[Show abstract][Hide abstract] ABSTRACT: Objective. To provide information on the value of Patient Acceptable Symptom State (PASS) in rheumatoid arthritis (RA) by the
identification of PASS thresholds for patient-reported outcomes (PROs) composite scores. Methods. The characteristics of RA
patients with affirmative and negative assignment to PASS were compared. Contributors to physician response were estimated by
logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic (ROC) curve methods.
Results. 303 RA patients completed the study. All PROs were different between the PASS (+) and PASS (−) groups (𝑝 < 0.0001).
The thresholds with the 75th percentile approach were 2.0 for the RA Impact of Disease (RAID) score, 2.5 for the PRO-CLinical
ARthritisActivity (PRO-CLARA) index, and 1.0 for the Recent-OnsetArthritis Disability (ROAD) questionnaire.Thecut-off values
for Clinical DiseaseActivity Index (CDAI)were in themoderate range of disease activity.Assessing the size of the logistic regression
coefficients, the strongest predictors of PASS were the disease activity (𝑝 = 0.0007) and functional state level (0.006). Conclusion.
PASS thresholds were relatively high and many patients in PASS had moderate disease activity states according to CDAI. Factors
such as disease activity and physical function may influence a negative PASS.
BioMed Research International 06/2015; 2015(Suppl 2):8. DOI:10.1155/2015/930756 · 3.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ultrasound (US) is a cost-effective, noninvasive, accessible imaging modality that clinicians use at the point of care to assess disease activity and therapeutic efficacy in different rheumatic conditions. However, its utility has been prevalently demonstrated in the field of chronic arthritides. Only in the last few years there was an interest to explore the potential of US beyond the musculoskeletal area. In this way, preliminary US data about the assessment of the different targets involved in systemic sclerosis such as joints, tendons, skin, vessels, and lung have been provided. The main purpose of this US review is to provide an overview of the potential role of US in the multi-target assessment of SSc and to discuss the current evidence supporting its relevance and applications in daily clinical practice.
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p < 0.0001); the estimated prevalence in AS was 12.7 % and in axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) (p < 0.0001), only ASDAS had sufficient discriminatory ability to assess disease activity. The addition of only one marker of inflammation led to an adequate level of significance (ASDAS-CRP, p = 0.0018; ASDAS-ESR, p = 0.003). FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.
Rheumatology International 02/2014; 34(8). DOI:10.1007/s00296-014-2955-9 · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Digital ulcers (DU) affect 50% of systemic sclerosis (SSc) patients, representing a challenging clinical problem. Despite a high negative predictive value, capillaroscopic scores proposed to select patients at risk for DU show an inadequate positive predictive value, especially in patients without previous DU.
To increase the predictive value for DU development of capillaroscopy, through a predictive risk chart taking into account capillaroscopic, demographic, and clinico-serological parameters.
Two hundred and nineteen unselected SSc patients from 8 Italian Rheumatology Centers were consecutively enrolled during a 6-month period. Demographic, clinical, serological and instrumental data and capillaroscopy skin ulcers risk index (CSURI) were collected.
A multivariate logistic regression analysis showed a significant positive association between DU appearance and male gender, DU history, altered CSURI, and ESR. A prediction risk chart of the development of DU within 6 months were built on the basis of the above parameters. According to the risk level, four risk classes were identified: low (≤19.3%); medium (>19.3%, ≤58.6%); high (>58.6%, ≤89.2%), and very high risk (>89.2%).
The systematic evaluation of the above parameters can be helpful to identify patients at risk to develop DU optimizing preventive vasoactive therapy.
[Show abstract][Hide abstract] ABSTRACT: Background Several studies have been carried out in systemic sclerosis (SSc) in order to correlate the microvascular changes with the clinical features and organ involvement, most of them through qualitative or semiquantitative assessment of the morphological abnormalities forming the so-called scleroderma pattern. Quantitative studies about the scleroderma pattern (SP) arecurrently scarce and none is addressed to the relationship with the characteristics of the disease.
Objectives To evaluate in a series of SSc patients the association between the type and extent of the SP with both clinical features and disease severity.
Methods Fifty-four patients (47 women, mean age 59.5 yrs, median disease duration 13.0 yrs) consecutively enrolled, underwent nailfold videocapillaroscopy. For each patient, a total of 32 images were collected (4 images were representative of the entire nailfold per each finger). All images were classified according to the following patterns: normal, nonspecific, SP (with no reduction of the capillary density, with a slight reduction of the capillary density, and with avascular areas). The videocapillaroscopic patterns were correlated with several features as sex, age, disease duration, Raynaud’s phenomenon, digital ulcers (DU). Moreover, skin, muscle, gastrointestinal, pulmonary, heart and renal involvement were considered. Finally, the overall score of disease severity was calculated.
Results A total of 1728 images were analyzed. Patients were divided into 4 groups, on the basis of the extent ofthe SP. Ingroup 1 (6 pts) the extent was less than 25%, in group 2 (5 pts) the extent was between 25-50%, in group 3 (16 pts) between 50-75%, in group 4 (27 pts) the extent was more than 75%. Group 1 and group 2 showed no significant relationship with any of the variables considered. Patients in group 3 had a significant correlation with the presence of DU (p=0.007). Group 4 showed a significant correlation with disease severity (p=0.034), history of DU (p=0.045) and the presence of active DU (p=<0.0001). The extent of SP without reduction of the capillary density was correlated with calcinosis (p=0.036) and renal involvement (p=0.025). The extent of SPwith a slight reduction of capillary density was not associated with any clinical characteristic. The extent of SP with avascular areas showed a significant relationship with disease severity (p=0.001), lung fibrosis (p=0.014), gastrointestinal involvement (p=0.014), skin involvement (p=0.037), history of DU(p=0.045), active DU (p=0.001). No association was found between patterns and disease duration.
Conclusions Disease severity in SSc patients was significantly associated with a greater extent of the SP. The correlation observed between the presence of DU and/or history of DU both with the extent of the SP and the avascular areas represents a relevant data, confirming the hypothesis of a strong relationship between the peripheral vascular involvement and the degree of nailfold vascularisation. The lack of correlation between the type and extent of the SP with the disease duration supports the concept that the severity of microangiopathy is not a characteristic of the late stages of the SSc.
Disclosure of Interest None Declared
Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A653-A653. DOI:10.1136/annrheumdis-2013-eular.1941 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Nailfold videocapillaroscopy (VCP) has gained considerable interest by rheumatologists over the past years due its utility in both clinical practice and research, and has become an established method to assess the microcirculation “status” in patients with Raynaud’s phenomenon (RP) and systemic sclerosis (SSc). Although it has been demonstrated that technical skills in VCP can quickly be attained (1), the recognition and interpretation of both the “normal” VCP pattern and the pathological findings, typical of the “scleroderma pattern” (SP), require more time and a more careful standardization.
Objectives To test the learning curve of four rheumatologists with little or no experience in VCP who attended an intensive training programme focused on the interpretation of the normal pattern, the main capillary abnormalities and SP, and to determine the inter-reader agreement compared with an experienced investigator.
Methods Five investigators (1 senior, 1 junior with little experience in VCP and 4 beginners) participated in the exercise. The study consisted of two steps. In the first step, an independent investigator selected representative VCP images of normal patterns and SP patterns. The second step included the training programme that was run for 4 hours per day for seven days. The senior investigator provided the basic knowledge to recognize and interpret the normal pattern, the capillary abnormalities, such as giant capillaries, irregularly enlarged capillaries, micro-haemorrhages, and the different types of SP, according to Maricq (classification A) and Cutolo (classification B) (2,3).
Results A total of 300 VCP images were assessed by all the investigators. Both k-values and overall agreement percentages of qualitative and quantitative assessments showed a progressive improvement, from poor to excellent, from the beginning to the end of the exercise. According to the classification A, the global κ values in the first session were 0.468 for the junior and 0.394, 0.529 and 0.514 for the 1st, 2nd and 3rd beginner respectively, whereas in the last session were 0.812 for the junior and 0.842, 0.844 and 0.794 for the 1st, 2nd and 3rd beginner respectively. For the classification B the global κ values in the first session were 0.349 for the junior and 0.391, 0.398 and 0.397 for the 1st, 2nd and 3rd beginner respectively whereas they were 0.786 for the junior and 0.812, 0.743 and 0.832 for 1st, 2nd and 3rd beginner, respectively, in the last session. Both sensitivity and specificity in the assessment of SP at the last session of reading were high (100% and 86% for the junior; 99% and 79% for the 1st beginner; 99% and 82% for the 2nd beginner; 98% and 79% for the 3rd beginner).
Conclusions Our pilot study suggests that after a short intensive, one-week training programme, novice investigators in VCP are able to correctly assess the normal pattern and the SP achieving good inter-reader agreement rates.
Disclosure of Interest None Declared
Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):611-612. DOI:10.1136/annrheumdis-2012-eular.3359 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background There is an increasing evidence supporting power Doppler (PD) ultrasound as a sensitive imaging technique for the assessment of disease activity and therapy monitoring in patients with chronic arthritis, including psoriatic arthritis (PsA). The recent availability of probes with Doppler frequency higher than 10 MHz allows the detection of even minimal blood flow changes of superficial targets such as nail and skin (1).
Objectives To investigate the role of PD ultrasound for the assessment of blood flow changes induced by anti-TNFα therapy at five target areas (joint, tendon, enthesis, skin and nail) in patients with PsA.
Methods Sixteenpatients with diagnosis of PsA (receiving different anti-TNFα: 9 adalimumab, 4 etanercept and 3 infliximab),and clinical involvement of multiple targets (joint, tendon, enthesis, skin, nail) were enrolled. Before the PD ultrasound assessment all patients underwent a clinicalexamination aimed to detect tenderness and/or swellingat joints, tendons, and entheses level. Moreover, HAQ modified for spondyloarthritis (-S), PASI and NAPSI were assessed. At baseline, all clinically involved targets were scannedand those showing the highest expression of PD signal, one for each target area, were selected to be scanned at follow-up visit 8 weeks after. For each target a semi-quantitative PD scoring (0 to 3) was used. Clinical and PD assessments were performed on the same day both at baseline and at follow-up visit.
Results A total of 60 targets (16 joints, 9 tendons, 11 enthesis, 16 psoriatic plaques and 8 psoriatic nails) were assessed. A significant improvement of the clinical scores was found at follow-up with respect to the baseline: HAQ-S [mean ± SD: 0.88±0.20 vs 0.47±0.12 respectively (p=0.0001)]; PASI [mean ± SD: 17.5±5.3 vs 8.0±2.7 respectively (p=0.0001)] and NAPSI [mean ± SD: 2.2±2.6 vs 0.8±1.0 respectively (p=0.35)]. PD ultrasound findings at baseline and follow-up were: joint [median; range: 2.5; 1-3 vs 1; 0-2, respectively (p=0.0001)], tendon [median; range: 2; 0-3 vs 0; 0-1, respectively (p=0.04)]; enthesis [median; range: 1.5; 0-2 vs 0 0-2, respectively (p=0.04)], skin [median; range: 3; 2-3 vs 0.5; 0-2, respectively (p=0.0001)] and nail [median: range: 0; 0-1 vs 0; 0-1, respectively (p=0.3657)]. There was no significant correlation between HAQ-S and PD ultrasound findings (p=0.51)at baseline and at follow-up (p=0.93), respectively.The mean time (± SD) spent on baseline ultrasound examinations was: 10.5 (± 2.0) minutes and no more than 7 (± 1.5) minutes for follow-up assessment.
Conclusions PD ultrasound provides a useful and feasible method for short-term multi-target monitoring of anti-TNFα therapy effect in patients with PsA. Ongoing investigation including a wider cohort of patients, more centres and testing the reproducibility will provide further information regarding the advantages and limitations of this multi-target approach in patients with PsA.
Disclosure of Interest None Declared
Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):692-692. DOI:10.1136/annrheumdis-2012-eular.943 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To determine the sensitivity, specificity, and accuracy of ultrasound (US) in the detection of cartilage calcification at knee level in patients with calcium pyrophosphate deposition disease (CPDD) and to assess the interobserver reliability. Methods
Seventy-four CPDD patients and 83 controls with other chronic arthritis were included. All patients underwent a clinical examination, synovial fluid analysis, and radiographic assessment of the knee. US examinations were performed in order to detect hyperechoic spots within the hyaline cartilage layer and hyperechoic areas within the meniscal fibrocartilage. Twenty patients were assessed by 2 operators in order to calculate the interobserver reliability. ResultsA total of 314 knees in 157 patients (74 with CPDD, 19 with rheumatoid arthritis, 17 with spondyloarthritis, 32 with osteoarthritis, and 15 with gout) were assessed. In the 74 patients with CPDD, hyaline cartilage spots were detected by US in at least 1 knee in 44 patients (59.5%), whereas radiography detected hyaline cartilage spots in 34 patients (45.9%) (P < 0.001). Meniscal fibrocartilage calcifications were detected by US in 67 of the 74 CPDD patients (90.5%), whereas conventional radiography detected calcifications in 62 patients (83.7%) (P = 0.011). The criterion validity expressed as percentage of sensitivity, specificity, and accuracy of US in the detection of articular cartilage calcification was high. Both kappa values and overall agreement percentages showed moderate to excellent agreement. ConclusionUS is an accurate and reliable imaging technique in the detection of articular cartilage calcification at knee level in patients with CPDD.
[Show abstract][Hide abstract] ABSTRACT: Objectives
To systematically review the evidence for a synergistic effect of combining rehabilitation with biological anti-tumour necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS).
Data were analysed to identify the most effective rehabilitation programmes, the best endpoints for effectiveness, and patient subgroups most likely to benefit from combination therapy. Systematic Medline and Embase searches were performed to identify studies evaluating rehabilitation programmes and biological therapy in patients with AS. Evidence was categorised by study type, and efficacy, adverse effects, and other outcomes were summarised.
Of the 75 studies identified; 13 investigated the combination of a rehabilitation programme with TNF inhibitor therapy while the remainder studied rehabilitation with standard therapy (often not specified). Data from these few studies suggest that combined rehabilitation plus anti-TNF therapy is more effective in terms of symptom severity, disease activity, disability and quality of life indices versus biologic alone or rehabilitation with standard medical therapy, or, in non-comparative studies, compared with baseline. The most effective rehabilitation appears to be supervised or in-patient programmes with an educational component. Available data do not provide guidance on most appropriate endpoints or identify patients most likely to benefit from combination therapy. Combined, TNF inhibitor and rehabilitation therapy appear to have a synergistic effect, possibly due to increased adherence to exercise. Exercise regimes are more effective if supervised and include an education component.
Further randomized, controlled trials comparing endpoints and investigating longer-term benefits of combining TNF inhibitors with rehabilitation in different AS subgroups are needed.
Seminars in arthritis and rheumatism 01/2014; 44(5). DOI:10.1016/j.semarthrit.2014.09.012 · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nailfold capillaroscopy has been extensively applied in a broad spectrum of pathologic conditions, but very few data have been published in healthy individuals. The aim of this study was to describe the nailfold capillary findings on a large series of healthy subjects using the video-capillaroscopy technique. Nailfold capillaries were studied based on their morphology, dimensions and density. Then, to evaluate jointly the association between different capillary findings groups of subjects which were homogeneous for their characteristics, cluster analysis was performed. The results (median) of capillary measurements were as follows: loop length 207 μm, external diameter 39 μm, internal diameter 17 μm, apical diameter 17 μm, intercapillary distance 143 μm. Based on the cluster analysis three major "normal" morphologic capillaroscopic patterns were depicted: 1) the "perfect normal" pattern mainly with 2 to 5 U shaped loops /mm and≤2 tortuous loops /mm; 2) the "normal" pattern with≥5 U shaped loops /mm and 3) the "unusual normal" with at least 1 meandering or bushy loop, or at least 1 microhaemorrhage, or with >4 crossed loops /mm. Regarding the loop measurements, the majority of subjects had a median of 7 capillaries/mm with a median length of 198 micron.
Microvascular Research 07/2013; 90. DOI:10.1016/j.mvr.2013.07.001 · 2.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To observe for changes in capillary morphology and architecture by tight sequential videocapillaroscopic (VCP) assessment in patients with dermatomyositis (DM) and systemic sclerosis (SSc).
VCP examination was performed in 6 patients with DM and 9 with SSc, at baseline and after one month for three times. Four consecutive fields were examined bilaterally for any single finger (from 2nd to 5th). The best visible image per each digit was selected and images from baseline and follow-up were analysed as a sequence, to allow the same capillaries to be tracked and re-assessed. The following abnormalities were identified: homogeneous enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhaemorrhages, microaneurysms and neoangiogenesis. Capillary density was also considered.
A significant progressive change of the following abnormalities was detected in DM patients with respect to SSc patients: microhaemorrhages (p=0.009), avascular areas (p=0.024), neoangiogenesis (p=0.001), microaneurysms (0.001), and irregular enlarged capillaries (p=0.044). No significant differences were found for homogeneous enlarged capillaries (p=0.140), giant capillaries (p=1.0) and hairpin/crossed capillaries (0.516).
Our preliminary study demonstrated a rapid change of the capillary morphology and architecture in DM with respect to SSc patients. Additional investigations involving larger series of patients may be useful to support more strongly our observations.
[Show abstract][Hide abstract] ABSTRACT: To test the learning curve of rheumatologists with different experience in videocapillaroscopy (VCP) attending an intensive training program focused on interpretation of the main capillary nailfold abnormalities, the scleroderma (systemic sclerosis, SSc) pattern, and the normal pattern, and to determine their interreader agreement with an experienced investigator.
Five investigators (1 senior, 1 junior, and 3 beginners) participated in the exercise. The study was composed of 2 steps. First, an independent investigator selected representative VCP images of normal patterns and capillary abnormalities. The second step included the training program, which ran 4 hours per day for 7 days. The senior rheumatologist taught investigators to recognize and interpret the normal pattern, the capillary abnormalities, and the different types of SSc pattern. These abnormalities were considered: homogeneously enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhemorrhages, neoangiogenesis, avascular areas, and capillary density.
A total of 300 VCP images were read from all the investigators. Both κ values and overall agreement percentages of qualitative and quantitative assessments showed progressive improvement from poor to excellent from the beginning to the end of the exercise. The sensitivity and specificity of the participants in the assessment of SSc pattern at the last lecture session were high.
Our pilot study suggests that after an intensive 1-week training program, novice investigators with little or no experience in VCP are able to interpret the main capillary abnormalities and SSc pattern and to achieve good interreader agreement rates.
The Journal of Rheumatology 04/2012; 39(6):1248-55. DOI:10.3899/jrheum.111299 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate (MSU) crystals in the joints and soft tissues, consisting of a self-limited acute phase characterized by recurrent attacks of synovitis and a chronic phase in which inflammatory and structural changes of the joints and periarticular tissues may lead to persistent symptoms. Acute gout is characterized by a sudden monoarthritis of rapid onset, with intense pain, mostly affecting the big toe (50% of initial attacks), the foot, ankle, midtarsal, knee, wrist, finger, and elbow. Acute flares also occur in periarticular structures, including bursae and tendons. The presence of characteristic MSU crystals in the joint fluid, appearing needle-like and showing strong negative birefringence by polarized microscopy, is pivotal to confirm the diagnosis of gout. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. During the period between acute attacks the patient is asymptomatic even if MSU deposition may continue to increase silently. The factors that control the rate, location, and degree of ongoing deposition in gouty patients are not well defined. Chronic gout is the natural evolution of untreated hyperuricemia in patients with gouty attacks followed by pain-free intercritical periods. It is characterized by the deposition of solid MSU crystal aggregates in a variety of tissues including joints, bursae and tendons. Tophi can occur in a variety of locations including the helix of the ear, olecranon bursa, and over the interphalangeal joints. Their development is usually related with both the degree and the duration of hyperuricemia. About 20% of patients with gout have urinary tract stones and can develop an interstitial urate nephropathy. There is a strong association between hyperuricaemia and the metabolic syndrome (the constellation of insulin resistance, hypertension, obesity and dyslipidaemia), and gouty patients often have a medical history of kidney disease, diabetes mellitus and signs of vascular illness such as coronary artery disease, heart failure and stroke, resulting with a poor overall quality of life.
[Show abstract][Hide abstract] ABSTRACT: Introduction The early detection of systemic sclerosis (SSc) patients at high risk of developing digital ulcers could allow preventive treatment, with a reduction of morbidity and social costs. In 2009, a quantitative score, the capillaroscopic skin ulcer risk index (CSURI), calculated according to the formula 'D×M/N(2'), was proposed, which was highly predictive of the appearance of scleroderma digital ulcers within 3 months of capillaroscopic evaluation.
This multicentre study aims to validate the predictive value and reproducibility of CSURI in a large population of SSc patients.
CSURI was analysed in 229 unselected SSc patients by nailfold videocapillaroscopy (NVC). All patients were re-evaluated 3 months later with regard to the persistence and/or appearance of new digital ulcers.
57 of 229 patients presented with digital ulcers after 3 months. The receiver operating characteristic curve analysis showed an area under the curve of 0.884 (95% CI 0.835 to 0.922), with specificity and sensitivity of 81.4% (95% CI 74.8 to 86.89) and 92.98% (95% CI 83.0 to 98.0), respectively, at the cut-off value of 2.96. The reproducibility of CSURI was validated on a random sample of 81 patients, with a κ-statistic measure of interrater agreement of 0.8514.
The role of CSURI was confirmed in detecting scleroderma patients with a significantly high risk of developing digital ulcers within the first 3 months from NVC evaluation. CSURI is the only method validated to predict the appearance of digital ulcers and its introduction into routine clinical practice might help optimise the therapeutic strategy of these harmful SSc complications.
Annals of the rheumatic diseases 09/2011; 71(1):67-70. DOI:10.1136/annrheumdis-2011-200022 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Carpal tunnel syndrome, the most common peripheral neuropathy, results from compression of the median nerve at the wrist, and is a cause of pain, numbness and tingling in the upper extremities and an increasingly recognized cause of work disability. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated. Moreover, it has suggested that patients reduce activities at home and work that exacerbate symptoms. Pyridoxine and diuretics, since are largely utilised, are no more effective than placebo in relieving the symptoms. Non steroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injection may improve symptoms for a longer period. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness, and if symptoms are intermittent rather than constant. If symptoms are refractory to conservative measures, the option of surgical therapy may be considered.
[Show abstract][Hide abstract] ABSTRACT: There is a growing number of papers investigating the diagnostic potential of ultrasonography in the assessment of patients with psoriatic arthritis and supporting its higher sensitivity over clinical examination in the diagnosis of synovitis, enthesitis and tenosynovitis. Less attention has been paid on both skin and nail, frequently involved in this condition. The aim of this paper is to show the potential of ultrasound in a multi-target assessment (joints, tendons, entesis, skin and nails) in patients with psoriatic arthritis, using the last generation ultrasound equipment.
[Show abstract][Hide abstract] ABSTRACT: The main aim of the present study was to determine the prevalence of subclinical entheseal involvement at lower limbs by ultrasound (US) in patients with psoriasis. The secondary aim was to determine the interobserver reliability of the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and power Doppler (PD) technique in the assessment of enthesopathy.
The study was conducted on 45 patients with psoriasis and 45 healthy sex- and age-matched controls. All patients with no clinical evidence of arthritis or enthesitis underwent an US examination. All US findings were identified according to GUESS. The interobserver reliability was calculated in 15 patients with psoriasis.
A total of 450 entheses in 45 patients with psoriasis were evaluated by US. In 148 of 450 (32.9%) entheses, grayscale US found signs indicative of enthesopathy. In 4/450 (0.9%) entheses PD signal was detected. In the healthy population, US found signs of enthesopathy in 38 of 450 (8.4%) entheses and no PD signal was detected. The GUESS score was significantly higher in patients with psoriasis than in healthy controls (P < 0.0001). Both concordance correlation coefficient and unweighted κ values for US findings showed an excellent agreement (0.906 and 0.890, respectively).
Our results indicate that both grayscale US and PD findings indicative of enthesopathy were more frequent in patients with psoriasis. The US ability to detect signs of subclinical enthesopathy should be the object of longitudinal investigations to define its value in predicting the clinical onset of psoriatic arthritis.
Seminars in arthritis and rheumatism 04/2011; 40(5):407-12. DOI:10.1016/j.semarthrit.2010.05.009 · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the role of elastosonography to improve the reliability of the ultrasound in the measurement of the dermal thickness at finger level in systemic sclerosis (SSc).
Twenty-two patients with a diagnosis of SSc were consecutively recruited. In all patients at the second finger level of the dominant hand the dorsal aspect of proximal and middle phalanx was assessed in grey-scale and also using the elastosonography by an experienced musculoskeletal sonographer. The first step of the study was directed to explore the correlation between measurements of the dermal thickness using the grey-scale and elastosonography. Subsequently, the intra and the inter-reader reliability (between the sonographer who performed the ultrasound study and another sonographer) in the ultrasound measurements of the dermal thickness was assessed. Intra and inter-reader reliability was calculated using intra-class correlation coefficient (ICC) and illustrated by Bland-Altman plots.
The ICC values were 0.904 and 0.979 for the intra-observer agreement, and 0.726 and 0.881 for the inter-observer agreement, using only the grey-scale and also the elastosonography, respectively. An excellent correlation was obtained between measurements in grey-scale and adopting the elastosonography by the experienced sonographer (rho=0.99), while the rho values between the two readers were 0.59 and 0.88, using the conventional technique and also the elastosonography, respectively.
Elastosonography can improve the reliability of the US measurements of the dermal thickness at finger level in patients with SSc, helping for the identification of the interface dermis/hypodermis.
Clinical and experimental rheumatology 01/2011; 29(6):926-32. · 2.72 Impact Factor