Ultrasonographic analysis in knee osteoarthritis: evaluation of inter-observer reliability.

OBJECTIVES: Evidence for the validity of US in detecting structural joint pathology in OA is increasing. However, despite the rapidly emerging field of US in OA, few studies have reported on the inter-observer reliability of US to date. The objective of this study was to assess inter-observer reliability of ultrasonography (US) in the evaluation of specifically defined features in osteoarthritis (OA) of the knee. METHODS: US was performed independently by two rheumatologists in 60 outpatients fulfilling the American College of Rheumatology clinical criteria for knee OA. The acquisition protocol comprised medial meniscus protrusion, synovial hypertrophy, effusion, infrapatellar bursitis and cartilage thickness. Cartilage thickness and meniscal protrusion (if >3 mm) were measured on a continuous scale, all other variables were scored dichotomously. RESULTS: Inter-observer agreement (κ-value) was moderate for protrusion of the medial meniscus (0.54), good for infrapatellar bursitis (0.66) and effusion (0.74), excellent for Bakers' cyst (0.85) and poor for the detection of synovial hypertrophy (-0.08). Inter-observer reliability was good for the measurement of medial meniscus protrusion (correlation coefficient 0.80, 95% limits of agreement -1.93 to 1.94 mm) and cartilage thickness (correlation coefficient 0.62 and 0.68, 95% limits of agreement -0.87 to 0.84 mm and -0.77 to 0.96 mm at the medial and lateral condyle respectively). CONCLUSIONS: This study demonstrated good reproducibility of US in the assessment of the majority of the investigated mechanical, inflammatory and degenerative features of knee OA, and contributes to exploring the use of US in knee OA as a useful tool in research as well as in clinical practice.

[Various manifestations of calcium pyrophosphate-associated arthritis]. / De diverse uitingen van calciumpyrofosfaat-artritis.

In calcium pyrophosphate (CPP)-associated arthritis, deposits of calcium pyrophosphate lead to acute attacks of painful joint inflammation. The disease may present with signs of systemic inflammation such as fever, mimicking an infectious disease. Early recognition and treatment of this disease can prevent overdiagnosis and joint damage. In this article we describe three different patient cases of CPP-associated arthritis. The diversity of clinical presentation in CPP-associated arthritis can be of interest to different medical specialties who will occasionally encounter them in daily practice.

[A man with rheumatoid arthritis and a painful neck]. / Hevige nekpijn bij een man met reumatoïde artritis.

An 80-year-old man with long-standing rheumatoid arthritis presented with severe neck pain. No preceding trauma had occurred and he had no neurological complaints. A CT scan revealed vertical atlanto-axial subluxation without compression of the medulla oblongata. After conservative treatment the pain diminished. There were no neurological complications at follow-up.

Prognostic value of renal hemodynamic characteristics in patients with proliferative lupus nephritis.

BACKGROUND/AIM: Previous studies showed that renal hemodynamic parameters, especially the filtration fraction (FF), are decreased in patients with active lupus nephritis (LN). In this study, we evaluate the prognostic value of renal hemodynamic function tests on the renal outcome in patients with proliferative LN. METHODS: We performed a retrospective cohort study of our patients with proliferative LN from 1986 to 2005. Glomerular filtration rate (GFR) and FF before treatment were measured. Treatment failure was defined as a renal relapse or development of end-stage renal disease. RESULTS: Thirty-seven patients were included. The median follow-up period was 8 years. Creatinine clearance, GFR, and FF before treatment correlated with the creatinine clearance at the end of follow-up (p = 0.001, p = 0.006, and p = 0.04, respectively). The FF was decreased in 92% of our patients, but FF and GFR did not have a prognostic value with regard to treatment failure. CONCLUSIONS: Most patients with proliferative LN had a low FF. Low GFR and FF at baseline were correlated with a worse renal function at the end of follow-up, but this had no prognostic value in individual patients.

[Unexplained pain in the ankle and foot. Consider transient osteoporosis]. / Onbegrepen pijn van de enkel en voet. Denk aan voorbijgaande osteoporose.

Transient osteoporosis is an increasingly recognized condition that causes severe pain in weight-bearing joints and is characterized by otherwise unexplained bone-marrow oedema on MRI. We present two patients, a 40-year-old man and a 60-year-old woman, with longstanding severe pain in the foot and ankle. Both had invalidating pain with only mild swelling of the foot or ankle. Laboratory investigation was unremarkable, and conventional X-ray showed osteopenia of the bones involved. In both cases, consecutive MRIs showed migrating bone marrow oedema. The patients were treated with analgesics, immobilization of the body parts concerned and an intravenous bisphosphonate.

[A man with swollen fingers]. / Een man met zwellingen van de vingers.

A 28-year-old man was referred to our hospital because of localised swelling of his fingers, with suspicion of arthritis of the proximal interphalangeal (PIP) joints. At physical examination we observed a swelling, superficial to the PIP joints. Ultrasonography revealed a hypo-echoic structure above the extensor tendon, typical for knuckle pads.

Lack of association of C-C chemokine receptor 5 Δ32 deletion status with rheumatoid arthritis, systemic lupus erythematosus, lupus nephritis, and disease severity.

OBJECTIVE: C-C chemokine receptor 5 (CCR5) plays an important role in inflammation. A 32 base-pair (Δ32) deletion in the CCR5 gene leads to a nonfunctional receptor. This deletion has been reported to have a protective effect on the development and progression of several autoimmune diseases. We investigated whether the Δ32 deletion is associated with disease susceptibility in a population of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and lupus nephritis (LN); and whether it is associated with disease severity. METHODS: DNA samples from 405 RA patients, 97 SLE patients, 113 LN patients, and 431 healthy controls were genotyped for the CCR5 Δ32 deletion. Differences in genotype frequencies were tested between patients and controls. Association of genotypes with disease severity was analyzed. RESULTS: Genotype frequencies of each group were in Hardy-Weinberg equilibrium. The genotype frequencies of patients did not differ significantly from controls (CCR5/Δ32, Δ32/Δ32: RA 18.3% and 1.2%, respectively; SLE 17.5% and 2.1%; LN 13.3% and 1.8%; controls 20.0% and 2.8%). However, there was a trend for lower Δ32 deletion allele frequency in LN patients compared to controls (p = 0.08). There was no significant association between the CCR5 status and disease severity in RA, SLE, or LN. CONCLUSION: Although an association with LN cannot be excluded, the CCR5 Δ32 deletion does not seem to be a disease susceptibility genotype for RA, SLE, or LN. No significant effect of the Δ32 deletion on disease severity was demonstrated.

[Serious sequelae of hypothermia in cryoglobulinaemia]. / Ernstige gevolgen van afkoeling bij cryoglobulinemie.

Cryoglobulinaemia was diagnosed in three patients. The first was a 61-year-old man with severe skin involvement and polyneuropathy caused by type I cryoglobulinaemia associated with a small B cell clone in the bone marrow. A 73-year-old woman presented with neuropathy and renal and skin involvement due to type II cryoglobulinaemia associated with hepatitis C virus infection. The third patient was a 23-year-old woman with skin and renal involvement caused by type III cryoglobulinaemia. Cryoglobulins are circulating proteins that precipitate below a temperature of 37 degrees Celsius. This precipitation causes several signs and symptoms and, in some cases, severe organ damage. According to the Brouet classification, there are three different types of cryoglobulinaemia. Treatment focuses on their underlying causes and on the prevention of cryoglobulin precipitation. It is important to avoid hypothermia, which was the cause of severe manifestations in two of our patients.

A newly identified deletion of 970 bp at the alpha-globin locus that removes the promoter region of the alpha1 gene.

The most common causes of alpha-thalassemia (thal) are deletions that remove a part, or one or both of the functional alpha-globin genes. These deletions cause diminished expression of the alpha-globin protein, which may result in relatively low hemoglobin (Hb) and/or mean corpuscular volume (MCV) values. We here report the identification of a 970 bp deletion in the alpha1-globin gene that encompasses the entire promoter region of the alpha1-globin gene and 26 bp encoding the 5' end of the mRNA. Thus, the affected alpha1-globin gene is prone to be nonfunctional. We therefore nominated the newly identified deletion allele alpha-alphaDelta970. The MCV values of four related carriers of the alpha-alphaDelta970 allele were slightly lowered, consistent with the presence of three functional alpha-globin genes.