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Nakamura T, Nagira K, Nakagawa N, Takasu Y, Ishida K, Hayashibara M, Hagino H, Nagashima H. Characteristics of patients presenting with concomitant carpal tunnel syndrome at the initial diagnosis with rheumatoid arthritis. Mod Rheumatol 2024; 34:960-965. [PMID: 38244590 DOI: 10.1093/mr/road116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the clinical characteristics of patients who presented with concomitant carpal tunnel syndrome (CTS) at the initial diagnosis with rheumatoid arthritis (RA). METHODS We analyzed patients with newly diagnosed RA at a single institution between 2012 and 2021. Patient demographic and laboratory data, the 2010 ACR/EULAR classification criteria, and the duration from the initial visit to RA diagnosis were compared between RA patients with concomitant CTS (RA with CTS group) and those without CTS (RA without CTS group). RESULTS The study included 235 patients (157 females), of which 11 patients (4.7%) presented with CTS at the initial diagnosis with RA. In the RA with CTS group, the age was significantly higher (P = .033), all patients were female, and anti-cyclic citrullinated peptide antibody (ACPA) was negative, and the duration to RA diagnosis was longer than in the RA without CTS group. Among all RA with CTS patients, ultrasonography showed power Doppler signal-positive tenosynovitis in the carpal tunnel, which is not usually detected in idiopathic CTS. CONCLUSIONS Patients with concomitant CTS at the initial diagnosis with RA were characterized by old age, female sex, and negative ACPA. Patients with symptoms of CTS should undergo ultrasonography for early diagnosis of RA.
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Affiliation(s)
- Taiki Nakamura
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Keita Nagira
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Naoki Nakagawa
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Yuta Takasu
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Koji Ishida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masako Hayashibara
- Department of Orthopedic Surgery, Yonago Medical Center, Yonago, Tottori, Japan
| | - Hiroshi Hagino
- Department of Rehabilitation, Sanin Rosai Hospital, Yonago, Tottori, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Serrano-Warleta M, Palomeque-Vargas A, Manzo R, Blanco-Cáceres B, Vazquez-Díaz M, Guillen-Astete C. Usefulness of ultrasound in clinical decision-making in rheumatology clinical practice: A single-center longitudinal study. REUMATOLOGIA CLINICA 2024; 20:147-149. [PMID: 38431489 DOI: 10.1016/j.reumae.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The purpose of the present study is to identify the extent to which it affects clinical decisions in a single-centre observational retrospective study. METHOD The results of 801 requests and 1174 consecutive individual ultrasound examinations performed over 10 months were analysed. RESULTS The most frequent indication was diagnostic assistance (39%) followed by assessment of inflammatory activity (34%). By topography, the hand was the most frequently studied region (51%), followed by the foot (18.1%). Of all requests, 67% had an impact on decision-making. The impact on clinical decision-making was associated with a shorter waiting time for the evaluation of the results, being the greatest in those ultrasound scans performed on demand on the same day of the request. In 73% of bilateral ultrasound studies, findings in one of the joints exemplified the overall result reported. CONCLUSIONS Rheumatological musculoskeletal ultrasound has proven to be a useful decision-making technique, the greater the impact of which is seen the shorter the waiting time before it is performed.
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Affiliation(s)
| | | | - Rosa Manzo
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Boris Blanco-Cáceres
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mónica Vazquez-Díaz
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos Guillen-Astete
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Wang J, Wang M, Qi Q, Wu Z, Wen J. High-frequency ultrasound in patients with seronegative rheumatoid arthritis. Sci Rep 2022; 12:21372. [PMID: 36494477 PMCID: PMC9734155 DOI: 10.1038/s41598-022-25958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the value of high-frequency ultrasound (HFUS) in differentiation of the seronegative rheumatoid arthritis (SNRA) and osteoarthritis (OA) and in the diagnosis of SNRA. 83 patients diagnosed with SNRA (SNRA group) and 40 diagnosed with OA (OA group) who received HFUS were retrospectively analyzed. The grayscale (GS) scores, power Doppler (PD) scores, and bone erosion (BE)scores were recorded, and added up to calculate the total scores of US variables. The correlations of the total scores of US variables with the 28-joint disease activity score (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were analyzed. The diagnostic efficacy of the total scores of US variables for SNRA was assessed. In the SNRA group, the detection rate of abnormal US findings in the joints and tendons by GS and PD as well as BE was higher than those in the OA group. There were significant differences between the two groups in GS scores and PD scores of joints and tendons, and BE scores of joints (P < 0.05). In the SNRA group, the total scores of most US variables were positively correlated with CRP, ESR, and DAS28 (P < 0.05), while such correlations were not observed in the OA group (P > 0.05). Among different US variables, the diagnostic value of total PD scores of the joints was the highest for SNRA. HFUS could be used to differentiate SNRA from OA and make a diagnosis of SNRA based on joint and tendon synovial sheath assessment.
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Affiliation(s)
- Junkui Wang
- grid.412633.10000 0004 1799 0733Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Miao Wang
- grid.412633.10000 0004 1799 0733Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Qinghua Qi
- grid.412633.10000 0004 1799 0733Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Zhibin Wu
- grid.412633.10000 0004 1799 0733Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Jianguo Wen
- grid.412633.10000 0004 1799 0733Henan Joint International Pediatric Urodynamic Center, The First Affiliated Hospital of Zhengzhou, Zhengzhou, 450052 China
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Kirby C, Flood R, Mullan R, Murphy G, Kane D. Evolution of ultrasound in giant cell arteritis. Front Med (Lausanne) 2022; 9:981659. [PMID: 36262280 PMCID: PMC9574015 DOI: 10.3389/fmed.2022.981659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Ultrasound (US) is being increasingly used to diagnose Giant Cell Arteritis (GCA). The traditional diagnostic Gold Standard has been temporal artery biopsy (TAB), but this is expensive, invasive, has a false-negative rate as high as 60% and has little impact on clinical decision-making. A non-compressible halo with a thickened intima-media complex (IMC) is the sonographic hallmark of GCA. The superficial temporal arteries (STA) and axillary arteries (AA) are the most consistently inflamed arteries sonographically and imaging protocols for evaluating suspected GCA should include at least these two arterial territories. Studies evaluating temporal artery ultrasound (TAUS) have varied considerably in size and methodology with results showing wide discrepancies in sensitivity (9–100%), specificity (66–100%), positive predictive value (36–100%) and negative predictive value (33–100%). Bilateral halos increase sensitivity as does the incorporation of pre-test probability, while prior corticosteroid use decreases sensitivity. Quantifying sonographic vasculitis using Halo Counts and Halo Scores can predict disease extent/severity, risk of specific complications and likelihood of treatment response. Regression of the Halo sign has been observed from as little as 2 days to as late as 7 months after initiation of immunosuppressive treatment and occurs at different rates in STAs than AAs. US is more sensitive than TAB and has comparable sensitivity to MRI and PET/CT. It is time-efficient, cost-effective and allows for the implementation of fast-track GCA clinics which substantially mitigate the risk of irreversible blindness. Algorithms incorporating combinations of imaging modalities can achieve a 100% sensitivity and specificity for a diagnosis of GCA. US should be a standard first line investigation in routine clinical care of patients with suspected GCA with TAB reserved only for those having had a normal US in the context of a high pre-test probability.
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Affiliation(s)
- Colm Kirby
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland,Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland,*Correspondence: Colm Kirby
| | - Rachael Flood
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Ronan Mullan
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Grainne Murphy
- Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
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Perceived quality of training in musculoskeletal ultrasound in Spanish rheumatology services. ACTA ACUST UNITED AC 2021; 18:349-354. [PMID: 34373233 DOI: 10.1016/j.reumae.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound has been included in the training of residents in rheumatology in recent years, as a result of its increased use in daily clinical practice. Our objective is to evaluate the perceived quality of ultrasound training of residents in rheumatology services in Spain. MATERIAL AND METHODS Online survey aimed at rheumatologists who began their training in rheumatology between 2009 and 2019. RESULTS One hundred thirty-nine rheumatologists participated in the survey, of which 97.1% had at least one ultrasound machine in their training centre. Up to 51.1% performed a rotation in ultrasound and 56% had an ultrasound consultation. Access to SER courses was high (87.8%) while access to EULAR courses was limited (17.3%) and up to 69.1% of residents did not complete the competency accreditation. Training in evaluation of inflammatory joint activity, entheses and microcrystalline diseases received the highest scores. Evaluation of ultrasound training during the residency was good in 36% of cases, fair in 28.1%, poor in 18% and excellent in 12.9%. Of those surveyed, 88% consider their clinical practice as a rheumatologist to have improved. CONCLUSIONS Most residents have performed ultrasound rotations. Participation in SER ultrasound courses is high and moderate in EULAR courses, while only a minority completed the competency accreditation. The overall degree of satisfaction with training in ultrasound during residency is good and, in the opinion of residents, contributes to the improvement of their skills as rheumatologists.
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Molina Collada J, Mayordomo L. Perceived Quality of Training in Musculoskeletal Ultrasound in Spanish Rheumatology Services. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00062-0. [PMID: 33931334 DOI: 10.1016/j.reuma.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound has been included in the training of residents in rheumatology in recent years, as a result of its increased use in daily clinical practice. Our objective is to evaluate the perceived quality of ultrasound training of residents in rheumatology services in Spain. MATERIAL AND METHODS Online survey aimed at rheumatologists who began their training in rheumatology between 2009 and 2019. RESULTS One hundred thirty-nine rheumatologists participated in the survey, of which 97.1% had at least one ultrasound machine in their training centre. Up to 51.1% performed a rotation in ultrasound and 56% had an ultrasound consultation. Access to SER courses was high (87.8%) while access to EULAR courses was limited (17.3%) and up to 69.1% of residents did not complete the competency accreditation. Training in evaluation of inflammatory joint activity, entheses and microcrystalline diseases received the highest scores. Evaluation of ultrasound training during the residency was good in 36% of cases, fair in 28.1%, poor in 18% and excellent in 12.9%. Of those surveyed, 88% consider their clinical practice as a rheumatologist to have improved. CONCLUSIONS Most residents have performed ultrasound rotations. Participation in SER ultrasound courses is high and moderate in EULAR courses, while only a minority completed the competency accreditation. The overall degree of satisfaction with training in ultrasound during residency is good and, in the opinion of residents, contributes to the improvement of their skills as rheumatologists.
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Affiliation(s)
- Juan Molina Collada
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Lucía Mayordomo
- Servicio de Reumatología, Hospital Universitario Valme, Sevilla, España
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Flower VA, Barratt SL, Hart DJ, Mackenzie AB, Shipley JA, Ward SG, Pauling JD. High-frequency Ultrasound Assessment of Systemic Sclerosis Skin Involvement: Intraobserver Repeatability and Relationship With Clinician Assessment and Dermal Collagen Content. J Rheumatol 2020; 48:867-876. [PMID: 33132218 DOI: 10.3899/jrheum.200234] [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] [Accepted: 10/16/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The modified Rodnan skin score (mRSS) remains the preferred method for skin assessment in systemic sclerosis (SSc). There are concerns regarding high interobserver variability of mRSS and negative clinical trials utilizing mRSS as the primary endpoint. High-frequency ultrasound (HFUS) allows objective assessment of cutaneous fibrosis in SSc. We investigated the relationship between HFUS with both mRSS and dermal collagen. METHODS Skin thickness (ST), echogenicity, and novel shear wave elastography (SWE) were assessed in 53 patients with SSc and 15 healthy controls (HCs) at the finger, hand, forearm, and abdomen. The relationship between HFUS parameters with mRSS (n = 53) and dermal collagen (10 patients with SSc and 10 HCs) was investigated. Intraobserver repeatability of HFUS was calculated using intraclass correlation coefficients (ICCs). RESULTS HFUS assessment of ST (hand/forearm) and SWE (finger/hand) correlated with local mRSS at some sites. Subclinical abnormalities in ST, echogenicity, and SWE were present in clinically uninvolved SSc skin. Additionally, changes in echogenicity and SWE were sometimes apparent despite objectively normal ST on HFUS. ST, SWE, and local mRSS correlated strongly with collagen quantification (r = 0.697, 0.709, 0.649, respectively). Intraobserver repeatability was high for all HFUS parameters (ICCs for ST = 0.946-0.978; echogenicity = 0.648-0.865; and SWE = 0.953-0.973). CONCLUSION Our data demonstrate excellent reproducibility and reassuring convergent validity with dermal collagen content. Detection of subclinical abnormalities is an additional benefit of HFUS. The observed correlations with collagen quantification support further investigation of HFUS as an alternative to mRSS in clinical trial settings.
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Affiliation(s)
- Victoria A Flower
- V.A. Flower, Consultant Rheumatologist, MBBS, PhD, J.D. Pauling, Consultant Rheumatologist and Senior Lecturer, BMBS, PhD, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, Department of Pharmacy and Pharmacology, University of Bath, Bath;
| | - Shaney L Barratt
- S.L. Barratt, BMBS, PhD, Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol
| | - Darren J Hart
- D.J. Hart, Clinical Scientist, PhD, J.A. Shipley, Clinical Scientist, PhD, Clinical Measurement and Imaging Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath
| | - Amanda B Mackenzie
- A.B. Mackenzie, Senior Lecturer, PhD, Department of Pharmacy and Pharmacology, University of Bath, Bath
| | - Jacqueline A Shipley
- D.J. Hart, Clinical Scientist, PhD, J.A. Shipley, Clinical Scientist, PhD, Clinical Measurement and Imaging Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath
| | - Stephen G Ward
- S.G. Ward, Professor, PhD, Centre for Therapeutic Innovation & Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - John D Pauling
- V.A. Flower, Consultant Rheumatologist, MBBS, PhD, J.D. Pauling, Consultant Rheumatologist and Senior Lecturer, BMBS, PhD, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, Department of Pharmacy and Pharmacology, University of Bath, Bath
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Practical ultrasound workshops to teach medical students basic concepts of ultrasound semiology. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Paternain Nuin A, Malmierca Ordoqui P, Igual Rouilleault AC, Soriano Aguadero I, Pueyo Villoslada JC. Practical ultrasound workshops to teach medical students basic concepts of ultrasound semiology. RADIOLOGIA 2020; 62:306-312. [PMID: 32035725 DOI: 10.1016/j.rx.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of practical ultrasound workshops for the acquisition and consolidation of conceptual learning about the basic physics and semiology of ultrasonography aimed at third-year medical school students doing the physical examination module of their studies. MATERIAL AND METHODS We carried out practical ultrasound workshops with two groups of 177 and 175 students in two consecutive academic years. All students had taken a class in basic radiology in the previous year. Students examined each other with ultrasonography under instructors' supervision in a two-hour session. Before and after the workshop, students did a seven-question multiple-choice test about basic semiology and answered two questions evaluating their degree of confidence in interpreting ultrasonographic images and handling the ultrasound scanner on a scale from 1 to 10. RESULTS No significant differences were found between the scores obtained in the two groups. Overall, the mean score on the multiple-choice test improved from 59.71% on the initial assessment to 88.29% on the post-workshop assessment (p <0.01). Confidence in interpreting images improved from 3.39/10 to 6.28/10 (p <0.01), and confidence in handling the equipment improved from 3.73/10 to 6.51/10 (p <0.01). CONCLUSION Practical workshops were useful for learning basic concepts about ultrasound imaging, allowing students to significantly improve their scores on the multiple-choice test. Students had a low level of confidence in their ability to interpret ultrasound images and handle the equipment before starting the workshop, but their confidence improved significantly after completing the workshop.
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Affiliation(s)
- A Paternain Nuin
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - P Malmierca Ordoqui
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | | | - I Soriano Aguadero
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - J C Pueyo Villoslada
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Boylan M. Should ultrasound be used routinely in the diagnosis of rheumatoid arthritis? Ir J Med Sci 2019; 189:735-748. [PMID: 31646431 DOI: 10.1007/s11845-019-02096-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A growing body of evidence indicates the benefits of early diagnosis of rheumatoid arthritis (RA) and prompt treatment with disease-modifying anti-rheumatic drugs (DMARDS) in terms of relieving symptoms, improving prognosis, and reducing long-term complications. There is however some controversy over the most beneficial method of imaging in providing accurate early diagnosis. Though current practice favours clinical and radiological assessment, this is increasingly supplemented by ultrasound techniques (and, to a lesser extent, CT and MRI scanning). While EULAR and ESSR favour the use of ultrasonography (US) as the first-line investigation in cases of suspected RA, a recent NICE review upholds the traditional place of plain film radiographs of hands and feet to detect erosions as early signs of synovitis. This review considers the evidence for US in the early diagnosis of RA and the case for it becoming the primary assessment modality in rheumatology clinics. AIMS This paper aims to assess the current literature on the efficacy of ultrasonography in diagnosing early RA, by comparing US with alternative imaging modalities. The goal is to propose the most appropriate method of diagnosis to improve early initiation of DMARD treatment for optimum disease outcomes. METHODS Searches for related studies and review articles were carried out using electronic databases and hand searches. Additional references were gleaned from the bibliographies of included papers. Related articles and pop-outs from PubMed were also used. The search was refined in PubMed, by only using reviews which were written in English and published in past 10 years and had full free text available. RESULTS This review confirms that US has a high level of sensitivity in diagnosing RA (and hence a low risk of missing cases of RA which might benefit from early treatment with DMARDs). It also has a high level of specificity (and hence a low risk of falsely diagnosing somebody with RA who may suffer adverse effects of DMARD therapy). US is already widely available and well accepted by clinicians and patients. It does not involve exposure to radiation and can be readily delivered by appropriately trained staff. CONCLUSION This review of relevant studies indicates that US should become accepted as the investigation with the most favourable balance of benefits to risks in the early diagnosis of RA. Given the continuing controversy surrounding studies of different imaging techniques in RA, further research into the diagnostic role of US in RA is indicated.
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Affiliation(s)
- Maria Boylan
- Graduate Entry Medical School, University of Limerick - Faculty of Education & Health Services, Limerick, V94 T9PX, Ireland.
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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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Andréu JL, Silva-Fernández L, Galla T. Progress of the attractiveness of Rheumatology among medical speciality training candidates (MIR) in Spain. REUMATOLOGIA CLINICA 2018; 14:150-154. [PMID: 27988135 DOI: 10.1016/j.reuma.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the progress of the attractiveness of rheumatology at successive MIR calls, from 1983 to 2014. METHODS Candidates in the Spanish training system for medical doctors choose their specialties sequentially, ordered by their ranking in the qualifying exam (MIR). The highest, median and lowest rank of candidates choosing rheumatology training positions in every MIR call from 1983 to 2014 was requested from the Department of Management of Specialized Medical Training (General Department of Professional Regulation; Spanish Ministry of Health). To compare, the same data was requested for other specialties. In order to define and analyze the attractiveness of each specialty we introduce an 'index of attractiveness', based on the normalized difference of the actual median rank reported for each year and the average median obtained in 1000 simulations in which candidates choose specialties at random. RESULTS Regarding the median of the election of rheumatology, the range went from 244th in 1983 to 3394th in 2008, showing a progressive increase over the years in absolute figures. A mathematical simulation allowed quantifying the difference between the observed median and what would have happened if specialties had been chosen by pure chance. Results show a tendency to recover the attractiveness of rheumatology in recent years. CONCLUSIONS After a sharp decline in the attractiveness of rheumatology during the last years of the 20th century, there seems to be a recovery.
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Affiliation(s)
- José Luis Andréu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España.
| | - Lucía Silva-Fernández
- Sección de Reumatología, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Tobias Galla
- Theoretical Physics, School of Physics and Astronomy, The University of Manchester, Mánchester, Reino Unido
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Guillen Astete CA, Larena Grijalva C. Myofibroblastic sarcoma of the trapezius muscle. ACTA ACUST UNITED AC 2017; 15:e47-e48. [PMID: 28754518 DOI: 10.1016/j.reuma.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022]
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Hussain Manik Z, George J, Sockalingam S. Ultrasound Assessment of Synovial Thickness of Some of the Metacarpophalangeal Joints of Hand in Rheumatoid Arthritis Patients and the Normal Population. SCIENTIFICA 2016; 2016:5609132. [PMID: 27190682 PMCID: PMC4846766 DOI: 10.1155/2016/5609132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 06/05/2023]
Abstract
Objective. To compare ultrasound synovial thickness of the 2nd, 3rd and 4th metacarpophalangeal joints (MCPJ) in a group of patients with proven rheumatoid arthritis (RA) and a control group of normal individuals. Materials and Methods. This is a cross-sectional study comprising 30 rheumatoid arthritis patients and 30 healthy individuals. Ultrasound scans were performed at the dorsal side of 2nd, 3rd, and 4th MCPJ of both hands in RA patients and the healthy individuals. Synovial thickness was measured according to quantitative method. The synovial thickness of RA patients and healthy individuals was compared and statistical cut-off was identified. Results. Maximum synovial thickness was most often detected at the radial side of the 2nd MCPJ and 3rd MCPJ and ulnar side of the 4th MCPJ of both hands which is significantly higher (p < 0.05) in RA patients compared to healthy individuals. With high specificity (96%) and sensitivity (90%) the optimum cut-off value to distinguish RA patients and healthy individuals' synovial thickness differs for the radial side of the 2nd and 3rd MCPJ and ulnar side of the 4th MCPJ. Conclusion. Patients with early RA appear to exhibit a characteristic pattern of synovitis which shows radial side predominance in the 2nd and 3rd MCPJ and ulnar side in the 4th MCPJ.
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Affiliation(s)
- Zuhudha Hussain Manik
- University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John George
- University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sargunan Sockalingam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Castro ADAE, Skare TL, Nassif PAN, Sakuma AK, Barros WH. Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers. Radiol Bras 2015; 48:287-91. [PMID: 26543279 PMCID: PMC4633072 DOI: 10.1590/0100-3984.2014.0069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy
hospital workers, establishing the respective epidemiological associations. Materials and Methods Two hundred individuals were submitted to wrist ultrasonography to measure the
median nerve area. They were questioned and examined for epidemiological data,
body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the
Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome
severity. A median nerve area ≥ 9 mm2 was considered to be
diagnostic of carpal tunnel syndrome. Results Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It
was observed the association of carpal tunnel syndrome with age
(p < 0.0001), paresthesia (p < 0.0001),
Tinel’s test (p < 0.0001), Phalen’s test (p
< 0.0001), BCTQ score (p < 0.0001), and years of formal
education (p < 0.0001). Years of formal education was the only
variable identified as an independent risk factor for carpal tunnel syndrome (95%
CI = 1.03 to 1.24). Conclusion The prevalence of carpal tunnel syndrome in a population of hospital workers was
of 34%. The number of years of formal education was the only independent risk
factor for carpal tunnel syndrome.
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Affiliation(s)
- Adham do Amaral E Castro
- Master, MD, Radiologist, Postgraduate student of Ultrasonography, Computed Tomography and Magnetic Resonance Imaging at Hospital Israelita Albert Einstein, São Paulo, Part Time Dedication, Fellow PhD degree, Instituto de Pesquisas Médicas, Faculdade Evangélica do Paraná - Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil
| | - Thelma Larocca Skare
- PhD, MD, Rheumatologist, Head of Rheumatology Service, Hospital Universitário Evangélico de Curitiba, Full Professor of Rheumatology, Faculdade Evangélica do Paraná, Curitiba, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- PhD, MD, Digestive System Surgeon, Head of the Service of Bariatric and Metabolic Surgery, Hospital Universitário Evangélico de Curitiba, Associate Professor of Traumatology, Surgical Practice II and Scientific Methodology at Faculdade Evangélica do Paraná, Curitiba, PR, Brazil
| | - Alexandre Kaue Sakuma
- MD, Scientific Research student of Instituto de Pesquisas Médicas da Faculdade Evangélica do Paraná - Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brasil
| | - Wagner Haese Barros
- MD, Radiologist, Trainee in Locomotor System Radiology at Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
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Ivanac G, Morović-Vergles J, Brkljačić B. Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis. Croat Med J 2015; 56:280-9. [PMID: 26088853 PMCID: PMC4500980 DOI: 10.3325/cmj.2015.56.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the role of gray-scale and color duplex-Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. METHODS Ulnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). RESULTS Clinical indicators changed significantly after treatment: ESR from 38.1±22.4 mm/h to 27.8±20.9 mm/h (P=0.013), DAS 28 from 5.47±1.56 to 3.87±1.65 (P<0.001), and HAQ from 1.26±0.66 to 0.92±0.74 (P=0.030), indicating therapeutic effectiveness. In all MCP and UC joints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol. CONCLUSION Gray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy.
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Affiliation(s)
| | | | - Boris Brkljačić
- Boris Brkljačić, Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Avenija G. Šuška 6, 10000 Zagreb, Croatia,
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17
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Hsiao YF, Li KJ. Clinical Application of Musculoskeletal Ultrasound in Rheumatology. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mata Arnaiz MC, de Miguel Mendieta E. Usefulness of ultrasonography in the assessment of peripheral enthesis in spondyloarthritis. ACTA ACUST UNITED AC 2013; 10:113-9. [PMID: 24360900 DOI: 10.1016/j.reuma.2013.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/11/2013] [Indexed: 12/01/2022]
Abstract
Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis. However, in clinical practice, its presence often goes unnoticed because of the lack of precision and sensitivity of physical examination to detect it. Viable, valid and reliable imaging tests are needed for early diagnosis, as well as a good sensitivity to change to monitor therapeutic response. In this paper we review the most relevant aspects of current knowledge of the enthesis and discusses the validity of ultrasound for assessing enthesitis in spondyloarthritis and its sensitivity to change to monitor therapeutic response.
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