EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT.

OBJECTIVES: To develop evidence-based recommendations for the diagnosis of hand osteoarthritis (OA). METHODS: The multidisciplinary guideline development group, representing 15 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched for systematically. Whenever possible, the sensitivity, specificity and likelihood ratio (LR) were calculated; relative risk and odds ratios were estimated for risk factors for hand OA. Quality of evidence was categorised using the European League Against Rheumatism (EULAR) hierarchy, and strength of recommendation was assessed by the EULAR visual analogue scale. RESULTS: Diagnostic topics included clinical manifestations, radiographic features, subgroups, differential diagnosis, laboratory tests, risk factors and comorbidities. The sensitivity, specificity and LR varied between tests depending upon the cut-off level, gold standard and controls. Overall, no single test could be used to define hand OA on its own (LR <10) but a composite of the tests greatly increased the chance of the diagnosis. The probability of a subject having hand OA was 20% when Heberden nodes alone were present, but this increased to 88% when in addition the subject was over 40 years old, had a family history of nodes and had joint space narrowing in any finger joint. CONCLUSION: Ten key recommendations for diagnosis of hand OA were developed using research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features.

Comparative evaluation of various methods of detecting antibodies against soluble nuclear antigens.

Results of anti-ENA antibody employing double diffusion in agar gel, electroimmunoprecipitation (CIE) or passive hemagglutination were compared. The studies were performed on 164 patients including 79 patients with rheumatoid arthritis (RA), 46 patients with systemic lupus erythematosus (SLE), 25 patients with systemic sclerosis (PSS), 13 patients with polymyositis (PM) 5 patients with MCTD and on 30 healthy individuals. The obtained data prompt us to recommend demonstration and identification of anti-ENA antibodies in a screening type CIE assay followed by determination of their titer by hemagglutination test.

Serological abnormalities in families of patients with rheumatoid arthritis: eight to twelve years follow-up study.

Serum gammaglobulin level, the presence of rheumatoid factor and of anti-nuclear antibodies were re-examined after 8 to 12 years in families of 21 seropositive rheumatoid arthritis patients. In the time 8 members of the families developed rheumatoid arthritis and the number of persons with elevated serum gammaglobulins increased. Rheumatoid tests yielded variable results. No relationship could be demonstrated between development of disease symptoms and the earlier presence of rheumatoid factor.

Relationship between antinuclear antibodies and differential cell counts in synovial fluid of patients with rheumatoid arthritis.

Presence and titres of organ non-specific and granulocyte-specific antinuclear antibodies (ON-ANA and GS-ANA) were studied in 100 samples of synovial fluids taken from 95 patients with seropositive rheumatoid arthritis and in corresponding sera. At the same time the white cell count as well as the percentage of granulocytes and granulocytes with pycnotic or fragmented nuclei (PGS and FGS, respectively) were evaluated in the synovial fluid sediment. Twenty six percent of synovial fluid samples were positive for ON-ANA and the same percentage of samples were positive for GS-ANA. Titres of GS-ANA showed a clear inverse correlation with the number of granulocytes. The rate of PGS as well as of FGS increased with the titer of both types of studied ANA, however, a significant correlation was observed only between the percentage of these cells and GS-ANA. Differences in specificity and titres of ANA were demonstrated in samples of synovial fluids taken at the same time from both knee joints of 5 patients under study. The differences were also noticed when the specificity and titer of ANA present in synovial fluid and serum samples were compared. A case of rheumatoid arthritis showing sudden appearance of numerous plasma cells in the synovial fluid in course of the disease is presented. This patient initially had no ANA in the synovial fluid or in serum, but ANA were detected at the time of synovial fluid plasmacytosis. These data indicate that a local production of ANA is likely to take place in ANA positive rheumatoid arthritis.

[The history of internal medicine in Poznan from the year 1919]. / Dzieje szpitalnictwa poznanskiego w zakresie chorób wewnetrznych od 1919 roku.

After the 1st World War (1914-1918) the greatest influences in the development of internal medicine were the foundation of Poznán University and its first Dean Prof. H. Swiecicki - a physician. Due to cooperation with Prof. A. Wrzosek the School of Medicine was created. In addition to those mentioned above were the first creators of internal medicine Professors: W. Jezierski, J. Lubieniecki and I. Hoffmann. During World War II Poznan medicine suffered badly. After the War there was a renewal of Poznan and in internal medicine appeared excellent leaders: prof. J. Roguski, prof. S. Kwasniewski and prof. F. Labendzinski. Thanks to them 1st 2nd and 3rd Departments of Internal Medicine transformed in narrow specialized departments integrated in the Institute of Internal Disease and led by prof. K. Jasinski and his vice head prof. J. Hasik and prof. M. Gembicki. In the 1985 there appeared from Internal Institute the Institute of Cardiology with the head prof. A. Cieslinski. There was also overworked the status of out-clinic internal medicine (prof. I. Zimmerman-Górska, dr W. P. Kasprzak).

Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database.

OBJECTIVE: To determine the prevalence of and independent factors associated with joint involvement in a large population of patients with systemic sclerosis (SSc). METHODS: This study was cross-sectional, based on data collected on patients included in the European League Against Rheumatism (EULAR) Scleroderma Trials and Research (EUSTAR) registry. We queried this database to extract data regarding global evaluation of patients with SSc and the presence of any clinical articular involvement: synovitis (tender and swollen joints), tendon friction rubs (rubbing sensation detected as the tendon was moved), and joint contracture (stiffness of the joints that decreased their range of motion). Overall joint involvement was defined by the occurrence of synovitis and/or joint contracture and/or tendon friction rubs. RESULTS: We recruited 7286 patients with SSc; their mean age was 56 +/- 14 years, disease duration 10 +/- 9 years, and 4210 (58%) had a limited cutaneous disease subset. Frequencies of synovitis, tendon friction rubs, and joint contractures were 16%, 11%, and 31%, respectively. Synovitis, tendon friction rubs, and joint contracture were more prevalent in patients with the diffuse cutaneous subset and were associated together and with severe vascular, muscular, renal, and interstitial lung involvement. Moreover, synovitis had the highest strength of association with elevated acute-phase reactants taken as the dependent variable. CONCLUSION: Our results highlight the striking level of articular involvement in SSc, as evaluated by systematic examination in a large cohort of patients with SSc. Our data also show that synovitis, joint contracture, and tendon friction rubs are associated with a more severe disease and with systemic inflammation.