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Di Matteo A, Cipolletta E, Destro Castaniti GM, Smerilli G, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Bruns A, Carrara G, Cazenave T, Ciapetti A, Cosatti MA, de Agustín JJ, Di Carlo M, Di Donato E, Di Geso L, Duran E, Elliott A, Estrach C, Farisogulları B, Fiorenza A, Fodor D, Gabba A, Hernández-Díaz C, Huang F, Hurnakova J, Li L, Jesus D, Karadag O, Martire MV, Massarotti M, Michelena X, Musca AA, Nair J, Okano T, Papalopoulos I, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Satulu I, Scioscia C, Scirè CA, Sun F, Tamas MM, Tanimura S, Ventura-Rios L, Voulgari PV, Vreju FA, Vukatana G, Wong E, Yang J, Zacariaz Hereter J, Zanetti A, Grassi W, Filippucci E. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study. Rheumatology (Oxford) 2022; 61:4863-4874. [PMID: 35293988 DOI: 10.1093/rheumatology/keac162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. METHODS In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. RESULTS Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. CONCLUSIONS The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.
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Affiliation(s)
- Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Palermo, Italy
| | - Gianluca Smerilli
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Carla Airoldi
- Rheumatology, Hospital Provincial, Rosario, Argentina
| | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Alessandro Ciapetti
- Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Micaela Ana Cosatti
- CEMIC, Centro de investigaciones médicas Norberto Quirno, Buenos Aires, Argentina
| | - Juan José de Agustín
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Di Carlo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen's University, Belfast
| | - Cristina Estrach
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Bayram Farisogulları
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alessia Fiorenza
- SSD Reumatologia, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Gabba
- Rheumatology Clinic, ATS Sardegna, Medicina Specialistica Ambulatoriale, Oristano, Nuoro
| | - Cristina Hernández-Díaz
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Feng Huang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Ling Li
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, UK
| | - Xabier Michelena
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alice Andreea Musca
- Internal Medicine and Rheumatology Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Jagdish Nair
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Faculdade de Medicina, Coimbra University, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Iulia Satulu
- Rheumatology Department, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Crescenzio Scioscia
- Department of Emergency and Organ Transplants (DETO), Rheumatology Unit, Bari
| | | | - Fei Sun
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Maria-Magdalena Tamas
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Rheumatology Department, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Paraksevi V Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Ernest Wong
- Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Jinshui Yang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
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Atchia I, Brown AK, Chitale S, Ciechomska A, Estrach C, Karim Z, Wakefield RJ. Recommendations for rheumatology ultrasound training and practice in the UK. Rheumatology (Oxford) 2021; 60:2647-2652. [PMID: 33167033 DOI: 10.1093/rheumatology/keaa656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice. METHOD A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work. RESULTS Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG. CONCLUSION These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes.
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Affiliation(s)
- Ismaël Atchia
- Rheumatology Department, Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | | | - Sarang Chitale
- Rheumatology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Cristina Estrach
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Zunaid Karim
- Rheumatology, Mid Yorkshire NHS Trust, Yorkshire, UK
| | - Richard J Wakefield
- Department of Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
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Lee CN, Dey M, Hng M, Peterson S, Rahiman I, Elshafei M, Estrach C, Goodson NJ. P009 Service evaluation to optimise ophthalmological services for hydroxychloroquine retinal screening. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Hydroxychloroquine (HCQ), a frequently-used therapy in rheumatology, can be associated with retinal toxicity. More stringent screening and monitoring guidelines for HCQ-related retinopathy were published by the Royal College of Ophthalmologists (RCOphth) in 2018. Recommendations include: 1) baseline retinal screening within six-twelve months of commencing HCQ; 2) subsequent annual monitoring for at-risk patients, specifically: concurrent tamoxifen-use, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, HCQ dose >5mg/kg/day; 3) annual monitoring for all other patients after five years continuous treatment; 4) patient education on HCQ retinopathy. We quantified the rheumatology HCQ exposure and estimated burden on ophthalmology, to inform the development of HCQ retinal screening services.
Methods
Cross-sectional data were extracted for patients established on HCQ between 1995-2020 including: weight; eGFR; concomitant retino-toxic medication; concomitant retinal pathology; HCQ dose and duration; documentation of patient education on retinal side-effects. Documentation of relevant ophthalmic testing at baseline (i.e. at time of starting HCQ) were recorded, specifically colour fundus photography, spectral domain optical coherence tomography (SD-OCT) and 10-2 Humphrey visual field (HVF) testing as necessary. Subsequent monitoring with 10-2 HVFs, SD-OCT, autofluorescence (AF) and electrodiagnostic tests (EDTs) as appropriate annually from baseline and from 5 years was recorded.
Results
150 patients were included, 84% female, with a mean baseline age of 50.7 years (SD 14.8) and mean weight of 76.4kg (SD 17.6). 63% were on HCQ >5 years (mean duration 7.0 years, SD 5.1). At time of auditing, 50% (75/150) patients had permanently ceased HCQ (62% due to treatment >5 years). 60% patients had documented evidence of education regarding HCQ retinopathy. Of the 150 patients, 39% had baseline risks for retinopathy. 6% had a baseline eGFR <60ml/min/1.73m2. 32% were commenced on HCQ dose greater than 5mg/kg/day. No patients were on concomitant tamoxifen; one patient was on a known retino-toxic drug (quinine). 4% of patients had pre-existing retinal pathology. Of the 75 patients still taking HCQ at time of auditing, 27 (36%) had baseline risk factors warranting yearly retinal screening and 44 (58%) had been on treatment >5years. Most ophthalmology reviews were put on hold until a screening service was established. Of the small number (5.3%) that had baseline ophthalmic screening, 12.5% had colour photography and 75% had SD-OCT. No patients required HVF testing or EDTs. Annual screening revealed 50% of patients had 10-2 HVFs; 75% had SD-OCT; 75% had AF. Only one patient developed maculopathy, not attributed to HCQ.
Conclusion
Our results demonstrate the need for service development to facilitate adherence to RCOphth guidance. Up to 40% of patients started on HCQ have baseline risks for retinopathy, most due to dosing >5mg/kg/day warranting yearly screening. Our findings will inform development of a rheumatology HCQ retinal screening pathway and services, to ensure safe long-term use of HCQ.
Disclosure
C. Lee*: None. M. Dey*: None. M. Hng: None. S. Peterson: None. I. Rahiman: None. M. Elshafei: None. C. Estrach: None. N.J. Goodson: None.
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Affiliation(s)
- Chan Ning Lee
- Department of Ophthalmology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Mrinalini Dey
- University of Liverpool, Institute of Life Course & Medical Sciences, Liverpool, UNITED KINGDOM
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Mooikhin Hng
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
- Department of Rheumatology, Penang Hospital, 10990 George Town, Penang, MALAYSIA
| | - Simon Peterson
- Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Imna Rahiman
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Mohamed Elshafei
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Cristina Estrach
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Nicola J Goodson
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
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Soares I, Cotton C, Brinkley L, Estrach C. P141 Young Ambassadors Project: engaging patients attending a specialised young adult clinic. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Emerging literature has highlighted that transition to adult services is a challenging time where many young patients are lost to follow up and disengage with health services. Furthermore, developmentally appropriate healthcare improves adherence and empowers young people. This recognises the changing biopsychosocial development needs of young people and advocates for a ‘young-person-friendly’ service. Aintree Hospital runs a young adult clinic based on the EULAR guidelines. Attending patients suggested that their positive experience could support and improve engagement of peers ready for transition. At the same time, they raised that the existing shared clinical area did not feel tailored to them given the lack of age-appropriate literature and lack of representation in the existing displays. This feedback led the team to a review of the service with the ultimate aim to improve patient engagement and satisfaction.
Methods
Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary healthcare team alongside a group of willing young adult patients (Young Ambassadors) identified a strategy to improve the young adult clinical area and facilitate transition peer support. Pilot funding was obtained from the Trust, with the aim to expand the methods to other specialities if successful.
Results
The team worked with the Young Ambassadors and a professional media company to produce ‘pop-ups’ featuring photographs of our young adult patients with positive inspirational messages. These were purposefully produced as mobile units rather than static posters to increase flexibility of use. We also improved the availability of age-appropriate literature in the waiting room (e.g. literature from Arthur’s Place, a magazine and social network for young adults with arthritis). Additionally, we developed a set of videos featuring three of our Young Ambassadors talking about their transition experience and how this affected their day-to-day lives. The videos will be available to patients ready to enter transition while still in children’s services. We envisage that this initiative will provide a patient perspective of living with chronic conditions, empower young people to take control of their health needs and therefore increase adherence, independence and promote positive career and life goals. Lastly, through the project and focus group sessions, our patients have already started a support network for young patients with rheumatic diseases.
Conclusion
Our young patients are keen to be involved in service development and wish to raise awareness of their life with chronic rheumatic diseases. We will measure the impact of our interventions through patient satisfaction questionnaires, group feedback sessions and by auditing patient attendance rates pre- and post-project. By working with our Young Ambassadors, we have successfully developed patient-led initiatives, tailored to young adult patients with the aim of improving future engagement and empowerment.
Disclosures
I. Soares None. C. Cotton None. L. Brinkley None. C. Estrach None.
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Affiliation(s)
- Ines Soares
- Rheumatology, Liverpool University Hospital Foundation Trust, LIVERPOOL, UNITED KINGDOM
| | - Caroline Cotton
- Rheumatology, Liverpool University Hospital Foundation Trust, LIVERPOOL, UNITED KINGDOM
| | - Lorraine Brinkley
- Rheumatology, Liverpool University Hospital Foundation Trust, LIVERPOOL, UNITED KINGDOM
| | - Cristina Estrach
- Rheumatology, Liverpool University Hospital Foundation Trust, LIVERPOOL, UNITED KINGDOM
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Simpson E, Hock E, Stevenson M, Wong R, Dracup N, Wailoo A, Conaghan P, Estrach C, Edwards C, Wakefield R. What is the added value of ultrasound joint examination for monitoring synovitis in rheumatoid arthritis and can it be used to guide treatment decisions? A systematic review and cost-effectiveness analysis. Health Technol Assess 2018; 22:1-258. [PMID: 29712616 PMCID: PMC5949573 DOI: 10.3310/hta22200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Synovitis (inflamed joint synovial lining) in rheumatoid arthritis (RA) can be assessed by clinical examination (CE) or ultrasound (US). OBJECTIVE To investigate the added value of US, compared with CE alone, in RA synovitis in terms of clinical effectiveness and cost-effectiveness. DATA SOURCES Electronic databases including MEDLINE, EMBASE and the Cochrane databases were searched from inception to October 2015. REVIEW METHODS A systematic review sought RA studies that compared additional US with CE. Heterogeneity of the studies with regard to interventions, comparators and outcomes precluded meta-analyses. Systematic searches for studies of cost-effectiveness and US and treatment-tapering studies (not necessarily including US) were undertaken. MATHEMATICAL MODEL A model was constructed that estimated, for patients in whom drug tapering was considered, the reduction in costs of disease-modifying anti-rheumatic drugs (DMARDs) and serious infections at which the addition of US had a cost per quality-adjusted life-year (QALY) gained of £20,000 and £30,000. Furthermore, the reduction in the costs of DMARDs at which US becomes cost neutral was also estimated. For patients in whom dose escalation was being considered, the reduction in number of patients escalating treatment and in serious infections at which the addition of US had a cost per QALY gained of £20,000 and £30,000 was estimated. The reduction in number of patients escalating treatment for US to become cost neutral was also estimated. RESULTS Fifty-eight studies were included. Two randomised controlled trials compared adding US to a Disease Activity Score (DAS)-based treat-to-target strategy for early RA patients. The addition of power Doppler ultrasound (PDUS) to a Disease Activity Score 28 joints-based treat-to-target strategy in the Targeting Synovitis in Early Rheumatoid Arthritis (TaSER) trial resulted in no significant between-group difference for change in Disease Activity Score 44 joints (DAS44). This study found that significantly more patients in the PDUS group attained DAS44 remission (p = 0.03). The Aiming for Remission in Rheumatoid Arthritis (ARCTIC) trial found that the addition of PDUS and grey-scale ultrasound (GSUS) to a DAS-based strategy did not produce a significant between-group difference in the primary end point: composite DAS of < 1.6, no swollen joints and no progression in van der Heijde-modified total Sharp score (vdHSS). The ARCTIC trial did find that the erosion score of the vdHS had a significant advantage for the US group (p = 0.04). In the TaSER trial there was no significant group difference for erosion. Other studies suggested that PDUS was significantly associated with radiographic progression and that US had added value for wrist and hand joints rather than foot and ankle joints. Heterogeneity between trials made conclusions uncertain. No studies were identified that reported the cost-effectiveness of US in monitoring synovitis. The model estimated that an average reduction of 2.5% in the costs of biological DMARDs would be sufficient to offset the costs of 3-monthly US. The money could not be recouped if oral methotrexate was the only drug used. LIMITATIONS Heterogeneity of the trials precluded meta-analysis. Therefore, no summary estimates of effect were available. Additional costs and health-related quality of life decrements, relating to a flare following tapering or disease progression, have not been included. The feasibility of increased US monitoring has not been assessed. CONCLUSION Limited evidence suggests that US monitoring of synovitis could provide a cost-effective approach to selecting RA patients for treatment tapering or escalation avoidance. Considerable uncertainty exists for all conclusions. Future research priorities include evaluating US monitoring of RA synovitis in longitudinal clinical studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42015017216. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Emma Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Naila Dracup
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Allan Wailoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Philip Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Cristina Estrach
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher Edwards
- National Institute for Health Research (NIHR) Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Richard Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
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Davies P, Kennedy J, Nair J, Thompson RN, Estrach C. O34 Cost-effectiveness of a clinical nurse specialist performing targeted musculoskeletal ultrasound in the rheumatology clinic. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul Davies
- Rheumatology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Joanne Kennedy
- Rheumatology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Jagdish Nair
- Rheumatology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Robert N Thompson
- Rheumatology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Cristina Estrach
- Rheumatology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UNITED KINGDOM
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Sparks CR, Ling SF, Sharpley D, Chitale S, Estrach C, Goodson NJ. 38. Does Treating Early Rheumatoid Arthritis Within the Window of Opportunity Improve Outcomes at 1 Year? Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu097.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chitale S, Estrach C, Boswell W, Thompson R, Moots RJ, Goodson N. FRI0100 Treat to target: defining the optimum target to prevent radiographic erosion progression during the first year of treatment in an early rheumatoid arthritis cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ling SF, Chitale S, Estrach C, Moots RJ, Goodson N. SAT0049 Obesity is Associated with Reduced Improvement in Functional Disability After 1 Year of Treatment: Results from an Inception Early Rheumatoid Arthritis Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wakefield RJ, D'Agostino MA, Naredo E, Buch MH, Iagnocco A, Terslev L, Ostergaard M, Backhaus M, Grassi W, Dougados M, Burmester GR, Saleem B, de Miguel E, Estrach C, Ikeda K, Gutierrez M, Thompson R, Balint P, Emery P. After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?: Table 1. Postgrad Med J 2012; 88:482-6. [DOI: 10.1136/postgradmedj-2011-201048rep] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wakefield RJ, D'Agostino MA, Naredo E, Buch MH, Iagnocco A, Terslev L, Ostergaard M, Backhaus M, Grassi W, Dougados M, Burmester GR, Saleem B, de Miguel E, Estrach C, Ikeda K, Gutierrez M, Thompson R, Balint P, Emery P. After treat-to-target: can a targeted ultrasound initiative improve RA outcomes? Ann Rheum Dis 2012; 71:799-803. [PMID: 22562979 DOI: 10.1136/annrheumdis-2011-201048] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network--the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.
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Affiliation(s)
- Richard J Wakefield
- Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine LIMM, University of Leeds, Leeds, UK
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Verstappen S, Lunt M, Bunn D, Scott DG, Symmons D, Kinloch AJ, Brintnell W, Alzabin S, Wilson E, Barran L, Wegner N, Bell DA, Cairns E, Venables PJ, Mercer LK, Davies R, Lunt M, Galloway J, Watson KD, Dixon W, MacGregor A, Guile G, Skinner J, Fairweather-Tait S, Cassidy A, Richards B, Spector T, Wang W, Ling S, Chitale S, Sharpley D, Moots R, Estrach C, Goodson NJ, Mattey DL, Dawson SR, Healey EL, Packham JC. Concurrent oral 3 - Environmental and genetic factors: OP16. In Patients with Early Inflammatory Polyarthritis, Younger Age, Acpa Positivity, Shared Epitope, And Inefficacy of the First Dmard are Associated with the Need to Start a Biological Therapy: Results from the Norfolk Arthritis Register (NOAR). Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chitale S, Ciapetti A, Hodgson R, Grainger A, O'Connor P, Goodson NJ, Thompson RN, Estrach C, Moots RJ, Grassi W, Anderson ME. Magnetic resonance imaging and musculoskeletal ultrasonography detect and characterize covert inflammatory arthropathy in systemic sclerosis patients with arthralgia. Rheumatology (Oxford) 2010; 49:2357-61. [DOI: 10.1093/rheumatology/keq268] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Emery P, Buch MH, Ostör A, Kirkham B, Taylor P, Estrach C, Jenkinson T, McInnes I, Porter D. Symmetrical polyarthritis. Time for treatment targets in rheumatoid arthritis. BMJ 2010; 341:c4170. [PMID: 20685790 DOI: 10.1136/bmj.c4170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Westlake SL, Colebatch AN, Baird J, Kiely P, Quinn M, Choy E, Ostor AJ, Edwards CJ, Jankowska B, Uchmanowicz I, Polanski J, Dudek K, Suresh R, Horwood N, Sandoo A, van Zanten JV, Smith JP, Carroll D, Toms TE, Kitas GD, Chitale S, Estrach C, Thompson R, Sathyamurthy S, Goodson N, Toms TE, Panoulas VF, Douglas KM, Kitas GD, Abozaid HS, Fathi NA, Scott DL, Steer S, Galloway J, Dixon W, Mercer L, Watson K, Mark L, Hyrich K, Symmons D, Hirsch G, Klocke R, Toberty E, Coulson E, Saravanan V, Heycock C, Rynne M, Hamilton J, Kelly C, Tsang R, Coulson E, Saravanan V, Heycock C, Hamilton J, Kelly C, El Miedany Y, Palmer D, Collins D, Arnold T, Juarez M, Waller R, Williamson L, Price E, Suppiah R, Doyle A, Rai R, Dalbeth N, Lobo M, Braun J, McQueen F, Cader Z, Filer A, Buckley CD, Raza K, Mirjafari H, Farragher T, Verstappen SM, Bunn D, Charlton-Menys V, Marshall T, Symmons DP, Bruce IN, Steven R, Crilly A, Lockhart JC, Ferrell WR, McInnes IB, Ahmed U, Rabbani N, Filer A, Watts R, Raza K, Thornalley P, Nikiphorou E, Young A, Kiely P, Walsh D, Williams R, Iskandar M, Farragher T, Bunn D, Symmons D, El Miedany Y, El Gaafary M, Palmer D, Filer A, de Pablo P, Allen G, Nightingale P, Jordan A, Jobanputra P, Buckley C, Raza K, Gordon R, Snowden N, Gwynne C, Amos N, Camilleri J, El Miedany Y, El Gaafary M, Youssef S, Palmer D, Silburn S, Pullar T, Vinod K, Fardon T, Scott IC, Kingsley G, Scott DL, Koduri G, Norton S, Young A, Cox N, Prouse P, Dixey J, Williams P, Jones N, Suppiah R, Newton J, Litwic AE, Ledingham JM, Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Koutedakis Y, Kitas GD, Ramachandran Nair J, Mewar D, Long KS, Coulson E, Saravanan V, Heycock C, Hamilton J, Kelly C, El Miedany Y, Youssef S, Palmer D. Rheumatoid Arthritis: Clinical Aspects [322-355]: 322. The Effect of Biologics on Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Systematic Literature Review. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Luqmani R, Hennell S, Estrach C, Basher D, Birrell F, Bosworth A, Burke F, Callaghan C, Candal-Couto J, Fokke C, Goodson N, Homer D, Jackman J, Jeffreson P, Oliver S, Reed M, Sanz L, Stableford Z, Taylor P, Todd N, Warburton L, Washbrook C, Wilkinson M. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology (Oxford) 2009; 48:436-9. [PMID: 19174570 DOI: 10.1093/rheumatology/ken450a] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raashid Luqmani
- Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.
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Belloso A, Estrach C, Keith AO. Supraglottic stenosis in localized Wegener granulomatosis. Ear Nose Throat J 2008; 87:E11-E14. [PMID: 18633919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We present what we believe is the first reported case of a patient with supraglottic stenosis secondary to Wegener granulomatosis. The diagnosis was unclear initially because the biopsy results were nonspecific, but a finding of an elevated cytoplasmic-pattern antineutrophil cytoplasmic antibody (c-ANCA) level established the diagnosis of localized supraglottic Wegener granulomatosis. Wegener granulomatosis is characterized by necrotizing vasculitis that is localized predominantly to the kidneys and the upper and lower airways. In the airways, subglottic involvement is well documented, but to the best of our knowledge, supraglottic stenosis has not previously been described. Localized forms of Wegener granulomatosis are characterized by limited disease that involves only the upper airway. The diagnosis in localized forms is complex because histology is diagnostic in only 50% of cases, and only 60% of patients have a positive c-ANCA level. We discuss the diagnostic criteria and management strategies for these localized forms.
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Affiliation(s)
- Antonio Belloso
- Department of Otolaryngology, Blackpool Victoria Hospital, Blackpool, UK.
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Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G, Fokke C, Goodson N, Jeffreson P, Lamb E, Mohammed R, Oliver S, Stableford Z, Walsh D, Washbrook C, Webb F. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Rheumatoid Arthritis (the first two years). Rheumatology (Oxford) 2006; 45:1167-9. [PMID: 16844700 DOI: 10.1093/rheumatology/kel215a] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Luqmani
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
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Estrach C, Abernethy VE, Dawson JK. Infections and anti-TNF therapy: strategies for screening based on clinical experience. Rheumatology (Oxford) 2004; 43:115-6; author reply 116. [PMID: 14681572 DOI: 10.1093/rheumatology/keg484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Estrach C, Mpofu S, Thompson RN, Williams E, Abernethy VE, Moots RJ. Swollen joint count as a predictor of response to anti-tumor necrosis factor ? therapy in rheumatoid arthritis: Comment on the article by Sokka and Pincus. ACTA ACUST UNITED AC 2003; 48:3611-3; author reply 3613-5. [PMID: 14674016 DOI: 10.1002/art.11335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mpofu S, Estrach C, Curtis J, Moots RJ. Treatment of respiratory complications in recalcitrant relapsing polychondritis with infliximab. Rheumatology (Oxford) 2003; 42:1117-8. [PMID: 12923271 DOI: 10.1093/rheumatology/keg280] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Estrach C, Mpofu S, Moots RJ. Behçet's syndrome: response to infliximab after failure of etanercept. Rheumatology (Oxford) 2002; 41:1213-4. [PMID: 12364656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Abstract
Necrotizing granulomatous nodules are a common feature in patients with rheumatoid disease, affecting 20 per cent of seropositive patients. Although most commonly found subcutaneously at points of pressure, these nodules may occur in the connective tissues elsewhere in the body. In the upper aerodigestive tract, nodules have been described in diverse locations, but commonly in the trachea, larynx and the ear. We present the first reported case of a rheumatoid nodule affecting the nasal septum.
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Affiliation(s)
- A Belloso
- Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK.
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Pal B, Laing H, Estrach C. A cyberclinic in rheumatology. J R Coll Physicians Lond 1999; 33:161-2. [PMID: 10340266 PMCID: PMC9665673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To evaluate the feasibility of a rheumatology consultation and advisory service using internet and e-mail. METHODS We placed a detailed rheumatology proforma on our website for general practitioners to complete and e-mail to our outpatients clinic. To study its feasibility, two junior doctors interviewed and completed the proforma for 207 new patients. Based on this information, the consultant provided provisional diagnoses, work up & management plans, which were then compared with those drawn up following face-to-face assessment of the same patients in the outpatients clinic. RESULTS In most instances the pre- and post-examination diagnoses, work up & management plans were similar. Diagnostic concurrence was noted in 178 (86%) patients; no changes were required in x-rays and other tests requested in 129 (62%) patients; and the suggested treatment (including corticosteroid injections) remained the same in 153 (74%) patients. CONCLUSION Our results suggest that it is feasible to offer an e-mail or internet based outpatients consultation and advisory service in rheumatology and possibly other disciplines.
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Affiliation(s)
- B Pal
- South Manchester University Hospitals NHS Trust, Withington Hospital.
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