Assessing forefoot bursitis in rheumatoid arthritis: a comprehensive approach with ultrasound, MRI, and baropodometry.

AIM: In rheumatoid arthritis (RA), forefoot bursitis is prevalent, with limited studies comparing ultrasonography (US) and Magnetic Resonance Imaging (MRI). This study aims to evaluate these bursae, providing a comparative analysis of US and MRI, and explore associations with demographic, disease-related factors, pain, clinical examination, and baropodometryin RA patients. MATERIAL AND METHODS: Participants with RA were recruited from the day-hospital clinic. The forefeet were assessed clinically, and the selected foot was examined by US and MRI to evaluate intermetatarsal (IMB) and submetatarsal bursitis (SMB). Baropodometry assessed plantar pressures and contact surfaces. RESULTS: Thirty-five RA patients were enrolled, 85.7% females, mean age 59.2 (11.3) years, mean body mass index (BMI) 26.5 (5.7) kg/m2, median disease duration of 36.0 (16.5-114.0) months, and 34.3% with painful forefoot. A total of 140 intermetatarsal and 175 submetatarsal spaces were evaluated. Agreement between US and MRI was high (PA=97.14%, k=0.801, p<0.001), and interobserver reliability for both modalities was excellent (US: PA=98.73%, k=0.888, p<0.001; MRI: PA=98.41%, k=0.900, p<0.001). IMB was negatively associated with disease duration (the only independent predictor) and linked to clinical signs like the opening toes sign and hammer toe deformity. SMB showed an association with BMI and erosions. Baropodometric analysis indicated no significant differences in plantar pressures for IMB, and larger contact surfaces in SMB regions. CONCLUSIONS: US and MRI are valuable tools for forefoot bursitis evaluation. IMB is associated with disease duration (negative association), the opening toes sign, and hammer toe deformity, while SMB correlates with BMI, erosions, and foot architectural deformity. Baropodometry revealed larger contact surfaces in regions with SMB.

Shear wave elastography as a new method to identify parotid lymphoma in primary Sjögren Syndrome patients: an observational study.

Parotid non-Hodgkin lymphoma (NHL) in primary Sjögren syndrome (pSS) has no specific biomarker for diagnosis. Salivary glands ultrasound (US) is largely used, but its contribution in detecting parotid NHL has not been established. The aim of our study was to determine the added value of bidimensional shear wave elastography (2D-SWE) in pSS diagnosis and to determine its accuracy in identifying parotid NHL. Grey-scale US (GSUS) and 2D-SWE of salivary glands were performed in 35 patients with pSS and 35 healthy controls. The GSUS scores were calculated and the mean of three SWE consecutive measurements was used to appreciate the gland stiffness. SWE increase the diagnostic rate at a cut-off of 6.45 kPa (from 88.6 to 94.2%, p < 0.001) only if applied in patients with insufficient GSUS criteria for pSS diagnosis. The parotid glands with NHL (8 patients, all mucosa-associated lymphoid tissue type) had hyperechoic bands in more than half of the glandular parenchyma (in 68.75% of the glands), large hypoechoic area > 20 mm (all glands), traced gland area over 5 cm2 (all glands), parotid US score greater than 13 (in 68.75% of the glands), and high stiffness (elasticity modulus 13.9 ± 4.08 vs 6.32 ± 2.24) (all p < 0.001). These findings give high sensitivity (92.3%), specificity (100%), and positive (100%) and negative predictive values (98.3%) for NHL identification. The rest of GSUS findings did not correlate with the classic risk factors for lymphoma development (all p > 0.05). 2D-SWE had added value for pSS diagnosis in cases where GSUS aspect is normal or nonspecific. The higher stiffness of parotid NHL can be used for early diagnosis, biopsy guidance, and, possible, for treatment monitoring.

Multimodal ultrasound investigation (grey scale, Doppler and 2D-SWE) of salivary and lacrimal glands in healthy people and patients with diabetes mellitus and/or obesity, with or without sialosis.

AIM: To evaluate the ultrasound (US) modifications [grey scale, Doppler, 2D-share wave elastography (2D-SWE)] ofsalivary (parotid and submandibular) and lacrimal glands in healthy people and patients with diabetes mellitus and/or obesity, with or without sialosis. MATERIAL AND METHODS: We evaluated 170 patients (1020 glands, 1700 grey scale and Doppler images), split in two groups (group 1- healthy people, group 2- obese and/or diabetes patients, with or without sialosis). For each patient we assessed the parotid, submandibular and lacrimal glands in grey scale US (echogenicity, homogeneity, glandular contour, posterior border, lymph nodes), color Doppler US and 2D-SWE. All images were analyzed by two examiners blinded to each other or to patients. RESULTS: The interobserver agreement was strong or moderate for all parameters. In group 2, the salivary glands had increased echogenicity, homogeneous aspect and invisible posterior border (all p<0.001). There was no significant variation of elasticity modulus in the groups analyzed (5.46±1.57 vs 5.67±1.81 in parotid, 8.63±1.84 vs 8.55±1.94 in submandibular and 9.47±2.1 vs 9.53±2.23 in lacrimal glands, all p>0.05) or according to the body mass index (BMI), sex, patient age, the aspect in grey scale/Doppler US or the presence of sialosis (all p>0.05). CONCLUSION: The main US differences between healthy people and patients with diabetes mellitus and/or obesity are suggested by the echogenicity, homogeneity, posterior border and the size of glandular area. No significant differences of elasticity modulus were found between the analyzed groups or related to BMI, sex, patient age or other grey scale/Doppler US items analyzed.

Knee osteoarthritis grading by resonant Raman and surface-enhanced Raman scattering (SERS) analysis of synovial fluid.

In this preliminary study on synovial fluid (SF), knee osteoarthritis (OA) grading of n = 23 patients was accomplished by combining two methods: resonant Raman spectroscopy, and surface-enhanced Raman scattering (SERS) of native proteins acquired with iodide-modified silver nanoparticles and a laser emitting at 633 nm. Based on principal component analysis-linear discriminant analysis (PCA-LDA), the SERS spectra of proteins enabled the classification of low-grade and high-grade OA groups with an accuracy of 91%. Resonant Raman spectra of SF, recorded with laser excitation at 532 nm, exhibited carotenoid-associated bands that were less intense in the case of high-grade knee OA patients. Based on the resonant Raman spectra, the grading of OA patients was accomplished with an accuracy of 74%. Concatenating SERS and Raman spectral information increased the classification accuracy between the two groups to 100%. These results demonstrate the potential of Raman and SERS as a point-of-care method for aiding OA grading.

SERS-based quantification of albuminuria in the normal-to-mildly increased range.

The lack of an accurate point-of-care detection system for microalbuminuria represents an important unmet medical need that contributes to the morbidity and mortality of patients with kidney diseases. In this proof-of-concept study, we used SERS spectroscopy to detect urinary albumin concentrations in the normal-to-mildly increased albuminuria range, a strategy that could be useful for the early diagnosis of renal impairment due to uncontrolled hypertension, cardiovascular disease or diabetes. We analyzed 27 urine samples by SERS, using iodide-modified silver nanoparticles and we could discriminate between groups with high and low albumin concentrations with an overall accuracy of 89%, 93% and 89%, using principal component analysis-linear discriminant analysis and cut-off values of 3, 6 and 10 µg mL-1 for urinary albumin concentrations, respectively. We achieved a detection limit of 3 µg mL-1 for human serum albumin based on the 1002 cm-1 SERS band, attributed to the ring breathing vibration of phenylalanine. Our detection limit is similar to that of the immunoturbidimetric assays and around one order of magnitude below the detection limit of urinary dipsticks used to detect microalbuminuria. We used principal least squares regression for building a spectral model for quantifying albumin. Using an independent prediction set, the R2 and root mean squared error of prediction between predicted and reference values of human serum albumin concentrations were 0.982 and 2.82, respectively. Here, we show that direct SERS spectroscopy has the sensitivity required for detecting clinically relevant concentrations of urinary albumin, a strategy that could be used in the future for the point-of-care screening of microalbuminuria.

High-frequency sonography in the evaluation of nail psoriasis.

AIM: To evaluate the morphostructural aspects and nail vascularity in the nail unit of patients with psoriasis, and to evaluate whether there are differences among psoriatic patients with and without nail involvement. MATERIAL AND METHODS: Nail plates and nail bed changes, nail fold vessel resistance index (NVRI), power and color Doppler blood flow appearances were investigated in 23 patients with moderate-to-severe psoriasis, with and without nail involvement, and compared to those of 11 healthy participants. RESULTS: Ventral nail plate deposits were present only in psoriasis patients. Irregular or totally fused nail plates and increased nail plate thickness was frequently observed in psoriasis patients compared to controls. NVRI was increased in psoriatic patients' nails compared to controls (0.62 vs. 0.57, p<0.0001). In the psoriasis patient group there was significant statistical difference in NVRI in patients with nail involvement compared to those without (0.66 vs. 0.55, p<0.0001). CONCLUSIONS: High-frequency gray scale sonography provides valuable information regarding morphostructural changes in nail unit structure in patients with psoriasis. Power Doppler imaging enables blood flow assessment in psoriasis nail induced changes.

Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis.

AIMS: The ultrasonographic (US) evaluation of the median nerve at the level of the carpal tunnel outlet (CTO) and mid forearm in pediatric patients with mucopolysaccharidosis type II (MPS II) and comparison with healthy subjects. MATERIAL AND METHOD: Fifteen children with MPS II and 44 healthy children were included in the study and they were divided into three age groups. The cross-sectional area, the appearance of the nerve, and the ratio of the cross-sectional areas were evaluated by US. RESULTS: At the level of the CTO the mean area of the nerve was increased in all MPS II groups compared with the correspondent healthy age groups and the differences were statistically significant (p<0.01). At the level of the mid forearm the differences were statistically significant only for the first age group. Other US findings at the level of the CTO in the MPS II groups were represented by hypoechogenicity (86.67 % on the right and 93.33% on the left), thickened fascicles (80% bilaterally), irregular contour (53.33% bilaterally) and the presence of the Doppler signal including the nerve (26.67 % on the right and 33.33 % on the left). The CTO/mid forearm cross-sectional area ratio was higher in all MPS II age groups and the differences were statistically significant (p<0.001). CONCLUSION: In patients with MPS II there are significant US changes in the size and aspect of the median nerve.

Gray scale and power Doppler ultrasonography in evaluation of early rheumatoid arthritis.

INTRODUCTION: Ultrasonography provides information regarding synovial membrane proliferation and its vascularization. The AIM of our study was to evaluate the role of gray scale and power Doppler ultrasonography in assessing early rheumatoid arthritis by analyzing the scores determined by the evaluation of synovial proliferation, joint effusion, erosion or soft tissue swelling. MATERIAL AND METHODS: The study was prospective comprising 34 patients (31 female, 3 men), mean age 45.68 years, with clinical changes and biochemical early rheumatoid arthritis. Bilateral wrist, II-V metacarpophalangeal, and proximal interphalangeal joints were evaluated by dorsal and palmar scans. RESULTS: The mean duration from the onset of symptoms was 3.46 months. Based on the clinical, biochemical and US scores the patients from our study presented early stages of RA. Also, statistically significant correlations were observed between the time elapsed from the onset, the changes highlighted by ultrasound and the stage of the disease (stage 0 or 1). CONCLUSIONS: Our study confirms that US evaluation of changes in the joints of the hand offers useful information for staging the diagnosis of RA.