affiliation(s)
- Maxime Dougados
- Paris-Descartes University, Medicine Faculty, UPRES EA 4058, AP-HP, Cochin Hospital, Department of Rheumatology B, Paris, France.
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De Miguel Mendieta E, Rejón Geib E. [Ultrasound scores in spondyloarthritis]. REUMATOLOGIA CLINICA 2010; 6 Suppl 1:37-40. [PMID: 21794753 DOI: 10.1016/j.reuma.2009.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/16/2009] [Indexed: 11/29/2022]
Abstract
Ultrasound is proving its validity in the assessment of patients with spondyloarthritis. This paper reviews the various indices validated for the quantification of the activity or for the diagnosis of involvement of peripheral joints, enthesis and sacroiliac joints of these patients. The studies are still preliminary but point to future uses of ultrasound in spondyloarthritis.
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