S. Seric

Institut za onkologiju i radiologiju Srbije, Beograd, Central Serbia, Serbia

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Publications (6)43.94 Total impact

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    ABSTRACT: Background Gray scale ultrasound (US) detects from 2 up to 9 times more erosions on B mode scans than standard radiographs of hand and feet in patients with rheumatoid arthritis (RA). Nowadays, mainly for research purposes, US erosions of small joints were semiquantitatively scored 0–3 according to the Szkudlarek and Scoring by UltraSound Structural erosion (ScUSSe) systems, respectively. Objectives To assess the construct validity of new US erosion score (USES) and ability of new method to detect erosions of small joints in patients with RA as well as to suggest a new USES for erosion quantification. Methods Sixty-three patients (48 females and 15 males) with clinically active disease were prospectively recruited at the Institute of Rheumatology, Belgrade, Serbia. All of them were treated with Methotrexate, or with other DMARDs, including biologic agents. The study was conducted in agreement with the Declaration of Helsinki and was approved by relevant ethics committee. The mean age of patients (S.D.) was 54.7 (12.7) years (range 24-78 years) and the mean disease duration was 28.8 (29.0) months (range 4-156 months). Forty-six pts (73.0%) were rheumatoid factor positive, and 45 pts (71.4%) anti-CCP positive. The patients underwent clinical and laboratory assessment, along with blinded power Doppler US (PDUS) and grey-scale (GS) US (GSUS) examination. A GSUS examination for presence, total surface, and total volume of erosions on 22 joints (2 wrists, 10 metacarpophlangeal joints – MCPs, and 10 metatarsophalangeal joints – MTPs) was performed by two independent examiners, blinded to clinical findings. GSUS examinations were based on standard EULAR reference scans, using US workstation Esaote My Lab 70xvg with 18 MHz linear probe. Surface USES (sUSES) was calculated as a sum of multiplications of long axis with short axis diameters of erosions, and volumetric USES (vUSES) as a sum of multiplications of long axis diameter, short axis diameter, and depth diameter of erosions. Results Five thousand five hundred and forty-four joint quadrants and 1386 joints were examined by two ultrasound operators. Erosions were detected by US in 264 (19,0%) joints. Strong positive linear correlation was found between s USES, vUSES and standard radiographic damage index, such as Sharp van der Heijde score (r=0.66, and r=0.67, respectively, p<0.001). Correlations between sUSES and vUSES with DAS28, HAQ, levels of ESR and CRP were weak and statistically insignificant, except between sUSES with serum levels of CRP (r=0.30, p<0.02). Conclusions Owing to our findings of strong positive linear correlation with the most utilized radiographic score (Sharp van der Heijde score), surface and volumetric ultrasound erosion scores showed at least decent ability to measure damage of hand and feet joints in patients with rheumatoid arthritis. Our next step in development of ultrasound erosion scores will be assessment of reliability and sensitivity to change of these scores in patients with early rheumatoid arthritis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2918
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Objectives To evaluate bone erosions of MTP5 joints in early rheumatoid arthritis (RA) patients (pts) without structural radiographic changes by echosonography and to investigate clinical importance of autoantibodies against citrullinated peptides/proteins (ACPA) and rheumatoid factor (RF) in its detection. Methods A group of 120 patients (85 female) with early RA (≤1 year duration, mean duration 5.4 month, (Eular 2010 classification criteria) were enrolled in the cross sectional study. None of the patients had erosions on radiographs of hands and feet and were not previously treated with DMARDs and/or glucocorticoid. Ultrasound (US) examination of MTP5 joints was performed by Esaote My Lab 70 machine equipped with 8-18 MHz linear probe. Finding of bone erosion was defined according to OMERACT US group definition. The following laboratory parameters in sera of pts were monitored: presence and concentration of ACPA, presence of RF, erythrocyte sedimentation rate (ESR) and level of CRP. Collected data were analyzed in SPSS 16 system. Results A 240 MTP5 joints out of 120 pts were assesed by US.The MTP5 bone erosion was found at 74 (61.7%) pts. Among 120 pts 88 pts were ACPA positive with 257.1 IU/ml mean concentration and 83 pts were RF positive. There was no statistically significant difference between group of pts with and without US detected bone erosions regarding age of pts (56.9 yr. vs 52.5 yr, p=0.333), duration of RA (5.8 vs 4.8 months, p=0.712) and ESR (60.2 vs 50.5, p=0.825). Patients with MTP 5 US detected bone erosion had statistically significant higher concentration of ACPA than pts without US detected bone erosions, (323.8 vs 151.3, p=0.005) and higher level of CRP (39.7 g/l vs 25.3 g/l, p=0.024). Sixty-one ACPA positive pts and 13 ACPA negative had US detected MTP5 bone erosions in opposite to 27 ACPA positive and 19 ACPA negative pts without them. The difference was statistically significant (p=0.01). Fifty-five pts with MTP5 US detected bone erosion had positive RF and 19 pts had RF negative in contrast to 28 RF positive and 18 RF negative pts without them. The difference was not statistically significant (p=0.155). The 0.66 value of the area under the ROC curve was found for ACPA and 0.57 value for RF. The 66% sensitivity and 61% specificity of ACPA and 74% sensitivity and 29% specificity of RF was established in detection of US MTP5 bone erosion for value on 174 of cut off. Conclusions Erosions of MTP 5 joints were detected by echosonography in 62% of early rheumatoid arthritis patients without erosions visible on X-ray. ACPA positivity was weakly associated with presence of MTP5 erosions. There was no significant correlation between US bone erosions and RF positivity. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4252 Objectives To evaluate bone erosions of MTP5 joints in early rheumatoid arthritis (RA) patients (pts) without structural radiographic changes by echosonography and to investigate clinical importance of autoantibodies against citrullinated peptides/proteins (ACPA) and rheumatoid factor (RF) in its detection. Methods A group of 120 patients (85 female) with early RA (≤1 year duration, mean duration 5.4 month, (Eular 2010 classification criteria) were enrolled in the cross sectional study. None of the patients had erosions on radiographs of hands and feet and were not previously treated with DMARDs and/or glucocorticoid. Ultrasound (US) examination of MTP5 joints was performed by Esaote My Lab 70 machine equipped with 8-18 MHz linear probe. Finding of bone erosion was defined according to OMERACT US group definition. The following laboratory parameters in sera of pts were monitored: presence and concentration of ACPA, presence of RF, erythrocyte sedimentation rate (ESR) and level of CRP. Collected data were analyzed in SPSS 16 system. Results A 240 MTP5 joints out of 120 pts were assesed by US.The MTP5 bone erosion was found at 74 (61.7%) pts. Among 120 pts 88 pts were ACPA positive with 257.1 IU/ml mean concentration and 83 pts were RF positive. There was no statistically significant difference between group of pts with and without US detected bone erosions regarding age of pts (56.9 yr. vs 52.5 yr, p=0.333), duration of RA (5.8 vs 4.8 months, p=0.712) and ESR (60.2 vs 50.5, p=0.825). Patients with MTP 5 US detected bone erosion had statistically significant higher concentration of ACPA than pts without US detected bone erosions, (323.8 vs 151.3, p=0.005) and higher level of CRP (39.7 g/l vs 25.3 g/l, p=0.024). Sixty-one ACPA positive pts and 13 ACPA negative had US detected MTP5 bone erosions in opposite to 27 ACPA positive and 19 ACPA negative pts without them. The difference was statistically significant (p=0.01). Fifty-five pts with MTP5 US detected bone erosion had positive RF and 19 pts had RF negative in contrast to 28 RF positive and 18 RF negative pts without them. The difference was not statistically significant (p=0.155). The 0.66 value of the area under the ROC curve was found for ACPA and 0.57 value for RF. The 66% sensitivity and 61% specificity of ACPA and 74% sensitivity and 29% specificity of RF was established in detection of US MTP5 bone erosion for value on 174 of cut off. Conclusions Erosions of MTP 5 joints were detected by echosonography in 62% of early rheumatoid arthritis patients without erosions visible on X-ray. ACPA positivity was weakly associated with presence of MTP5 erosions. There was no significant correlation between US bone erosions and RF positivity. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4252
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood. Significant proportions of patients have residual weakness, muscle atrophy, joint contractures, and calcinosis. Recently, new clinical findings, such as lipodystrophy accompanied with increased fat deposition in certain areas, have been reported. So far, it is not known whether the redistribution of body fat may be the type of lipedema of lower extremity. We describe a 39-year-old woman who was diagnosed with JDM at the age of 7. Later she developed symmetrical lipodystrophy of upper extremities and symmetrical lipedema of lower extremities (making 2 and 58.3 % of total body fat mass, respectively), with multiple calcified nodules in the subcutaneous tissues. These nodules gradually increased in size despite therapy. Capillaroscopy findings showed scleroderma-like abnormalities. ANA and anti-U1RNP antibodies were positive. Similar cases with simultaneous occurrence of the lipedema of lower extremities, lipodystrophy of upper extremities, and severe calcinosis complicating JDM have not been published so far. We showed that the calcinosis and lipodystrophy were associated with short duration of active disease. Also, we display case that raises the question whether it is possible overlapping autoimmune diseases revealed during follow-up.
    No preview · Article · May 2014 · Rheumatology International
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    ABSTRACT: Objectives To compare disease activity in patients with rheumatoid arthritis (RA) after two years treatment with anti TNF therapy estimated by ultrasound and clinical examination (US) of 28 joints. Methods A total 30 RA pts. after anti TNF (Etanercept) treatment lasting for two years, were enrolled in study. Seventy three percent (22/30) of pts. were female, the mean age of patients was 52.7±9.4 yr. The mean duration of the disease was 132±94.0 months. Ultrasound examination of 28 joints included in DAS 28 was performed by Esaote My Lab 70 machine equipped 8-18 MHz linear probe. The total number of 840 joints were examined. The presence of joint effusion and Power Doppler (PD) signal was assessed qualitatively, (present or not). The simultaneous presence of joint effusion and PD signal at the same joint, were considered as ultrasonographic sign of disease activity. RA disease activity was assessed by DAS-28. All pts. were completed HAQ. Structural joint damage was evaluated by Sharp/van der Heijde method. The pts. with RA remission (the value of DAS-28<2.6) and low (the value of DAS-28 3.2≥ 2.6) disease activity were further analyzed. The data were analyzed in SPSS system. Results The mean value of DAS 28 was 3.4±1.4, HAQ 0.5±0.5 and Sharp/van der Heijde score 101.1±63.4.5. The pts. had 5.5 joints with effusion and 1.2 joints with positive PD signal in average by US in opposite to 1.4 swollen and 2.7 painful joints in average by clinical examination. Only one patient had no evidence of joint effusion while thirteen (43%) had no PD signal presence by ultrasound examination in contrast to fifteen (50%) pts. without swollen and twelve (40%) pts. without painful joints by clinical examination. Nineteen (57.5%) pts. had ultrasonographic sign of disease activity. Six pts. were found with DAS 28 remission. The frequency of ultrasonographic evidence of disease activity was present at 33.3% of pts. in contrast to 62.5% of pts.with value of DAS>2.6. The difference was not statistically significant (p=0.360). Thirteen pts. were found with low disease activity according to DAS 28. The frequency of ultrasonographic evidence of disease activity was present at 62% of pts. in opposite to 53 % of pts.with very active RA. The difference was not statistically significant (p=0.721). Conclusions Despite signs of RA remission or low disease activity according to DAS 28, patients had some evidence of joint inflammation confirmed by ultrasound after two years of treatment with anti TNF therapy. Disclosure of Interest None Declared
    No preview · Article · Jun 2013 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Extracellular matrix degradation is regulated mainly by matrixmetalloproteinases (MMPs). MMP-3 can degrade many components of the extracellular matrix and an increase in serum MMP-3 concentration has been proposed as a synovial derived marker of inflammation. Objectives To determine matrix metalloproteinase-3 (MMP-3) serum levels in anti Scl 70 positive patients with systemic sclerosis (SSc) and to study clinical significance and the relationship between MMP-3 and pulmonary and joint involvement Methods Forty-seven anti-Scl 70 antibodies positive patients with systemic sclerosis (43 female, 4 male) and 50 healthy controls were included in the study. All SSc patients underwent standard assessment, including laboratory tests, physical examination with joint assessment, chest X-ray and pulmonary functional tests, including diffusion capacity for carbon monoxide (DLco) and forced vital capacity (FVC). Levels of MMP-3 were measured with specific ELISA kit (Aeskulisa DF) with normal range between 18-60 ng/ml for female and 24-120ng/ml for male. Results SSc patients had significantly higher MMP-3 concentration compared to healthy donors 122.64±188.40 vs. 57.4±46.79, p<0.001. Twenty-two (46.8%) SSs pts had increased MMP-3 levels above normal range and those had more frequently pulmonary fibrosis (p<0.001) and arthritis (p<0.001). Patients with increased levels of MMP-3 had significantly more frequently reduction in DLco <75% predicted (p<0.001). Conclusions In 47 patient with systemic sclerosis and anti-Scl 70 positive antibodies, high levels of MMP-3 significantly positively correlate with pulmonary fibrosis, DLCo < 75% predicted and joint involvement (arthritis). Disclosure of Interest None Declared
    No preview · Article · Jun 2013 · Annals of the Rheumatic Diseases
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    ABSTRACT: The purpose of this paper is to evaluate the image quality and dose to patients in the radiography of sacroiliac joints and to perform a clinical comparative study of digital and conventional screen-film radiography. Routine radiography of sacroiliac joint was performed in 60 patients using digital and screen-film radiography. The visibility of five anatomical regions and the overall image quality were rated by experienced radiologists. Patient dose assessment in terms of entrance surface air kerma (ESAK) was performed. The digital system showed slightly improved visualisation of specific anatomical structures. Overall image quality was significantly better in the digital when compared with the screen-film imaging system. The average ESAK was 2.4 mGy in screen-film and 3.6 mGy in digital radiography. The digital radiography provided equal or better visibility of anatomical details and overall image quality, but on higher dose levels. Therefore, the practice on digital systems must be optimised.
    No preview · Article · Nov 2012 · Radiation Protection Dosimetry