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1.
J Med Ultrasound ; 32(1): 25-31, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38665346

RESUMO

Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed their diagnostic utility for osteomyelitis (OM) and arthritis. We included articles that studied ultrasonographic findings of periosteal changes in OM and arthropathies with aims to systematically review periosteal manifestations of each condition and summarize diagnostic values of each finding. A total of 13 articles were included in the systematic review. Of these, 10 articles are on OM, 3 articles are on psoriatic arthritis (PsA), 1 article is on rheumatoid arthritis (RA), and 1 article is on gouty arthritis (GA). In OM, subperiosteal fluid/subperiosteal collection (SF/SC) was detected in 32%-76% within 72 h after presentation. Periosteal reaction (PR) was seen after day 4 and the sensitivity on US ranges from 33% to 100%. In PsA, PR was seen near 16%-59% in active PsA joints. Periosteal changes are rarely detected in RA joints. Small hyperechoic spots were seen in 87.5% of GA. SF/SC may be seen on US as the earliest sign followed by PR for OM. PR is more specific in PsA than RA. Further investigations on periosteal abnormalities on US are warranted to confirm our findings.

2.
Clin Exp Rheumatol ; 41(1): 24-31, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35238759

RESUMO

OBJECTIVES: Ultrasound evaluation of the Achilles tendon has been utilised to assess involvement at the entheses in the setting of various inflammatory, metabolic, and mechanical processes. The purpose of this systematic review was to evaluate the differences in ultrasound findings at the Achilles enthesis between inflammatory tendinopathy (IT) versus non-inflammatory tendinopathy (NIT). METHODS: A review of all studies involving ultrasound evaluation of IT or NIT (mechanical or metabolic) affecting the Achilles enthesis was performed by searching the Embase, PubMed and Medline databases from start until October 2020. We assessed study quality and extracted summary data from each individual study. We used random-effects meta-analysis to determine the average proportion of affected anatomic sites across all studies for each abnormality, weighting the analysis based on the size of each individual study. RESULTS: Achilles enthesis thickening was more frequent in the symptomatic IT (sIT) group (37.8%) compared to the unspecified IT (25%), NIT (11.2%) and healthy control (2.7%) groups. Increased vascularity at the enthesis was more common in the NIT (23.4%) group compared to the IT (9%), sIT (8.6%) and healthy control (0.1%) groups. Erosions were more common among the IT (17.3%) and sIT (14%) groups compared to the NIT (2.2%) and healthy controls (0.3%) groups. CONCLUSIONS: While Achilles enthesis thickening, Doppler signal and calcaneal erosions discriminate IT from healthy subjects, erosions are more likely to distinguish IT from NIT than thickening or Doppler signal. Additional study is needed to quantify the diagnostic performance of ultrasound at this location given the frequency of abnormalities in NIT.


Assuntos
Tendão do Calcâneo , Tendinopatia , Humanos , Tendão do Calcâneo/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler
3.
J Infect Dis ; 223(4): 581-588, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33216906

RESUMO

BACKGROUND: The effectiveness of interleukin-6 inhibitors (IL-6i) in ameliorating coronavirus disease 2019 (COVID-19) remains uncertain. METHODS: We analyzed data for patients aged ≥18 years admitted with a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test at 4 safety-net hospital systems with diverse populations and high rates of medical comorbidities in 3 US regions. We used inverse probability of treatment weighting via machine learning for confounding adjustment by demographics, comorbidities, and disease severity markers. We estimated the average treatment effect, the odds of IL-6i effect on in-hospital mortality from COVID-19, using a logistic marginal structural model. RESULTS: Of 516 patients, 104 (20.1%) received IL-6i. Estimate of the average treatment effect adjusted for confounders suggested a 37% reduction in odds of in-hospital mortality in those who received IL-6i compared with those who did not, although the confidence interval included the null value of 1 (odds ratio = 0.63; 95% confidence interval, .29-1.38). A sensitivity analysis suggested that potential unmeasured confounding would require a minimum odds ratio of 2.55 to nullify our estimated IL-6i effect size. CONCLUSIONS: Despite low precision, our findings suggested a relatively large effect size of IL-6i in reducing the odds of COVID-19-related in-hospital mortality.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Tratamento Farmacológico da COVID-19 , Mortalidade Hospitalar , Interleucina-6/antagonistas & inibidores , Adulto , Idoso , COVID-19/mortalidade , Comorbidade , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Ann Rheum Dis ; 79(7): 908-913, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32213497

RESUMO

OBJECTIVE: To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility. METHODS: Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC. RESULTS: We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L. CONCLUSIONS: A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.


Assuntos
Doenças Reumáticas/diagnóstico , Líquido Sinovial/química , Tenossinovite/diagnóstico por imagem , Tenossinovite/metabolismo , Ultrassonografia Doppler/estatística & dados numéricos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Doenças Reumáticas/etiologia , Sensibilidade e Especificidade , Tenossinovite/complicações
5.
Curr Rheumatol Rep ; 22(8): 36, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32562049

RESUMO

PURPOSE OF REVIEW: For 30 years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren's syndrome, the scoring systems used for this purpose, and the ultrasound similarities and differences between Sjögren's syndrome and some of its potential salivary gland mimics. RECENT FINDINGS: Hypo/anechoic glandular lesions are the major ultrasound characteristic found in Sjögren's syndrome. Most studies have reported such ultrasound abnormalities to have a sensitivity and specificity in the range of 65-85% and 85-95%, respectively, as well as a positive likelihood ratio between 4 and 12. However, similar findings can also be seen in sarcoidosis, amyloidosis, IgG4-related disease, HIV, and lymphoma. A "nodal" pattern of involvement or the ultrasound artifact of "through transmission" can help distinguish some of these mimics from Sjogren's syndrome. Ultrasound can substantially influence the diagnosis of Sjögren's syndrome.


Assuntos
Glândulas Salivares , Síndrome de Sjogren , Diagnóstico Diferencial , Humanos , Glândulas Salivares/diagnóstico por imagem , Glândulas Salivares/patologia , Sensibilidade e Especificidade , Síndrome de Sjogren/diagnóstico por imagem , Ultrassonografia
6.
J Med Ultrasound ; 28(3): 179-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33282663

RESUMO

The "snowstorm" sign refers to the ultrasound appearance of motile hyperechoic specks within synovial fluid and has been reported to have a high specificity for gout. We describe three additional etiologies commonly encountered in the rheumatology clinic that can produce a snowstorm: calcium pyrophosphate deposition disease, fibrin collections/rice bodies, and gas bubbles in viscous synovial fluid.

7.
J Med Ultrasound ; 26(2): 77-80, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30065523

RESUMO

BACKGROUND: We evaluated the risk of lateral circumflex femoral artery (LCFA) injury during ultrasound-guided intra-articular hip injections. METHODS: This study was divided into three parts. (1) Four ultrasound-guided hip injections were performed on human cadavers. With needles in place, tissues were dissected to expose the LCFA. (2) Ultrasound-trained rheumatologists marked a planned needle trajectory from skin to hip joint on live human ultrasound images during an Observed Structured Clinical Examination (OSCE). Doppler was subsequently activated to locate the LCFA, and the distance between trajectory and arterial signal was recorded. (3) Rheumatologists certified in musculoskeletal ultrasound were surveyed about joint injection vascular complications. RESULTS: (1) In one of the four cadaveric dissections, the needle made direct contact with the LCFA. (2) Of 27 OSCE participants, only two activated Doppler before marking simulated hip injection trajectories. Trajectories passed through LCFA Doppler signal in six (22%) cases. Mean minimal distance from trajectory to arterial signal was 4 mm (range, 0-11 mm). (3) Of 62 survey respondents, 24% stated that they did not use Doppler routinely. While none reported bleeding injuries with their patients, 16% knew of a hip injection-related vascular complication performed by another provider. CONCLUSION: There is a risk of LCFA injury during ultrasound-guided hip joint injection. Routine use of Doppler should be considered in standard hip injection protocols.

8.
N Engl J Med ; 369(5): 417-27, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23902481

RESUMO

BACKGROUND: The 18-month efficacy of a single course of rituximab as compared with conventional immunosuppression with cyclophosphamide followed by azathioprine in patients with severe (organ-threatening) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is unknown. METHODS: In a multicenter, randomized, double-blind, double-dummy, noninferiority trial, we compared rituximab (375 mg per square meter of body-surface area administered once a week for 4 weeks) followed by placebo with cyclophosphamide administered for 3 to 6 months followed by azathioprine for 12 to 15 months. The primary outcome measure was complete remission of disease by 6 months, with the remission maintained through 18 months. RESULTS: A total of 197 patients were enrolled. As reported previously, 64% of the patients in the rituximab group, as compared with 53% of the patients in the cyclophosphamide-azathioprine group, had a complete remission by 6 months. At 12 and 18 months, 48% and 39%, respectively, of the patients in the rituximab group had maintained the complete remissions, as compared with 39% and 33%, respectively, in the comparison group. Rituximab met the prespecified criteria for noninferiority (P<0.001, with a noninferiority margin of 20%). There was no significant difference between the groups in any efficacy measure, including the duration of complete remission and the frequency or severity of relapses. Among the 101 patients who had relapsing disease at baseline, rituximab was superior to conventional immunosuppression at 6 months (P=0.01) and at 12 months (P=0.009) but not at 18 months (P=0.06), at which time most patients in the rituximab group had reconstituted B cells. There was no significant between-group difference in adverse events. CONCLUSIONS: In patients with severe ANCA-associated vasculitis, a single course of rituximab was as effective as continuous conventional immunosuppressive therapy for the induction and maintenance of remissions over the course of 18 months. (Funded by the National Institute of Allergy and Infectious Diseases and others; RAVE ClinicalTrials.gov number, NCT00104299.)


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Monoclonais Murinos/administração & dosagem , Azatioprina/uso terapêutico , Ciclofosfamida/uso terapêutico , Fatores Imunológicos/administração & dosagem , Anticorpos Monoclonais Murinos/efeitos adversos , Anticorpos Monoclonais Murinos/uso terapêutico , Azatioprina/efeitos adversos , Linfócitos B , Ciclofosfamida/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Humanos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Recidiva , Indução de Remissão , Rituximab
9.
J Ultrasound Med ; 34(1): 83-93, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25542943

RESUMO

OBJECTIVES: To determine the feasibility and accuracy of sonographically guided posterior subtalar joint (PSTJ) injections performed through the sinus tarsi. METHODS: A single experienced operator completed 10 sonographically guided PSTJ injections via the sinus tarsi on 10 unembalmed cadaveric ankle-foot specimens. Injections were performed using a 17-5-MHz linear transducer, a 25-gauge, 50-mm needle, and an out-of-plane, anterior-to-posterior needle trajectory parallel to the calcaneal surface. Sonographic assessment for fluid in the posterior and lateral PSTJ recesses, sinus tarsi, and peroneal tendon sheath was performed before and after injections of 2 and 4 mL of tap water. Two additional specimens were injected with a contrast agent: 1 via the sonographically guided approach and another by a computed tomographically guided approach. RESULTS: All 10 sonographically guided PSTJ tap water injections were accurate, distending both the posterior and lateral PSTJ recesses. In addition, all 10 specimens showed posterior recess distension by 2 mL, whereas only 2 specimens (20%) showed lateral recess distension at this volume. By 4 mL, both recesses were clearly distended in all specimens. Both contrast agent injections produced similar PSTJ computed tomographic arthrograms and patterns of recess distension similar to the sonographically guided tap water injections. No sonographically guided PSTJ injection placed fluid in the peroneal tendon sheath. CONCLUSIONS: Sonographically guided PSTJ injections via the sinus tarsi can accurately and specifically deliver injectate into the PSTJ while monitoring injectate flow within the posterior recess. The sinus tarsi approach may be used as an alternative technique to perform sonographically guided PSTJ injections when clinically appropriate.


Assuntos
Articulação Talocalcânea/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Cadáver , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Reprodutibilidade dos Testes
10.
N Engl J Med ; 363(3): 221-32, 2010 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-20647199

RESUMO

BACKGROUND: Cyclophosphamide and glucocorticoids have been the cornerstone of remission-induction therapy for severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis for 40 years. Uncontrolled studies suggest that rituximab is effective and may be safer than a cyclophosphamide-based regimen. METHODS: We conducted a multicenter, randomized, double-blind, double-dummy, noninferiority trial of rituximab (375 mg per square meter of body-surface area per week for 4 weeks) as compared with cyclophosphamide (2 mg per kilogram of body weight per day) for remission induction. Glucocorticoids were tapered off; the primary end point was remission of disease without the use of prednisone at 6 months. RESULTS: Nine centers enrolled 197 ANCA-positive patients with either Wegener's granulomatosis or microscopic polyangiitis. Baseline disease activity, organ involvement, and the proportion of patients with relapsing disease were similar in the two treatment groups. Sixty-three patients in the rituximab group (64%) reached the primary end point, as compared with 52 patients in the control group (53%), a result that met the criterion for noninferiority (P<0.001). The rituximab-based regimen was more efficacious than the cyclophosphamide-based regimen for inducing remission of relapsing disease; 34 of 51 patients in the rituximab group (67%) as compared with 21 of 50 patients in the control group (42%) reached the primary end point (P=0.01). Rituximab was also as effective as cyclophosphamide in the treatment of patients with major renal disease or alveolar hemorrhage. There were no significant differences between the treatment groups with respect to rates of adverse events. CONCLUSIONS: Rituximab therapy was not inferior to daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and may be superior in relapsing disease. (Funded by the National Institutes of Allergy and Infectious Diseases, Genentech, and Biogen; ClinicalTrials.gov number, NCT00104299.)


Assuntos
Anticorpos Monoclonais/uso terapêutico , Ciclofosfamida/uso terapêutico , Granulomatose com Poliangiite/tratamento farmacológico , Imunossupressores/uso terapêutico , Poliangiite Microscópica/tratamento farmacológico , Administração Oral , Idoso , Anticorpos Anticitoplasma de Neutrófilos/sangue , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos , Linfócitos B/efeitos dos fármacos , Ciclofosfamida/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Análise de Intenção de Tratamento , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Prednisona/uso terapêutico , Qualidade de Vida , Indução de Remissão , Rituximab
11.
J Am Acad Dermatol ; 69(6): 954-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24075227

RESUMO

BACKGROUND: Levamisole is present as a contaminant or additive in most cocaine sold in the United States. Cases of agranulocytosis attributed to levamisole-tainted cocaine have been widely described. A vasculopathic reaction to levamisole has also been reported; however, diagnostic features such as antineutrophil cytoplasmic antibody (ANCA) and additional autoimmune marker positivity are not well recognized. As such, many patients are given a misdiagnosis, prompting aggressive and often unnecessary treatment. OBJECTIVE: We hope to educate practitioners about the clinical and laboratory features of levamisole-induced vasculopathy to ensure accurate diagnosis and management. METHODS: This was a case series. RESULTS: Six patients were admitted with purpuric lesions and vasculitic changes on biopsy specimen; 5 of them were given the diagnosis of and treated for autoimmune conditions before their true diagnosis was revealed. All patients had ANCA positivity, and 4 had additional abnormalities in autoimmune markers. All patients reported recent cocaine abuse, and were ultimately given the diagnosis of levamisole-induced vasculopathy. LIMITATIONS: This observational study is limited by sample size. CONCLUSIONS: Patients presenting with purpuric lesions with ANCA positivity should be assessed for cocaine exposure. It is important to recognize that levamisole may not only induce ANCA positivity but also other autoimmune marker abnormalities. Patients can often be treated with less aggressive therapeutic strategies than what is used for primary ANCA-associated vasculitides.


Assuntos
Doenças Autoimunes/diagnóstico , Transtornos Relacionados ao Uso de Cocaína , Levamisol/toxicidade , Doenças Vasculares/induzido quimicamente , Doenças Vasculares/diagnóstico , Adulto , Idoso , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Ultrasound Med ; 32(10): 1735-43, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24065254

RESUMO

OBJECTIVES: The purpose of this study was to establish standards for musculoskeletal ultrasound competency through knowledge and skills testing using criterion-referenced methods. METHODS: Two groups of rheumatology fellows trained in musculoskeletal ultrasound through a standardized curriculum, which required submission of ultrasound studies for review over 8 months. Both groups then completed written and practical examinations in musculoskeletal ultrasound. Instructors, advanced users, and intermediate users of musculoskeletal ultrasound served as comparison groups. A passing score (competency) was established for the written examination by the Angoff procedure and for the practical examination by the borderline method. RESULTS: Thirty-eight fellows (19 in each group) took the final examination. Five fellows failed the written examination, and 1 failed the practical examination, whereas none of the advanced users failed. Written examination scores did not differ between the two fellow groups (74% versus 70%; P > .05), were reliable, and were able to discriminate between the intermediate and advanced groups. Practical and written examination results correlated in both groups (first group, r = 0.70; P = .0008; second group, r = 0.59; P = .009). CONCLUSIONS: Criterion-referenced methods were used for the first time to determine fellow musculoskeletal ultrasound competency. The examination used to determine competency was reproducible, was reliable, and could differentiate musculoskeletal ultrasound users with different levels of experience. Most rheumatology fellows completing our program passed the written and practical examinations, suggesting achievement of basic musculoskeletal ultrasound competency.


Assuntos
Avaliação Educacional/normas , Guias como Assunto , Internato e Residência/normas , Sistema Musculoesquelético/diagnóstico por imagem , Radiologia/normas , Reumatologia/educação , Ultrassonografia/normas , Adulto , Currículo/normas , Currículo/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Competência Profissional/normas , Competência Profissional/estatística & dados numéricos , Radiologia/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Estados Unidos , Adulto Jovem
13.
J Clin Rheumatol ; 19(7): 382-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24048117

RESUMO

BACKGROUND: Eosinophilic fasciitis (EF) is an autoimmune, fibrotic disorder described initially with scleroderma-like skin changes where deep soft tissue sampling that includes fascia is frequently felt to be necessary to confirm the diagnosis. OBJECTIVE: The objective of this study was to distinguish forearm involvement by EF from other fibrosing diseases and from control subjects with normal skin and fascia using B-mode ultrasound. METHODS: A cross-sectional study over a 4-year period in which clinically involved forearm skin of consecutive patients with EF (n = 12), diabetic cheiroarthropathy (n = 8), diffuse systemic sclerosis (n = 23), and control subjects (n = 8) was evaluated by 12-MHz, B-mode ultrasound for degree of subcutaneous tissue compressibility, and this finding was compared with the criterion standard of clinical diagnostic criteria for each disease process. RESULTS: Subcutaneous compressibility in EF was significantly reduced when compared with diffuse systemic sclerosis and with control subjects. Subcutaneous thinning was observed in some patients with EF (4/12), diabetic cheiroarthropathy (4/8), and diffuse systemic sclerosis (6/23), but not in control subjects. Diabetic cheiroarthropathy and diffuse systemic sclerosis patients with subcutaneous thinning had less than 20% subcutaneous compressibility, whereas only 1 of 12 EF patients had compressibility of more than 20% regardless of subcutaneous thinning. CONCLUSIONS: A 12-MHz, B-mode ultrasound may be used to measure subcutaneous compressibility, thereby serving as an adjunct tool in distinguishing EF from diffuse systemic sclerosis, especially when tissue sampling is less feasible or when the result of tissue sampling is equivocal.


Assuntos
Eosinofilia/diagnóstico por imagem , Fasciite/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Fasciite/diagnóstico , Feminino , Antebraço , Humanos , Masculino , Pessoa de Meia-Idade , Esclerodermia Difusa/diagnóstico , Esclerodermia Difusa/diagnóstico por imagem , Pele/diagnóstico por imagem , Dermatopatias/diagnóstico , Dermatopatias/diagnóstico por imagem , Tela Subcutânea/diagnóstico por imagem
14.
Clin Rheumatol ; 41(12): 3825-3835, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36008579

RESUMO

INTRODUCTION/OBJECTIVES: There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. METHOD: Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. RESULTS: Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. CONCLUSIONS: This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.


Assuntos
Cotovelo , Articulação do Ombro , Humanos , Ombro , Punho , Técnica Delphi , Extremidade Superior
15.
Clin Rheumatol ; 40(11): 4373-4377, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33813621

RESUMO

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease affecting not only the synovial joints but also multiple extra-articular sites, including ankle and foot soft tissue. Hindfoot abnormalities usually follow those in the forefoot, with up to 4 out of 10 patients experiencing talalgia during their disease course. Enthesophytosis, retrocalcaneal bursitis, and plantar fasciitis are among the most common etiologies, while heel fat pad abnormalities like subcalcaneal bursitis are rare. Here, we report two cases of subcalcaneal bursitis, and the first case of heel fat pad and subcalcaneal bursa herniation in patients with established RA, along with a comprehensive literature review of subcalcaneal bursitis and other heel fat pad abnormalities in RA. Subcalcaneal bursitis, also referred to as panniculitis, inflammatory-edematous lesion, or adventitial (adventitious) bursitis has been reported in up to 10% of patients with RA. It appears as a compressible, heterogeneous, and hypoechoic subcalcaneal mass on ultrasound (US), with peripheral vascularization on Doppler US. Patients may present with heel discomfort. Ultrasonographic assessment is usually sufficient to confirm the presence of heel fat pad pathologies. Rest, analgesics, and mechanical aids with or without addition of disease-modifying antirheumatic drugs are usually employed, while intervention is rarely required.


Assuntos
Artrite Reumatoide , Fasciíte Plantar , Tecido Adiposo/diagnóstico por imagem , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Calcanhar/diagnóstico por imagem , Humanos , Ultrassonografia
16.
Ann Anat ; 235: 151663, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33387611

RESUMO

OBJECTIVE: To determine the effect of knee flexion and submaximal isometric quadriceps muscle (Q) contraction on the patellar tendon (PT), the infrapatellar fat pad (IPFP), and the deep infrapatellar bursa (IPB) from extension to full flexion. METHODS: In Study 1, the dominant knee of seven healthy subjects was studied in full extension and at 60° flexion during relaxation and Q contraction. Each knee was inspected and palpated, the transverse infrapatellar diameter was measured by plicometry, and measurements of the anteroposterior (AP) thickness of the IPFP were made by ultrasound (US). In Study 2, the dominant knee of seven healthy subjects was studied by US in full flexion, and then, at 15° decrements, down to 60° flexion during relaxation and Q contraction. Both studies had IRB approval. Results were analyzed with the Wilcoxon test and descriptive statistics. RESULTS: In Study 1, Q contraction caused straightening of the patellar tendon (PT), a statistically significant widening of the IPFP by plicometry, and an increased AP thickness of the IPFP by US, in both knee positions. In Study 2, in full knee flexion, the PT contacted the tibial cortex in all seven subjects. Upon increasing extension, the PT-tibial cortex contact was lost in all subjects nearing 90° flexion. The contraction of the Q made the concave PT straight, grew the width of the underlying IPFP, and the apron of the IPFP moved distally within the IPB in all knee positions. A small amount of bursal fluid was present in all seven subjects. CONCLUSION: Q contraction makes the IPFP bulge anteriorly, on both sides of the PT, and distally into the IPB, with possible biomechanical implications. In full knee flexion, the PT contacted the tibia, confirming a fulcrum at this site.


Assuntos
Articulação do Joelho , Músculo Quadríceps , Fenômenos Biomecânicos , Humanos , Joelho , Contração Muscular , Patela , Amplitude de Movimento Articular
17.
Clin Rheumatol ; 40(10): 4233-4242, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33821367

RESUMO

BACKGROUND/OBJECTIVE: A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs. METHODS: Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test. RESULTS: Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation. CONCLUSION: Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points • The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. • The transverse sacroiliac joint view was suggested to be performed based on practice focus.


Assuntos
Tornozelo , Tornozelo/diagnóstico por imagem , Consenso , Técnica Delphi , Humanos , América do Norte , Ultrassonografia
18.
Semin Arthritis Rheum ; 51(3): 644-649, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33468347

RESUMO

OBJECTIVE: This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS: Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS: Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION: A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.


Assuntos
Gota , Consenso , Exercício Físico , Gota/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Ultrassonografia
19.
Rheumatology (Oxford) ; 49(6): 1069-75, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20202926

RESUMO

OBJECTIVES: To obtain an objective, unbiased assessment of skin fibrosis in patients with SSc for use in clinical trials of SSc disease-modifying therapeutics. METHODS: Skin biopsies from the dorsal forearm of six patients with diffuse SSc and six healthy controls, and skin biopsies from the forearm of one patient with diffuse SSc before and following 1 year treatment with mycophenolate mofetil were analysed by confocal laser scanning microscopy (CLSM) with specific antibodies against collagen types I and III or fibronectin. The integrated density of fluorescence (IDF) was calculated employing National Institutes of Health-ImageJ software in at least four different fields per biopsy spanning the full dermal thickness. RESULTS: The intensities of collagen types I and III and fibronectin IDF were 174, 147 and 139% higher in SSc skin than in normal skin, respectively. All differences were statistically significant. The sum of the IDF values obtained for the three proteins yielded a comprehensive fibrosis score. The average fibrosis score for the six SSc samples was 28.3 x 10(6) compared with 18.6 x 10(6) for the six normal skin samples (P < 0.0001). Comparison of skin biopsies obtained from the same SSc patient before treatment and after 12 months of treatment with mycophenolate mofetil showed a reduction of 39% in total fibrosis score after treatment. CONCLUSIONS: CLSM followed by quantitative image analysis provides an objective and unbiased assessment of skin fibrosis in SSc and could be a useful end-point for clinical trials with disease-modifying agents to monitor the response or progression of the disease.


Assuntos
Fibrose/patologia , Imunossupressores/uso terapêutico , Microscopia Confocal/métodos , Ácido Micofenólico/análogos & derivados , Escleroderma Sistêmico/patologia , Adulto , Biópsia , Estudos de Casos e Controles , Ensaios Clínicos como Assunto , Colágeno/metabolismo , Feminino , Fibrose/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Escleroderma Sistêmico/tratamento farmacológico , Pele/anatomia & histologia , Pele/metabolismo , Estatística como Assunto
20.
BMC Musculoskelet Disord ; 11: 232, 2010 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-20932341

RESUMO

BACKGROUND: There are no proven therapies that modify the structural changes associated with osteoarthritis (OA). Preclinical data suggests that intra-articular recombinant human BMP-7 (bone morphogenetic protein-7) has reparative effects on cartilage, as well as on symptoms of joint pain. The objective of this study was to determine the safety and tolerability as well as dose-limiting toxicity and maximal tolerated dose of intra-articular BMP-7. The secondary objectives were to determine the effect on symptomatic responses through 24 weeks. METHODS: This was a Phase 1, double-blind, randomized, multi-center, placebo-controlled, single-dose escalation safety study consisting of 4 dosing cohorts in participants with knee OA. Each cohort was to consist of 8 treated participants, with treatment allocation in a 3:1 active (intra-articular BMP-7) to placebo ratio. Eligible participants were persons with symptomatic radiographic knee OA over the age of 40. The primary objective of this study was to determine the safety and tolerability of BMP-7 including laboratory assessments, immunogenicity data and radiographic assessments. Secondary objectives were to determine the proportion of participants with a 20%, 50%, and 70% improvement in the WOMAC pain and function subscales at 4, 8, 12, and 24 weeks. Other secondary outcomes included the change from baseline to 4, 8, 12, and 24 weeks for the OARSI responder criteria. RESULTS: The mean age of participants was 60 years and 73% were female. All 33 participants who were enrolled completed the study and most adverse events were mild or moderate and were similar in placebo and BMP-7 groups. The 1 mg BMP-7 group showed a higher frequency of injection site pain and there was no ectopic bone formation seen on plain x-rays. By week 12, most participants in both the BMP-7 and placebo groups experienced a 20% improvement in pain and overall the BMP-7 group was similar to placebo with regard to this measurement. In the participants who received 0.1 mg and 0.3 mg BMP-7, there was a trend toward greater symptomatic improvement than placebo. The other secondary endpoints showed similar trends including the OARSI responder criteria for which the BMP-7 groups had more responders than placebo. CONCLUSIONS: There was no dose limiting toxicity identified in this study. The suggestion of a symptom response, together with the lack of dose limiting toxicity provide further support for the continued development of this product for the treatment of osteoarthritis.


Assuntos
Proteína Morfogenética Óssea 7/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Idoso , Proteína Morfogenética Óssea 7/efeitos adversos , Estudos de Coortes , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/metabolismo , Avaliação de Resultados em Cuidados de Saúde/métodos , Radiografia , Resultado do Tratamento
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