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Hamel C, Avard B, Gorelik N, Heroux M, Mai D, Sheikh A, Vo A, Watson ML, Rakhra K. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:269-278. [PMID: 37635274 DOI: 10.1177/08465371231190807] [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] [Indexed: 08/29/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Musculoskeletal System Expert Panel consists of musculoskeletal radiologists, a family physician, a sports and exercise medicine physician, emergency medicine physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 25 musculoskeletal clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for 1 or more of these clinical/diagnostic scenarios. Recommendations from 41 guidelines (50 publications) and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 124 recommendation statements across the 25 scenarios related to the evaluation of the musculoskeletal system. This guideline presents the methods of development and the recommendations for imaging in the context of musculoskeletal pain, infection, tumors, arthropathies, metabolic bone disease, stress injuries, orthopedic hardware, avascular necrosis/bone infarction, and complex regional pain syndrome.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Natalia Gorelik
- Department of Radiology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adnan Sheikh
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | - Kawan Rakhra
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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D'Agostino MA, Schett G, López-Rdz A, Šenolt L, Fazekas K, Burgos-Vargas R, Maldonado-Cocco J, Naredo E, Carron P, Duggan AM, Goyanka P, Boers M, Gaillez C. Response to Secukinumab on Synovitis using Power Doppler Ultrasound in Psoriatic Arthritis: 12-week Results from a Phase III Study, ULTIMATE. Rheumatology (Oxford) 2021; 61:1867-1876. [PMID: 34528079 PMCID: PMC9071547 DOI: 10.1093/rheumatology/keab628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives To investigate the dynamics of response of synovitis to IL-17A inhibition
with secukinumab in patients with active PsA using Power Doppler
ultrasound. Methods The randomized, placebo-controlled, Phase III ULTIMATE study enrolled PsA
patients with active ultrasound synovitis and clinical synovitis and
enthesitis having an inadequate response to conventional DMARDs and
naïve to biologic DMARDs. Patients were randomly assigned to receive
either weekly subcutaneous secukinumab (300 or 150 mg according to
the severity of psoriasis) or placebo followed by 4-weekly dosing
thereafter. The primary outcome was the mean change in the ultrasound Global
EULAR and OMERACT Synovitis Score (GLOESS) from baseline to week 12. Key
secondary endpoints included ACR 20 and 50 responses. Results Of the 166 patients enrolled, 97% completed 12 weeks of
treatment (secukinumab, 99%; placebo, 95%). The primary end
point was met, and the adjusted mean change in GLOESS was higher with
secukinumab than placebo [−9 (0.9) vs −6
(0.9), difference (95% CI): −3 (−6, −1);
one-sided P=0.004] at week 12. The difference in
GLOESS between secukinumab and placebo was significant as early as one week
after initiation of treatment. All key secondary endpoints were met. No new
or unexpected safety findings were reported. Conclusion This unique ultrasound study shows that apart from improving the signs and
symptoms of PsA, IL-17A inhibition with secukinumab leads to a rapid and
significant reduction of synovitis in PsA patients. Trial registration ClinicalTrials.gov; NCT02662985.
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Affiliation(s)
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich Alexander University of Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University of Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alejandra López-Rdz
- Dermatológico Country, PSOAPS Psoriasis Clinical and Research Centre, Guadalajara, Mexico
| | - Ladislav Šenolt
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Katalin Fazekas
- Department of Rheumatology, Miskolci Semmelweis Hospital and University Teaching Hospital, Miskolci, Hungary
| | | | | | - Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | | | | | - Maarten Boers
- Department of Epidemiology and Data Science; and Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Fassio A, Matzneller P, Idolazzi L. Recent Advances in Imaging for Diagnosis, Monitoring, and Prognosis of Psoriatic Arthritis. Front Med (Lausanne) 2020; 7:551684. [PMID: 33195301 PMCID: PMC7658536 DOI: 10.3389/fmed.2020.551684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory condition characterized by a strong heterogeneity and multifaceted behavior. PsA manifests in two types—axial and peripheral—which may be present at the same time. Peripheral manifestations can be further divided into the articular (arthritis) and extra-articular (i.e., enthesitis and dactylitis) subgroups. In such a complex disease, imaging is often required to characterize the type of involvement and to evaluate the radiological damage and progression of PsA. In addition, imaging plays a pivotal role in clinical practice; that is, for axial involvement. Conventional radiology has been the main standard of reference for many years. However, in recent years, there has been growing interest in different imaging modalities, such as ultrasonography (US) and magnetic resonance imaging (MRI). All these techniques play a role in the diagnosis and follow-up of patients with PsA and cover all the types of the disease. US and MRI have good sensitivities and specificities for detecting synovitis, and this may be helpful for differential diagnosis with other musculoskeletal diseases and useful in the early or preclinical phases of the disease. However, US is not useful in the diagnosis of axial PsA. In addition, other modalities have been investigated in the field of PsA imaging. Computed tomography (CT), in particular, dual energy-CT and high-resolution peripheral CT (HRpQ-CT) might play an important role in the assessment of bone damage, erosions, and new bone formation. Regarding advanced functional imaging, FDG PET/CT is another interesting technique for exploring disease activity.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
- *Correspondence: Angelo Fassio
| | - Peter Matzneller
- Rheumatology Service, South Tyrolean Health Trust, Silandro Hospital, Silandro, Italy
| | - Luca Idolazzi
- Rheumatology Unit, University of Verona, Verona, Italy
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Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice. Rheumatol Int 2019; 39:2119-2127. [DOI: 10.1007/s00296-019-04441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
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Navarro-Compán V, Otón T, Loza E, Almodóvar R, Ariza-Ariza R, Bautista-Molano W, Burgos-Vargas R, Collantes-Estévez E, de Miguel E, González-Fernández C, Gratacós J, Ibáñez S, Juanola X, Maldonado-Cocco J, Moltó A, Mulero J, Pacheco-Tena C, Ramos-Remus C, Sanz-Sanz J, Valle-Oñate R, Zarco P, Marzo-Ortega H. Assessment of SpondyloArthritis International Society (ASAS) Consensus on Spanish Nomenclature for Spondyloarthritis. ACTA ACUST UNITED AC 2018; 16:333-338. [PMID: 30193774 DOI: 10.1016/j.reuma.2018.07.014] [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: 05/08/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To develop a consensus to standardize the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). METHODS An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Española de Reumatología (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de España (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. RESULTS Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. CONCLUSIONS Through this standardization, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes.
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Affiliation(s)
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España
| | | | | | | | | | | | | | | | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí de Sabadell, I3PT, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - Sebastián Ibáñez
- Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago de Chile, Chile
| | - Xavier Juanola
- Hospital Universitario de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | | | - Anna Moltó
- Hôpital Cochin Hospital, Assistance Publique Hôpitaux de Paris-INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, París, Francia
| | - Juan Mulero
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Cronicodegenerativas, Ciudad de México, México
| | - Jesús Sanz-Sanz
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Helena Marzo-Ortega
- NIHR Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Reino Unido
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Tenten-Diepenmaat M, van der Leeden M, Vliet Vlieland TPM, Dekker J. Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis. J Foot Ankle Res 2018; 11:37. [PMID: 29988776 PMCID: PMC6030746 DOI: 10.1186/s13047-018-0276-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. METHODS The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. RESULTS In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. CONCLUSIONS These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.
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Affiliation(s)
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Thea P. M. Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
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