Diagnostic Accuracy of Clinical Tests and Imaging Exams for Femoroacetabular Impingement: An Umbrella Review of Systematic Reviews.

OBJECTIVE: To synthesize available evidence about diagnostic accuracy of clinical tests and imaging examinations for femoroacetabular impingement (FAI) syndrome. DESIGN: Umbrella review. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Systematic reviews (SR) indexed in Embase, LIVIVO, PubMed, SCOPUS, the Cochrane Library, and Web of Science were searched in a 2-phase process. SR assessing diagnostic accuracy were considered eligible. RESULTS: From 1520 studies, 6 SR were included, which evaluated 24 primary studies related to FAI syndrome. Of these, 5 SR assessed clinical tests, and a substantial heterogeneity was found concerning reference standards adopted across primary studies, which included arthroscopy, clinical examination (associated or not with imaging exams), intra-articular injections, and open surgery. Most clinical tests presented higher values of sensitivity compared with specificity, although evidence was considered limited because the same primary studies were often included across SR. Nonetheless, evidence around the flexion adduction internal rotation (FADIR) test was considered stronger and its use as a screening tool was consistently supported. Only one SR assessed the accuracy of imaging examinations, which adopted open surgery as the sole reference standard. Most imaging exams presented considerably high values of sensitivity, although specificity values were notably lower. CONCLUSIONS: No robust recommendations can be provided for most clinical tests, although the FADIR test, in particular, was consistently supported as a screening tool. Moreover, although imaging examinations showed considerably high sensitivity values, evidence was considered sparse and further research is strongly recommended to validate its use as reference standards for diagnostic accuracy data.

Neuro-Behçet's disease, its mimickers and anti-TNF therapy: a case-based review.

When the central nervous system is the primary affected site in an initial attack of Behçet's disease (BD), the differential diagnosis is particularly challenging. Because the specificity of immunobiologic therapy is growing, the specific diagnosis may impact the chosen therapy. For instance, anti-tumour necrosis factor agents are efficacious in BD but may be harmful in multiple sclerosis or systemic lupus erythematosus. We present two cases with similar neurological features but different diagnosis (BD and systemic lupus erythematosus) as a starting point to review diagnostic and therapeutic approaches for neuro-BD and its differential diagnoses.

Toll-like receptor (TLR) 2 is upregulated on peripheral blood monocytes of patients with psoriatic arthritis: a role for a gram-positive inflammatory trigger?

UNLABELLED: Toll-like receptor (TLR) 2 and TLR4 are able to activate innate immune cells in response to gram-positive and gramnegative bacteria, respectively. Psoriatic arthritis (PsA) is a chronic inflammatory joint disease and gram-positive streptococcus may have a role in its pathogenesis, suggesting the importance of TLR2 stimulation in PsA. OBJECTIVES: To assess TLR2 and TLR4 expressions on innate immune cells of PsA patients, relating to clinical disease activity. METHODS: Forty-five patients with peripheral joint manifestations of PsA were included and disease activity was assessed by Disease Activity Score of 28 joint counts (DAS28). 32 healthy subjects constituted the control group. Membrane-bound TLR2 and TLR4 expressions were assessed on peripheral blood monocytes and neutrophils by flow cytometry. RESULTS: Twenty-seven patients had active PsA (DAS28 higher than 2.6) and 18 had inactive disease. TLR2 was significantly upregulated on monocytes in both active and inactive PsA group, comparing to healthy controls. TLR4 was similarly expressed in all tested groups. CONCLUSIONS: TLR2 is overexpressed by PsA monocytes, suggesting that gram-positive exposure could induce higher inflammatory responses in this disease.

Infliximab treatment in pachydermoperiostosis: a rare disease without an effective therapeutic option.

Hypertrophic osteoarthropathy (HOA) is characterized by periostitis of tubular bones, thickened skin, and digital clubbing. Its pathogenesis is unknown but an inflammatory factor and increased bone remodeling have been implicated. It is a very rare disease, usually diagnosed late with few therapeutic options. Bone and joint pains are secondary to periostitis and are usually difficult to control. Tumor necrosis factor-alpha is a cytokine that induces other inflammatory cytokine production, has an osteoclastogenic effect in different rheumatic diseases and probably also has an important role in periostitis and the systemic inflammatory manifestations in HOA. We describe the case of a patient with the primary form of HOA, who had refractory bone pain and arthritis that responded partially to infliximab treatment.

CD11b expression on polymorphonuclear leukocytes from patients with ankylosing spondylitis in a lipopolysaccharide-stimulated whole blood ex vivo model.

AIM: Ankylosing spondylitis (AS) is a chronic inflammatory disease that compromises the axial skeleton, causing pain and disability. The involved mechanisms are not completely understood, but evidence suggests a role of the gut microbiota in eliciting innate immune responses. We conducted an experimental study to determine if AS patients exhibit an enhanced inflammatory response to microbial compounds. METHOD: We incubated whole peripheral blood of AS patients and healthy controls with phosphate-buffered saline (PBS) or lipopolysaccharide (LPS) for 48 h with saturating levels of labeled antibodies (CD66b, CD11b and human leukocyte antigen type DR [HLA-DR]) for flow cytometry. CD11b and HLA-DR expression levels were assessed in polymorphonuclear leukocytes (PMN) (CD66b high - HLA-DR low). We also measured basal CD11b and HLA-DR levels on circulating PMN (without incubation). RESULTS: We found that CD11b and HLA-DR levels were similarly elevated in response to LPS on PMNs from healthy controls (HC) and AS patients. Basal levels of CD11b and HLA-DR on circulating PMN from AS patients and HC were similar. However, significantly lower levels of CD11b and HLA-DR were observed in PMNs from AS patients than HC in response to incubation with PBS for 48 h. CONCLUSION: We concluded that the response of AS innate immune cells to LPS is similar to that observed in immune cells from HCs, and suggested that the lower PMN activation of AS patients after 48 h saline incubation is mainly due to anti-inflammatory medication.

Pulmonary amyloidosis in Sjögren's syndrome: a rare diagnosis for nodular lung lesions.

Lung involvement in Sjögren's syndrome (SS) can affect trachea, bronchus, small airways, pleura and may cause interstitial lung injury. It may also be associated with malignancies, particularly non-Hodgkin's lymphoma, which is a well-recognized complication of this disease. Here we describe the occurrence of localized amyloidosis presenting as pulmonary nodules in a patient with newly diagnosed SS. We highlight this rare occurrence as a diagnostic possibility that should be considered in the evaluation of pulmonary involvement in this disease.