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Umezawa M, Haruki M, Yoshida M, Kamimura M, Soga K. Effects of Processing pH on Emission Intensity of Over-1000 nm Near-Infrared Fluorescence of Dye-Loaded Polymer Micelle with Polystyrene Core. ANAL SCI 2021; 37:485-490. [PMID: 33342927 DOI: 10.2116/analsci.20scp09] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fluorescence imaging using the over-thousand-nanometer (OTN) near-infrared (NIR) light is an emerging method for an in vivo imaging analysis of deep tissues without physical sectioning. Polymer micelle nanoparticles (PNPs) composed of organic polymers encapsulating an OTN-NIR fluorescent dye, IR-1061, in their hydrophobic core are expected to be biocompatible probes. Because IR-1061 quickly quenches due to the vibration of polar hydroxyl bonding in its surroundings, the influence of hydroxyl ions should be minimized. Herein, we investigated the effect of the hydrogen ion concentration during the preparation process using IR-1061 and an organic polymer, poly(ethylene glycol)-block-polystyrene (PEG-b-PSt), on the emission properties of the obtained OTN-PNPs. The OTN-PNP has a hydrodynamic diameter of 20 - 30 nm and emits 1110-nm fluorescence that is applicable to angiography. The loading efficiency of IR-1061 in the OTN-PNPs increased when prepared in an aqueous solution with a low hydroxyl ion concentration. In this solution (pH 3.0), highly emissive OTN-PNPs was obtained with IR-1061 at lower nominal concentrations. Decreasing the hydroxyl ion concentration during the preparation process yields highly emissive OTN-PNPs, which may improve the in vivo imaging analysis of biological phenomena in deep tissues.
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Affiliation(s)
- Masakazu Umezawa
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science
| | - Mae Haruki
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science
| | - Moe Yoshida
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science
| | - Masao Kamimura
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science
| | - Kohei Soga
- Department of Materials Science and Technology, Faculty of Industrial Science and Technology, Tokyo University of Science
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Wu M, Peng L, Donroe JH, Kohler MJ, Wang L, Zeng X, Li M, Hsieh E. Musculoskeletal ultrasound imaging training, use, and knowledge among rheumatologists in China. Clin Rheumatol 2020; 40:321-330. [PMID: 32506316 DOI: 10.1007/s10067-020-05175-4] [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: 03/31/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/OBJECTIVES Musculoskeletal ultrasound (MSUS) has been extensively studied by rheumatologists in Europe and the Americas, but less is known about MSUS use in Asia. Our hypothesis is that MSUS use is less prevalent in China as compared with its Western counterparts. This study reports the most up-to-date recommendations for MSUS use in rheumatology globally and is also the first study to characterize the current practices, training, and perceptions regarding MSUS of rheumatologists in China. METHOD A 43-question survey was designed and distributed via mobile application to members of the Chinese Rheumatology Association, primarily to investigate the current prevalence and utilization of MSUS in China. Statistical analyses included the use of chi-square tests and independent-samples t tests, with p values less than 0.05 considered statistically significant. RESULTS The results showed low rates of MSUS training (129/528, 24%) and current MSUS use (89/524, 17%) in China. However, there was a high level of interest in learning MSUS, especially among younger respondents. Lack of access to training programs and user variability in skill were seen as significant barriers to the uptake of MSUS. CONCLUSIONS Despite low rates of MSUS training and utilization, the vast majority of respondents believe that MSUS should become a standard clinical tool in rheumatology, and there was great interest in undergoing training. Importantly, lack of access to MSUS training programs and user variability in skill were seen as significant obstacles to the more widespread use of MSUS, which suggests a need for more standardized, high-quality MSUS training in China. Key Points • A low percentage of Chinese rheumatologists (17%) currently use MSUS. • Chinese rheumatologists expressed a high level of interest in obtaining MSUS training. • The greatest perceived obstacle to more widespread MSUS use is the lack of training programs.
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Affiliation(s)
- Margaret Wu
- Yale University School of Medicine, New Haven, CT, USA
| | - Linyi Peng
- Department of Rheumatology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Eastern District, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Joseph H Donroe
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Minna J Kohler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Li Wang
- Department of Rheumatology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Eastern District, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Eastern District, Beijing, 100730, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Eastern District, Beijing, 100730, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education & National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy and Immunology, Yale University School of Medicine, 300 Cedar Street, TAC S-525, PO Box 208031, New Haven, CT, 06520, USA.
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Hamada S A, Sherief E F, Osama K. Value of ultrasound examination of the Leeds Enthesitis Index in assessment of disease activity in psoriatic arthritis. RHEUMATICA ACTA: OPEN ACCESS 2020; 4:001-006. [DOI: 10.17352/raoa.000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Quantitative analysis of therapeutic response in psoriatic arthritis of digital joints with Dual-energy CT iodine maps. Sci Rep 2020; 10:1225. [PMID: 31988331 PMCID: PMC6985244 DOI: 10.1038/s41598-020-58235-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to investigate the feasibility of quantitative assessment of the therapeutic response in psoriatic arthritis (PsA) by measuring iodine uptake using a Dual-energy CT (DECT) iodine map. The study included 74 symptomatic and 74 matching non-symptomatic joints of 26 consecutive PsA patients who underwent two contrast enhanced DECTs of the hand or foot, pre and post medical interventions. Symptomatic and matched non-symptomatic control joints were scored with the PsA DECT Scoring System (PsADECTS), which was derived by modifying the PsA MRI Scoring System (PsAMRIS), a recently validated scoring system that assesses PsA changes on MRI. Quantified iodine uptake measured using the DECT iodine map was compared to the PsADECTS score. Efficacy of PsA treatment was confirmed by the improved clinical findings. Both PsADECTS and iodine uptake also showed significant improvement after treatment (Wilcoxon signed-rank test: z = 7.38, p < 0.005; z = 6.20, p < 0.005, respectively). The treatment effects of PsADECTS score and iodine uptake showed a good correlation with each other (Spearman’s ρ = 0.58 p < 0.005). Inter-reader agreement for PsADECTS score and iodine uptake were either moderate or good. In conclusion, our study showed that the DECT iodine map is a valid tool for quantitative assessment of the therapeutic response of PsA.
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Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther 2020; 22:1. [PMID: 31898524 PMCID: PMC6939339 DOI: 10.1186/s13075-019-2050-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Early differentiation between different types of inflammatory arthritis and subsequent initiation of modern treatments can improve patient outcomes by reducing disease activity and preventing joint damage. Routine clinical evaluation, laboratory testing, and radiographs are typically sufficient for differentiating between inflammatory and predominantly degenerative arthritis (e.g., osteoarthritis). However, in some patients with inflammatory arthritis, these techniques fail to accurately identify the type of early-stage disease. Further evaluation by ultrasound imaging can delineate the inflammatory arthritis phenotype present. Ultrasound is a noninvasive, cost-effective method that enables the evaluation of several joints at the same time, including functional assessments. Further, ultrasound can visualize pathophysiological changes such as synovitis, tenosynovitis, enthesitis, bone erosions, and crystal deposits at a subclinical level, which makes it an effective technique to identify and differentiate most common types of inflammatory arthritis. Limitations associated with ultrasound imaging should be considered for its use in the differentiation and diagnosis of inflammatory arthritides.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209, USA.
| | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Dejaco C, Putrik P, Unger J, Aletaha D, Bianchi G, Bijlsma JW, Boonen A, Cikes N, Finckh A, Gossec L, Kvien TK, Madruga Dias J, Matteson EL, Sivera F, Stamm TA, Szekanecz Z, Wiek D, Zink A, Ramiro S, Buttgereit F. EULAR 'points to consider' for the conduction of workforce requirement studies in rheumatology. RMD Open 2018; 4:e000780. [PMID: 30714579 PMCID: PMC6336096 DOI: 10.1136/rmdopen-2018-000780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/30/2018] [Accepted: 09/22/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Current methods used for forecasting workforce requirements in rheumatology are disparate, as are the parameters incorporated into workforce projection studies. The objective of these European League Against Rheumatism (EULAR points to consider (PTC) is to guide future workforce studies in adult rheumatology in order to produce valid and reliable manpower estimates. METHODS The EULAR Standardised Operating Procedures were followed. A multidisciplinary task force with experts including patients with rheumatic diseases from 11 EULAR countries and the USA was assembled. A systematic literature review (SLR) was conducted to retrieve workforce models in rheumatology and other medical fields. PTC were based on expert opinion informed by the SLR, followed by group discussions with consensus obtained through informal voting. The level of agreement with the PTC was voted anonymously. RESULTS A total of 10 PTC were formulated. The task force recommends models integrating supply (=workforce available in rheumatology), demand (=health services requested by the population) and need (=health services that are considered appropriate to serve the population). In general, projections of workforce requirements should consider all factors relevant for current and future workload in rheumatology inside and outside of direct patient care. Forecasts of workforce supply should consider demography and attrition of rheumatologists, as well as the effects of new developments in healthcare. Predictions of future need/demand should take demographic, sociocultural and epidemiological development of the population into account. CONCLUSION These EULAR-endorsed PTC will provide guidance on the methodology and the parameters to be applied in future national and international workforce requirement studies in rheumatology.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
- Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Julia Unger
- Department of Health Studies, FH JOANNEUM, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Gerolamo Bianchi
- Division of Rheumatology, ASL3-Azienda Sanitaria Genovese, Genova, Italy
| | - Johannes W Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nada Cikes
- Division of Clinical Immunology & Rheumatology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Axel Finckh
- Division of Rheumatology, Department of Internal Medicine Specialities, Geneva University Hospital, Geneva, Switzerland
| | - Laure Gossec
- Rheumatology Department, Pitié Salpêtrière hospital, APHP, Paris, France
- Sorbonne Université, Paris, France
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Joao Madruga Dias
- Department of Rheumatology, Centro Hospitalar Médio Tejo, Torres Novas, Portugal
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, United States
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Dieter Wiek
- EULAR Standing Committee of PARE, Zurich, Switzerland
| | - Angela Zink
- Deutsches Rheuma-Forschungszentrum, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charitè University Hospital, Berlin, Germany
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charitè University Hospital, Berlin, Germany
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Kamel SR, Sadek HA, Mohamed FA, Osman HM. Role of ultrasound disease activity score in assessing inflammatory disease activity in rheumatoid arthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anti-TNF-Alpha-Adalimumab Therapy Had Time Lag of Improvement in Synovial Hypertrophy Compared to Rapid Response in Power Doppler Synovial Vascularity. Mediators Inflamm 2017; 2017:1658397. [PMID: 29104376 PMCID: PMC5606135 DOI: 10.1155/2017/1658397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives The quantification of synovitis is of great significance for follow-up in patients with rheumatoid arthritis (RA). This study aimed to validate the use of power Doppler ultrasonography (PDUS) for evaluating synovial vascularity and synovial hypertrophy for synovitis in patients with rheumatoid arthritis treated with adalimumab. Materials and Methods The synovial disease activity and vascularity of RA on both wrists (radio-carpal joint) were assessed using GS and PDUS to derive the composite US scores based on abnormal counts and severity. The relationship between each measure was determined. Results The 71 patients who received adalimumab therapy had significantly decreased DAS28, ESR, and CRP. After one month, PD score decreased and then remained low for 12 months. Synovial hypertrophy did not change until 3-6 months after, when it started to improve (p = 0.017). By multivariate analysis, sex, age, BMI, and DAS28 did not lead to any difference between synovial hypertrophy and PDUS changes (p = 0.498). Discussion Composite US markers of synovial hypertrophy correlate significantly to the DAS28 score and ESR/CRP in adult RA. The time needed for synovial hypertrophy to decrease may be up to 3-6 months after adalimumab therapy. Switching to biological therapy before 3-6 months is inappropriate and ineffective.
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Bowling K, Rait J, Atkinson J, Srinivas G. Temporal artery biopsy in the diagnosis of giant cell arteritis: Does the end justify the means? Ann Med Surg (Lond) 2017; 20:1-5. [PMID: 28663795 PMCID: PMC5479941 DOI: 10.1016/j.amsu.2017.06.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/07/2017] [Accepted: 06/11/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early temporal artery biopsy is recommended in all patients with suspected cranial GCA (Giant Cell Arteritis) by the BSR (British Society of Rheumatology) and BHPR (British Health Professionals in Rheumatology) guidelines. This should be performed within one week ideally. AIM To assess ACR (American College of Rheumatology) score at presentation and whether temporal artery biopsy result affects clinical management of the clinically suspected GCA patient. METHOD Case records of all temporal artery biopsies performed within January 2012 until December 2014 were analysed for size and result of biopsy and this was correlated to clinical management following result. RESULTS 129 temporal arteries were biopsied with a total of 17 positive biopsy results. 10 biopsy samples were insufficient to confirm or refute GCA. 8 patients within the biopsies negative for GCA had their prednisolone therapy stopped. 5 patients had unknown follow up, with the remainder (89, 87.3%) of the patients continued prednisolone management for treatment of GCA for at least 6 weeks. CONCLUSION Overall 13.2% of our biopsies were positive for GCA and 87.3% of biopsy negative patients continued prednisolone therapy on clinical grounds. In the face of new diagnostic tests (high resolution MRI (Magnetic Resonance Imaging), colour duplex USS (Ultra Sound Scan) and PET (Positive Emission Topography) can we justify invasive surgery to all patients on histological grounds when the results may not alter management? Further investigation is needed directly comparing newer imaging modalities to histology.
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Affiliation(s)
- K. Bowling
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay, TQ2 7AA, United Kingdom
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Husic R, Lackner A, Stradner MH, Hermann J, Dejaco C. Joint positions matter for ultrasound examination of RA patients—increased power Doppler signal in neutral versus flat position of hands. Rheumatology (Oxford) 2017; 56:1312-1319. [DOI: 10.1093/rheumatology/kex153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Indexed: 11/13/2022] Open
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Fukuda T, Umezawa Y, Tojo S, Yonenaga T, Asahina A, Nakagawa H, Fukuda K. Initial Experience of Using Dual-Energy CT with an Iodine Overlay Image for Hand Psoriatic Arthritis: Comparison Study with Contrast-enhanced MR Imaging. Radiology 2017; 284:134-142. [PMID: 28045646 DOI: 10.1148/radiol.2016161671] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To determine the feasibility of dual-energy (DE) computed tomography (CT) with an iodine overlay image (IOI) for evaluation of psoriatic arthritis in the hand. Materials and Methods Approval from the institutional ethics committee and written informed consent from all patients were obtained. This prospective study included 16 patients who had psoriasis with finger joint symptoms from January 2015 to January 2016. Contrast material-enhanced (CE) DE CT and 1.5-T CE magnetic resonance (MR) imaging were performed within 1 month of each other. DE CT was performed with a tube voltage of 80 kV and 140 kV with use of a 0.4-mm tin filter. Images acquired with both modalities were evaluated by two radiologists independently by using a semiquantitative scoring system. Interreader agreement was calculated for each modality: Weighted κ values were calculated for synovitis, flexor tenosynovitis, and extensor peritendonitis, and κ values were calculated for periarticular inflammation. With consensus scores and CE MR images as the reference, the sensitivity and specificity of IOI DE CT for inflammatory lesions were calculated. Statistical analysis of discordant readings was performed by using the McNemar test. Results Interreader agreement for inflammatory lesions was excellent or good (weighted κ = 0.83 and κ = 0.75 in IOI DE CT; weighted κ = 0.81 and κ = 0.87 in CE MR imaging). The sensitivity and specificity of IOI DE CT were 0.78 and 0.87, respectively. Total agreement was 86.3%; however, there were significantly more lesions detected with IOI DE CT than with CE MR imaging alone (134 vs 20 lesions in 1120 evaluated items; P < .001). Sixty-nine percent of the abnormalities detected with IOI DE CT alone were located in distal interphalangeal joints. Conclusion IOI DE CT is a new imaging modality that may be useful for evaluating psoriatic arthritis in the hand, particularly in the detection of inflammatory lesions in small joints, and may be more useful than CE MR imaging, within the limitation that there is no histopathologic reference. © RSNA, 2017.
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Affiliation(s)
- Takeshi Fukuda
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Yoshinori Umezawa
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Shinjiro Tojo
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Takenori Yonenaga
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Akihiko Asahina
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Hidemi Nakagawa
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
| | - Kunihiko Fukuda
- From the Departments of Radiology (T.F., S.T., T.Y., K.F.) and Dermatology (Y.U., A.A., H.N.), The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo 1058471, Japan
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Histologisch nachgewiesene Riesenzellarteriitis und Sehverlust. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mathew AJ, Coates LC, Danda D, Conaghan PG. Psoriatic arthritis: lessons from imaging studies and implications for therapy. Expert Rev Clin Immunol 2016; 13:133-142. [DOI: 10.1080/1744666x.2016.1215245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ashish J. Mathew
- Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Laura C. Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Debashish Danda
- Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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14
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Michelsen B, Diamantopoulos AP, Hammer HB, Soldal DM, Kavanaugh A, Haugeberg G. Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity. Ann Rheum Dis 2016; 75:2108-2113. [PMID: 27091837 DOI: 10.1136/annrheumdis-2015-208806] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria. METHODS In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Disease Activity Score (PASDAS) were assessed. Remission criteria were explored. US evaluation was performed on 34 joints, in addition to joints being tender/swollen by 66/68 joint count, 30 tendons, 10 entheses and additionally entheses found to be tender by clinical examination of 19 other entheses. Power Doppler (PD) and grey scale global scores on joints, entheses and tendons were assessed. US remission was defined as no PD activity in joints, entheses and tendons. RESULTS DAPSA and DAS28, but not CPDAI and PASDAS, were associated with PD activity. MDA was fulfilled in 22.7% and the clinical remission criteria in 5.7%-9.9% of the patients. US remission was found in 49.6% of the patients. The prevalence of PD activity at joints, entheses and tendons was similar for patients fulfilling versus not fulfilling MDA/clinical remission criteria. MDA (OR 2.3, p=0.048), DAPSA ≤3.3 (OR 4.2, p=0.025) and Boolean's (OR=7.8, p=0.033) definitions of remission were found to predict US remission. CONCLUSIONS We found major discrepancies between US and clinical findings. DAPSA and DAS28 reflected US findings better than CPDAI and PASDAS. MDA, DAPSA and Boolean's remission criteria predicted US remission.
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Affiliation(s)
- Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Andreas P Diamantopoulos
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag M Soldal
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, USA
| | - Glenn Haugeberg
- Department of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
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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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Gutierrez M, Di Matteo A, Rosemffet M, Cazenave T, Rodriguez-Gil G, Diaz CH, Rios LV, Zamora N, Guzman MDCG, Carrillo I, Okano T, Salaffi F, Pineda C. Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: A randomized comparative study. Joint Bone Spine 2015; 83:161-6. [PMID: 26645159 DOI: 10.1016/j.jbspin.2015.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up. METHODS Patients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate. RESULTS A total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P=0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P=0.0001, P=0.012 and P=0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P=0.0002), whereas no statistical differences were found in the GS findings between the groups (P=0.5627). CONCLUSION Our study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.
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Affiliation(s)
- Marwin Gutierrez
- Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy.
| | - Andrea Di Matteo
- Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy
| | - Marcos Rosemffet
- Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina
| | - Tomas Cazenave
- Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina
| | - Gustavo Rodriguez-Gil
- Secion de Reumatologia, Hospital Municipal de Bahìa Blanca, Calle Estomba 968, 8000 Bahia Blanca, Argentina
| | - Cristina Hernandez Diaz
- Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico
| | - Lucio Ventura Rios
- Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico
| | - Natalia Zamora
- Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina
| | | | - Ignacio Carrillo
- Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka City, University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, 545-8585 Osaka, Japan
| | - Fausto Salaffi
- Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico
| | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico
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Duftner C, Dejaco C, Kainberger F, Machold K, Mandl P, Nothnagl T, DeZordo T, Husic R, Schüller-Weidekamm C, Schirmer M. Empfehlungen der Österreichische Gesellschaft für Rheumatologie und Rehabilitation/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound zur Anwendung des Ultraschalls bei rheumatischen Erkrankungen in der klinischen Praxis. Wien Klin Wochenschr 2014; 126:809-14. [DOI: 10.1007/s00508-014-0606-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
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Chacko JG, Chacko JA, Salter MW. Review of Giant cell arteritis. Saudi J Ophthalmol 2014; 29:48-52. [PMID: 25859139 DOI: 10.1016/j.sjopt.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/16/2014] [Accepted: 10/01/2014] [Indexed: 11/26/2022] Open
Abstract
Giant-cell arteritis (GCA) is a systemic autoimmune disease affecting primarily the elderly. Giant cell arteritis can cause sudden and potentially bilateral sequential vision loss in the elderly. Therefore, it is considered a medical emergency in ophthalmology and a significant cause of morbidity in an increasingly aging population. Ophthalmologists need to be able to recognize the classic symptoms and signs of this disease, and then be able to work-up and treat these patients in an efficient manner. An in-depth review of GCA from the literature as well as personal clinical experience follows.
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Affiliation(s)
- Joseph G Chacko
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 W. Markham, #523, Little Rock, AR 72205, USA
| | | | - Michael W Salter
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 W. Markham, #523, Little Rock, AR 72205, USA
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Schmidt WA. Role of ultrasound in the understanding and management of vasculitis. Ther Adv Musculoskelet Dis 2014; 6:39-47. [PMID: 24688604 DOI: 10.1177/1759720x13512256] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vasculitis is characterized by a circumferential vessel-wall thickening ('halo'), which can be visualized by modern imaging techniques. In particular, the resolution of ultrasound has increased to 0.1 mm. Ultrasound detects abnormalities that are pathognomonic even in arteries with a diameter below 1 mm. It is particularly helpful in the diagnosis of large-vessel vasculitides, such as classic temporal arteritis, large-vessel giant-cell arteritis (GCA), Takayasu arteritis and idiopathic aortitis. Echocardiography is important for determining cardiac involvement in Takayasu arteritis and also for examining the coronary arteries of children with suspected Kawasaki disease, which is a medium-vessel vasculitis. In small vessel vasculitides ultrasound has only a role for determining the distribution or organ involvement. Fast-track clinics for the diagnosis of GCA help to initiate treatment before complications such as blindness occur; patients receive appointments within 24 h in these clinics. Clinical examination and ultrasound of temporal and axillary arteries are performed by an experienced rheumatologist. In most cases this is able to determine if GCA is present. Temporal artery biopsy can be still carried out in ambivalent cases. The wall swelling of temporal arteries disappears after 2-3 weeks of glucocorticoid treatment. After 3 days of treatment, diagnosis becomes more difficult with ultrasound in some cases. In larger arteries, such as the axillary arteries, wall thickening disappears within months. It tends to be darker (more hypoechoic) in acute disease because of oedema.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany
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Ultrasonography is useful to detect subclinical synovitis in SLE patients without musculoskeletal involvement before symptoms appear. Clin Rheumatol 2014; 33:341-8. [PMID: 24478125 DOI: 10.1007/s10067-014-2502-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 12/11/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to investigate the frequency of the subclinical synovitis in hand or wrist joints of the SLE patients using ultrasonography (US) and to correlate them with clinical parameters. Forty-eight systemic lupus erythematosus (SLE) patients without musculoskeletal (MS) involvement were enrolled and underwent clinical and laboratory examinations. Gray-scale and power Doppler (PD) US was performed for imaging the wrist, second and third metacarpophalangeal (MCP) joints, and flexor tendons on non-dominant sides of the individuals. US synovitis index (USSI) and PD index were calculated as sum of the synovitis and PD semiquantitative scores, respectively, obtained from each joint. Subclinical synovitis was found by US in 28 (58.3%) out of 48 patients. US revealed synovitis of the wrist in 16 (33.3%) patients, of the second MCP joint in 14 (29.2%) and of the third MCP joint in 15 (31.3%). PD signals in three (6.3%) patients and tenosynovitis in two (4.2%) were also detected. USSI scores showed significant positive correlation with erythrocyte sedimentation rate (ESR) levels (r = 0.30, p < 0.05) or anti-dsDNA Ab titers (r = 0.34, p < 0.05). Within 6 months after US examination, new MS symptoms were developed in 11 (22.9%) patients. Older age at diagnosis (OR 1.283, 95% CI 1.029-1.601, p = 0.027) or higher USSI scores (OR 12.93, 95% CI 1.023-163.503, p = 0.048) were independently associated with development of new MS symptoms. Subclinical synovitis is common in SLE patients who do not suffer from MS symptoms. US is useful to detect joint abnormalities before symptoms appear in SLE patients.
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Duftner C, Schüller-Weidekamm C, Mandl P, Nothnagl T, Schirmer M, Kainberger F, Machold K, Dejaco C. Clinical implementation of musculoskeletal ultrasound in rheumatology in Austria. Rheumatol Int 2013; 34:1111-5. [PMID: 24071934 DOI: 10.1007/s00296-013-2863-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
Abstract
The aim of the study is to assess the clinical implementation of musculoskeletal ultrasound (MSUS) in rheumatology in Austria. A survey was conducted among Austrian rheumatologists and physicians of other specialties with a focus on rheumatology. The questionnaire was designed by the members of the Austrian Radiology-Rheumatology Initiative for Musculoskeletal UltraSound including the following items: demographics, access to MSUS and MSUS training, application of MSUS to support diagnosis, monitoring and treatment decisions, and obstacles for the routine performance of MSUS. Eighty-eight (21.9 %) out of the 402 surveyed physicians responded. No access to MSUS and/or inadequate training in the technique was more commonly reported by senior (>50 years; 64.3 and 67.7 %, respectively) than by younger physicians (16.7 %, p = 0.01 and 18.5 %, p < 0.001, respectively). The lowest availability of sonography was found among senior rheumatologists (25.0 %, p = 0.001 compared to the total group). MSUS is routinely used for diagnosis and/or monitoring purposes by 12.5 % of physicians and 20.5 % perform sonography in clinically unclear cases. A limited number of physicians apply the method to support treatment decisions and/or to evaluate treatment success. The most important obstacles for routine application of MSUS in rheumatology are limited access to ultrasound machines, lack of training/education in the technique, and time constraints in daily routine. Low access to high-end ultrasound devices, lack of training, and time constraints may explain the low appreciation of MSUS among Austrian physicians evaluating patients with rheumatic diseases.
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Affiliation(s)
- Christina Duftner
- Department of Internal Medicine, General Hospital of Kufstein, Endach 27, 6330, Kufstein, Austria
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Husic R, Gretler J, Felber A, Graninger WB, Duftner C, Hermann J, Dejaco C. Disparity between ultrasound and clinical findings in psoriatic arthritis. Ann Rheum Dis 2013; 73:1529-36. [DOI: 10.1136/annrheumdis-2012-203073] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chakr RMDS, Mendonça JA, Brenol CV, Xavier RM, Brenol JCT. Assessing rheumatoid arthritis disease activity with ultrasound. Clin Rheumatol 2013; 32:1249-54. [PMID: 23700041 DOI: 10.1007/s10067-013-2291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 01/19/2023]
Abstract
In practice, composite indices are used for rheumatoid arthritis (RA) disease activity evaluation. Despite valid and widely used, not rarely composite indices miss accuracy. Ultrasound (US) is more precise than clinical examination in synovitis appraisal. US-based disease activity estimation depends on the detection of synovitis. The most common synovitis abnormalities are proliferation, effusion, and neoangiogenesis. Gray scale ultrasound identifies synovial hypertrophy and effusion with its good soft tissue contrast. Additionally, power Doppler ultrasound depicts neoangiogenesis within synovia, remarking local inflammation. Several studies have combined local US findings to develop a patient level disease activity index. Most of them summed selected joint scores in an overall score of disease activity and evaluated its correlation with clinical composite indexes. To be incorporated into clinical practice, an overall US score must have some fundamental characteristics such as reproducibility, viability, and sensitivity to change over time. In global US score development, finding the joints that truly estimate individual disease activity is highly challenging. This article presents an up-to-date literature review on assessing RA disease activity with US and depicts the challenges in finding the perfect global US score.
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Affiliation(s)
- Rafael Mendonça da Silva Chakr
- Rheumatology Division Faculty, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, suite 645, Porto Alegre, Rio Grande do Sul, CEP 90035-903, Brazil.
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Paresce E, De Lucia O, Bruschi E, Giacomelli L, Epis OM. Use of ultrasound-assisted arthroscopy in rheumatology: an experience in 11 patients with different rheumatic diseases. ACTA ACUST UNITED AC 2013; 7:309-12. [DOI: 10.1517/17530059.2013.794136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kang T, Horton L, Emery P, Wakefield RJ. Value of ultrasound in rheumatologic diseases. J Korean Med Sci 2013; 28:497-507. [PMID: 23580002 PMCID: PMC3617300 DOI: 10.3346/jkms.2013.28.4.497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 01/25/2013] [Indexed: 01/17/2023] Open
Abstract
The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.
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Affiliation(s)
- Taeyoung Kang
- Department of Rheumatology, Yonsei Univeristy Wonju College of Medicine, Wonju, Korea
- Division of Rheumatic and Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
| | - Laura Horton
- Division of Rheumatic and Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
| | - Paul Emery
- Division of Rheumatic and Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
| | - Richard J. Wakefield
- Division of Rheumatic and Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
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Dejaco C, Duftner C, Wipfler-Freissmuth E, Weiss H, Schneider T, Schirmer M. Elderly- versus younger-onset rheumatoid arthritis: Higher levels of ultrasound-detected inflammation despite comparable clinical disease activity. Arthritis Care Res (Hoboken) 2013; 65:304-8. [DOI: 10.1002/acr.21823] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/27/2012] [Indexed: 11/08/2022]
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Fukae J, Isobe M, Kitano A, Henmi M, Sakamoto F, Narita A, Ito T, Mitsuzaki A, Shimizu M, Tanimura K, Matsuhashi M, Kamishima T, Atsumi T, Koike T. Positive synovial vascularity in patients with low disease activity indicates smouldering inflammation leading to joint damage in rheumatoid arthritis: time-integrated joint inflammation estimated by synovial vascularity in each finger joint. Rheumatology (Oxford) 2012. [PMID: 23192908 DOI: 10.1093/rheumatology/kes310] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jun Fukae
- Hokkaido Medical Center for Rheumatic Diseases, 1-45, 3-Chome, 1-Jo, Kotoni, Nishi-ku, Sapporo 063-0811, Japan.
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Abstract
Inflammatory arthritis involves a diverse range of conditions in which an uncontrolled immune response occurs. A number of advances in assessment, diagnosis and treatment have been made in recent years. Drug therapies used in inflammatory arthritis aim to reduce symptoms and suppress inflammation, joint damage and disability. In rheumatoid arthritis (RA), immunosuppression is used in almost all patients, with an emphasis on early aggressive treatment to achieve clinical remission. This approach is less successful in spondylarthropathies, for which non-steroidal anti-inflammatory drugs remain first-line therapy. The use of biologic therapies has increased dramatically across a range of indications and has resulted in improved outcomes for patients. These agents are associated with an increased risk of infection, particularly tuberculosis in patients receiving tumour necrosis factor inhibitors. Alternative biologics have entered clinical practice for RA in recent years, and clinical trials using these agents, as well as novel non-biologic therapies, are in progress for RA and other conditions.
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Affiliation(s)
- Nicola J Gullick
- Academic Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, London.
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Abstract
PURPOSE OF REVIEW Imaging of inflammatory activity is of increasing importance, and among available modalities, ultrasonography and magnetic resonance imaging (MRI) seem to be of highest impact. The present review includes recent studies describing several aspects of these modalities as well as short descriptions of other promising imaging methods in rheumatoid arthritis (RA). RECENT FINDINGS High reliability has been shown for evaluation of ultrasonography still images. Recently excellent reliability was found when an atlas was used as reference for scoring dynamic images with ultrasonography. The optimal number of joints to examine by ultrasonography for follow-up during therapeutic interventions needs to be further explored. Use of ultrasonographic guidance for injections has showed improved clinical results when compared with blind injections. Ultrasonographic pathology, especially power Doppler, was found to be of predictive value in patients with arthritis. Cartilage damage is an important aspect of structural joint damage in RA, and a reliable assessment system of joint space narrowing has been developed for use with conventional MRI, and various biochemical MRI techniques are being developed to visualize cartilage quality, of which delayed gadolinium-enhanced magnetic resonance imaging of cartilage seems to be the most promising method in RA. SUMMARY Novel imaging modalities, especially ultrasonography and MRI, will be of increasing importance to visualize joint inflammation and aid in the diagnosis, treatment and follow-up of patients with RA.
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Abstract
CLINICAL/METHODICAL ISSUE Clinical examination and laboratory results are often insufficient to support therapeutic decisions. STANDARD RADIOLOGICAL METHODS Diagnosis and organ-related imaging may provide important additional information for initial diagnosis (differential diagnoses), follow-up and prognosis. Especially functional imaging techniques, such as ultrasound and magnetic resonance imaging are becoming more and more important for early diagnosis. METHODICAL INNOVATIONS Imaging is already recognized in the classification criteria of several rheumatic diseases and new criteria for spondyloarthritis and polymyalgia rheumatica aim more and more at early diagnosis using functional imaging techniques, such as ultrasound and magnetic resonance imaging. PERFORMANCE Specific imaging findings are helpful for eliminating differential diagnoses. During follow-up disease control the status as well as progression of structural damage can be documented. In selected diseases imaging allows prognostic statements on both disease progression and therapeutic response to specific medication. ACHIEVEMENTS The evidential value of imaging results varies with the rheumatological expectations. PRACTICAL RECOMMENDATIONS Overall rheumatological expectations on imaging differ widely and therefore support a differentiated use of imaging techniques.
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Affiliation(s)
- C Dejaco
- Klinik für Innere Medizin, Univ.-Klinikum Innsbruck, Anichstr. 35, A-6020, Innsbruck, Österreich
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Dejaco C, Duftner C, Schirmer M. [Recent advances in polymyalgia rheumatica]. MMW Fortschr Med 2012; 154:54-57. [PMID: 22642006 DOI: 10.1007/s15006-012-0038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Dejaco C, Duftner C, Wipfler-Freissmuth E, Weiss H, Graninger WB, Schirmer M. Ultrasound-defined remission and active disease in rheumatoid arthritis: association with clinical and serologic parameters. Semin Arthritis Rheum 2011; 41:761-7. [PMID: 22055540 DOI: 10.1016/j.semarthrit.2011.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 09/14/2011] [Accepted: 09/20/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association of clinical and/or serological parameters with ultrasound-defined disease activity in rheumatoid arthritis (RA). METHODS Retrospective analysis of 149 consecutive RA patients routinely assessed by sonography of the wrists, metacarpo-phalangeal, and proximal interphalangeal joints. Semiquantitative scoring of synovial hypertrophy/effusion and power Doppler (PD) signals was performed. Sonographic remission was defined by the absence of PD signals. Number of tender and swollen joints, global assessment of disease activity by the physician (VAS-phys) and patient (VAS-pt), C-reactive protein (CRP), erythrocyte sedimentation rate, duration of morning stiffness (MS), simplified disease activity index, disease activity score for 28 joints, clinical disease activity index, and health assessment questionnaires were recorded. RESULTS PD signals as a sign of active disease were observed in 117 (78.5%) RA patients. CRP, erythrocyte sedimentation rate, and MS were higher in patients with PD signals than in patients in remission. CRP >5.0 mg/L (normal values 0-5.0 mg/L), MS >15 minutes, or the combination of both revealed odds ratios of 5.0, 3.0, or 18.9, respectively, to indicate sonography-defined active disease. The other parameters showed no association with the presence or absence of PD-signals. CONCLUSIONS Sonography-defined disease activity is associated with CRP and MS, whereas current composite scores and its clinical components did not match this definition.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria
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