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Yamamoto EK, Yamada H, Sendo S, Yasuba H, Nishimura K, Ueda Y, Saegusa J. Musculoskeletal ultrasound findings in adult-onset Still's disease: A case series. Joint Bone Spine 2024; 91:105771. [PMID: 39271051 DOI: 10.1016/j.jbspin.2024.105771] [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: 06/10/2024] [Revised: 08/02/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024]
Abstract
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology characterized by high spiking fever, salmon-like skin rash, arthritis, and elevated serum ferritin levels. Early detection of AOSD is remarkably difficult because of the lack of serologic biomarkers, nonspecific presentation, and rarity of the disease. Although arthralgia and arthritis are the most frequent symptoms and are correlated with health-related quality of life in patients with AOSD, the inflammatory changes associated with these symptoms have not been elucidated. We performed musculoskeletal ultrasound (MSKUS) in 11 patients between January 1, 2008 and July 31, 2023, seven of whom had abnormalities. MSKUS findings of those cases suggested that some patients with AOSD could present with tenosynovitis, tendonitis/peritendonitis, bursitis, and enthesitis along with synovitis. This case series demonstrate the diversity of inflammatory articular manifestations of AOSD identified by MSKUS.
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Affiliation(s)
- Eriko Kashihara Yamamoto
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Hirotaka Yamada
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Sho Sendo
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Haruka Yasuba
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Keisuke Nishimura
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yo Ueda
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Jun Saegusa
- Department of Rheumatology and Clinical Immunology, Kobe University Hospital, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
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2
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Fairchild RM, Deluna MD, Golovko V, Mar DA, Baker MC, Nishio J, Horomanski AL. Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center. Semin Arthritis Rheum 2023; 63:152276. [PMID: 37857047 DOI: 10.1016/j.semarthrit.2023.152276] [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: 06/29/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC). METHODS We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic. RESULTS From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results. CONCLUSIONS These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.
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Affiliation(s)
- Robert M Fairchild
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Mariani D Deluna
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Valentyn Golovko
- Stanford Health Care, Department of Quality, Patient Safety & Effectiveness, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - Diane A Mar
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Matthew C Baker
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jane Nishio
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Audra L Horomanski
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
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El genedi SH, Salem MN, Farid M, Ahmed TM, Taha HA. Detection of joint involvement in patients with systemic lupus erythematosus using musculoskeletal ultrasound and its correlation with disease activity. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2023. [DOI: 10.1186/s43088-023-00372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Musculoskeletal symptoms are common and could be the first presenting symptom in up to 50% of systemic lupus erythematosus patients, and they affect more than 95% of patients during the clinical course. The present study aimed to assess joint involvement in the wrists, hands, and knees of SLE patients using musculoskeletal ultrasonography and to correlate these findings with disease activity.
The study enrolled 40 Patients with SLE who were attending the Immunology outpatient clinic and internal medicine department of Beni-Suef University Hospital and 20 age and sex nearly matched healthy controls who have no rheumatological complaints. Participants had a comprehensive physical examination, series of laboratory tests, functional assessment by Health Assessment Questionnaire score, disease activity assessment of by European Consensus Lupus Activity score, and radiological examination by high-resolution Ultrasound machine called (LOGIC P 9) using a gray-scale US mode (13–18 MHz) with Power Doppler to detect joint synovitis, synovial hypertrophy, bone erosions and or tenosynovitis.
Results
There was a statistically significant prevalence of US abnormality of knee joints in both asymptomatic and symptomatic cases versus controls contrary to the wrist and hand US abnormality. The presence of SLE increases the risk of US abnormalities in knee joints 28 times more than controls also increasing the age of the patient one year increase the probability of getting abnormal findings in the knee joint by 1.156 times. While the only independent variable that can affect US abnormal findings in the wrist joint is the increase in Systolic Blood Pressure 1 mmHg with 1.06 times.
Conclusion
Musculoskeletal Ultrasound with applied Power Doppler is a good tool for the detection of early affection of joints either in symptomatic or asymptomatic SLE patients.
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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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Raja AE, Shustorovich A, Robinson DM, Alfonso K, Meyer R, Roemmich RT, Eng C, Wisniewski SJ, Cabahug P. Musculoskeletal Ultrasound as a Motivator for Selecting a Physical Medicine and Rehabilitation Residency Program in the United States: A Multicenter Survey Study. Am J Phys Med Rehabil 2022; 101:97-103. [PMID: 33605576 PMCID: PMC8371081 DOI: 10.1097/phm.0000000000001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT This study aimed to determine the influence of musculoskeletal ultrasound (MSKUS) curriculum on applicants during the residency-selection process. A survey of 666 applicants for the Johns Hopkins University, Mayo Clinic, and Harvard/Spaulding Rehabilitation Physical Medicine and Rehabilitation programs was conducted in June 2020. A total of 180 respondents scored the influence of a MSKUS curriculum on their decision making for residency selection. In addition, applicants were asked to rank specific areas of physical medicine and rehabilitation that influenced their decision making. Participants most commonly included MSKUS in their top three areas of interest when constructing their rank order list. When asked whether MSKUS presence within a program had an effect during the interview-selection process, 71% responded with "very important" or "absolutely essential" (P < 0.001). For 74% of applicants, exposure to MSKUS in residency was an important factor when creating their rank order list (P < 0.001). More than 92% of applicants stated that they are "likely" or "very likely" to use MSKUS in their future practice and 83% would recommend a program with MSKUS to future candidates (P < 0.001). Based on these results, a large percentage of physical medicine and rehabilitation applicants intend on using MSKUS in their future practice. Therefore, MSKUS may be an important factor for residency selection.
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Affiliation(s)
- Altamash E Raja
- From the Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland (AER, AS, RM, RTR, PC); Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts (DMR, CE); Department of Physical Medicine & Rehabilitation, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota (KA, SJW); and Center for Movement Studies (RTR) and International Center for Spinal Cord Injury (PC), Kennedy Krieger Institute, Baltimore, Maryland
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Dando C, Ellis R, Carroll M, Molyneux P, Gijon-Nogueron G, Siddle HJ, Cherry L, Gatt A, Bowen C. Exploring the use of musculoskeletal ultrasound imaging by podiatrists: an international survey. J Foot Ankle Res 2021; 14:39. [PMID: 33980274 PMCID: PMC8114514 DOI: 10.1186/s13047-021-00478-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Podiatrists, in musculoskeletal services, are demonstrating an expansion of their practice skills through the use of ultrasound imaging. There is an assumption that this practice is beneficial within the context of patient care and health systems. The aim of this research was to further investigate the use of musculoskeletal ultrasound (MSUS) by podiatrists within their clinical setting and gain additional insights into the impact that they perceive use of MSUS has on their approaches to management of musculoskeletal foot and ankle problems. Method An international study utilising a cross-sectional design and an internet-based platform was undertaken. The survey was developed and implemented through three phases: 1. survey development, 2. face validity agreement via questionnaire review, and 3. survey distribution and data collection. Twenty-two survey questions were developed and set as a two-step approach collecting quantitative data (part 1) and qualitative free text data (part 2). Data was exported from SurveyMonkey and analysed using Microsoft Excel software. Counts and frequencies were calculated for responses to all twenty closed questions. Responses to the two final open-ended questions were analysed using thematic analysis to search for patterns related to podiatrists’ perceptions of impact. Results Two hundred and thirty-two eligible participants consented to complete the survey. The majority (n = 159) of respondents were from the UK and Spain. Commonly MSUS has been used in practice for (i) diagnosing pathology, (ii) supporting rehabilitation, (iii) supporting interventions or (iv) research purposes. Most frequently, MSUS was used to assist in the diagnosis of injury/pathology (84%). A range of free text comments were received from the participants in response to the question relating to their thoughts on the impact of using MSUS imaging in their practice (n = 109) and on their perceptions of how the use of MSUS has influenced their approaches to management of their patients’ musculoskeletal foot and ankle problems (n = 108). Thematic analysis of the free text comments generated four themes: (i) diagnosis, (ii) delivery and access of care, (iii) patient education and engagement, and (iv) patient empowerment. Conclusion The perceived benefit podiatrists indicated in using MSUS as part of their practice is the perceived improvement in patient journeys through tighter, focused management plans and reduced waiting times. An additional novel finding was that MSUS provided the capacity for podiatrists to better inform patients of their diagnosis, which they believed led to improved engagement and consequent empowerment of patients in their treatment plans. We propose further investigation of patient experiences as well as testing of the model that embeds podiatrists’ use of MSUS as a key skill in musculoskeletal foot and ankle services. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00478-4.
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Affiliation(s)
- Charlotte Dando
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Richard Ellis
- School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand.,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand
| | - Matthew Carroll
- School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand.,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand
| | - Prue Molyneux
- School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand.,Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, NZ, New Zealand
| | | | - Heidi J Siddle
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lindsey Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK.,The Academy of Research and Improvement, Solent NHS Trust, Southampton, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton, UK
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7
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Abstract
OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.
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Amatto MD, Rambaransingh B, Yu JC. An Evaluation of Musculoskeletal Interventional Ultrasound Training in Canadian Physical Medicine and Rehabilitation Residency Programs. PM R 2020; 13:1148-1156. [PMID: 33247549 DOI: 10.1002/pmrj.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ultrasound is a rapidly evolving field of medicine with strong utility in musculoskeletal practices. In Canadian physical medicine and rehabilitation (PM&R) residency programs there are no national standards for objectives of training in this area. This possible disconnection between demand and availability could lead to gaps in education. OBJECTIVE (1) To determine the current state of interventional musculoskeletal ultrasound (MSUS) training in Canadian PM&R residency programs, as perceived by both residents and program directors; (2) to evaluate the perspectives of experts in the field on current and future MSUS curriculum inclusion. DESIGN This study was a cross-sectional cohort study using an explanatory sequential mixed methods design. SETTING This project included anonymous online surveys and targeted telephone/in-person semistructured interviews. PARTICIPANTS Participants were Canadian PM&R residents or clinicians. Survey responses included 71 residents and nine program directors. Interviews were conducted with nine MSUS experts. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcome measures included residents' level of interest, amount of exposure, and barriers to training. Themes regarding resident exposure and future directions for MSUS training were obtained based on expert interviews. RESULTS The vast majority (97%) of current PM&R residents are interested in using ultrasound clinically, with 73% reporting having had "none" to "limited exposure" in MSUS. Expert interviews revealed four major themes: (1) appropriate training is dependent on access, (2) MSUS represents an emerging standard of care, (3) a minimal baseline level of competence should be expected, and (4) various strategies may be used to integrate basic MSUS into existing residency curriculums. CONCLUSIONS The use of ultrasound as a clinical tool is rapidly increasing. Current PM&R residents have a desire to incorporate this skill into their future practices. Although barriers exist to implementing this training on a national level, the future looks promising with multiple strategies outlined to assist the process.
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Affiliation(s)
- Michael D Amatto
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brian Rambaransingh
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jaime C Yu
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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9
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Blake Holloway W, Grove J, Tyson A, Rochford L, Day L, Resuehr D. Utilization of a Co-enrolled Course Structure for Point-of-Care Ultrasound Training in the Undergraduate Medical Education Setting. MEDICAL SCIENCE EDUCATOR 2020; 30:31-39. [PMID: 34457633 PMCID: PMC8368844 DOI: 10.1007/s40670-019-00831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With continuing advancements in software, electronics, and miniaturization, ultrasound (US) is quickly becoming an everyday tool of numerous medical specialties. With the advent of new handheld and other small-scale units, physicians have a tool to obtain on demand imaging without exposing the patient to ionizing radiation in the pocket of their white coat. As such, the need for competency in US is increasing. Currently, US training primarily occurs in residency, with only a handful of institutions incorporating US into the undergraduate medical education (UME) curriculum. To date, no ideal method has been presented (Amini et al., Intern Emerg Med. 10(5):613-8, 2015; Wilson et al., J Ultrasound Med. 36(2):321-5, 2017). Presented herein is a method for the addition of US training into the undergraduate medical curriculum. Utilizing a co-enrolled course format, 6 medical students were given basic training in the history and physics of US, echocardiography (ECHO), right upper quadrant (RUQ) ultrasound, focused assessment with sonography for trauma (FAST), and extended (eFAST) exams, vascular access techniques, and MSK ultrasound over 17 sessions. Students theoretical knowledge was assessed during team-based learning (TBL) sessions in an individual and group readiness assurance test (IRAT/GRAT) format. Students' practical skill was assessed in an objective structured clinical examination (OSCE) format. Students demonstrated notable proficiency with the US unit and were able to conduct both US-guided peripheral and central vascular access techniques. Furthermore, students were able to identify 80% or more of the required structures for the RUQ, ECHO, and eFAST US exams.
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Affiliation(s)
| | - Jordan Grove
- The University of Alabama School of Medicine, Birmingham, AL USA
| | - Anna Tyson
- The University of Alabama School of Medicine, Birmingham, AL USA
| | - Laura Rochford
- The University of Alabama School of Medicine, Birmingham, AL USA
| | - Lee Day
- The University of Alabama School of Medicine, Birmingham, AL USA
| | - David Resuehr
- Department of Cellular, Developmental, and Integrative Biology, University of Alabama in Birmingham, Birmingham, AL USA
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10
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Serum Pyridinoline is Associated With Radiographic Joint Erosions in Rheumatoid Arthritis. Arch Rheumatol 2020; 34:387-394. [PMID: 32010887 DOI: 10.5606/archrheumatol.2019.7243] [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: 10/23/2018] [Accepted: 02/07/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the serum pyridinoline (Pyd) levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of serum Pyd levels with radiographic joint erosions. Patients and methods Serum samples were obtained from 48 patients with RA (9 males, 39 females; mean age 60.5 years; range 54 to 64 years) and 48 healthy controls (9 males, 39 females; mean age 57.5 years; range, 47 to 65 years). The enzyme-linked immunosorbent assay method was used for quantitative analysis of serum Pyd. Besides, all RA patients were assessed for joint damage based on modified Sharp score, disease activity based on disease activity score in 28 joints and functional capacity based on health assessment questionnaire-disability index. Results The median serum Pyd levels were significantly higher among the RA patients (110.20 ng/mL [92.30-120.64]) compared to the controls (98.22 ng/mL [85.54-111.41]); p<0.05. RA patients with erosive disease had significantly higher serum Pyd levels (p=0.024). There was a significant positive correlation between serum Pyd levels and joint erosion score (r=0.285, p=0.049). The serum Pyd levels had no demonstrable association with disease activity or functional capacity. Steroid therapy did not appear to influence the levels of serum Pyd. Conclusion Rheumatoid arthritis patients had significantly higher levels of serum Pyd compared to healthy controls. The serum Pyd levels had significant correlation with radiographic joint erosions which reflected disease damage.
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11
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Volland LM, Zhou JY, Barnes RFW, Kruse-Jarres R, Steiner B, Quon DV, Bailey C, Hughes TH, Moore RE, Chang EY, von Drygalski A. Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1569-1581. [PMID: 30371941 DOI: 10.1002/jum.14846] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. METHODS Thirty-one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra- and inter-rater reliability, 8 musculoskeletal US-experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty-three musculoskeletal US-inexperienced providers performed similar assessments. Inter-operator reliability was established by 6 musculoskeletal US-experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. RESULTS The musculoskeletal US-experienced providers showed excellent intra-and inter-rater reliability for tissue measurements (ICCs, 0.94-0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87-0.94). Inter-operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US-inexperienced providers showed excellent inter-rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). CONCLUSIONS The JADE protocol appears feasible for quantifying hemophilic intra-articular abnormalities. Musculoskeletal US-trained hemophilia providers showed high intra-rater, inter-rater, and inter-operator reliability, supporting JADE as a protocol for clinical management and research.
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Affiliation(s)
- Lena M Volland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Cindy Bailey
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Tudor H Hughes
- Department of Radiology, University of California, San Diego, California, USA
| | - Randy E Moore
- General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
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12
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Kaeley GS, MacCarter DK, Pangan AL, Wang X, Kalabic J, Ranganath VK. Clinical Responses and Synovial Vascularity in Obese Rheumatoid Arthritis Patients Treated with Adalimumab and Methotrexate. J Rheumatol 2018; 45:1628-1635. [PMID: 30173153 DOI: 10.3899/jrheum.171232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Obese patients with rheumatoid arthritis (RA) report more joint swelling and tenderness and often have poorer responses to therapy than nonobese patients. The aim of this posthoc analysis of the MUSICA trial was to compare imaging and clinical disease activity measures in obese and nonobese patients with RA. METHODS MUSICA evaluated methotrexate (MTX) 20 mg/week versus 7.5 mg/week in combination with adalimumab (ADA) in RA patients with an inadequate response to MTX. Patients were categorized by baseline body mass index as normal (< 25), overweight (≥ 25 to < 30), or obese (≥ 30). Synovial vascularity and hypertrophy, swollen and tender joint counts (SJC and TJC), American College of Rheumatology (ACR) responses, and low disease activity (LDA), defined as Clinical Disease Activity Index < 10 and 28-joint count Disease Activity Score using C-reactive protein (DAS28-CRP) < 3.2, were assessed at weeks 12 and 24. RESULTS Patient characteristics were similar among groups at baseline. Obese patients had numerically smaller changes from baseline to weeks 12/24 in SJC, TJC, DAS28-CRP, and synovial hypertrophy and vascularity versus nonobese patients. Significantly fewer obese patients reached ACR20/50 at weeks 12 and 24, and LDA at Week 12; this difference was especially apparent in patients receiving 7.5 mg/week MTX but was no longer significant at Week 24. CONCLUSION Obese patients with RA had worse clinical and ultrasonographic responses than nonobese patients, which were partly overcome with time. Obese patients may experience better and faster clinical improvements if ADA is initiated with high-dose (20 mg/week) rather than low-dose MTX. [ClinicalTrials.gov: NCT01185288].
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Affiliation(s)
- Gurjit S Kaeley
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles
| | - Daryl K MacCarter
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles
| | - Aileen L Pangan
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles
| | - Xin Wang
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles
| | - Jasmina Kalabic
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles
| | - Veena K Ranganath
- From the Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, Florida; Department of Rheumatology, North Valley Hospital, Whitefish, Montana; Global Medical Affairs, AbbVie Inc., North Chicago, Illinois; Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois; Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA; Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. .,G.S. Kaeley, MD, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine; D.K. MacCarter, MD, Department of Rheumatology, North Valley Hospital; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; X. Wang, PhD, Data and Statistical Sciences, AbbVie Inc.; J. Kalabic, MD, Pharmaceutical Development, AbbVie Deutschland GmbH & Co. KG; V.K. Ranganath, MD, Division of Rheumatology, University of California at Los Angeles.
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13
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Takase-Minegishi K, Horita N, Kobayashi K, Yoshimi R, Kirino Y, Ohno S, Kaneko T, Nakajima H, Wakefield RJ, Emery P. Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. Rheumatology (Oxford) 2017; 57:49-58. [DOI: 10.1093/rheumatology/kex036] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/14/2022] Open
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Fuda AI, Hashaad NI, Galal O, Azzam AM. Ultrasonographic findings of the shoulders in Egyptian patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/1110-161x.200836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja OH, Dong Y, Abramowicz JS, Vinayak S, Westerway SC, Nolsøe CP, Chou YH, Blaivas M. Point of Care Ultrasound: A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:49-58. [PMID: 27472989 DOI: 10.1016/j.ultrasmedbio.2016.06.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice. However, its use and teaching are different from continent to continent and from country to country. This World Federation for Ultrasound in Medicine and Biology position paper discusses the current status and future perspectives of PoC-US. Particular attention is given to the different uses of PoC-US and its clinical significance, including within emergency and critical care medicine, cardiology, anesthesiology, rheumatology, obstetrics, neonatology, gynecology, gastroenterology and many other applications. In the future, PoC-US will be more diverse than ever and be included in medical student training.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China.
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Liliana Chiorean
- Département d'imagerie médicale, Clinique des Cévennes 07100 Annonay, France
| | - Xin Wu Cui
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jacques S Abramowicz
- Section of Ultrasound, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Sudhir Vinayak
- Department of Imaging & Diagnostic Radiology, WFUMB COE, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Christian Pállson Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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Cao K, Mills DM, Thiele RG, Patwardhan KA. Toward Quantitative Assessment of Rheumatoid Arthritis Using Volumetric Ultrasound. IEEE Trans Biomed Eng 2016; 63:449-58. [DOI: 10.1109/tbme.2015.2463711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: Relation to disease activity, clinical and radiological findings. EGYPTIAN RHEUMATOLOGIST 2015. [DOI: 10.1016/j.ejr.2014.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Patil P, Dejaco C, Dasgupta B. A pragmatic approach to imaging in large vessel vasculitis. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1056150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Troum OM, Pimienta OL, Schmidt WA, Ostergaard M, D'Agostino MA, Gaylis N, Arnold W, Ben-Artzi A, Ranganath V, Seraphine JL, Peterfy C. Proceedings from the 7th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) conference. Semin Arthritis Rheum 2015; 45:115-21. [PMID: 25908178 DOI: 10.1016/j.semarthrit.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/17/2022]
Abstract
The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in clinical practice and research. Because the field of musculoskeletal (MSK) imaging is rapidly evolving, continuous education in the field is imperative. ISEMIR's international faculty and world-renowned experts presented the newest information as it relates to the use of magnetic resonance imaging (MRI) and ultrasound (US) at the 7th annual ISEMIR meeting which took place on April 12-14, 2014 in Santa Monica, California. Presentations from the meeting can be viewed at www.isemir.org.
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Affiliation(s)
- Orrin M Troum
- Keck School of Medicine, University of Southern California, Santa Monica, CA
| | - Olga L Pimienta
- Keck School of Medicine, University of Southern California, Santa Monica, CA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Mikkel Ostergaard
- Copenhagen University Hospital at Hvidovre and Herly, Copenhagen, Denmark
| | | | - Norman Gaylis
- Arthritis and Rheumatic Disease Specialties, Aventura, FL
| | | | - Ami Ben-Artzi
- University of California Los Angeles, Los Angeles, CA
| | | | - Judy L Seraphine
- International Society for Musculoskeletal Imaging in Rheumatology, Suite 301. 342 N. Main St, Suite 301, West Hartford, CT 06117.
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Dale J, Purves D, McConnachie A, McInnes I, Porter D. Tightening up? Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy. Arthritis Care Res (Hoboken) 2014; 66:19-26. [PMID: 24376248 DOI: 10.1002/acr.22218] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 10/15/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the level of agreement and potential impact on disease-modifying antirheumatic drug (DMARD) escalation decisions and of adding musculoskeletal ultrasound (MSUS) assessment of disease activity to the Disease Activity Score in 28 joints (DAS28) in early rheumatoid arthritis (RA). METHODS Data were gathered from 53 early RA patients randomized to the MSUS assessment group of the Targeting Synovitis in Early Rheumatoid Arthritis study. DAS28 scores were calculated every month. MSUS was performed on patients with low disease activity (DAS28 <3.2) and on those with moderate disease activity (3.2 ≤ DAS28 <5.1) without clinically swollen joints (swollen joint count [SJC] ≤1). Fourteen joints (bilateral proximal interphalangeal joints 2 and 3, metacarpophalangeal [MCP] joints 2 and 3, the radiocarpal, and metatarsophalangeal joints 2 and 5) were examined. Active disease was defined as ≥2 joints demonstrating any power Doppler (PD) signal. Data from 414 paired DAS28 and MSUS assessments were pooled to determine the level of agreement between each method. RESULTS A total of 369 MSUS assessments were conducted on patients with DAS28 <3.2; 92 (25%) of these assessments identified active disease. A total of 271 MSUS assessments were performed on those with DAS28 <2.6; 66 (24%) of these identified active disease. Forty-five MSUS assessments were conducted on patients with 3.2 ≤ DAS28 <5.1 and SJC ≤1; 15 (33%) of these assessments confirmed active disease. On 120 occasions (29%), MSUS findings contradicted the DAS28 and led to modified treatment decisions. The joints that most frequently exhibited PD signal were radiocarpal and index and middle MCP joints. CONCLUSION Compared to the DAS28, global RA disease activity assessment using a limited MSUS joint set provided additional disease activity information and led to altered treatment decisions in a significant minority of occasions. This may allow further tailoring of DMARD therapy by supporting DMARD escalation in patients with continuing subclinical synovitis and preventing escalation in symptomatic patients with minimal clinical and/or ultrasonographic synovitis.
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Affiliation(s)
- James Dale
- University of Glasgow, Glasgow, Scotland
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