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1.
Clin Exp Rheumatol ; 38 Suppl 126(4): 73-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33025891

RESUMO

OBJECTIVES: Rheumatoid arthritis (RA) patients with Sjögren's syndrome (SS) often present with more severe synovitis. We intended to clarify the impact of overlapping SS on ultrasound remission, functional ability and clinical decision-making in RA patients in a real-world cohort from 2009 to 2019. METHODS: The medical records of RA patients in our medical centre from 2009 to 2019 were reviewed. Cox proportional hazards models of ultrasound remission and no disability (by health assessment questionnaire [HAQ]) were conducted in both the 1-to-1 nearest propensity score matched (PSM) and unmatched cohorts between RA patients with SS (RA-SS) and without (RA-noSS) to correct critical confounders. Four kinds of PSM methods were used and the corresponding average treatment effect on the treated (ATT) was calculated to clarify the effect of overlapping SS on distinguishable characteristics or drug prescription in RA patients. RESULTS: A total of 1100 RA patients were included in the study, of which 133 (12.1%) overlapped with SS. Among 256 patients consisting of 128 RA-SS and 128 RA-noSS after 1-to-1 nearest PSM, overlapping SS was associated with a 44%, 32% lower probability of reaching ultrasound remission, no disability in RA patients, respectively. More hydroxychloroquine (HCQ) usage, less biologic disease-modifying anti-rheumatic drugs (bDMARDs) prescription were confirmed to be correlated with overlapping SS by the robust PSM. CONCLUSIONS: Overlapping SS is associated with a lower probability of reaching ultrasound remission and no disability in RA patients. HCQ may still be the mainstream of clinical decision making in RA-SS patients.


Assuntos
Artrite Reumatoide , Síndrome de Sjogren , Atividades Cotidianas , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Humanos , Pontuação de Propensão , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico por imagem , Síndrome de Sjogren/tratamento farmacológico , Ultrassonografia
2.
J Contemp Dent Pract ; 21(7): 769-775, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33020361

RESUMO

AIMS AND OBJECTIVES: Early detection of rheumatoid injury in the temporomandibular joint using CT, which accurately detects bone changes before the clinical symptoms start appearing to protect the joint from irreversible damage, and the correlation of those radiological changes with the duration of rheumatoid arthritis disease. MATERIALS AND METHODS: It included 45 people aged 27-74 years who reviewed the internal medicine and rheumatology clinics at Al-Mouwasat Hospital during 2016-2018 and are affected with rheumatoid arthritis according to the criteria American College of Arthritis (ACR) European League against Rheumatism (EULAR) 2010 criteria. The informed consent of the patient and the approval of the Scientific Research Council were obtained to conduct the research. RESULTS: Computed tomography revealed the radiological changes in the left and right side, respectively, in terms of p value <0.05: (1) Erosion of condyle (42.22-53.34%). (2) Decreased in the joint space (53.33-60.00%). (3) Mandibular subchondral cysts in both sides (77.14%). (4) Erosion of the articular fossa (48.89-57.78%). (5) Flattening of condyle (46.67-55.55%). (6) Effusion (2.22-4.44%). (7) Bone marrow edema (26.67-40.00%). (8) Subchondral sclerosis (60.00-73.33%). Conclusion and clinical significance: The occurrence of bone damage in the condyle and articular fossa of the temporomandibular joint despite the fact that the sample members have no clinical complaint indicates the ability of CT scan of early and accurate disclosure of rheumatoid injury in the temporomandibular joint.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X , Estados Unidos
3.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 897-901, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047726

RESUMO

OBJECTIVE: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). METHODS: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. RESULTS: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ2=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ2=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ2=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ2=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ2=7.131, P=0.008; χ2=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ2=0.220, P=0.755; χ2=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). CONCLUSION: The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.


Assuntos
Artrite Reumatoide , Osteoartrite , Reumatologia , Adolescente , Adulto , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sensibilidade e Especificidade , Estados Unidos
4.
Medicine (Baltimore) ; 99(37): e22185, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925790

RESUMO

BACKGROUND: To compare superb microvascular imaging with power Doppler imaging for evaluating joint lesion scores in rheumatoid arthritis based on high quality clinical cohort or case control studies. METHODS: We searched Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Chinese Biomedical Literature Database without restrictions of language and publication status. Two investigators will identify relevant trials, extract data, and appraise risk of bias in each eligible trial. Data will be pooled by either a fixed-effects model or a random-effects model according to the results of heterogeneity identification. The primary outcomes include a semi-quantitative scoring system, through which synovial vascularity intensity was evaluated by means of both power Doppler imaging (PDI) and superb microvascular imaging (SMI). This study will only include high quality clinical cohort or case control studies. Statistical analyses were conducted by STATA version 15.1 software. RESULTS: This meta-analysis included 11 studies. A total of 4342 joints were assessed through both SMI and PDI. The pooled summary odds ratio was 2.12 (95% confidence interval = 1.80-2.51) with statistical significance (z = 8.82, P < .01). In subgroup analyses, the results revealed also that SMI exhibited more sensitive performance in different subgroups. We found no evidence for publication bias (t = 0.55, P = .598). CONCLUSION: Our meta-analysis indicates that SMI ultrasound is more sensitive than conventional PDI in detecting synovitis in RA patients. INPLASY REGISTRATION NUMBER: INPLASY202060089.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Humanos , Microvasos/diagnóstico por imagem , Membrana Sinovial/irrigação sanguínea , Ultrassonografia/métodos
5.
Medicine (Baltimore) ; 99(30): e21151, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791688

RESUMO

BACKGROUND: The introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) into clinical practice has dramatically improve the clinical outcomes of individuals with rheumatoid arthritis (RA). However, bDMARDs are associated with high costs, which has resulted in restricted treatment access and a burden on medical insurance finances. Although biosimilars offer cost-saving, their effectiveness and safety must be established in Post-Marketing Surveillance (PMS). Infliximab (IFX), a chimeric monoclonal antibody to TNF-alpha, is the first bDMARD; its biosimilar, CT-P13, is the first biosimilar DMARD approved for RA treatment in Japan. We will evaluate whether switching from originator IFX to CT-P13 is not inferior for maintaining non-clinical relapse to continued treatment with originator IFX in RA patients achieving clinical remission. METHODS/DESIGN: This study is an interventional, multicenter, open-label, single-arm against historical control and noninferiority clinical trial with a 24-week follow-up. Eighty RA patients who are treated by originator IFX for ≥24 weeks and are achieving clinical remission will be included. Patients will be switched to CT-P13 with the unchanged dosing regimen. We will evaluate disease activity by measuring clinical disease activity indices and by using musculoskeletal ultrasound (MSUS). The primary endpoint is the ratio of patients who experience a nonclinical relapse during the study period. Important secondary endpoints are the changes from the baseline of the MSUS scores. We will also comprehensively analyze the serum levels of many biomarkers such as cytokines and chemokines. DISCUSSION: The study results are expected to show the noninferiority of switching to CT-P13 over the continuation of originator IFX. The strength of this study is its prospective evaluation of therapeutic efficacy using not only clinical disease activity indices but also MSUS to accurately and objectively evaluate disease activity at the joint level among patients drawn from multiple centers with a standardized evaluation by MSUS. We will explore whether parameters at baseline can predict a nonclinical relapse after switching from originator IFX to CT-P13 by integrating multilateral assessments, i.e., clinical disease activity indices, MSUS findings, and serum biomarkers. TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) on October 11, 2019 as jRCTs071190030.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Medicamentos Biossimilares/uso terapêutico , Quimiocinas/sangue , Infliximab/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Biomarcadores/sangue , Substituição de Medicamentos , Estudos de Equivalência como Asunto , Humanos , Japão , Quimioterapia de Manutenção , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Índice de Gravidade de Doença , Ultrassonografia , Adulto Jovem
6.
Medicine (Baltimore) ; 99(32): e21480, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769882

RESUMO

BACKGROUND: The introduction of biological disease-modifying anti-rheumatic drugs into clinical practice has dramatically improved the clinical outcomes of individuals with rheumatoid arthritis (RA). We are conducting the IFX-SIRIUS STUDY I that evaluates whether switching from originator infliximab (IFX) to its biosimilar, CT-P13, is not inferior in maintaining nonclinical relapse to continue treatment with originator IFX in patients with RA achieving clinical remission. It is the next great issue whether disease activity can be maintained in good condition after discontinuation of CT-P13 because no evidence is available regarding the clinical value of discontinuing biosimilars in patients with RA. Thus, we will evaluate whether a condition without clinical relapse will be maintained after discontinuation of CT-P13 in patients with RA, achieving clinical remission or low disease activity during the IFX-SIRIUS STUDY I. METHODS/DESIGN: This study is an interventional, multicenter, open-label, single-arm clinical trial with a 48-week follow-up. Patients with RA who are treated with CT-P13 and sustained nonclinical relapse during the IFX-SIRIUS STUDY I will be included. Patients will discontinue CT-P13 after the study period of the IFX-SIRIUS STUDY I. We will evaluate disease activity by clinical disease activity indices and musculoskeletal ultrasound (MSUS). The primary endpoint is the proportion of patients who do not have clinical relapse during the study period. Important secondary endpoints are the changes from the baseline of the MSUS scores. We will also comprehensively analyze the serum levels of multiple biomarkers, such as cytokines and chemokines. In addition, if a clinical relapse occurs in patients after the discontinuation of CT-P13, we will evaluate the effectiveness and safety of restarting CT-P13. DISCUSSION: The study results are expected to show the clinical benefit of the discontinuation of CT-P13 and effectiveness and safety of restarting CT-P13 after clinical relapse. The strength of this study is to prospectively evaluate the therapeutic effectiveness by not only clinical disease activity indices but also standardized MSUS findings in multiple centers. We will explore whether parameters at baseline can predict a nonclinical relapse after the discontinuation of CT-P13 by integrating multilateral assessments, that is, patient's characteristics, clinical disease activity indices, MSUS findings, and serum biomarkers. TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) on April 20, 2020 as jRCTs071200007.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Reumatoide/patologia , Medicamentos Biossimilares/administração & dosagem , Substituição de Medicamentos , Infliximab/administração & dosagem , Adulto , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Biomarcadores/análise , Estudos de Equivalência como Asunto , Feminino , Humanos , Quimioterapia de Indução , Japão , Masculino , Recidiva , Resultado do Tratamento , Ultrassonografia
7.
Ann Rheum Dis ; 79(9): 1189-1193, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32503859

RESUMO

OBJECTIVES: We have previously shown that neural network technology can be used for scoring arthritis disease activity in ultrasound images from rheumatoid arthritis (RA) patients, giving scores according to the EULAR-OMERACT grading system. We have now further developed the architecture of this neural network and can here present a new idea applying cascaded convolutional neural network (CNN) design with even better results. We evaluate the generalisability of this method on unseen data, comparing the CNN with an expert rheumatologist. METHODS: The images were graded by an expert rheumatologist according to the EULAR-OMERACT synovitis scoring system. CNNs were systematically trained to find the best configuration. The algorithms were evaluated on a separate test data set and compared with the gradings of an expert rheumatologist on a per-joint basis using a Kappa statistic, and on a per-patient basis using a Wilcoxon signed-rank test. RESULTS: With 1678 images available for training and 322 images for testing the model, it achieved an overall four-class accuracy of 83.9%. On a per-patient level, there was no significant difference between the classifications of the model and of a human expert (p=0.85). Our original CNN had a four-class accuracy of 75.0%. CONCLUSIONS: Using a new network architecture we have further enhanced the algorithm and have shown strong agreement with an expert rheumatologist on a per-joint basis and on a per-patient basis. This emphasises the potential of using CNNs with this architecture as a strong assistive tool for the objective assessment of disease activity of RA patients.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Reumatologia/métodos , Índice de Gravidade de Doença , Ultrassonografia/estatística & dados numéricos , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Articulações/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sinovite/diagnóstico por imagem , Ultrassonografia/métodos
8.
Ann Rheum Dis ; 79(7): 901-907, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32366522

RESUMO

OBJECTIVES: To investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA). METHODS: Baseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400). RESULTS: BE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer's V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1-132.8, p<0.01). CONCLUSIONS: In CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Doenças Ósseas/diagnóstico por imagem , Ultrassonografia , Adulto , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Doenças Ósseas/etiologia , Progressão da Doença , Feminino , Ossos do Pé/diagnóstico por imagem , Ossos do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
9.
Immunol Med ; 43(3): 115-120, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32393150

RESUMO

To compare therapeutic efficacy of tumour necrosis factor inhibitor (TNFi) cyclers and non-TNFi switchers in patients with rheumatoid arthritis (RA) having inadequate response to previous TNFis (TNF-IR patients) using composite measures including imaging assessment with power Doppler ultrasonography (PDUS). Patients with RA who had inadequate response to one or more previous TNFi agents with moderate or higher disease activity were enrolled. The outcomes of 56 TNF-IR patients were analysed. Patients were divided into 19 TNFi cyclers and 37 non-TNFi switchers (16 abatacept [ABT] and 21 tocilizumab [TCZ] switchers). Retention ratio at 6 months was significantly higher in non-TNFi switchers than in TNFi cyclers (p < .05). Although there was no significant difference, non-TNFi switchers tended to have a larger decrease than TNFi cyclers in efficacy indicators based on clinical disease activity index and PDUS. Multivariate logistic regression analysis identified a following independent factor associated with both EULAR good response and retention of a biologic agent: non-TNFi switch (p < .05 for both). Non-TNFi switchers were shown to have significantly higher percentage of EULAR good response and higher retention than TNFi cyclers. A non-TNFi biologic agent may hence be a preferential next-line treatment for TNF-IR patients.


Assuntos
Abatacepte/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Substituição de Medicamentos , Inibidores do Fator de Necrose Tumoral/administração & dosagem , Ultrassonografia , Abatacepte/efeitos adversos , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Inibidores do Fator de Necrose Tumoral/efeitos adversos
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(2): 202-208, 2020 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-32385026

RESUMO

Objective To explore the chest high-resolution computed tomography (HRCT) features in patients with rheumatoid arthritis (RA) complicated with pulmonary involvement. Methods Totally 161 patients with RA with lung involvement were collected from June 2014 to May 2018. The chest HRCT findings were retrospectively analyzed. According to the imaging features as well as the results of history taking,pulmonary function test,pathology,and bronchoalveolar lavage fluid test,RA-related lung diseases (RA-LD) were classified and their clinical characteristics were compared. Results These 161 RA-LD patients (56 males and 105 females) whose mean age at diagnosis was (60.7±12.8) years (14-85 years) included 87 cases of usual interstitial pneumonia (UIP) (including 16 cases of possible UIP),44 cases of non-specific interstitial pneumonia (NSIP),10 cases of organizing pneumonia,7 cases of lymphocytic interstitial pneumonia,9 cases of small airway disease (SAD) (including 8 cases of bronchiolitis obliterans and 1 case of follicular bronchiolitis),and 4 other lung manifestations (including 3 cases of diffuse alveolar hemorrhage and 1 case of rheumatoid nodules). The UIP group had the oldest average age [(63.3±12.1) years old] and the highest smoking rate (41.4%). The SAD group had the youngest average age [(54.7±15.1) years old] and there was no smoking history. There were significant differences between these two groups (P=0.020,P<0.001). Seventy patients (43.5%) with RA-LD were complicated with pleural lesions. Conclusions RA involving the lung is common and has varied imaging manifestations,with interstitial lung diseases (mainly UIP and NSIP) being the most important manifestations. RA patients should undergo lung HRCT as early as possible to identify the lung involvement and related types.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Feminino , Humanos , Pulmão , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Bone Joint J ; 102-B(4): 426-433, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228087

RESUMO

AIMS: To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps. METHODS: In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees posterior stabilized (PS) TKAs with patellar resurfacing in combination with adequate soft tissue balancing were used. RESULTS: Overall mean ROM in stiff knees increased preoperatively from 67° (0° to 80°) to 114° postoperatively (65° to 135°) (p < 0.001). Mean knee flexion improved from 82° (0° to 110°) to 115° (65° to 135°) and mean flexion contracture decreased from 14° (0° to 50°) to 1° (0° to 10°) (p < 0.001). The mean Knee Society Score (KSS) improved from 34 (0 to 71) to 88 (38 to 100) (p < 0.001) and the KSS Functional Score from 43 (0 to 70) to 86 (0 to 100). Seven knees (7%) required manipulations under anaesthesia (MUA) and none of the knees had flexion instability. The mean overall ROM in the control group improved from 117° (100° to 140°) to 123° (100° to 130°) (p < 0.001). Mean knee flexion improved from 119° (100° to 140°) to 123° (100° to 130°) (p < 0.001) and mean flexion contracture decreased from 2° (0° to 15°) to 0° (0° to 5°) (p < 0.001). None of the knees in the control group had flexion instability or required MUA. The mean KSS Knee Score improved from 48 (0 to 80) to 94 (79 to 100) (p < 0.001) and the KSS Functional Score from 52 (5 to 100) to 95 (60 to 100) (p < 0.001). Mean improvement in ROM (p < 0.001) and KSS Knee Score (p = 0.017) were greater in knees with preoperative stiffness compared with the control group, but the KSS Functional Score improvement was comparable (p = 0.885). CONCLUSION: TKA with a 2 mm increased flexion gap provided a significant improvement of ROM in knees with preoperative stiffness. While the improvement in ROM was greater, the absolute postoperative ROM was less than in matched non-stiff knees. PS TKA with patellar resurfacing and a 2 mm increased flexion gap, in combination with adequate soft tissue balancing, provides excellent ROM and knee function when stiffness of the knee had been present preoperatively. Cite this article: Bone Joint J 2020;102-B(4):426-433.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/cirurgia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Patela/cirurgia , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Scand J Rheumatol ; 49(3): 181-185, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32181696

RESUMO

Objective: Morning stiffness (MS) is characteristic of rheumatoid arthritis (RA). Despite its association with functional disability, the extent to which local inflammatory processes contribute to this symptom is unknown. Magnetic resonance imaging (MRI)-detected tenosynovitis of small joints is recognized as an early feature of RA, which is also associated with functional impairments. It has been proposed that tenosynovitis contributes to MS. Therefore, we assessed the relationship between MS and MRI-detected inflammation, in particular tenosynovitis.Method: In total, 286 consecutive patients newly presenting with undifferentiated arthritis and RA underwent contrast-enhanced 1.5 T MRI of (2-5) metacarpophalangeal, wrist, and (1-5) metatarsophalangeal joints. Scans were scored for tenosynovitis according to Haavardsholm, and for synovitis by Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). MS was dichotomized as ≥ 60 min or not. Associations between MS and tenosynovitis/synovitis were tested with logistic regression, data were categorized (solitary or simultaneous presence of synovitis/tenosynovitis), and the presence of an additive interaction was assessed.Results: MS was present in 40% of patients. Tenosynovitis was more often present in patients with MS than without MS [80% vs 65%, odds ratio (OR) 2.11, 95% confidence interval (1.21;3.69)]. Synovitis was more often present in patients with MS [58% vs 44%, OR 1.79 (1.11;2.91)]. In categorized analyses, concurrent synovitis and tenosynovitis had the largest association [OR 2.43 (1.30;4.54)], in contrast to solitary synovitis [OR 0.85 (0.21;3.47)]. The additive interaction was non-significant. The variance explained in all analyses was small (range 4-5%).Conclusion: Tenosynovitis, combined with synovitis, at small joints is associated with MS and contributes to the pathophysiology of MS.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Amplitude de Movimento Articular , Sinovite/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Articulação Metacarpofalângica/fisiopatologia , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Sinovite/fisiopatologia , Tenossinovite/fisiopatologia , Articulação do Punho/fisiopatologia
16.
Radiol Med ; 125(5): 481-490, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020529

RESUMO

OBJECTIVES: To systematically review the current literature concerning the role of superb microvascular imaging (SMI), a novel Doppler technique that enables detection of fine vessels and slow blood flow, in the evaluation of musculoskeletal disorders. METHODS: An online search of the literature was conducted for the period 2013 to April 2019 and included original articles written in English language. A data analysis was performed at the end of the literature search. RESULTS: Eight original articles with prospective design and one with retrospective design were included in this review: 4 studies focused on rheumatoid arthritis, 2 on rheumatoid and other arthritides, 1 on lateral epicondylosis and 2 on carpal tunnel syndrome. Sample size ranged from 26 to 83 patients. Despite some methodological differences, all studies compared the performance of SMI with that of a conventional Doppler technique such as power and color Doppler and found an improvement in vascularity detection with SMI. The main variations were in sample size, evaluated parameters and vascularity interpretation methods. Inter-observer agreement for SMI ranged from moderate to excellent. CONCLUSIONS: SMI is a promising tool for the diagnosis and treatment planning of different musculoskeletal disorders. Future investigations should include larger samples of patients with long-term follow-up.


Assuntos
Microvasos/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Velocidade do Fluxo Sanguíneo , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Microvasos/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Cotovelo de Tenista/diagnóstico por imagem , Cotovelo de Tenista/fisiopatologia , Ultrassonografia Doppler em Cores/métodos
17.
Radiology ; 295(1): 146-154, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32043949

RESUMO

Background Although tenosynovitis in the hands is associated with rheumatoid arthritis (RA), it is unknown whether tenosynovitis of the forefoot is associated with RA. Purpose To determine the anatomy of tendon sheaths of the forefoot and the relationship between MRI-detected tenosynovitis at metatarsophalangeal (MTP) joints and RA. Materials and Methods Fourteen forefeet of donated bodies were examined at flexor tendons and extensor tendons for the presence and course of tendon sheaths. In the prospective study between June 2013 and March 2016, newly presenting patients with RA, patients with other early arthritides, and healthy control participants all underwent MRI of unilateral MTP joints 1-5. MRI studies were scored by two independent readers for tenosynovitis, synovitis, and bone marrow edema. The association between the presence of these features and RA was examined by using logistic regression. Results Macroscopically, all extensor and flexor tendons crossing MTP joints demonstrated sheaths surrounding tendons. Microscopically, a synovial sheath was present. MRI evaluation was performed in 634 participants: 157 newly presenting patients with RA (109 women; mean age, 59 years ± 11 [standard deviation]), 284 patients with other early arthritides (158 women; mean age, 56 years ± 17), and 193 healthy control participants (136 women; mean age, 50 years ± 16). MRI-detected tenosynovitis was associated with RA, both when compared with patients with other arthritides (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.7, 3.9; P < .001) and healthy control participants (OR, 46; 95% CI: 14, 151; P < .001). The association was OR of 2.4 (95% CI: 1.5, 3.8; P < .001) for flexor tendons and OR of 3.1 (95% CI: 1.9, 5.2; P < .001) for extensor tendons. The sensitivity of tenosynovitis in RA was 65 of 157 (41%; 95% CI: 35%, 50%). The specificity for RA was 63 of 284 (78%; 95% CI: 72%, 82%) compared with other arthritides, and three of 193 (98%; 95% CI: 96%, 99%) compared with healthy control participants. Conclusion Tendons at metatarsophalangeal joints are surrounded by tenosynovium. MRI-detected tenosynovitis at metatarsophalangeal joints was specific for rheumatoid arthritis when compared with findings in patients with other arthritides and findings in healthy control participants. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Antepé Humano/diagnóstico por imagem , Imagem por Ressonância Magnética , Articulação Metatarsofalângica , Tendões/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Idoso , Artrite Reumatoide/complicações , Cadáver , Feminino , Antepé Humano/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tendões/anatomia & histologia , Tenossinovite/complicações
18.
Sci Rep ; 10(1): 1047, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31974480

RESUMO

Non-invasive imaging of arthritis activity in rheumatoid arthritis (RA) patients using macrophage PET holds promise for early diagnosis and therapeutic response monitoring. Previously obtained results with macrophage tracer (R)-[11C]PK11195 were encouraging, but the imaging signal could be further improved by reduction of background uptake. Recently, the novel macrophage tracer [18F]fluoro-PEG-folate was developed. This tracer showed excellent targeting of the folate receptor ß on activated macrophages in synovial tissue in a preclinical arthritic rat model. We performed three substudies to investigate the biodistribution, potential for imaging arthritis and kinetic properties of [18F]fluoro-PEG-folate in RA patients. Firstly, biodistribution demonstrated fast clearance of [18F]fluoro-PEG-folate from heart and blood vessels and no dose limiting uptake in organs. Secondly, [18F]fluoro-PEG-folate showed uptake in arthritic joints with significantly lower background and hence significantly higher target-to-background ratios as compared to reference macrophage tracer (R)-[11C]PK11195. Lastly, dynamic scanning demonstrated fast tracer uptake in affected joints, reaching a plateau after 1 minute, co-existing with a rapid blood clearance. In conclusion, this first in man study demonstrates the potential of [18F]fluoro-PEG-folate to image arthritis activity in RA with favourable imaging characteristics of rapid clearance and low background uptake, that allow for detection of inflammatory activity in the whole body.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Receptor 2 de Folato/metabolismo , Ácido Fólico/análogos & derivados , Macrófagos/fisiologia , Polietilenoglicóis/farmacocinética , Tomografia por Emissão de Pósitrons/métodos , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Diagnóstico Precoce , Feminino , Radioisótopos de Flúor/farmacocinética , Ácido Fólico/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Molecular/métodos , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/metabolismo
19.
Acad Radiol ; 27(7): 937-943, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31980382

RESUMO

RATIONALE AND OBJECTIVES: To evaluate the role of musculoskeletal ultrasound (MSUS) in the grading of rheumatoid arthritis (RA) wrist and hand joints and correlate it with clinical, laboratory, and radiological data. MATERIALS AND METHODS: A cross-sectional study recruited 50 patients in a tertiary care hospital. RA activity was assessed by DAS28. MSUS dorsal longitudinal scan was performed on the wrists, MCPs, and PIPS joints using high frequency (18 MHZ) linear transducer. 100 wrists in three different views, 500 MCPs, 500 PIPs were evaluated using the grayscale ultrasound and power Doppler ultrasound semiquantitative scale and scores ranging from 0-3. The results were correlated with clinical, laboratory and radiological data. All patients' wrist and hand joints X-rays were evaluated using the Larsen score. RESULTS: The mean age of the patients (49 females and one male) was 44.58 ± 10.07 years, and their mean disease duration was 16.26 ± 1.07 years. The mean DAS28 was 5.19 ± 0.95. 97.5% of joints had grade I Larsen score, 11.07% of the joints had erosions, 9.2% of the joints had effusions, 23.8% of the joints had synovial thickening, 11.9% of the joints showed PD signals and 3.5% of the joints were accompanied with tenosynovitis. Significant relations (p < 0.05) found among DAS28 and (PD signals, synovial thickening, tenosynovitis, effusion, and Larsen score). A nonsignificant relation (p > 0.05) among DAS28 and erosions detected by MSUS and X-ray. CONCLUSION: MSUS is powerful in the detection of early RA regarding synovitis, joint effusion, tenosynovitis, and bone erosions, which were correlated with clinical and laboratory parameters.


Assuntos
Artrite Reumatoide , Articulação da Mão , Adulto , Artrite Reumatoide/diagnóstico por imagem , Estudos Transversais , Feminino , Articulação da Mão/diagnóstico por imagem , Humanos , Articulações , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Ultrassonografia , Ultrassonografia Doppler , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
20.
Clin Exp Rheumatol ; 38(5): 917-924, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31969232

RESUMO

OBJECTIVES: Patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have an increased premature prevalence of atherosclerosis. We aimed to determine whether there are differences in the prevalence of classic cardiovascular risk factors between SLE and RA. We also analysed the effect of traditional cardiovascular risk factors on the development of subclinical atherosclerosis in both conditions and if some disease-characteristic features are associated with these traditional cardiovascular risk factors. METHODS: This was a cross-sectional study encompassing 602 individuals, 276 SLE and 326 RA patients. Subclinical atherosclerosis (presence of carotid plaques and carotid intima-media thickness [cIMT]) was determined by carotid ultrasonography. A multivariable regression analysis was performed to evaluate whether classic cardiovascular-related risk factors differentially influence subclinical carotid atherosclerosis in SLE compared to RA patients. RESULTS: Age (interaction factor [if] p=0.000), hypertension (if p=0.034), and diabetes (if p=0.037) had a higher effect on cIMT in RA than in SLE subjects. However, these traditional cardiovascular factors did not yield different effects on the presence of carotid plaques in RA and SLE when the univariate interaction was analysed. In addition, no differences were found in the influence of hypertension, diabetes, dyslipidaemia or current smoking on cIMT or carotid plaque after adjusting for demographics, the presence of other traditional cardiovascular factors, and disease-related data. Moreover, the additive effect of several cardiovascular risk factors on the subclinical carotid atherosclerosis did not differ between the two diseases. CONCLUSIONS: The influence of traditional cardiovascular risk factors on cIMT and carotid plaque is similar in RA and SLE.


Assuntos
Artrite Reumatoide , Aterosclerose , Doenças Cardiovasculares , Doenças das Artérias Carótidas , Lúpus Eritematoso Sistêmico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/epidemiologia , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Fatores de Risco
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