1
|
Thomsen RS, Nilsen TIL, Haugeberg G, Sitter B, Kavanaugh A, Pedersen SJ, Hoff M. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:743. [PMID: 37726677 PMCID: PMC10508016 DOI: 10.1186/s12891-023-06871-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA) there is a theoretical risk of increased disease activity related to strenuous physical activity, including exercise. We evaluated the effect of high intensity interval training (HIIT) on objective measures of inflammation in PsA assessed by ultrasound (US) of peripheral joints and entheses, and by bone marrow edema (BME) on MRI of the sacroiliac joints (SIJ) and spine. METHODS We randomly assigned 67 PsA patients to an intervention group that performed structured HIIT for 11 weeks, or to a control group instructed not to change their physical exercise habits. Outcome measures included US evaluation of the total cohort and MRI in a subgroup of 41; both assessed at 3 months. We calculated the proportions with an increased US B-mode and power-doppler (PD) signal of joints and entheses and Spondyloarthritis-Research-Consortium-of-Canada (SPARCC)-BME score of the SIJ and spine for both groups. RESULTS Proportions with an increased US B-mode score of the joints were 32% and 28% in HIIT and control groups, respectively. Corresponding proportions of PD scores of the joints were 7% and 10% and PD scores of entheses were 32% and 31%. The proportions with increased MRI BME of the SIJ were 6% in the HIIT group and 10% in the control group. Corresponding proportions were 6% and 5% for the MRI BME of the spine. CONCLUSION In PsA patients with a low to moderate disease activity, there was no clear evidence of objectively measured increased inflammation after HIIT, as evaluated by US and MRI. TRIAL REGISTRATION ClinicalTrials.gov NCT02995460 (16/12/2016).
Collapse
Affiliation(s)
- Ruth Stoklund Thomsen
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway.
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Glenn Haugeberg
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Division of Rheumatology, Department of Internal Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Beathe Sitter
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, School of Medicine, University of California, San Diego, USA
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Denmark
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
2
|
Schreiner JK, Scheicht D, Karakostas P, Recker F, Ziob J, Behning C, Preuss P, Brossart P, Schäfer VS. Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound. Scand J Rheumatol 2023; 52:51-59. [PMID: 34904536 DOI: 10.1080/03009742.2021.1998972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of joint, enthesis, bursa, and tendon ultrasound findings in large and medium joints of young, healthy individuals. METHOD Ultrasound assessment of large and medium joints, bursae, tendons, and entheses was performed in healthy individuals below the age of 30 years. Participants also underwent bioelectrical impedance analysis and conducted supervised weight training to determine maximum strength. The prevalence of ultrasound findings was calculated and a binary logistic regression model was applied to evaluate factors associated with the present findings. RESULTS Fifty-one healthy individuals (52.9% female) with a mean age of 23.7 years were included in this study. Joint effusion in at least one joint was observed in 72.6% of the individuals (n = 37) and entheseal pathology in at least one enthesis was detected in 27.5% (n = 14). A binary logistic regression model indicated a significant association between reported hours of sports activity per week and the prevalence of effusion in the knee (p = 0.017). In addition, associations were observed between entheseal pathology in at least one entheseal site and body mass index (BMI) (p = 0.015) as well as fat mass index (p = 0.026). CONCLUSION Joint effusion in large and medium joints, as well as entheseal hyperperfusion, bursal effusion, and tendon sheath effusion, are found in healthy individuals. Hours of sports activity per week, BMI and fat mass index showed significant associations with the findings in joints and entheses.
Collapse
Affiliation(s)
- J K Schreiner
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - D Scheicht
- Department of Rheumatology, Porz am Rhein Hospital, Cologne, Germany
| | - P Karakostas
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - F Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - J Ziob
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - C Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - P Preuss
- University Sports Division, University Bonn, Bonn, Germany
| | - P Brossart
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - V S Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
3
|
Cushman DM, Petrin Z, Cummings K, Eby SF, English J, Teramoto M. Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain. Clin J Sport Med 2022; 32:493-500. [PMID: 34759186 PMCID: PMC9085961 DOI: 10.1097/jsm.0000000000000984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. DESIGN Longitudinal, prospective cohort study. SETTING 2019 Salt Lake City Marathon. PARTICIPANTS Recreational half-marathon and full-marathon runners. ASSESSMENT OF RISK FACTORS The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. MAIN OUTCOME MEASURES Development of pain based on the presence of asymptomatic tendon abnormalities. RESULTS One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. CONCLUSIONS The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.
Collapse
Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Ziva Petrin
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Bellevue, Washington
| | - Keith Cummings
- Proliance Orthopaedics & Sports Medicine, Bellevue, Washington; and
| | - Sarah F Eby
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Joy English
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| |
Collapse
|
4
|
Schreiner JK, Recker F, Scheicht D, Karakostas P, Ziob J, Behning C, Preuss P, Brossart P, Schäfer VS. Changes in ultrasound imaging of joints, entheses, bursae and tendons 24 and 48 h after adjusted weight training. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111610. [PMID: 35898563 PMCID: PMC9310201 DOI: 10.1177/1759720x221111610] [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: 03/05/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Joint effusion and enthesitis are common ultrasound findings in rheumatic
diseases such as rheumatoid arthritis or spondyloarthritis. However, changes
of joints and entheses were not only observed in patients but also in
physically active individuals and athletes. Objectives: The purpose of this study was to evaluate joint, entheseal, bursal and tendon
musculoskeletal ultrasound (MSUS) findings in large and medium joints of
young healthy individuals after completing a standardised weight
training. Design: This is a prospective cohort study. Methods: MSUS examinations of large- and medium-sized joints, and related entheseal
sites, bursae and tendons were performed on young healthy individuals (ages
18–30 years). Before, 24 and 48 h after completing 1 h of standardised
weight exercise, the subjects were evaluated by MSUS. The development of the
MSUS findings and associated effects were examined using generalised linear
mixed effects models. Results: In total, 51 healthy individuals (52.9% female) with a mean age of 23.7
(±2.5) years were enrolled. The results showed an increase in the number of
individuals with at least one joint effusion from 37 (72.5%) before the
weight training to 48 (94.1%) after 48 h. Entheses with pathologies were
observed in 14 participants (27.5%) at baseline, increasing to 29
participants (56.9%) 48 h after the weight training. Biceps tendon sheath
effusion was detected in 9 individuals (17.6%) prior to training, rising to
22 individuals (43.1%) after 48 h. A significant increase in the number of
joints with effusion and abnormal entheses within 48 h after the weight
training was indicated by the generalised linear mixed effects models. Conclusion: Within 48 h after the weight training session, a significant increase in the
prevalence of joint effusion in large and medium joints and the prevalence
of abnormal entheses was observed. As a result, when performing and
interpreting an MSUS examination, the patient’s physical activities should
be taken into account.
Collapse
Affiliation(s)
- Julia K Schreiner
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Dennis Scheicht
- Department of Rheumatology, Porz am Rhein Hospital, Cologne, Germany
| | - Pantelis Karakostas
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Jana Ziob
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Peter Preuss
- University Sports Division, University Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Valentin S Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Haematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
Collapse
Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
6
|
Identification of Knee Effusions With Ultrasound: A Comparison of Three Methods. Clin J Sport Med 2022; 32:e19-e22. [PMID: 32032167 DOI: 10.1097/jsm.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether simple methods can improve identification of suprapatellar joint fluid during sonographic evaluation of the knee. DESIGN Prospective cohort study. SETTING Outpatient orthopaedic clinic. PATIENTS Fifty-two patients were sequentially recruited from an orthopaedic clinic. INTERVENTIONS Bilateral sonographic evaluation of the suprapatellar recess with static scanning, parapatellar pressure, or patient-initiated quadriceps contraction. MAIN OUTCOME MEASURES Identification of fluid in the suprapatellar recess. RESULTS Fifty-two patients (104 knees), consisting of 57 (54.8%) painful knees, were examined. Static scanning identified 45 effusions, parapatellar pressure identified 58 effusions, and quadriceps contraction identified 77 effusions. Quadriceps contraction was superior to parapatellar pressure for identifying an effusion {P < 0.001, proportion ratio [PR] = 1.33 [95% confidence interval (CI) = 1.16, 1.52]}, painful knee effusions [P = 0.036, PR = 1.24 (95% CI = 1.06-1.44)], and painless knee effusions (P = 0.006, PR = 1.50 [95% CI = 1.16-1.93]). Both methods were superior to static scanning. Parapatellar pressure identified effusions in 16.9% of knees not seen on static scanning, whereas quadriceps contraction identified effusions in 54.2% of knees not seen on static scanning. Inter-rater reliability kappa values were 0.771 for static scanning (95% CI = 0.605-0.937), 0.686 for parapatellar pressure (95% CI = 0.531-0.840), and 0.846 for quadriceps contraction (95% CI = 0.703-0.990). CONCLUSIONS Parapatellar pressure and patient-initiated quadriceps contraction both improve sonographic detection of suprapatellar joint fluid with high inter-rater reliability; however, quadriceps contraction was superior to parapatellar pressure when assessing for grade 1 or occult effusions.
Collapse
|
7
|
Mistegaard CE, Proft F. The Complement System in Spondyloarthritis: What Do We Know? Rheumatology (Oxford) 2022. [DOI: 10.17925/rmd.2022.1.2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Spondyloarthritis (SpA) encompasses a group of rheumatologic diseases, including axial spondyloarthritis (axSpA), psoriatic arthritis, arthritis with associated inflammatory bowel disease (i.e. Crohn’s disease and ulcerative colitis), reactive arthritis and undifferentiated SpA, which all share certain clinical, biological and genetic features. However, the pathogenesis remains largely unexplained. Recent evidence suggests an autoinflammatory component of the disease. The complement system is a cornerstone of the innate immune system. This review aims to evaluate the current knowledge of the complement system in SpA. Animal models have shown that complement activation is associated with axSpA. Complement proteins L-ficolin and H-ficolin levels are elevated in patients with axSpA, and complement factor C3 levels decrease after the initiation of tumour necrosis factor-inhibitor therapy. Associations with disease activity are inconsistent, as one study found that the serum levels of complement factors C3 and C4 did not differ in patients with different Bath Ankylosing Spondylitis Disease Activity Index scores but, in another study, were associated with baseline Ankylosing Spondylitis Disease Activity Score with C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index improvement after treatment with a tumour necrosis factor inhibitor. Future studies should focus on the complement system in various SpA entities, involvement in pathogenesis and disease progression under clinically relevant conditions.
Collapse
|
8
|
Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
Collapse
Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
| |
Collapse
|
9
|
Simon D, Kleyer A, Bayat S, Knitza J, Valor-Mendez L, Schweiger M, Schett G, Tascilar K, Hueber AJ. Biomechanical stress in the context of competitive sports training triggers enthesitis. Arthritis Res Ther 2021; 23:172. [PMID: 34154651 PMCID: PMC8215784 DOI: 10.1186/s13075-021-02530-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/11/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the influence of mechanical stress on the development of immediate enthesitis. METHODS The BEAT study is an interventional study that assessed entheses in competitive badminton players before and immediately after a 60-min intensive training session. Power Doppler (PD) signal and Gray scale (GS) changes were assessed in the insertion sites of both Achilles tendon, patellar tendons, and lateral humeral epicondyles and quantified using a validated scoring system. RESULTS Thirty-two badminton players were included. One hundred ninety-two entheseal sites were examined twice. The respective empirical total scores for PD examination were 0.1 (0.3) before and 0.5 (0.9) after training. Mean total GS scores were 2.9 (2.5) and 3.1 (2.5) before and after training, respectively. The mean total PD score difference of 0.4 between pre- and post-training was significant (p = 0.0014), whereas no significant difference for the mean total GS score was observed. Overall, seven participants (22%) showed an increased empirical total PD score. A mixed effects model showed a significant increase of PD scores after training, with a mean increase per site of 0.06 (95% CI 0.01 to 0.12, p = 0.017). CONCLUSIONS Mechanical stress leads to rapid inflammatory responses in the entheseal structures of humans. These data support the concept of mechanoinflammation in diseases associated with enthesitis.
Collapse
Affiliation(s)
- David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany. .,Rheumazentrum Erlangen, 91054, Erlangen, Germany.
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Sara Bayat
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Larissa Valor-Mendez
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Marina Schweiger
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany.,Rheumazentrum Erlangen, 91054, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany. .,Rheumazentrum Erlangen, 91054, Erlangen, Germany. .,Section Rheumatology, Sozialstiftung Bamberg, 96049, Bamberg, Germany.
| |
Collapse
|
10
|
The arterial blood supply of the symphysis pubis - Spatial orientated and highly variable. Ann Anat 2020; 234:151649. [PMID: 33227373 DOI: 10.1016/j.aanat.2020.151649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Open surgical treatment of the pubic region and adductor related pathologies require an exact knowledge of the arterial blood supply of the symphysis pubis that seems furthermore important to explain the hematogenous occurrence of symphysitis. Pubic bone marrow oedema (PBME) is a frequent occurring magnetic resonance imaging finding in groin pain. However, even asymptomatic athletes present PBME and a correlation to the physical activity or higher blood flow was suggested. Data on the vascular anatomy of the symphysis pubis are rare. METHODS Ten formaldehyde-embalmed cadavers were dissected, and the arterial blood supply was investigated and photographically documented. RESULTS In the majority of cases the following pattern was determined: superior-inferior epigastric artery (n=12 hemipelves), inferior - dorsal artery of the penis/dorsal artery of the clitoris (n=16), posterior- obturator artery (n=16 hemipelves), anterior- deep external pudendal artery (n=14 hemipelves). Besides variations for the deep external pudendal artery anteriorly, we observed a highly variable arterial supply, especially superior. Superior in 4/10 cadavers, inferior in 0/10 cadavers, posterior in 2/10 cadavers and anterior in 5/10 cadavers side variations were found. CONCLUSION The symphysis pubis has a spatial and rich organized arterial blood supply with several variations. Despite the symphysis pubis is recognized as bradytroph, the high number of vessels is presumably required in stress situations for example in heavy training.
Collapse
|
11
|
Wervers K, Herrings I, Luime JJ, Tchetverikov I, Gerards AH, Hazes JMW, Vis M. Association of Physical Activity and Medication with Enthesitis on Ultrasound in Psoriatic Arthritis. J Rheumatol 2019; 46:1290-1294. [PMID: 30824661 DOI: 10.3899/jrheum.180782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enthesitis is a manifestation of psoriatic arthritis (PsA), but its symptoms are difficult to interpret clinically. We investigated the associations of ultrasonographic changes in entheses with clinical characteristics in patients with PsA, and compared enthesis changes of patients aged 35 to 60 years with healthy volunteers of that age. METHODS Consecutive patients with PsA participated in this cross-sectional study, irrespective of enthesitis complaints and age. We collected data about complaints, physical activity and activity avoidance, medication, and clinical enthesitis. Inflammatory and structural enthesis changes were scored with the modified MAdrid Sonographic Enthesitis Index (MASEI). Among all patients, associations between ultrasound (US) scores and clinical characteristics were investigated using linear regression. We compared US scores of healthy volunteers and patients with PsA aged 35-60 years using Wilcoxon rank-sum tests. RESULTS Eighty-four patients with PsA and 25 healthy volunteers participated. In patients with PsA, we found a small association between higher inflammatory-modified MASEI score and older age (β 0.07, 95% CI 0-0.13) and current use of biologics (β 1.56, 95% CI 0.16-2.95). Patients who reported avoiding activities had significantly lower inflammatory-modified MASEI scores (β -1.71, 95% CI -3.1 to -0.32) than those who did not. The patients with PsA aged 35-60 years (n = 50) had similar inflammatory scores as healthy volunteers but higher structural scores (median 6 vs 2; p = 0.01). CONCLUSION Within patients with PsA, avoiding physical activity, younger age, and not using biologics were associated with less enthesis inflammation. Patients with PsA and healthy volunteers aged 35 to 60 years displayed similar levels of inflammatory changes of the entheses, but patients had more structural damage.
Collapse
Affiliation(s)
- Kim Wervers
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Irene Herrings
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Jolanda J Luime
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Ilja Tchetverikov
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Andreas H Gerards
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Johanna M W Hazes
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands.,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam
| | - Marijn Vis
- From the Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam; Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht; Department of Rheumatology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands. .,K. Wervers, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Herrings, MD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; J.J. Luime, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital Dordrecht; A.H. Gerards, MD, Department of Rheumatology, Vlietland Hospital; J.M. Hazes, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam; M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam.
| |
Collapse
|
12
|
Wervers K, Vis M, Rasappu N, van der Ven M, Tchetverikov I, Kok MR, Gerards AH, Hazes J, Luime JJ. Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers. Scand J Rheumatol 2018; 47:291-294. [PMID: 29291671 DOI: 10.1080/03009742.2017.1393695] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index (MASEI) enables us to distinguish these groups in an extreme comparison. METHOD New and established PsA patients and healthy volunteers (aged 20-30 years) were recruited. The triceps, quadriceps, patellar, Achilles and elbow extensor tendon insertion, and plantar fascia entheses were investigated sonographically for structural changes, erosions, calcifications, increased thickness, bursitis, and power Doppler (PD) signal according to the MASEI. RESULTS The study included 25 new and 25 established PsA patients, and 25 healthy volunteers. Increased thickness and PD signal in knee entheses were common for patients and healthy volunteers, while changes at other locations predominantly occurred in patients only. PD was recoded (1, one spot; 1.5, two or three spots; 2, confluent signal; 3, severe confluent signal) and thickness of knee entheses excluded. This resulted in different modified MASEI scores between PsA patients and young healthy controls: median (interquartile range) modified MASEI of 13 (10-22.5) in new PsA, 13.5 (9.5-18) in established PsA, and 3 (1-8.5) in healthy volunteers (p = 0.002). CONCLUSIONS Structural ultrasound changes and PD in entheses are common in both new and established PsA and healthy controls. MASEI score did not differentiate PsA patients from young healthy volunteers. After recoding of PD severity and excluding thickness of knee entheses, marked differences between PsA patients and healthy controls were observed.
Collapse
Affiliation(s)
- K Wervers
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| | - M Vis
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| | - N Rasappu
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| | - M van der Ven
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| | - I Tchetverikov
- b Department of Rheumatology , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - M R Kok
- c Department of Rheumatology , Maasstad Hospital , Rotterdam , The Netherlands
| | - A H Gerards
- d Department of Rheumatology , Vlietland Hospital , Schiedam , The Netherlands
| | - Jmw Hazes
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| | - J J Luime
- a Department of Rheumatology, Erasmus MC , University Medical Centre , Rotterdam , The Netherlands
| |
Collapse
|
13
|
Proft F, Grunke M, Reindl C, Schramm MA, Mueller F, Kriegmair M, Leipe J, Weinert P, Schulze-Koops H, Witt M. Erratum to: The influence of long distance running on sonographic joint and tendon pathology: results from a prospective study with marathon runners. BMC Musculoskelet Disord 2016; 17:381. [PMID: 27590906 PMCID: PMC5010742 DOI: 10.1186/s12891-016-1223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabian Proft
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Mathias Grunke
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Christiane Reindl
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Markus A Schramm
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Felix Mueller
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Maximilian Kriegmair
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Jan Leipe
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Peter Weinert
- Leibniz-Rechenzentrum der Bayerischen Akademie der Wissenschaften, Garching, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Matthias Witt
- Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, University of Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany.
| |
Collapse
|