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Di Matteo A, Smerilli G, Di Donato S, Liu AR, Becciolini A, Camarda F, Cazenave T, Cipolletta E, Corradini D, de Agustín JJ, Destro Castaniti GM, Di Donato E, Di Geso L, Duran E, Farisogullari B, Fornaro M, Francioso F, Giorgis P, Granel A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Karadag O, Li L, Marin J, Martire MV, Michelena X, Moscioni E, Muntean L, Piga M, Rosemffet M, Rovisco J, Sahin D, Salaffi F, Saraiva L, Scioscia C, Tamas MM, Tanimura S, Venetsanopoulou A, Ventura-Rios L, Villota O, Villota-Eraso C, Voulgari PV, Vukatana G, Zacariaz Hereter J, Marzo-Ortega H, Grassi W, Filippucci E. Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study. Ann Rheum Dis 2024; 83:847-857. [PMID: 38443140 DOI: 10.1136/ard-2023-225443] [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: 03/07/2024]
Abstract
OBJECTIVES To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Di Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - An Ran Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Camarda
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Tomas Cazenave
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Provincial Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Emine Duran
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bayram Farisogullari
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Marco Fornaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Pamela Giorgis
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Amelia Granel
- Rheumatology, Hospital San Roque de Gonnet, La Plata, Buenos Aires, Argentina
| | | | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Diogo Jesus
- Rheumatology Department, Leiria Hospital Centre, Pousos, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - Omer Karadag
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ling Li
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Josefina Marin
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Xabier Michelena
- Rheumatology Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Laura Muntean
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Matteo Piga
- Rheumatology Unit, University of Cagliari, Cagliari, Italy
| | - Marcos Rosemffet
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Didem Sahin
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Liliana Saraiva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Crescenzio Scioscia
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Maria-Magdalena Tamas
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, The Hokkaido Medical Center, Sapporo, Japan
| | - Aliki Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Lucio Ventura-Rios
- Division of Rheumatology, National Institute of Rehabilitation Luis Guillermo Ibarra, Ciudad de Mexico, Mexico
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, San Juan de Pasto, Colombia
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Catalina Villota-Eraso
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Johana Zacariaz Hereter
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
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Corte G, Atzinger A, Temiz SA, Noversa de Sousa R, Mutlu MY, Schoenau V, Raimondo MG, Kleyer A, Kuwert T, Ramming A, Simon D, Sticherling M, Schmidkonz C, Schett G, Fagni F. Anatomical pattern of entheseal and synovial fibroblast activation in patients with psoriasis and its risk of developing psoriatic arthritis. RMD Open 2024; 10:e004294. [PMID: 38862244 PMCID: PMC11168197 DOI: 10.1136/rmdopen-2024-004294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES To assess the presence and anatomical distribution of activated fibroblasts in the joints and entheses of patients with psoriasis with arthralgia and to test how fibroblast activation visualised by 68gallium-labelled fibroblast activation protein inhibitor-04 (68Ga-FAPI-04)-positron emission tomography (PET)/CT correlates with clinical tenderness, musculoskeletal ultrasound findings and progression to psoriatic arthritis (PsA). METHODS We conducted a prospective cohort study in patients with psoriasis and arthralgia who underwent clinical and ultrasound evaluation and whole-body PET/CT imaging with 68Ga-FAPI-04. 68Ga-FAPI-04 uptake at synovial and entheseal sites was assessed by maximal standardised uptake values (SUVmax) and PET/CT Joint Index (JI); logistic regression models were used to investigate its correlation with clinical and ultrasound findings. Survival analyses were performed on patients with at least 6 months of follow-up. RESULTS 36 patients with psoriasis were enrolled. 68Ga-FAPI-04 uptake was found in 318 (7.9%) joints and 369 (7.3%) entheses in 29 (80.6%) participants, with a mean SUVmax (SD) of 3.2 (1.8) for joints and 2.9 (1.6) for entheses. Large joints and the lower limbs were predominantly affected. A significant positive relationship was found between 68Ga-FAPI-04-PET/CT signal intensity and the 68 tender joint count (SUVmax: p<0.001; PET/CT-JI: p<0.001) and tender entheses count (SUVmax: p<0.001; PET/CT-JI: p=0.002). No correlations were found with ultrasound findings (SUVmax: p=0.969; PET/CT-JI: p=0.720). Patients with relevant synovio-entheseal 68Ga-FAPI-04 uptake showed a statistically significant higher risk of developing PsA (p=0.02), independent of ultrasound findings. CONCLUSIONS Patients with psoriasis presenting with arthralgia show localised signs of resident tissue activation in joints and entheses, which are associated with higher risk of developing PsA.
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Affiliation(s)
- Giulia Corte
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Selahattin Alp Temiz
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Rita Noversa de Sousa
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
| | - Melek Yalcin Mutlu
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Verena Schoenau
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Maria Gabriella Raimondo
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Michael Sticherling
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
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Patience A, Steultjens M, Siebert S, Hendry G. Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: a cross-sectional observational study. Rheumatol Int 2024:10.1007/s00296-024-05629-x. [PMID: 38850322 DOI: 10.1007/s00296-024-05629-x] [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: 02/20/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
The Achilles tendon (AT) insertion is the most common site of enthesitis in psoriatic arthritis (PsA). The structure and function of the AT in PsA, and the prevalence of mid-portion pathology, is unknown. To compare the structure and function of the AT in people with PsA with self-reported AT pain (PsA + AT), PsA without self-reported AT pain (PsA-AT) and healthy controls. A cross-sectional, observational study was conducted. The ATs were assessed by clinical and US examination (B-mode and Power Doppler), performance-based testing (bilateral heel raise test (HRT) and 10 m walk test), and patient-reported outcome measures (PROMs) (including the Victorian Institute of Sport Assessment-Achilles [VISA-A]). Between-group differences were described using descriptive statistics, Chi-squared testing, parametric (1-way ANOVA) and non-parametric (Mann-Whitney or Kruskal-Wallis) testing. 22 PsA (11 per group) and 11 healthy control participants who were comparable in terms of sex, age, and BMI (PsA-AT = longer PsA disease duration) were recruited. VISA-A scores were significantly worse in the PsA + AT group compared to the PsA-AT group and healthy controls (p < 0.001). Inflammatory US features were significantly more prevalent in the PsA + AT group (p < 0.001). Mid-portion AT pathology was observed in the PsA + AT group, irrespective of entheseal disease. Clinical examination alone missed 5/7 cases of 'active' US-confirmed AT enthesitis. AT functional deficits were significant in the PsA + AT group and both PsA groups had lower HRT repetition rates and walked slower compared to healthy controls. Less than 1/3 of the PsA + AT group had received podiatry or physiotherapy care. Significant differences in the structure and function of the AT in PsA were noted. Despite management in line with current guidance, AT pain appears to persist and can result in severe functional impairment.
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Affiliation(s)
- Aimie Patience
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- MSK Podiatry, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Martijn Steultjens
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gordon Hendry
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
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Garcia-Pompermayer MR, Ayton SG, Molina-Collada J, Tamborrini G, Sanchez MED, Luna KS, Elizondo MAG. The power of us: breaking barriers and bridging the gap of ultrasound in rheumatology to empower a new generation. Clin Rheumatol 2024; 43:2103-2116. [PMID: 38653847 DOI: 10.1007/s10067-024-06973-w] [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: 02/24/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This study assesses musculoskeletal ultrasound (MSUS) knowledge, attitudes, and practices among young rheumatologists in Mexico, aiming to identify barriers and facilitators to its clinical use. METHODS An online survey distributed to a network of young rheumatologists captured demographics, institutional, and personal MSUS information. Multivariable analysis identified factors associated with positive MSUS attitudes. RESULTS Ninety-six rheumatologists (39.18% national response rate) completed the survey. Of respondents (54.2% females, median age 35.1 years), 81.2% deemed MSUS necessary in clinical rheumatology. The main barriers included limited training access (56.2%) and required training time (54.1%). Lack of scientific evidence was not a major barrier (60.4%). Positive MSUS attitudes were associated with learning from conferences (p = 0.029) and colleagues (p = 0.005), formal (p = 0.043), and in-person training (p = 0.020), MSUS use in practice (p = 0.027), and use by radiologists in their institute (p < 0.001). Interest in learning MSUS (88.5%) was significantly higher in those with positive attitudes (94.4%, p < 0.001). Elastic net analysis identified key drivers, including learning MSUS from conferences, colleagues, and in residency; using MSUS in practice; respondent-performed MSUS; and MSUS use by radiologists. Statistically significant associations were found with using MSUS for synovitis/inflammatory joint disease (OR = 1.43, 95% CI 1.00-2.05) and MSUS use by radiologists in respondent's institutes (OR = 1.70, 95% CI 1.20-2.90). CONCLUSION Most young rheumatologists in Mexico recognize the necessity of MSUS in clinical practice. By addressing identified barriers, encouraging rheumatologist-radiologist collaboration, and establishing a regulatory body to certify rheumatologist's MSUS experience, there is an opportunity to empower them with the necessary skills for effective MSUS use, ultimately benefiting patient care.
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Affiliation(s)
| | - Sarah G Ayton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Juan Molina-Collada
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | | | - Karina Silva Luna
- Reumatología, Instituto de Medicina Interna, Hospital Zambrano-Hellion, Tecnologico de Monterrey, Monterrey, Mexico
| | - Mario Alberto Garza Elizondo
- Reumatología, Instituto de Medicina Interna, Hospital Zambrano-Hellion, Tecnologico de Monterrey, Monterrey, Mexico
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Amer AS, Al Shambaky AY, Ameen SG, Sobih AK. Hematological indices in psoriatic enthesopathy: relation to clinical and ultrasound evaluation. Clin Rheumatol 2024; 43:1909-1917. [PMID: 38584198 PMCID: PMC11111547 DOI: 10.1007/s10067-024-06951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Enthesopathy is considered a crucial aspect of assessment and outcome in psoriatic arthritis (PsA). Musculoskeletal ultrasound (MSUS) is a critical tool for accurately detecting enthesitis. Recent research focuses on identifying simple biomarkers for detecting and monitoring psoriatic enthesopathy. Red cell distribution width (RDW), mean platelet volume (MPV), and neutrophil/lymphocyte ratio (NLR) are components of a complete blood count (CBC) and are reliable bio-inflammatory markers in various rheumatic diseases. AIM OF WORK To measure MPV, RDW, and NLR in psoriatic enthesopathy and determine their relationship to disease activity and MSUS findings. PATIENTS AND METHODS This study focused on 30 people with psoriatic arthritis (PsA) as per CASPAR criteria, along with 20 control subjects. Enthesopathy was evaluated clinically using the Leeds Enthesitis Index (LEI). The modified Disease Activity Index of Psoriatic Arthritis (DAPSA28) was calculated, and RDW, MPV, NLR, CRP, and ESR were measured. Each enthesis in LEI was radiologically assessed using plain radiography and MSUS according to OMERACT definitions. RESULTS There was a significant relationship between clinical tenderness, the presence of enthesophytes on plain radiography, and MSUS findings at entheses sites (p < 0.001 for each). Psoriatic patients had higher levels of RDW and MPV (p < 0.001 and 0.01, respectively) than controls, with no significant differences in NLR (p = 0.189) between the two groups. RDW and MPV levels were positively correlated with the DAPSA28 score. CONCLUSION Monitoring PsA disease activity can be improved by considering RDW and MPV as reliable indicators and using them to screen for psoriatic enthesopathy with MSUS indices. Key points • Clinically identifying enthesitis in patients with PsA can be challenging. Imaging MSUS indices hold promise for objective analysis, but there is no consensus on which indices to use in clinical trials and daily practice. • Patients with psoriatic enthesopathy have higher RDW and MPV levels, which are positively correlated with DAPSA28 score. • RDW and MPV can be considered in the turn of improved screening of psoriatic enthesopathy with MSUS scores.
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Affiliation(s)
- Arwa S Amer
- Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Benha University, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Arab Republic of Egypt.
| | - Ahmed Y Al Shambaky
- Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Benha University, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Arab Republic of Egypt
| | - Seham G Ameen
- Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Arab Republic of Egypt
| | - Amira Khalil Sobih
- Faculty of Medicine, Benha University, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Arab Republic of Egypt
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Iqbal A, Ahmad M, Murray KJ, Sim J, Lund TJS, Andrade AJ, Perez-Sanchez A, Mader MJ, Haro EK, Williams JP, Nathanson R, Soni NJ. Current Use and Barriers to Point-of-Care Ultrasound in Rheumatology: A National Survey of VA Medical Centers. Rheumatol Ther 2024; 11:855-867. [PMID: 38581600 PMCID: PMC11111613 DOI: 10.1007/s40744-024-00665-2] [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: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. METHODS A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. RESULTS All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). CONCLUSION Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. TRIAL REGISTRATION NCT03296280.
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Affiliation(s)
- Ayesha Iqbal
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
- Division of Rheumatology, Emory School of Medicine, Atlanta, GA, USA
| | - Madiha Ahmad
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
- Division of Rheumatology, Emory School of Medicine, Atlanta, GA, USA
| | - Kevin J Murray
- Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jison Sim
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
- Division of Rheumatology, Emory School of Medicine, Atlanta, GA, USA
| | - Terry J S Lund
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7885, San Antonio, TX, 78229, USA
| | - Anthony J Andrade
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7885, San Antonio, TX, 78229, USA
| | - Ariadna Perez-Sanchez
- Division of Hospital Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7885, San Antonio, TX, 78229, USA
| | - Michael J Mader
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Elizabeth K Haro
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jason P Williams
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7885, San Antonio, TX, 78229, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of Hospital Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7885, San Antonio, TX, 78229, USA.
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
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Wang Y, Zhu Y, Zhang F, Chen X, Chen J, Jiang W, Chen S, Yang J, Zhang Q. The value of combined ultrasound contrast arthrography and subacromial-subdeltoid bursography for detecting and differentiating the rotator cuff tear subtypes in patients with the uncertain rotator cuff tear. Eur Radiol 2024; 34:3503-3512. [PMID: 37855852 DOI: 10.1007/s00330-023-10183-4] [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: 02/14/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES In this study, ultrasound (US) contrast arthrography and subacromial-subdeltoid bursography with the contrast agent of SonoVue were performed to evaluate their value for detecting and differentiating the rotator cuff tear (RCT) subtypes in patients with the uncertain RCT. METHODS A total of 102 patients with the clinically suspected RCTs in the orthopedic clinic were prospectively recruited and underwent conventional high-frequency US for the category of undoubted full-thickness RCT, uncertain RCT, and intact rotator cuff. Among these patients, the patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. The arthroscopic findings were used as the gold standard in this study. RESULTS After the conventional US screening, 62 patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. All the US contrast arthrography and subacromial-subdeltoid bursography were successfully performed and no severe side effects were observed in all the patients. For full-thickness tears, the sensitivity and specificity of the combined US contrast arthrography and subacromial-subdeltoid bursography were 94.7% (CI: 0.72-1.0) and 81.4% (CI: 0.66-0.91), respectively, and for articular-side tears 100% (CI: 0.51-1) and 100% (CI: 0.92-1), respectively, and for the bursal-side tears 84.6% (CI: 0.54-0.97) and 97.9% (CI: 0.88-1.0), respectively. The main inconsistency between the contrast-enhanced US and arthroscopy was that 7 patients with arthroscopic proved concurrent articular- and bursal-side tears were indicated as full-thickness RCTs on contrast-enhanced US. CONCLUSIONS Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs. CLINICAL RELEVANCE STATEMENT When conventional high-frequency US has some difficulty in differentiating the full-thickness from partial-thickness RCTs, combined US contrast arthrography and subacromial-subdeltoid bursography could be used to improve the detection accuracy of RCT subtypes. KEY POINTS • This is the first study by injection of the US contrast agent SonoVue into the shoulder joint cavity and subacromial-subdeltoid bursa for the detection and differentiation of the RCT subtypes among the people with the uncertain RCT by conventional US screening. • The SonoVue was injected into the glenohumeral joint cavity under US guidance to differentiate the full-thickness RCTs from partial-thickness RCTs. • Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs.
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Affiliation(s)
- Yuexiang Wang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fei Zhang
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - Xianghui Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jian Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenli Jiang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Siming Chen
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jing Yang
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Qiang Zhang
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
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Vinter-Hviid F, Sloth C, Savarimuthu TR, Iturrate I. Safe contact-based robot active search using Bayesian optimization and control barrier functions. Front Robot AI 2024; 11:1344367. [PMID: 38741717 PMCID: PMC11089096 DOI: 10.3389/frobt.2024.1344367] [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: 11/25/2023] [Accepted: 03/07/2024] [Indexed: 05/16/2024] Open
Abstract
In robotics, active exploration and learning in uncertain environments must take into account safety, as the robot may otherwise damage itself or its surroundings. This paper presents a method for safe active search using Bayesian optimization and control barrier functions. As robot paths undertaken during sampling are continuous, we consider an informative continuous expected improvement acquisition function. To safely bound the contact forces between the robot and its surroundings, we leverage exponential control barrier functions, utilizing the derivative of the force in the contact model to increase robustness to uncertainty in the contact boundary. Our approach is demonstrated on a fully autonomous robot for ultrasound scanning of rheumatoid arthritis (RA). Here, active search is a critical component of ensuring high image quality. Furthermore, bounded contact forces between the ultrasound probe and the patient ensure patient safety and better scan quality. To the best of our knowledge, our results are both the first demonstration of safe active search on a fully autonomous robot for ultrasound scanning of rheumatoid arthritis and the first experimental evaluation of bounding contact forces in the context of medical robotics using control barrier functions. The results show that when search time is limited to less than 60 s, informative continuous expected improvement leads to a 92% success, a 13% improvement compared to expected improvement. Meanwhile, exponential control barrier functions can limit the force applied by the robot to under 5 N, even in cases where the contact boundary is specified incorrectly by -1 or +4 mm.
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Affiliation(s)
| | - Christoffer Sloth
- SDU Robotics, Maersk McKinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thiusius Rajeeth Savarimuthu
- ROPCA ApS, Odense, Denmark
- SDU Robotics, Maersk McKinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Iñigo Iturrate
- SDU Robotics, Maersk McKinney Moller Institute, University of Southern Denmark, Odense, Denmark
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Naredo E, D'Agostino MA, Terslev L, Pineda C, Miguel MI, Blasi J, Bruyn GA, Kortekaas MC, Mandl P, Nestorova R, Szkudlarek M, Todorov P, Vlad V, Wong P, Bakewell C, Filippucci E, Zabotti A, Micu M, Vreju F, Mortada M, Mendonça JA, Guillen-Astete CA, Olivas-Vergara O, Iagnocco A, Hanova P, Tinazzi I, Balint PV, Aydin SZ, Kane D, Keen H, Kaeley GS, Möller I. Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis. Ann Rheum Dis 2024:ard-2023-225278. [PMID: 38531611 DOI: 10.1136/ard-2023-225278] [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: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - M Isabel Miguel
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - Joan Blasi
- Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - George A Bruyn
- Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands
- Reumakliniek Flevoland, Lelystad, Netherlands
| | - Marion C Kortekaas
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands
| | - Peter Mandl
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria
| | | | - Marcin Szkudlarek
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Zealand's University Hospital, Køge, Denmark
| | - Plamen Todorov
- Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Violeta Vlad
- Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania
| | - Priscilla Wong
- Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania
| | - Florentin Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Mohamed Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - José Alexandre Mendonça
- Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil
| | | | - Otto Olivas-Vergara
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
- Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Helen Keen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ingrid Möller
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
- Instituto Poal de Reumatología, Barcelona, Spain
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Liang S, Chen L, Liang R, Ling J, Hou M, Gao S, Ou M, Yang M. Emerging Role of Interleukin-38 (IL-38) in the Development of Rheumatoid Arthritis. Rheumatol Ther 2024; 11:349-362. [PMID: 38315401 PMCID: PMC10920486 DOI: 10.1007/s40744-024-00640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an incurable autoimmune disease. The role of interleukin-38 (IL-38), an anti-inflammatory cytokine, in RA is not fully understood, and its clinical relevance in RA remains unclear. This study aims to investigate the correlation of IL-38 with disease activity and the clinical manifestation of RA. METHODS In this cross-sectional study, patients with treatment-naïve RA (n = 63) and healthy controls (HC) (n = 60) were consecutively enrolled over a 15-month period. Patients with RA were categorized into three subgroups-low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA)-using the Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP). Circulating levels of IL-38, tumour necrosis factor (TNF), IL-6, IL-17, IL-1β, and 25(OH)D were assessed using enzyme-linked immunosorbent assay (ELISA). Clinical data, including duration, tender joints count (TJC), swollen joints count (SJC), patient global assessment (PGA), evaluator global assessment (EGA), bone mineral density (BMD), clinical disease activity index (CDAI), simplified disease activity index (SDAI), DAS28-CRP, joint musculoskeletal ultrasound (MSUS), and serological indicators were recorded. We determined the correlation between IL-38 and disease activity, as well as clinical manifestation in RA. RESULTS At the macroscopic level, musculoskeletal ultrasonography of joints in different stages of disease activity in RA suggests that, as the disease progresses, arthritis in the hand becomes more severe, accompanied by synovial thickening and pronounced blood flow signals in the joint area. The expression of IL-38, TNF, IL-6, IL-17 and IL-1β significantly increased in patients with RA compared to HC. Noteworthy differences were observed in the blood flow signal score, synovial signal score, IL-38, TNF, IL-6, IL-17 and IL-1β among the three subgroups (LDA, MDA and HDA). As disease activity increased in patients with RA, the blood flow signal score, synovial signal score and expression of TNF, IL-6, IL-17 and IL-1β exhibited a gradual increase, while the expression of IL-38 showed the opposite pattern. Inverse correlations were identified between IL-38 and pro-inflammatory cytokines (IL-6, IL-17), as well as key clinical parameters, including disease duration, SJC, TJC and DAS28-CRP score. CONCLUSION IL-38, intricately linked to the pathogenesis of RA, emerges as a promising therapeutic target for the management of this debilitating disease.
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Affiliation(s)
- Shengxiang Liang
- Health Management Center, Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541100, China
| | - Liting Chen
- Department of Rheumatology and Immunology, The First People's Hospital of Qinzhou, Qinzhou, 535000, China
| | - Ruilan Liang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Jiayi Ling
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Minghui Hou
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Song Gao
- Department of Ultrasound, The Affiliated Hospital of Guilin Medical University, Guilin, 541001, China
| | - Minglin Ou
- Central Laboratory, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541100, China
| | - Min Yang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guilin Medical University, Guilin, 541001, China.
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Sleeswijk Visser TSO, Brul SL, O'Neill S, van Es EM, Eygendaal D, de Vos RJ. Measuring Ultrasonographic Thickness of the Achilles Tendon Insertion Is Less Reliable Than the Midportion in Healthy Tendons and Patients With Tendinopathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:713-722. [PMID: 38140763 DOI: 10.1002/jum.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Ultrasound is the preferred imaging method in the diagnostic process of Achilles tendinopathy (AT). Ultrasound tissue characterization (UTC) is a frequently used, standardized and valid method to assess tendon geometry in AT patients. It is unknown whether UTC is reliable for measuring Achilles tendon thickness. The aim of the study was to assess intra- and inter-rater reliability of Achilles tendon thickness measurements using UTC in both asymptomatic individuals and patients with AT, and to evaluate if the reliability of thickness measurements differs between the midportion and insertional area. METHODS Exactly 50 patients with AT and 50 asymptomatic individuals were included. Using the conventional US and standardized UTC procedure maximum thickness was measured in the midportion and insertion region. To determine inter- and intra-rater reliabilities, the intraclass correlation coefficient (ICC) was used. RESULTS The ICC values for inter- and intra-rater reliability were classified as "excellent," for the AT group (0.93 [95% CI: 0.88-0.96] and 0.95 [0.92-0.97]) and asymptomatic participants (0.91 [0.87-0.94] and 0.94 [0.92-0.96]). The reliability of measuring tendon thickness in the midportion region was "excellent," with both inter-rater (0.97 [0.95-0.98]) and intra-rater (0.98 [0.96-0.99]) ICC values indicating high levels of agreement. In the insertional region, ICC values for inter-rater (0.79 [0.69-0.87]) and intra-rater (0.89 [0.84-0.93]) reliability were "moderate to good." CONCLUSION We showed excellent reliability for measuring the US thickness of the midportion and good reliability of measuring the insertional region in patients with AT. Significantly lower ICCs were observed for the reliability of thickness measurements in the insertional region when compared with the midportion.
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Affiliation(s)
- Tjerk S O Sleeswijk Visser
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefano L Brul
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Seth O'Neill
- Department of Life Sciences, School of Allied Health, University of Leicester, Leicester, UK
| | - Eline M van Es
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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He X, Wang M, Zhao C, Wang Q, Zhang R, Liu J, Zhang Y, Qi Z, Su N, Wei Y, Gui Y, Li J, Tian X, Zeng X, Jiang Y, Wang K, Yang M. Deep learning-based automatic scoring models for the disease activity of rheumatoid arthritis based on multimodal ultrasound images. Rheumatology (Oxford) 2024; 63:866-873. [PMID: 37471602 DOI: 10.1093/rheumatology/kead366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity. METHODS Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR-OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience. RESULTS In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239-0.756, P < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model. CONCLUSION DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading.
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Affiliation(s)
- Xuelei He
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- School of Information Sciences and Technology, Northwest University, Xi'an, Shaanxi Province, People's Republic of China
- CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Ming Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenyang Zhao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qian Wang
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Rui Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Liu
- Department of Rheumatology and Immunology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Yixiu Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenhong Qi
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Na Su
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yao Wei
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Gui
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinping Tian
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaofeng Zeng
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuxin Jiang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Blanken AB, Korteweg M, van Boheemen L, van Vollenhoven RF, Nurmohamed MT, van der Laken CJ. Clinical evaluation of optical spectral transmission imaging for detection of disease activity in rheumatoid arthritis. Scand J Rheumatol 2024; 53:85-93. [PMID: 36974977 DOI: 10.1080/03009742.2023.2177382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To investigate the performance and factors of influence of optical spectral transmission (OST) imaging as a new technique for measuring joint inflammation in rheumatoid arthritis (RA). METHOD OST was performed in 24 RA patients and 37 controls. Mann-Whitney U-test was used to assess differences in OST score between RA patients and controls. Receiver operating characteristics (ROC), linear regression and generalized estimating equations analysis were used to assess the discriminative capability of OST and the association of OST score with clinical disease parameters, ultrasound, radiographic features and cardiovascular risk parameters. RESULTS Median OST score was higher in RA patients than in controls [16.9 (interquartile range 12.77-19.7) vs 12.11 (10.32-14.93)]. At patient level, OST score was moderately associated with ultrasound [beta 0.38 (95% CI 0.16-0.60), p = 0.001] and clinical disease activity [28-joint Disease Activity Score-C-reactive protein beta 0.30 (95% CI 0.04- 0.57), p = 0.024] in RA patients. In controls, male sex, high body mass index, and hypertension were associated with higher OST scores, while these associations were absent in RA. At joint level, the area under the ROC curve for OST score, with ultrasound or clinical swelling as reference, ranged from 0.63 to 0.70. Joint-space narrowing and malalignment were associated with higher OST joint scores, and subchondral sclerosis with lower scores. CONCLUSION OST provides an objective measure of synovitis and correlates moderately with other examined disease activity assessment tools. Clinical patient characteristics must be considered when interpreting the results.
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Affiliation(s)
- A B Blanken
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - M Korteweg
- Department of Radiology, Reade, Amsterdam, The Netherlands
| | - L van Boheemen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - R F van Vollenhoven
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - C J van der Laken
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
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14
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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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15
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Baldi C, Parisi S, Falsetti P, Sota J, Ditto MC, Capassoni M, D’alessandro M, Conticini E, Nacci F, Peroni CL, Cometi L, Fusaro E, Frediani B, Guiducci S. Efficacy and Safety of Upadacitinib in Rheumatoid Arthritis: Real-Life Experience from a Prospective Longitudinal Multicentric Study. J Clin Med 2024; 13:401. [PMID: 38256535 PMCID: PMC10816893 DOI: 10.3390/jcm13020401] [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: 11/03/2023] [Revised: 12/31/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We provide the first prospective longitudinal multicenter experience on Upadacitinib efficacy and safety profile in Rheumatoid Arthritis (RA) in a real-life context, focusing on clinimetric and ultrasonographic (US) data. METHODS RA patients referred to three Italian tertiary Centers who started Upadacitinib were enrolled as per ACR/EULAR classification criteria and prospectively reviewed. The primary aim of this study was to assess changes in clinimetric and ultrasonographic scores through time (at baseline, after 1 month, 3 months, and 6 months from the beginning of the therapy). Secondary aims were to: (i) estimate the impact of biologic lines of treatment and concomitant therapies on response to therapy; (ii) explore changes in laboratory parameters; and (iii) find potential predictive factors associated with response to therapy. RESULTS Seventy-one patients (49 Females and 22 Males) were included. Clinimetric scores, including the Disease Activity Score (DAS28-CRP) and Simplified Clinical Disease Activity Index (SDAI), and US findings (synovial hypertrophy and power Doppler) significantly improved (p = 0.029, p = 0.001, p = 0.001, p = 0.001, respectively). Regression analysis revealed a significant association between the concomitant csDMARDs therapy at baseline and the lack of improvement in synovial hypertrophy [OR -4.824, p = 0.010] as well as with DAS28-CRP [OR -0.690, p = 0.045], whereas the presence of increased ESR or CRP at baseline was able to predict a significant improvement in SDAI [OR 8.481, p = 0.003]. No adverse events, such as deep venous thrombosis, pulmonary embolism, or herpes zoster virus infection, were reported during this study observation. CONCLUSION Our real-life experience confirms the efficacy of Upadacitinib in terms of clinical and ultrasonographic improvement, as well as displaying a good safety profile.
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Affiliation(s)
- Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Simone Parisi
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Jurgen Sota
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Maria Chiara Ditto
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Marco Capassoni
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Miriana D’alessandro
- Respiratory Disease and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy;
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Francesca Nacci
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Clara Lisa Peroni
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Laura Cometi
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Serena Guiducci
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
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16
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Cipolletta E, Francioso F, Smerilli G, Di Battista J, Filippucci E. Ultrasound reveals a high prevalence of CPPD in consecutive patients with knee pain. Clin Rheumatol 2024; 43:435-441. [PMID: 37975949 DOI: 10.1007/s10067-023-06805-3] [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: 09/02/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
The objective of this study is to estimate the prevalence of US findings indicative of calcium pyrophosphate deposition (CPPD) in patients with knee pain. Consecutive patients with knee pain, equally distributed among males and females in seven different age-decades (21-90 years), were enrolled in a cross-sectional study. The presence of US OMERACT-defined CPPD (medial and lateral menisci and femoral hyaline cartilage) and osteophytes (medial and lateral compartments of the tibiofemoral joint) was scored as presence/absence in both knees. Four hundred twenty participants were enrolled (210 men/210 women). Fibrocartilage and hyaline cartilage CPPDs were detected by US in 94/420 (22.4%) and 41/420 (9.8%) participants, respectively. No significant sex differences were noted. The prevalence and the extent of CPPD increased with age. Fibrocartilage and hyaline cartilage CPPDs were identified in 0/60 participants in the third decade, and in 28/60 (46.7%) and 14/60 (23.3%) participants in the ninth decade, respectively (p for trend < 0.01). While fibrocartilage and hyaline cartilage CPPD is virtually absent in subjects younger than 40 and 50 years old, their prevalence steeply increases above from these age groups. Age (aIRR, 1.03; 95% CI, 1.02-1.05), osteophyte score (aIRR, 1.40; 95% CI, 1.22-1.60), and hyaline cartilage CPPD score (aIRR, 2.68; 95% CI, 2.06-3.49) were associated with fibrocartilage CPPD score, whereas age (aIRR, 1.02; 95% CI, 1.01-1.05) and fibrocartilage CPPD score (aIRR, 2.92; 95% CI, 2.29-3.72) were associated with hyaline cartilage CPPD score in multivariable negative binomial regression analyses. In conclusion, we report the US prevalence of CPPD in patients with knee pain. Fibrocartilage CPPD occurs at a younger age and is more prevalent than hyaline cartilage CPPD. Key points • Fibrocartilage CPPD occurs at a younger age and is more prevalent than hyaline cartilage CPPD. • Fibrocartilage and hyaline cartilage CPPDs are virtually absent in subjects younger than 40 and 50 years old. • In subjects older than 80 years, fibrocartilage and hyaline cartilage CPPD prevalence rises up to 46.7% and 23.3%, respectively.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
- Academic Rheumatology, University of Nottingham, Nottingham, UK.
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Battista
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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17
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Hafez AE, Taha AM, Moshrif A, Aly HM, Abdel Noor R, Mortada M, Elkhouli R. Ultrasound abnormalities of the major salivary glands in Egyptian patients with systemic sclerosis. Clin Rheumatol 2023; 42:3351-3360. [PMID: 37721645 PMCID: PMC10640493 DOI: 10.1007/s10067-023-06763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION/OBJECTIVES systemic sclerosis (SSc) is an autoimmune disorder with multiple organs destruction. This study aimed to identify the ultrasonographic changes of major salivary glands in Egyptian scleroderma patients and to detect their association to different disease manifestations. METHODS Forty-seven SSc patients and 43 apparent healthy volunteers were enrolled. Demographics, inflammatory markers, and autoimmune status were recorded. Ultrasound evaluation of salivary glands was performed. Salivary gland changes' associations were statistically examined with SSc susceptibility and disease manifestations. RESULTS Thirty-one SSc patients exhibited glandular pathology (p < 0.0001), compared to controls. Of these abnormalities, SSc patients showed a total parotid gray scale of 2, total submandibular gray scale of 2, total glandular gray scale of 4, and total glandular Doppler signal of 1 at p < 0.0001, compared to the control group. Patients with SSc and glandular pathology had a higher prevalence of arthritis (p = 0.029) and ESR (p = 0.002) than those with normal glandular ultrasound. Significant associations were reported between gray scale ultrasound (GSUS) of total parotid (odds ratio "OR" = 0.4), total submandibular (OR = 0.36), and total glandular (OR = 0.53) with susceptibility to SSc at p < 0.0001. Total glandular GSUS (p = 0.039) and total submandibular power Doppler (p = 0.044) correlated with the SSc duration. Total parotid GSUS (p = 0.008) and total glandular GSUS (p < 0.0001) correlated with Schirmer's test. CONCLUSIONS Major salivary glands are affected in SSc. Hence, scanning these glands with ultrasound is an additive tool besides the current practice. Key Points • Major salivary gland changes, observed by ultrasonography, are new findings in Egyptian SSc patients. • Ultrasound changes of major salivary glands are associated with inflammatory markers and clinical manifestations of SSc. • Scleroderma ultrasonography scans of the main salivary glands could be added to the routine work.
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Affiliation(s)
- Ahmed E Hafez
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Minia University, Minia, Egypt.
| | - AlShaimaa M Taha
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Abdelhfeez Moshrif
- Department of Rheumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Hany M Aly
- Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Rasha Abdel Noor
- Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Mortada
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Radwa Elkhouli
- Department of Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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18
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Amezcua-Guerra LM, Carbonell-Bobadilla N, Soto-Fajardo C, Vargas A, Batres-Marroquín AB, Vargas T, Medina-García AC, Hernández-Diazcouder A, Jiménez-Rojas V, Pineda C, Silveira LH. Influence of anti-carbamylated protein antibodies on disease activity and joint erosions in seronegative and seropositive rheumatoid arthritis. Rheumatol Int 2023; 43:2245-2250. [PMID: 37697044 DOI: 10.1007/s00296-023-05445-9] [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: 06/06/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
Anti-carbamylated protein (anti-CarP) antibodies are promising biomarkers in rheumatoid arthritis (RA), although their significance in seronegative disease (SNRA) remains uncertain. To assess the influence of anti-CarP antibodies on disease activity and erosive joint damage in SNRA patients. In RA patients, rheumatoid factor (RF), anti-citrullinated protein antibodies, and anti-CarP antibodies were measured. Disease activity was assessed using DAS28-CRP and SDAI indices, while musculoskeletal ultrasound identified bone erosions. A total of 77 patients were enrolled, comprising 49 with seropositive RA (SPRA) and 28 with SNRA. Notably, 28% of SPRA and 10% of SNRA patients were positive to anti-CarP antibodies. Anti-CarP-positive patients exhibited elevated C-reactive protein (median 10.6, interquartile range 4.6-20.0 vs. 3.4, 1.7-9.9 mg/L; p = 0.005), erythrocyte sedimentation rate (34, 19-46 vs. 16, 7-25 mm/h; p = 0.002), DAS28-CRP (3.2, 2.6-4.2 vs. 2.6, 1.9-3.5; p = 0.048), and SDAI (19.9, 6.3-32.1 vs. 10.9, 5.5-18.1; p = 0.034) indices. Multivariate analysis revealed RF positivity as the sole predictor for anti-CarP antibodies (odds ratio [OR] = 5.9). Musculoskeletal ultrasound revealed bone erosions in 36% of RA patients; 35% among anti-CarP-negative patients and 40% among anti-CarP-positive patients. Notably, RF presence (OR = 44.3) and DAS28-CRP index (OR = 2.4) emerged as predictors of musculoskeletal ultrasound-confirmed erosive joint disease. Anti-CarP antibodies are detected at similar frequencies among both SPRA and SNRA patients. While associated with increased disease activity, these antibodies did not correlate with increased erosive joint damage.
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Affiliation(s)
- Luis M Amezcua-Guerra
- Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico.
| | | | - Carina Soto-Fajardo
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Angelica Vargas
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ana B Batres-Marroquín
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Tania Vargas
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ana C Medina-García
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Adrian Hernández-Diazcouder
- Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Valentin Jiménez-Rojas
- Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Carlos Pineda
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis H Silveira
- Rheumatology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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19
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Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, Grimm A, Hobson-Webb LD, Kerasnoudis A, Mandeville R, Preston DC, Sakamuri S, Shahrizaila N, Shin S, Shook SJ, Wilder-Smith E, Walker FO. Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations. Muscle Nerve 2023; 68:375-379. [PMID: 37074101 DOI: 10.1002/mus.27830] [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: 08/16/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.
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Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Crump
- Department of Neurology, Austin Health and University of Melbourne, Heidelberg, Australia
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Steven J Shook
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Berne, Bern, Switzerland
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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20
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Wang CC, Hu TM, Chen CL, Hong CC, Chang YH, Kao CL. Concurrent Imaging and Clinical Study of the Efficacy of Hyaluronic Acid Injection for Knee Osteoarthritis: A Synovial Membrane Investigation with Ultrasound Imaging. Pharmaceuticals (Basel) 2023; 16:1186. [PMID: 37631101 PMCID: PMC10459875 DOI: 10.3390/ph16081186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
We investigated whether hyaluronic acid (HA) injections can ameliorate ultrasound-detected synovitis in knee osteoarthritis (OA). We recruited 103 patients with symptomatic knee OA and ultrasound-detected synovitis and performed two ultrasound-guided fluid drainage procedures, followed by the administration of a low-molecular-weight HA injection (2.5 mL) in the subpatellar bursa, at a 2-week interval. Knee ultrasound imaging evaluations were performed before injection (baseline) and at 1 and 6 months after the second injection and included the measurements of synovial vascularity by using color Doppler ultrasound, synovial fluid depth over the suprapatellar bursa (SF), and synovial hypertrophy (SH). Initial clinical assessments included a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). VAS scores decreased significantly at both 1-month and 6-month evaluations (p < 0.001). WOMAC scores also significantly decreased at 1 month (p < 0.001), but not at 6 months (p = 0.23). The ultrasound parameters did not significantly change, except color Doppler grading, which tended to decrease at the 6-month evaluation (p = 0.059). Our findings revealed that two ultrasound-guided HA injections following fluid drainage improved pain and knee function but did not considerably influence imaging-detected synovitis in patients with knee OA.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Tsung-Ming Hu
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Future Studies and LOHAS Industry, Fo Guang University, Yilan 262307, Taiwan
| | - Chien-Lung Chen
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan;
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chung-Chih Hong
- Tri-Service General Hospital Songshan Branch, Taipei 10508, Taiwan;
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11220, Taiwan;
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Section 2, Shi-Pai Road, Taipei 11220, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Chiao Tung University, Hsinchu 30010, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Sirotti S, Terslev L, Filippucci E, Iagnocco A, Moller I, Naredo E, Vreju FA, Adinolfi A, Becce F, Hammer HB, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Mandl P, MacCarter D, Mortada MA, Mouterde G, Porta F, Reginato AM, Schmidt WA, Serban T, Wakefield RJ, Zufferey P, Sarzi-Puttini P, Zanetti A, Damiani A, Pineda C, Keen HI, D'Agostino MA, Filippou G. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. THE LANCET. RHEUMATOLOGY 2023; 5:e474-e482. [PMID: 38251579 DOI: 10.1016/s2665-9913(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. METHODS In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. FINDINGS The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image-ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79-1·00] and κ 0·84 [0·79-0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). INTERPRETATION This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. FUNDING The Italian Ministry of Health - Ricerca Corrente.
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Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Iagnocco
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Ingrid Moller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; IIS-FJD, Universidad Autónoma of Madrid, Madrid, Spain
| | - Florentin A Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Antonella Adinolfi
- Rheumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Diaz
- Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Fabiana Figus
- Rheumatology Service, ASL Torino 3, Collegno Pinerolo, Turin, Italy
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Daryl MacCarter
- Department of Rheumatology, North Valley Hospital, Whitefish, MT, USA
| | - Mohamed A Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gael Mouterde
- Rheumatology Department & IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Rheumatology Section, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piercarlo Sarzi-Puttini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, WA, Australia
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy.
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22
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Fontes T, Saraiva F. Ultrasound exploration of the elbow: A user-friendly approach. Eur J Radiol 2023; 165:110896. [PMID: 37270897 DOI: 10.1016/j.ejrad.2023.110896] [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: 03/13/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
Ultrasound is a strong diagnostic and therapeutic tool for the elbow joint. Existing guidelines and protocols list relevant structures to be scanned but lack some logical connection and intermediate exploration manoeuvres to link each step, which we consider crucial from an operator's perspective that aims to be efficient in regular clinical practice. We present thirteen steps that are described in detail and accompanied by forty-seven ultrasound images, logically linked in what we believe is the best balance between detail and a real-world applicable protocol to perform an ultrasound of the elbow joint.
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Affiliation(s)
- Tomás Fontes
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal; Rheumatology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal.
| | - Fernando Saraiva
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
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23
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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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24
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Guízar-Sánchez C, Hernández-Díaz C, Guízar-Sánchez D, Meza-Sánchez AV, Torres-Serrano A, Camacho Cruz ME, Ventura-Ríos L. Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:512. [PMID: 37349815 DOI: 10.1186/s12891-023-06610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.
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Affiliation(s)
- Claudia Guízar-Sánchez
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | | | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, México, Av. Universidad 3004, Col. Copilco Universidad, Alcaldía Coyoacán, Cd. Universitaria.
| | - Ana Victoria Meza-Sánchez
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán., Ciudad de México, México
| | - Alejandra Torres-Serrano
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - María Elena Camacho Cruz
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - Lucio Ventura-Ríos
- Rheumatology Department, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, México
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25
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Vega-Fernandez P, De Ranieri D, Oberle E, Clark M, Bukulmez H, Lin C, Shenoi S, Thatayatikom A, Woolnough L, Benham H, Brunner E, Henrickson M, Pratt LR, Proulx-Gauthier JP, Janow G, Cassedy A, Ting TV, Roth J. Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle. Rheumatology (Oxford) 2023; 62:2239-2246. [PMID: 36308429 PMCID: PMC10234197 DOI: 10.1093/rheumatology/keac622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle. METHODS As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). RESULTS Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97). CONCLUSION A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.
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Affiliation(s)
- Patricia Vega-Fernandez
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Deirdre De Ranieri
- Division of Rheumatology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Edward Oberle
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Matthew Clark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hulya Bukulmez
- Division of Pediatric Rheumatology, Department of Pediatrics, Metro Health Medical System, Case Western Reserve University, Cleveland, OH, USA
| | - Clara Lin
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Susan Shenoi
- Seattle Children’s Hospital and Research Center University of Washington, Seattle, WA, USA
| | - Akaluck Thatayatikom
- AdventHealth Medical Group Pediatric Rheumatology and Immunology, Orlando, FL, USA
| | | | - Heather Benham
- Department of Pediatrics, Scottish Rite for Children, Frisco, TX, USA
| | - Emily Brunner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA, USA
| | - Michael Henrickson
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Laura R Pratt
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ginger Janow
- Joseph M. Sanzari Children’s Hospital, Hackensack, NJ, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy V Ting
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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26
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Sahbudin I, Singh R, De Pablo P, Rankin E, Rhodes B, Justice E, Derrett-Smith E, Amft N, Narayan N, McGrath C, Baskar S, Trickey J, Maybury M, Raza K, Filer A. The value of ultrasound-defined tenosynovitis and synovitis in the prediction of persistent arthritis. Rheumatology (Oxford) 2023; 62:1057-1068. [PMID: 35412605 PMCID: PMC9977123 DOI: 10.1093/rheumatology/keac199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The value of US-defined tenosynovitis in predicting the persistence of inflammatory arthritis is not well described. In particular, the predictive utility of US-defined tenosynovitis of larger tendons is yet to be reported. We assessed the value of US-defined tenosynovitis alongside US-defined synovitis and clinical and serological variables in predicting persistent arthritis in an inception cohort of DMARD-naïve patients with early arthritis. METHODS One hundred and fifty DMARD-naïve patients with clinically apparent synovitis of one or more joints and a symptom duration of ≤3 months underwent baseline clinical, laboratory and US (of 19 bilateral joints and 16 bilateral tendon compartments) assessments. Outcomes were classified as persistent or resolving arthritis after 18 months' follow-up. The predictive value of US-defined tenosynovitis for persistent arthritis was compared with those of US-defined synovitis, and clinical and serological variables. RESULTS At 18 months, 99 patients (66%) had developed persistent arthritis and 51 patients (34%) had resolving disease. Multivariate logistic regression analysis showed that US-detected digit flexor tenosynovitis [odds ratio (OR): 6.6, 95% CI: 2.0 , 22.1, P = 0.002] provided independent predictive data for persistence over and above the presence of US-detected joint synovitis and RF antibodies. In the RF/ACPA-negative subcohort, US-defined digit flexor tenosynovitis remained a significant predictive variable (OR: 4.7, 95% CI: 1.4, 15.8, P = 0.012), even after adjusting for US-defined joint synovitis. CONCLUSION US-defined tenosynovitis provided independent predictive data for the development of persistent arthritis. The predictive role of US-defined digit flexor tenosynovitis should be further assessed; investigators should consider including this tendon site as a candidate variable when designing imaging-based predictive algorithms for persistent inflammatory arthritis development.
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Affiliation(s)
- Ilfita Sahbudin
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Ruchir Singh
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Paola De Pablo
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Elizabeth Rankin
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Benjamin Rhodes
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Elizabeth Justice
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Emma Derrett-Smith
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Nicole Amft
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Nehal Narayan
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Catherine McGrath
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Sangeetha Baskar
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Jeanette Trickey
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Mark Maybury
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Andrew Filer
- Correspondence to: Andrew Filer, Reader in Translational
Rheumatology, Institute of Inflammation and Ageing, University of Birmingham, University
Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK. E-mail:
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27
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Koppikar S, Diaz P, Kaeley GS, Eder L. Seeing is believing: Smart use of musculoskeletal ultrasound in rheumatology practice. Best Pract Res Clin Rheumatol 2023; 37:101850. [PMID: 37481369 DOI: 10.1016/j.berh.2023.101850] [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: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/24/2023]
Abstract
Musculoskeletal ultrasonography has become an increasingly valuable tool as a complement to the physical exam in rheumatology practice. Its point-of-care access, low cost, safety, portability, and reliability in trained hands, make this technique especially useful in patients with inflammatory arthritis. Growing evidence has demonstrated the value of musculoskeletal ultrasound in the detection of inflammatory and structural changes in patients with joint pain without obvious joint swelling, in differentiating various inflammatory diagnoses, in the monitoring of inflammatory arthritis, and interventional procedures. The potential role of ultrasound guiding treat-to-target strategies or tapering treatment in inflammatory arthritis requires further research. However, musculoskeletal ultrasound can also have pitfalls and limitations that a clinician should be aware of.
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Affiliation(s)
- Sahil Koppikar
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pamela Diaz
- Departamento de Inmunologia Clinica y Reumatologia, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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28
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Cipolletta E, Abhishek A, Di Matteo A, Grassi W, Filippucci E. Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease. RMD Open 2023; 9:rmdopen-2022-002940. [PMID: 36927850 PMCID: PMC10030737 DOI: 10.1136/rmdopen-2022-002940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To test whether the double contour (DC) sign has a different dynamic behaviour in gout and calcium pyrophosphate deposition (CPPD) and whether the dynamic assessment of the DC sign increases its accuracy in gout diagnosis. METHODS This cross-sectional analysis included patients with gout meeting the 2015 ACR/EULAR classification criteria and patients with crystal-proven diagnosis of CPPD. Hyaline cartilages were explored by ultrasound (US) to detect the DC sign (ie, abnormal hyperechoic band over the superficial margin of hyaline cartilages) and its dynamic behaviour during joint movement was evaluated ((ie, movement of the DC sign together with subchondral bone (DC sign), or in the opposite direction (pseudo DC sign)). RESULTS Eighty-one patients with gout and 84 patients with CPPD underwent US assessment. Among them, 47 patients with gout and 9 patients with CPPD had evidence of the DC sign. During dynamic assessment, in all 47/47 patients with gout there was a DC sign. Conversely, in 7/9 (77.8%) patients with CPPD, there was a pseudo DC sign (p<0.01).The presence of DC sign during static assessment had a sensitivity, specificity and accuracy of 58.0% (95% CI 46.5% to 68.9%), 89.3% (95% CI 80.6% to 95.0%) and 73.9% (95% CI 66.5% to 80.5%) for gout, respectively. The dynamic evaluation improved the DC sign's diagnostic performance (p=0.01) as the specificity (97.6% (95% CI 91.7% to 99.7%)) and the accuracy (78.2% (95% CI 71.1% to 84.2%)) increased without loss in sensitivity. CONCLUSION The dynamic US assessment of the DC sign may help to differentiate the DC sign due to MSU crystals from the pseudo DC sign seen in CPPD, as they move in opposite directions.
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Affiliation(s)
- Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | | | - Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Gessl I, Hana CA, Deimel T, Durechova M, Hucke M, Konzett V, Popescu M, Studenic P, Supp G, Zauner M, Smolen JS, Aletaha D, Mandl P. Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2023; 82:344-350. [PMID: 36261248 DOI: 10.1136/ard-2022-222787] [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: 05/24/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to assess the predictive value of tenderness in the absence of swelling with consideration of other potential risk factors for subsequent radiographic progression in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS Clinical and sonographic (grey scale and power Doppler (PD)) examination of 22 joints of the hand were performed in patients with RA and PsA. The impact of tenderness on progression after 2 years was analysed in non-swollen joints for RA and PsA separately with multilevel mixed logistic regression analysis. RESULTS We included 1207 joints in 55 patients with RA and 352 joints in 18 patients with PsA. In RA, tenderness was associated with radiographic progression after 2 years (model 2: OR 1.85 (95% CI 1.01 to 3.27), p=0.047), although the association of PD (OR 2.92 (95% CI 1.71 to 5.00), p<0.001) and erosions (OR 4.74 (95% CI 2.44 to 9.23), p<0.001) with subsequent structural damage was stronger. In PsA, we found a positive but not significant association between tenderness and radiographic progression (OR 1.72 (95% CI 0.71 to 4.17), p=0.23). In contrast, similarly to RA, erosions (OR 4.62 (95% CI 1.29 to 16.54), p=0.019) and PD (OR 3.30 (95% CI 1.13 to 9.53), p=0.029) had a marked effect on subsequent structural damage. CONCLUSION Our findings imply that tenderness in non-swollen joints in RA is associated with subsequent damage. In both diseases, additional risk factors, such as sonographic signs for synovitis and baseline radiographic damage are associated with radiographic progression.
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Affiliation(s)
- Irina Gessl
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Claudia A Hana
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Deimel
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Martina Durechova
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Miriam Hucke
- Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Victoria Konzett
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Mihaela Popescu
- Department of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Paul Studenic
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria.,Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
| | - Gabriela Supp
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Michael Zauner
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
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Cipolletta E, Abhishek A, Di Battista J, Grassi W, Filippucci E. Ultrasonography in the prediction of gout flares: a 12-month prospective observational study. Rheumatology (Oxford) 2023; 62:1108-1116. [PMID: 35920773 DOI: 10.1093/rheumatology/keac367] [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: 03/11/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate whether US findings indicating MSU deposits and US-detected inflammation (i.e. power Doppler signal) predict gout flares over 12 months. METHODS Gout patients on urate-lowering therapy for at least the preceding 6 months were enrolled consecutively in this 12-month prospective, observational, single-centre study. A nested case-control analysis was performed. Cases were participants with at least one flare in the follow-up period, while controls did not self-report any gout flare. The US assessment included elbows, wrists, second MCP joints, knees, ankles, and first MTP joints. The US findings indicating MSU deposits [i.e. aggregates, double contour (DC) sign and tophi] were identified as present/absent according to the Outcome Measure in Rheumatology definitions. Power Doppler signal was scored semiquantitatively. Summated scores were calculated for each US finding. RESULTS Eighty-one gout participants were enrolled, and 71 completed the study. Thirty (42.3%) of 71 participants experienced at least one flare over 12 months, with a median of 2.0 flares. Cases had a greater US burden of MSU deposits (6.7 ± 4.7 vs 2.9 ± 2.6, P = 0.01) and power Doppler signal (3.73 ± 3.53 vs 0.82 ± 1.44, P < 0.01) than controls, at baseline. The baseline US scores indicating MSU deposits and US-detected inflammation were significantly associated with the occurrence (total MSU score, adjusted odds ratio:1.75, 95% CI: 1.26, 2.43; power Doppler score, adjusted odds ratio: 1.63, 95% CI: 1.12, 2.40) and the number (total MSU score, adjusted incidence risk ratio: 1.17, 95% CI: 1.08, 1.26; power Doppler score, adjusted incidence risk ratio: 1.29, 95% CI: 1.19, 1.40) of flares over 12 months in multivariate analyses. CONCLUSIONS Baseline US findings indicating MSU deposits and US-detected inflammation are independent predictors of gout flares over 12 months.
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Affiliation(s)
- Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy.,Academic Rheumatology, University of Nottingham, Nottingham, UK
| | | | - Jacopo Di Battista
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
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García-Almeida JM, García-García C, Vegas-Aguilar IM, Ballesteros Pomar MD, Cornejo-Pareja IM, Fernández Medina B, de Luis Román DA, Bellido Guerrero D, Bretón Lesmes I, Tinahones Madueño FJ. Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:74-84. [PMID: 36935167 DOI: 10.1016/j.endien.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 03/19/2023]
Abstract
Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.
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Affiliation(s)
- José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, IBIMA, CIBEROBN, Hospital Quirónsalud, University of Málaga, Spain.
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Isabel María Vegas-Aguilar
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, FIMABIS, Málaga, Spain
| | | | - Isabel María Cornejo-Pareja
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, IBIMA, CIBEROBN, Carlos III Health Institute, Málaga, Spain
| | - Beatriz Fernández Medina
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Daniel A de Luis Román
- Department of Endocrinology and Nutrition, Institute of Endocrinology and Nutrition, Medicine School and Department of Endocrinology and Investigation, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain
| | - Diego Bellido Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, A Coruña, Spain
| | - Irene Bretón Lesmes
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco J Tinahones Madueño
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, Spain
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Lescoat A, Robin F, Belhomme N, Ballerie A, de Saint Riquier M, Sebillot M, Albert JD, Le Gallou T, Perdriger A, Jégo P, Coiffier G, Cazalets C. Ultrasound Classification of Finger Pulp Blood Flow in Patients With Systemic Sclerosis: A Pilot Study. Arthritis Care Res (Hoboken) 2023; 75:299-306. [PMID: 34477332 DOI: 10.1002/acr.24779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/23/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. METHODS Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. RESULTS In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P = 0.024), whereas cold challenge decreased FPBF (P = 0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient = -0.50, P = 0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31-19.21], P < 0.0001). CONCLUSION PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | | | - Martine Sebillot
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, University of Rennes, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France, and Department of Rheumatology, CH Dinan, Dinan, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
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Vega-Fernandez P, Ting TV, Oberle EJ, McCracken C, Figueroa J, Altaye M, Cassedy A, Kaeley GS, Roth J. Musculoskeletal Ultrasound in Childhood Arthritis Limited Examination: A Comprehensive, Reliable, Time-Efficient Assessment of Synovitis. Arthritis Care Res (Hoboken) 2023; 75:401-409. [PMID: 34328679 PMCID: PMC8800943 DOI: 10.1002/acr.24759] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To develop and initially validate a comprehensive pediatric musculoskeletal ultrasound (MSUS) joint-specific scoring system, and to determine the minimum number of joints needed to identify active disease. METHODS A semiquantitative scoring system was developed by consensus and initially validated by interrater reliability using intraclass correlation coefficients (ICCs). Subsequently, newly diagnosed juvenile idiopathic arthritis patients with an active joint count of >4 had a 42-joint MSUS performed at baseline and 3 months using this protocol. A minimum set of joints needed to identify all patients with synovitis on MSUS was obtained through a data reduction process. Spearman's correlation (rs ) was calculated to determine the association between MSUS findings and clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10). Standardized response means (SMRs) were used to assess change over time. RESULTS The final joint-specific scoring system revealed an excellent interrater reliability (ICC 0.81-0.96) for all joints. Thirty patients were enrolled. Scanning 5 joints bilaterally (wrists, second and third metacarpophalangeal joints, knees and ankles) captured 100% of children with B-mode synovitis and had moderate correlation with the cJADAS10 at baseline (rs = 0.45). Mean ultrasound scores at baseline and follow-up were 28.3 and 22.3, with an SRM of 0.69 (P = 0.002) for 42 joints, and 36 and 27.7, with an SRM of 0.76 (P = 0.003) for the reduced joints, respectively. CONCLUSION A limited MSUS examination called musculoskeletal ultrasound in childhood arthritis limited examination (MUSICAL) captures all patients with active synovitis, and our new joint-specific scoring system is highly reliable and sensitive to change.
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Affiliation(s)
- Patricia Vega-Fernandez
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Tracy V Ting
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital and The Ohio State University, Pediatric Rheumatology, 700 Children's Drive, Columbus, Ohio, USA
| | | | - Janet Figueroa
- Emory University School of Medicine, Pediatrics, Atlanta, Georgia, USA
| | - Mekibib Altaye
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Amy Cassedy
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Gurjit S Kaeley
- University of Florida, Jacksonville, Rheumatology, Jacksonville, Florida, USA
| | - Johannes Roth
- Hebrew SeniorLife, IFAR, 1200 Centre St, Boston, Massachusetts, USA
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Tascilar K, Fagni F, Kleyer A, Bayat S, Heidemann R, Steiger F, Krönke G, Bohr D, Ramming A, Hartmann F, Klett D, Federle A, Regensburger AP, Wagner AL, Knieling F, Neurath MF, Schett G, Waldner M, Simon D. Non-invasive metabolic profiling of inflammation in joints and entheses by multispectral optoacoustic tomography. Rheumatology (Oxford) 2023; 62:841-849. [PMID: 35699479 DOI: 10.1093/rheumatology/keac346] [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: 01/30/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore the metabolic characteristics of arthritis and enthesitis using multispectral opto-acoustic tomography (MSOT), a technology using near-infrared multispectral laser to stimulate tissues and detect the emitted acoustic energy, enabling non-invasive quantification of tissue components in vivo based on differential absorbance at multiple wavelengths. METHODS We performed a cross-sectional study in patients with RA or PsA and healthy controls (HCs). Participants underwent clinical, ultrasonographic and MSOT examination of MCP and wrist joints as well as the entheses of the common extensor tendon at the lateral humeral epicondyles and of the patellar, quadriceps and Achilles tendon. MSOT-measured haemoglobin (Hb), oxygen saturation, collagen and lipid levels were quantified and scaled mean differences between affected and unaffected joints and entheses were calculated as defined by clinical examination or ultrasonography using linear mixed effects models. RESULTS We obtained 1535 MSOT and 982 ultrasonography scans from 87 participants (34 PsA, 17 RA, 36 HCs). Entheseal tenderness was not associated with significant metabolic changes, whereas enthesitis-related sonographic changes were associated with increased total Hb, oxygen saturation and collagen content. In contrast, the presence of arthritis-related clinical and sonographic findings showed increased Hb levels, reduced oxygen saturation and reduced collagen content. Synovial hypertrophy was associated with increased lipid content in the joints. CONCLUSION MSOT allows determination of distinct metabolic differences between arthritis and enthesitis in a non-invasive setting in humans in vivo.
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Affiliation(s)
- Koray Tascilar
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Filippo Fagni
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Arnd Kleyer
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Sara Bayat
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Robert Heidemann
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Florian Steiger
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Gerhard Krönke
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Daniela Bohr
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Andreas Ramming
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Fabian Hartmann
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Daniel Klett
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna Federle
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Adrian P Regensburger
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Alexandra L Wagner
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Ferdinand Knieling
- Deutsches Zentrum fuer Immuntherapie.,Department of Pediatrics and Adolescent Medicine
| | - Markus F Neurath
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
| | - Maximilian Waldner
- Deutsches Zentrum fuer Immuntherapie.,Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3.,Deutsches Zentrum fuer Immuntherapie
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Molyneux P, Bowen C, Ellis R, Rome K, Carroll M. International multispecialty consensus on how to image, define, and grade ultrasound imaging features of first metatarsophalangeal joint osteoarthritis, a Delphi consensus study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100336. [PMID: 36817088 PMCID: PMC9932210 DOI: 10.1016/j.ocarto.2023.100336] [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: 08/13/2022] [Revised: 12/18/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Objective To reach consensus concerning which ultrasound imaging features should be assessed and graded, and what ultrasound imaging procedure should be performed when examining osteoarthritic change in the first metatarsophalangeal joint. Design An online Delphi study was conducted over four iterative rounds with 16 expert health professionals. Items were scored from 0 to 100 (0 = not at all important; 100 = extremely important). Consensus was defined based upon an item receiving a median score of ≥70% acceptance. Items receiving median score of ≤50% were rejected. Items considered ambiguous (median score 51%-69% of acceptance) were assessed in an additional round. A final round determined the content validity of items through calculation of the content validity ratio and content validity index. Results Sixteen items were deemed essential, which included osteophytes graded dichotomously, cartilage damage graded continuously, synovitis and joint space narrowing graded on a semiquantitative scale. The panel deemed essential that the first metatarsophalangeal joint start in a neutral position, then move through range of motion for both dorsal and plantar scanning, orientating the probe in longitudinal and in transverse, whilst using first metatarsal head and proximal phalanx as anatomical landmarks. A supine body position was only deemed essential for a dorsal scan and a neutral foot/ankle position was only rated essential for a plantar scan. The content validity index of the 16 essential items was 0.19. Conclusion The consensus exercise has identified the essential components the ultrasound imaging acquisition procedure should encompass when examining first metatarsophalangeal joint osteoarthritis.
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Affiliation(s)
- Prue Molyneux
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, New Zealand,Corresponding author. School of Clinical Science, Faculty of Health and Environmental Science, Auckland University of Technology, 90 Akoranga Drive, Northcote, New Zealand.
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, UK
| | - Richard Ellis
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Keith Rome
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Matthew Carroll
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, New Zealand
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Smerilli G, Cipolletta E, Destro Castaniti GM, Di Matteo A, Di Carlo M, Moscioni E, Francioso F, Mirza RM, Grassi W, Filippucci E. Doppler Signal and Bone Erosions at the Enthesis Are Independently Associated With Ultrasound Joint Erosive Damage in Psoriatic Arthritis. J Rheumatol Suppl 2023; 50:70-75. [PMID: 35105703 DOI: 10.3899/jrheum.210974] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore the association of the Outcome Measures in Rheumatology ultrasound (US) entheseal abnormalities with the presence of US joint bone erosions in psoriatic arthritis (PsA). METHODS Consecutive patients with PsA were included in this cross-sectional study. Demographic and clinical variables were collected. A bilateral US assessment was carried out at the following entheses: plantar fascia, and the quadriceps, patellar (proximal and distal), and Achilles tendons. The following US entheseal abnormalities were registered: hypoechogenicity, thickening, Doppler signal < 2 mm from the bony cortex, calcification/enthesophyte, and bone erosion. The presence of US joint bone erosions was investigated at the second and fifth metacarpophalangeal joints, ulnar head, and fifth metatarsophalangeal (MTP) joint, bilaterally, as well as at the level of the most inflamed joint on physical examination. Multiple linear regression analysis was performed to identify clinical and/or US variables associated with US-detected joint bone erosions. RESULTS A total of 104 patients with PsA were enrolled. At least 1 joint bone erosion was found in 47 of 104 patients (45.2%). Bone erosions were most frequently detected at the fifth MTP joint level (42/208 joints [20.2 %] in 32/104 patients [30.8%]). In the multivariate model, only a power Doppler (PD) signal at the enthesis (P < 0.001, standardized β = 0.51), bone erosions at the enthesis (P = 0.02, standardized β = 0.20), PsA disease duration (P = 0.04, standardized β = 0.17), and greyscale joint synovitis (P = 0.03, standardized β = 0.42) were associated with US-detected joint bone erosions. CONCLUSION PD signal and bone erosions at the enthesis represent sonographic biomarkers of a more severe subset of PsA in terms of US-detected joint erosive damage.
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Affiliation(s)
- Gianluca Smerilli
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona;
| | - Edoardo Cipolletta
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- G.M. Destro Castaniti, MD, University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, "P. Giaccone" Hospital, Palermo
| | - Andrea Di Matteo
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Marco Di Carlo
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Erica Moscioni
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Francesca Francioso
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Riccardo Mashadi Mirza
- R. Mashadi Mirza, MD, Radiology Department, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Walter Grassi
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Emilio Filippucci
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
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Floris A, Rozza D, Zanetti A, Carrara G, Bellis E, Cauli A, Iagnocco A, Scirè CA, Piga M. Musculoskeletal ultrasound may narrow the gap between patients and physicians in the assessment of rheumatoid arthritis disease activity. Rheumatology (Oxford) 2022; 62:116-123. [PMID: 35482548 DOI: 10.1093/rheumatology/keac255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate the association between patient-physician discordance in the assessment of disease activity and residual US synovitis/tenosynovitis in a cohort of patients with RA in clinical remission. METHODS A post hoc analysis of the STARTER study, promoted by the Musculoskeletal-US (MSUS) Study Group of the Italian Society for Rheumatology, was performed using data from 361 consecutive patients with RA in clinical remission. The global assessment of disease activity by each patient (PGA) and evaluator/physician (EGA) was recorded on a 100-mm visual analogue scale. The PGA-EGA discordance was classified as positive (PGA>EGA) or negative (PGA<EGA) using a cut-off of ±10 mm. The association of discordance with greyscale (GS) and power Doppler (PD) synovitis (S) and tenosynovitis (T) scores was evaluated through logistic regression analysis. The odds ratio for each point of the scores, adjusted for prespecified confounders (adjOR), was calculated. RESULTS The mean (s.d.) PGA and EGA scores were 6.1 (7.1) and 8.8 (12) mm, respectively, with a median (IQR) absolute difference of 4 (0-10) mm. Positive and negative discordances were recorded in 39 (10.8%) and 65(18.0%) patients, respectively. The GS-S (adjOR 1.099) and PD-S (adjOR 1.167) scores were associated with positive discordance (P < 0.01), while the GS-T (adjOR 1.083), GS-S (adjOR 1.063) and PD-S (adjOR 1.089) scores were associated with negative discordance (P < 0.05). The PGA-EGA discordance did not predict flares at 6 and 12 months. CONCLUSIONS Patient-physician discordance is associated with the lack of US remission in patients with RA and may represent a further indication for MSUS.
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Affiliation(s)
- Alberto Floris
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Davide Rozza
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Emanuela Bellis
- Day Hospital Multidisciplinare Ospedale di Borgomanero e Ambulatori di Reumatologia, ASL Novara, Novara, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
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Mahmoud W, El-Naby MMH, Awad AA. Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management.
Results
Carpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed.
Conclusion
Synovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.
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Di Matteo A, Cipolletta E, Destro Castaniti GM, Smerilli G, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Bruns A, Carrara G, Cazenave T, Ciapetti A, Cosatti MA, de Agustín JJ, Di Carlo M, Di Donato E, Di Geso L, Duran E, Elliott A, Estrach C, Farisogulları B, Fiorenza A, Fodor D, Gabba A, Hernández-Díaz C, Huang F, Hurnakova J, Li L, Jesus D, Karadag O, Martire MV, Massarotti M, Michelena X, Musca AA, Nair J, Okano T, Papalopoulos I, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Satulu I, Scioscia C, Scirè CA, Sun F, Tamas MM, Tanimura S, Ventura-Rios L, Voulgari PV, Vreju FA, Vukatana G, Wong E, Yang J, Zacariaz Hereter J, Zanetti A, Grassi W, Filippucci E. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study. Rheumatology (Oxford) 2022; 61:4863-4874. [PMID: 35293988 DOI: 10.1093/rheumatology/keac162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. METHODS In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. RESULTS Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. CONCLUSIONS The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.
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Affiliation(s)
- Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Palermo, Italy
| | - Gianluca Smerilli
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Carla Airoldi
- Rheumatology, Hospital Provincial, Rosario, Argentina
| | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Alessandro Ciapetti
- Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Micaela Ana Cosatti
- CEMIC, Centro de investigaciones médicas Norberto Quirno, Buenos Aires, Argentina
| | - Juan José de Agustín
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Di Carlo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen's University, Belfast
| | - Cristina Estrach
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Bayram Farisogulları
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alessia Fiorenza
- SSD Reumatologia, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Gabba
- Rheumatology Clinic, ATS Sardegna, Medicina Specialistica Ambulatoriale, Oristano, Nuoro
| | - Cristina Hernández-Díaz
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Feng Huang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Ling Li
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, UK
| | - Xabier Michelena
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alice Andreea Musca
- Internal Medicine and Rheumatology Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Jagdish Nair
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Faculdade de Medicina, Coimbra University, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Iulia Satulu
- Rheumatology Department, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Crescenzio Scioscia
- Department of Emergency and Organ Transplants (DETO), Rheumatology Unit, Bari
| | | | - Fei Sun
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Maria-Magdalena Tamas
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Rheumatology Department, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Paraksevi V Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Ernest Wong
- Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Jinshui Yang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
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Matos AL, Natour J, Heldan de Moura Castro C, Machado FS, Takahashi RD, Furtado RNV. Higher rates of ultrasound synovial hypertrophy, bone erosion and power doppler signal in asymptomatic Brazilian elderly versus young adults: a cross-sectional study. Rheumatol Int 2022; 43:941-951. [PMID: 36315265 DOI: 10.1007/s00296-022-05212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
To evaluate the prevalence of musculoskeletal ultrasonography (MSUS) abnormalities in asymptomatic elderly individuals. A cross-sectional controlled study was conducted and MSUS of 23 joints (wrist, metacarpophalangeal-MCP, proximal interphalangeal-PIP, elbow, glenohumeral, hip, knee, ankle, and metatarsophalangeal-MTP joints) was performed in healthy individuals aged 18-29 (young, n = 32) and 60-80 years-old (elderly, n = 32). Quantitative synovial hypertrophy (SH) was measured in mm and a semiquantitative scoring system (0-3) was used to grade SH, power doppler (PD) and bone erosion (BE). Young and elderly participants were 26.2 ± 3.2 and 65.9 ± 4.4 years-old, respectively. As compared to the young participants, elderly individuals had higher SH values in 35% of the joint surfaces (P < 0.05), higher rates of scores 1-3 for SH at the dorsal surface of the 3rd MCP, palmar surface of the 2nd MCP, 2nd PIP, 3rd MCP and 3rd PIP and subtalar joints (17.2 vs. 1.6%, P = 0.002; 29.7 vs. 6.3%, P = 0.001; 12.5 vs. 1.6%, P = 0.016; 21.9 vs. 6.3%, P = 0.011; 21.9 vs. 7.8%, P = 0.025; and 24.2 vs. 6.3%, P = 0.005, respectively), BE at the radiocarpal, ulnocarpal, dorsal surface of the 2nd MCP and posterior area of the glenohumeral joints (10.9 vs. 1.6%, P = 0.028; 12.5 vs. 0%, P = 0.003; 9.4 vs. 0%, P = 0.012; and 29.7 vs. 10.9%, P = 0.008, respectively) and PD at the dorsal surface of the 2nd and 3rd MCP joints (9.4 vs. 0%; P = 0.012 and 7.8 vs. 0%; P = 0.023, respectively). BE scores ≥ 1 were more frequent in the elderly (P < 0.05) in 22 (88%) of the joint surfaces evaluated. MSUS abnormalities are more frequent in asymptomatic elderly individuals as compared to young subjects.
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Affiliation(s)
- Alexandre Lima Matos
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Disciplina de Reumatologia, Rua Botucatu, 740-3º andar-Vila Clementino, São Paulo, SP, Brazil
| | - Jamil Natour
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Disciplina de Reumatologia, Rua Botucatu, 740-3º andar-Vila Clementino, São Paulo, SP, Brazil
| | - Charlles Heldan de Moura Castro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Disciplina de Reumatologia, Rua Botucatu, 740-3º andar-Vila Clementino, São Paulo, SP, Brazil
| | - Flávia S Machado
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Disciplina de Reumatologia, Rua Botucatu, 740-3º andar-Vila Clementino, São Paulo, SP, Brazil
| | - Rogerio Diniz Takahashi
- Radiology Departament, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Rita Nely Vilar Furtado
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Disciplina de Reumatologia, Rua Botucatu, 740-3º andar-Vila Clementino, São Paulo, SP, Brazil.
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Agache M, Popescu CC, Popa L, Codreanu C. Ultrasound Enthesitis in Psoriasis Patients with or without Psoriatic Arthritis, a Cross-Sectional Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1557. [PMID: 36363514 PMCID: PMC9696198 DOI: 10.3390/medicina58111557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 09/23/2023]
Abstract
Background and objectives: The main objective of the current study was to describe the prevalence of enthesitis at different sites in a group of patients with psoriasis with or without psoriatic arthritis (PsA). Materials and Methods: The study included adult patients with psoriasis who underwent clinical examination, laboratory tests and ultrasound examination of the entheses. The enthesitis ultrasound scores (BUSES, MASEI, GUESS) were evaluated; the presence of OMERACT-defined enthesitis was also recorded for each scan site. Results: The study included 16 (57.1%) patients with PsA and 12 (42.9%) patients with psoriasis, with an increased average body mass index (29.3 kg/m2). Compared to psoriasis patients, PsA patients had a higher prevalence of nail psoriasis (68.8% compared to 33.3%; p = 0.063). There were no significant differences regarding the clinical examination of entheses between patients with psoriasis and patients with PsA (p = 0.459). Ultrasound scores, BUSES, GUESS and MASEI proved to have statistically significant higher median values in PsA patients compared to psoriasis patients. Compared to psoriasis patients, PsA patients had a significantly higher prevalence of OMERACT-defined enthesitis of the quadriceps tendon and inferior patellar ligament (both 81.3% compared to 25.0%, p = 0.003). Clinical examination of the lateral epicondyle and of the superior patellar ligament was consistent with their ultrasound examination (κ = 0.357, p = 0.043, respectively, κ = 0.404, p = 0.008). Conclusions: Clinical enthesitis scores do not differ between psoriasis and PsA patients. All analyzed ultrasound scores are significantly higher in patients with PsA. OMERACT-defined enthesitis has the ability to discriminate sonographic enthesitis between the two subgroups for bilateral quadriceps and inferior patellar tendon enthesitis. Bilateral ultrasound damage of entheses can suggest a PsA diagnosis.
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Affiliation(s)
- Mihaela Agache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu C. Popescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Liliana Popa
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology and Allergology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Cătălin Codreanu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
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Wüstner M, Radzina M, Calliada F, Cantisani V, Havre RF, Jenderka KV, Kabaalioğlu A, Kocian M, Kollmann C, Künzel J, Lim A, Maconi G, Mitkov V, Popescu A, Saftoiu A, Sidhu PS, Jenssen C. Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Short Version) - General Aspects. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:456-463. [PMID: 35850146 DOI: 10.1055/a-1854-2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This first position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards presents a common position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of ultrasound examinations by any professional ultrasound operator. It describes general aspects of professionality that ensure procedure quality, effectiveness, efficiency, and sustainability in virtually all application fields of medical ultrasound. Recommendations are given related to safety and indication of ultrasound examinations, requirements for examination rooms, structured examination, systematic reporting of results, and management, communication and archiving of ultrasound data. The print version of this article is a short version. The long version is published online.
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Affiliation(s)
- Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Maija Radzina
- Radiology Research laboratory, Riga Stradins University, Riga, Latvia
- Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Milan Kocian
- Anästhesie und Intensiv, Asklepios Klinik Burglengenfeld, Germany
- Visual Medicine s. r. o., Olomouc, Czech Republic
| | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
| | - Julian Künzel
- Otorhinolaryngology, University of Regensburg, Germany
| | - Adrian Lim
- Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, "L. Sacco" University Hospital, Milan, Italy
| | - Vladimir Mitkov
- Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alina Popescu
- Gastroenterology, University of Medicine and Pharmacy Timisoara, Romania
| | - Adrian Saftoiu
- Res Ctr Gastroenterol Hepatol, University of Medicine and Pharmacy of Craiova, Romania
| | - Paul S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
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43
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Cipolletta E, Filippucci E, Di Matteo A, Tesei G, Cosatti MA, Di Carlo M, Grassi W. The Reliability of Ultrasound in the Assessment of Hyaline Cartilage in Rheumatoid Arthritis and Healthy Metacarpal Heads. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e65-e72. [PMID: 33126276 DOI: 10.1055/a-1285-4602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE i) To assess the inter- and intra-observer reliability of ultrasound (US) in the evaluation of the hyaline cartilage (HC) of the metacarpal head (MH) in patients with rheumatoid arthritis (RA) and in healthy subjects (HS) both qualitatively and quantitatively. ii) To calculate the smallest detectable difference (SDD) of the MH cartilage thickness measurement. iii) To correlate the qualitative scoring system and the quantitative assessment. MATERIALS AND METHODS US examination was performed on 280 MHs of 20 patients with RA and 15 HS using a very high frequency probe (up to 22 MHz). HC status was evaluated both qualitatively (using a five-grade scoring system) and quantitatively (using the average value of the longitudinal and transverse measures). The HC of MHs from II to V metacarpophalangeal joint of both hands were scanned independently on the same day by two rheumatologists to assess inter-observer reliability. All subjects were re-examined using the same scanning protocol and the same US setting by one sonographer after a week to assess intra-observer reliability. RESULTS The inter-observer agreement and intra-observer agreement were moderate to substantial (k = 0.66 and k = 0.73) for the qualitative scoring system and high (ICC = 0.93 and ICC = 0.94) for the quantitative assessment. The SDD of the MH cartilage thickness measurement was 0.09 mm. A significant correlation between the two scoring systems was found (r = -0.35; p < 0.001). CONCLUSION The present study describes the main methodological issues of HC assessment. Using a standardized protocol, both the qualitative and the quantitative scoring systems can be reliable.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Giulia Tesei
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Micaela Ana Cosatti
- Rheumatology and Immunology Unit, Norberto Quirno Center for Medical Education and Clinical Research, Buenos Aires, Argentina
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Wüstner M, Radzina M, Calliada F, Cantisani V, Havre RF, Jenderka KV, Kabaalioğlu A, Kocian M, Kollmann C, Künzel J, Lim A, Maconi G, Mitkov V, Popescu A, Saftoiu A, Sidhu PS, Jenssen C. Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Long Version) - General Aspects. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e36-e48. [PMID: 35850145 DOI: 10.1055/a-1857-4435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This first position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards presents a common position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of ultrasound examinations by any professional ultrasound operator. It describes general aspects of professionality that ensure procedure quality, effectiveness, efficiency, and sustainability in virtually all application fields of medical ultrasound. Recommendations are given related to safety and indication of ultrasound examinations, requirements for examination rooms, structured examination, systematic reporting of results, and management, communication and archiving of ultrasound data. The print version of this article is a short version. The long version is published online.
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Affiliation(s)
- Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Maija Radzina
- Radiology Research laboratory, Riga Stradins University, Riga, Latvia
- Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Milan Kocian
- Anästhesie und Intensiv, Asklepios Klinik, Burglengenfeld, Germany
- Visual Medicine s. r. o., Olomouc, Czech Republic
| | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
| | - Julian Künzel
- Otorhinolaryngology, University of Regensburg, Germany
| | - Adrian Lim
- Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, "L. Sacco" University Hospital, Milan, Italy
| | - Vladimir Mitkov
- Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alina Popescu
- Gastroenterology, University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Saftoiu
- Res Ctr Gastroenterol Hepatol, University of Medicine and Pharmacy of Craiova, Romania
| | - Paul S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
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Germanò G, Macchioni P, Maranini B, Ciancio G, Bonazza S, Govoni M, Salvarani C. Ultrasound response to tofacitinib in patients with rheumatoid arthritis: Data from a multicenter 24 weeks prospective study. Front Med (Lausanne) 2022; 9:990317. [PMID: 36226143 PMCID: PMC9549158 DOI: 10.3389/fmed.2022.990317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTreatment of rheumatoid arthritis (RA) should aim at full remission. Ultrasonography (US) might have an added value to clinical examination in assessing disease activity of RA. In this study we evaluated the ultrasound response, next to clinical and laboratory response, in RA patients treated with tofacitinib (TOF).MethodsIn this observational multicenter study, patients received TOF 5 mg twice daily, with or without the contemporary use of methotrexate or other conventional DMARD, for 24 weeks. All patients underwent clinical, laboratory and US examinations of 40 sites among joints and tendons. Sonographers were blinded to clinical and laboratory parameters. Data were assessed at baseline, week 2, 4, 8, 12 and 24. For each patient we used two US joint scores (Gray Scale –GS–and power Doppler –PD– score), a 0–3 semi-quantitative scale for each joint and the EULAR-OMERACT US scoring system (combined GS and PD graded from 0 to 3). Besides, we calculated a tenosynovitis scores (GS and PD) according to the OMERACT score.ResultsFifty-two RA patients completed the 6 months period study: mean disease duration 9.97 ± 8.75 years, baseline DAS28-CRP 4.9 ± 1.2, HAQ 1.4 ± 0.7, C-reactive protein (CRP 2.25 ± 3.11 mg/dl). Baseline joint (GS, PD and combined-US) and tendon US scores (GS and PD) were 23.5 ± 18.4, 22.7 ± 19.3, 25.7 ± 20.6, 10.5 ± 11.4 and 11.0 ± 12.0, respectively. US joint and tendon scores significantly reduced as early as T1 (week 2) examination as well as at week 4, 12 and 24, as compared to baseline values (p < 0.001 for all comparisons). Improvement of joint US scores (GS, PD and US-combined) correlated at T4 examination, with the reduction of serum CRP levels (rho 0.418, p = 0.036, rho 0.495, p = 0.004 and rho 0.454, p = 0.009, respectively). We did not find any correlation between the variations of DAS28-CRP and any US scores at any visits.ConclusionThese results provide evidence that TOF treatment leads to early (2 weeks) and persistent reduction of US signs of inflammation both at tendon and joint level comparable to clinical improvement.
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Affiliation(s)
- Giuseppe Germanò
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
- AUSL-IRCCS, Reggio Emilia, Italy
- *Correspondence: Giuseppe Germanò
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
- AUSL-IRCCS, Reggio Emilia, Italy
| | - Beatrice Maranini
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna Ferrara,, Ferrara, Italy
| | - Giovanni Ciancio
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna Ferrara,, Ferrara, Italy
| | - Sara Bonazza
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna Ferrara,, Ferrara, Italy
| | - Marcello Govoni
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna Ferrara,, Ferrara, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
- AUSL-IRCCS, Reggio Emilia, Italy
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Di Cosmo M, Fiorentino MC, Villani FP, Frontoni E, Smerilli G, Filippucci E, Moccia S. A deep learning approach to median nerve evaluation in ultrasound images of carpal tunnel inlet. Med Biol Eng Comput 2022; 60:3255-3264. [PMID: 36152237 PMCID: PMC9537213 DOI: 10.1007/s11517-022-02662-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
AbstractUltrasound (US) imaging is recognized as a useful support for Carpal Tunnel Syndrome (CTS) assessment through the evaluation of median nerve morphology. However, US is still far to be systematically adopted to evaluate this common entrapment neuropathy, due to US intrinsic challenges, such as its operator dependency and the lack of standard protocols. To support sonographers, the present study proposes a fully-automatic deep learning approach to median nerve segmentation from US images. We collected and annotated a dataset of 246 images acquired in clinical practice involving 103 rheumatic patients, regardless of anatomical variants (bifid nerve, closed vessels). We developed a Mask R-CNN with two additional transposed layers at segmentation head to accurately segment the median nerve directly on transverse US images. We calculated the cross-sectional area (CSA) of the predicted median nerve. Proposed model achieved good performances both in median nerve detection and segmentation: Precision (Prec), Recall (Rec), Mean Average Precision (mAP) and Dice Similarity Coefficient (DSC) values are 0.916 ± 0.245, 0.938 ± 0.233, 0.936 ± 0.235 and 0.868 ± 0.201, respectively. The CSA values measured on true positive predictions were comparable with the sonographer manual measurements with a mean absolute error (MAE) of 0.918 mm2. Experimental results showed the potential of proposed model, which identified and segmented the median nerve section in normal anatomy images, while still struggling when dealing with infrequent anatomical variants. Future research will expand the dataset including a wider spectrum of normal anatomy and pathology to support sonographers in daily practice.
Graphical abstract
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Affiliation(s)
- Mariachiara Di Cosmo
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, AN, Italy.
| | - Maria Chiara Fiorentino
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, AN, Italy
| | | | - Emanuele Frontoni
- Department of Political Sciences, Communication and International Relations, Università di Macerata, Macerata, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, "Carlo Urbani" Hospital, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, "Carlo Urbani" Hospital, Ancona, Italy
| | - Sara Moccia
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
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Bethina NK, Torralba KD, Choi KS, Fairchild RM, Cannella AC, Salto L, Kissin EY, Yinh J, Aggarwal M, Thiele R, Nishio MJ. North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study. Clin Rheumatol 2022; 41:3825-3835. [PMID: 36008579 DOI: 10.1007/s10067-022-06337-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. METHOD Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. RESULTS Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. CONCLUSIONS This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.
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Affiliation(s)
- Narandra K Bethina
- Division of Rheumatology and Clinical Immunology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristal S Choi
- Division of Rheumatology, University of CA-Los Angeles, Los Angeles, CA, USA
| | - Robert M Fairchild
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Amy C Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Salto
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Harvard Medical School, Boston, MA, USA
| | - Manushi Aggarwal
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Ralf Thiele
- Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA
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Carbonell-Bobadilla N, Soto-Fajardo C, Amezcua-Guerra LM, Batres-Marroquín AB, Vargas T, Hernández-Diazcouder A, Jiménez-Rojas V, Medina-García AC, Pineda C, Silveira LH. Patients with seronegative rheumatoid arthritis have a different phenotype than seropositive patients: A clinical and ultrasound study. Front Med (Lausanne) 2022; 9:978351. [PMID: 36052337 PMCID: PMC9424641 DOI: 10.3389/fmed.2022.978351] [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: 06/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is an inflammatory disease whose clinical phenotype largely depends on the presence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). Seronegative RA appears to be a less severe disease, but this remains controversial. This study aimed to assess whether seronegative patients show a less severe disease than seropositive patients. Methods A cross-sectional study was conducted on RA outpatients from a single center. Clinical activity scales, laboratory evaluations, and cardiovascular risk scores were assessed. Musculoskeletal ultrasound (US) examinations were performed. Results One hundred and fourteen patients were enrolled. Eighty-five were seropositive (76% women) and 29 seronegative (93% women). Seropositive patients had a younger age at disease onset (43 ± 14 vs. 54 ± 11; p = 0.001) and used sulfasalazine (47 vs. 17%; p = 0.004) and glucocorticoids (36 vs. 10%; p = 0.007) more frequently. No differences in clinical activity scales and in 10-year cardiovascular risk were observed. Pathological US data were found more frequently in seropositive patients in the 2nd metacarpophalangeal (MCP) joint, both in grayscale (71 vs. 38%; p = 0.008) and in power Doppler (PD; 53 vs. 9%; p < 0.001); erosions (36 vs. 9%; p = 0.020) were also more frequent. We found greater severity of PD signals in the 2nd MCP and 3rd MCP joints of the seropositive patients, while synovitis severity was higher only in the 2nd MCP joints. The percentage of total joints with erosions (9 vs. 1%; p < 0.001) and 2nd MCP joints with erosions (25 vs. 7%; p < 0.001) was higher in seropositive patients. Conclusion RA patients show a differentiated phenotype according to their ACPA and RF status. In seronegative patients, RA begins later in life and has a lower requirement for antirheumatic therapies. On US evaluation, seropositive patients show more joint damage, especially in MCP joints. Despite this, long-term cardiovascular risk is similar among RA patients, regardless of their RF and ACPA status.
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Affiliation(s)
| | - Carina Soto-Fajardo
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis M. Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | | | - Tania Vargas
- Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Valentin Jiménez-Rojas
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ana Cristina Medina-García
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carlos Pineda
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
- *Correspondence: Carlos Pineda
| | - Luis H. Silveira
- Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Frederiksen BA, Schousboe M, Terslev L, Iversen N, Lindegaard H, Savarimuthu TR, Just SA. Ultrasound joint examination by an automated system versus by a rheumatologist: from a patient perspective. Adv Rheumatol 2022; 62:30. [DOI: 10.1186/s42358-022-00263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The Arthritis Ultrasound Robot (ARTHUR) is an automated system for ultrasound scanning of the joints of both hands and wrists, with subsequent disease activity scoring using artificial intelligence. The objective was to describe the patient’s perspective of being examined by ARTHUR, compared to an ultrasound examination by a rheumatologist. Further, to register any safety issues with the use of ARTHUR.
Methods
Twenty-five patients with rheumatoid arthritis (RA) had both hands and wrists examined by ultrasound, first by a rheumatologist and subsequently by ARTHUR. Patient-reported outcomes (PROs) were obtained after the examination by the rheumatologist and by ARTHUR. PROs regarding pain, discomfort and overall experience were collected, including willingness to be examined again by ARTHUR as part of future clinical follow-up. All ARTHUR examinations were observed for safety issues.
Results
There was no difference in pain or discomfort between the examination by a rheumatologist and by ARTHUR (p = 0.29 and p = 0.20, respectively). The overall experience of ARTHUR was described as very good or good by 92% (n = 23), with no difference compared to the examination by the rheumatologist (p = 0.50). All (n = 25) patients were willing to be examined by ARTHUR again, and 92% (n = 23) would accept ARTHUR as a regular part of their RA clinical follow up. No safety issues were registered.
Conclusions
Joint ultrasound examination by ARTHUR was safe and well-received, with no difference in PRO components compared to ultrasound examination by a rheumatologist. Fully automated systems for RA disease activity assessment could be important in future strategies for managing RA patients.
Trial registration: The study was evaluated by the regional ethics committee (ID: S-20200145), which ruled it was not a clinical trial necessary for their approval. It was a quality assessment project, as there was no intervention to the patient. The study was hereafter submitted and registered to Odense University Hospital, Region of Southern Denmark as a quality assessment project and approved (ID: 20/55294).
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Podewski AF, Glimm AM, Fischer I, Bruyn GAW, Hanova P, Hammer HB, Aga AB, Haavardsholm EA, Ramiro S, Burmester GR, Backhaus M, Ohrndorf S. The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study. Arthritis Res Ther 2022; 24:183. [PMID: 35932087 PMCID: PMC9354335 DOI: 10.1186/s13075-022-02874-y] [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: 05/30/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. Methods RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. Results A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information. No major differences between the groups of early and established RA could be detected. Conclusions The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02874-y.
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Affiliation(s)
- A F Podewski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany.
| | - A M Glimm
- Department of Endocrinology, Nephrology, Rheumatology, Division Rheumatology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - I Fischer
- Biostatistics Tubingen, Tubingen, Germany
| | - G A W Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, Netherlands
| | - P Hanova
- Department of Rheumatology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - H B Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A B Aga
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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