RESUMEN

OBJECTIVE: To differentially diagnose and contextualize pathological lesions suggestive of rheumatoid arthritis. MATERIALS: The skeletal remains of a 25-30-year-old female dated to c. 1750-1550 BCE from a Nubian Pan-Grave cemetery at the site of Sheik Mohamed, near Aswan, Egypt. METHODS: The skeletal remains were examined macroscopically and a differential diagnosis was conducted following established protocols in the palaeopathological literature. RESULTS: Symmetrical, bilateral, erosive periarticular lesions with smooth edges were observed in multiple joints (especially in the hands and feet). CONCLUSIONS: Differential diagnosis suggests this individual had rheumatoid arthritis. SIGNIFICANCE: This case suggests the presence of rheumatoid arthritis in ancient Egypt, contributing to a more finely grained understanding of the antiquity and geographical distribution of the condition. LIMITATIONS: It was not possible to radiograph the skeletal remains. SUGGESTIONS FOR FURTHER RESEARCH: Researchers are encouraged to re-examine any archaeological examples of erosive polyarthropathy using current palaeopathological protocols and to explore the manifestation of rheumatoid arthritis on the African continent.

Asunto(s)

RESUMEN

OBJECTIVES: Patients with seronegative spondyloarthritis (SpA) - psoriatic arthritis (PsA) and ankylosing spondylitis (AS) - have a higher risk of cardiovascular morbidity and mortality. The aim of the present study was to evaluate the incidence and type of dyslipidemia, a potent atherosclerosis risk factor, in SpA patients. MATERIAL AND METHODS: It was a two-center, case-control study. Patients diagnosed with PsA and AS aged 23-60 years, with disease duration < 10 years, were enrolled. The inflammatory activity, serum levels of C-reactive protein (CRP) and lipid profile were evaluated in each patient. In patients > 40 years old, the 10-year risk of fatal cardiovascular disease (CVD), using Systematic Coronary Risk Evaluation (SCORE), was estimated. RESULTS: In total 79 patients with SpA were included in the study, with PsA diagnosed, n = 39 (mean age 45.1 ±9.6 years; 21, 53.9%, women), and with AS diagnosed, n = 40 (age 40.3 ±9.5; 12.3%, women), control group (CG): n = 88 (age 42.3 ±8.1; 42, 47.7% women). Based on the interview and laboratory tests, dyslipidemia was diagnosed in 19 (47.5%) patients with AS and in 28 (71.8%) patients with PsA. Most patients had hypercholesterolemia or mixed hyperlipidemia. Types of dyslipidemia were similar. In SpA patients (PsA and AS), the level of triglycerides (TG) and atherogenic index (AI) were significantly higher than in the CG, respectively TG in SpA: 116 (83-156) and in the CG: 91.2 (72.6-134.6) mg/dl, p = 0.0182; AI in SpA: 3.77 ±1.26 and in the CG: 2.58 ±1.27, p < 0.0001.The low-density cholesterol (LDL) level was significantly lower in SpA patients than in the CG, SpA: 109.1 ±29.4 vs. CG: 125.2 ±35.9 mg/dl, p = 0.0023. There was a strong negative correlation between CRP levels and HDL cholesterol levels in patients with PsA, rho = 0.42, p = 0.0132. Mean SCORE values were 2.33% in PsA patients and 2.38% in AS patients, which results in moderate 10-year risk of death from CVD. CONCLUSIONS: In young patients with spondyloarthropathies, inflammatory factors significantly influence dyslipidemia patterns, which result in higher TG and lower LDL cholesterol levels. In patients with PsA, dyslipidemia was diagnosed more often than in patients with AS.

RESUMEN

INTRODUCTION: The interaction between angiotensin-converting enzyme 2 (ACE2) and SARS-CoV-2 is a crucial factor in the viral infections leading to the release of inflammatory proteins, such as TNF-α. Thus, it is hypothesized that TNF-α blockers can prevent either COVID-19 incidence or its serious symptoms. TNF-α blockers are prescribed to treat various autoimmune disorders, including rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Therefore, the objective of this work was to examine this hypothesis that TNF-α blockers can prevent COVID-19 incidence in patients with RA or SpA. METHODS: A case-control study was conducted through interviews based on a structured questionnaire to investigate the frequency of COVID-19 incidence in 254 eligible patients with RA or SpA about whom 45% were under treatment with one type of TNF-α blockers including infliximab, adalimumab, and etanercept at least for 3 months during the COVID-19 pandemic. Interviews were carried out twice, at the beginning and the end of the study (June-December 2020). Patients with COVID-19 during the study or before that were considered as cases. The control group was patients without COVID-19 experience. Data were analyzed using descriptive statistics, and logistic regression was used to determine the relationships between COVID-19 incidence and independent variables. RESULTS: A small percentage of patients treated with TNF-α blockers (5.22%, 6/115) experienced COVID-19, while a large percentage of patients with COVID-19 did not receive TNF-α blockers (27.34%, 38/139). According to odds ratio, adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 up to 96.8, 95, and 80.3% (p < 0.05), respectively. Therefore, TNF-α blockers could probably decrease the chances of the COVID-19 incidence in patients with RA or SpA. CONCLUSIONS: A direct and positive correlation between the use of TNF-α blockers and a reduction in the incidence of COVID-19 could suggest the prophylactic role of these drugs in preventing COVID-19 in patients with RA and SpA.

RESUMEN

INTRODUCTION: The interaction between angiotensin-converting enzyme 2 (ACE2) and SARS-CoV-2 is a crucial factor in the viral infections leading to the release of inflammatory proteins, such as TNF-α. Thus, it is hypothesized that TNF-α blockers can prevent either COVID-19 incidence or its serious symptoms. TNF-α blockers are prescribed to treat various autoimmune disorders, including rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Therefore, the objective of this work was to examine this hypothesis that TNF-α blockers can prevent COVID-19 incidence in patients with RA or SpA. METHODS: A case-control study was conducted through interviews based on a structured questionnaire to investigate the frequency of COVID-19 incidence in 254 eligible patients with RA or SpA about whom 45% were under treatment with one type of TNF-α blockers including infliximab, adalimumab, and etanercept at least for 3 months during the COVID-19 pandemic. Interviews were carried out twice, at the beginning and the end of the study (June-December 2020). Patients with COVID-19 during the study or before that were considered as cases. The control group was patients without COVID-19 experience. Data were analyzed using descriptive statistics, and logistic regression was used to determine the relationships between COVID-19 incidence and independent variables. RESULTS: A small percentage of patients treated with TNF-α blockers (5.22%, 6/115) experienced COVID-19, while a large percentage of patients with COVID-19 did not receive TNF-α blockers (27.34%, 38/139). According to odds ratio, adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 up to 96.8, 95, and 80.3% (p < 0.05), respectively. Therefore, TNF-α blockers could probably decrease the chances of the COVID-19 incidence in patients with RA or SpA. CONCLUSIONS: A direct and positive correlation between the use of TNF-α blockers and a reduction in the incidence of COVID-19 could suggest the prophylactic role of these drugs in preventing COVID-19 in patients with RA and SpA.

RESUMEN

OBJECTIVE: To define the best cut-off value for identifying Achilles tendon thickening using ultrasound (US) in patients with spondyloarthropathies (SpA) and to assess its diagnostic utility in comparison with different cut-off values used in the literature. MATERIAL AND METHODS: One-hundred and one subjects (55 SpA patients and 46 age and body mass index ((BMI)-matched healthy controls (HC)) were investigated. US was performed using a MyLab70 US system (Esaote Biomedica, Genoa, Italy) with a linear probe (6-18 MHz). Three images per Achilles enthesis were stored and the antero-posterior thickness of the enthesis was measured at the level of the Achilles tendon deeper margin insertion into the calcaneal bone on the longitudinal median scan. The best cut-off value for each gender was determined by ROC curve analysis and compared to the other cut-off values in the literature: 1) 5.29 mm for both genders, and 2) 5.5 mm for females and 6.2 mm for males. The number of measurements exceeding the cut-off values as well as sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values were calculated. RESULTS: A significant difference was observed for Achilles enthesis thickness between genders (mean±SD: 4.6±0.7 mm in males vs. 4.0±0.8 mm in females, p<0.00) and between SpA patients and HC (mean±SD: 4.4±0.8 mm in SpA patients vs. 4.0±0.8 mm in HC, p<0.001). The ROC curve analysis revealed the best cut-off value to be 3.7 mm for females and 4.8 mm for males (SE: 43-70%, SP: 59-85%, PPV: 66-79%, NPV: 54-63%). Previously reported cut-off values were found to have high SP (91-98%) but very low SE (2-11%). CONCLUSION: Achilles tendon thickness differs between genders; thus, it is crucial to refer to normal values that are specific for gender. High cut-off values, as previously suggested, showed very low SE in the current study. When Achilles enthesis thickening is used for the purpose of screening enthesitis in SpA patients, a lower cut-off value has a higher SE with slightly worse SP, PPV and NPVs.

RESUMEN

PURPOSE: Sacroiliitis is one of the diagnostic criteria of seronegative SpA. The purpose of our study is to show the signal characteristics of the sacral and iliac surfaces by DWI which may contribute in early diagnosis of sacroiliitis and investigate the correlation between ADC values and clinical and laboratory parameters. MATERIALS AND METHODS: 62 patients with inflammatory low back pain, with a history or suspect of seronegative SpA are enrolled into the study. 40 age and sex-matched subjects without SpA constituted the control group. After obtaining routine T1 and T2 weighted sequences, echo planar imaging at b values of 0, 400 and 800 was performed. ADC values on both surfaces of the both sacroiliac joints were measured in all subjects. The CRP and sedimentation results and the presence of arthritis and enthesitis were also correlated with the ADC values. RESULTS: ADC values on both surfaces of the both sacroiliac joints were found 0.23 × 10(-3)mm(2)/sn in the control group. In the patient group, mean ADC value of 0.48 × 10(-3)mm(2)/sn was obtained (p<0.001), which was statistically significant, compatible with the increased diffusion due to medullary edema in early sacroiliitis. There was a slight correlation between CRP and ADC values; presumed to be showing the relation between the activity of the disease and the active inflammation on DWI. There was no correlation between arthritis and enthesitis and the ADC values (p>0.001). CONCLUSION: DWI, by measuring ADC values, adds significant information in the early diagnosis of sacroiliitis and may help to evaluate the efficiency of the treatment.

Asunto(s)

RESUMEN

PURPOSE: To evaluate the current United States Food and Drug Administration (FDA) recommendations regarding laser in situ keratomileusis (LASIK) surgery in patients with collagen vascular diseases (CVD) and assess whether these patients make appropriate candidates for laser vision correction, and offer treatment recommendations based on identified clinical data. METHODS: A literature search was conducted using PubMed, Medline, and Ovid to identify all existing studies of LASIK in patients with collagen vascular diseases. The search was conducted without date limitations. Keywords used for the search included MeSH terms: laser in situ keratomileusis, LASIK, refractive surgery, ocular surgery, and cataract surgery connected by "and" with the following MeSH and natural-language terms: collagen vascular disease, rheumatic disease, systemic disease, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, seronegative spondyloarthropathy, HLA B27, ankylosing spondylitis, reactive arthritis, psoriatic arthritis. The abstracts for all studies meeting initial search criteria were reviewed; relevant studies were included. No prospective studies were found; however, four retrospective case studies were identified that examined LASIK surgery in patients with CVD. Several case reports were also identified in similar fashion. RESULTS: The FDA considers CVD a relative contraindication to LASIK surgery, due largely to the ocular complications associated with disease in the CVD spectrum. However, recent studies of LASIK in patients with CVD indicate LASIK may be safe for patients with very well-controlled systemic disease, minimal ocular manifestations, and no clinical signs or history of dry-eye symptoms. CONCLUSION: LASIK surgery may be safe in patients with rheumatoid arthritis or systemic lupus erythematosus and the seronegative spondyloarthropathies if stringent preoperative criteria are met. Evidence suggests patients with Sjögren's syndrome are not suitable candidates for LASIK.

RESUMEN

AIM: To evaluate the role of fluorine-18-labeled fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in various rheumatic diseases and its potential in the early assessment of treatment response in a limited number of patients. METHODS: This study involved 28 newly diagnosed patients, of these 17 had rheumatoid arthritis (RA) and 11 had seronegative spondyloarthropathy (SSA). In the SSA group, 7 patients had ankylosing spondylitis, 3 had psoriatic arthritis, and one had non-specific SSA. Patients with RA were selected as per the American College of Rheumatology criteria. One hour after FDG injection, a whole body PET scan was performed from the skull vertex to below the knee joints using a GE Advance dedicated PET scanner. Separate scans were acquired for both upper and lower limbs. Post-treatment scans were performed in 9 patients in the RA group (at 6-9 wk from baseline) and in 1 patient with psoriatic arthropathy. The pattern of FDG uptake was analysed visually and quantified as maximum standardized uptake value (SUVmax) in a standard region of interest. Metabolic response on the scan was assessed qualitatively and quantitatively and was correlated with clinical assessment. RESULTS: The qualitative FDG uptake was in agreement with the clinically involved joints, erythrocyte sedimentation rate, C-reactive protein values and the clinical assessment by the rheumatologist. All 17 patients in the RA group showed the highest FDG avidity in painful/swollen/tender joints. The uptake pattern was homogeneous, intense and poly-articular in distribution. Hypermetabolism in the regional nodes (axillary nodes in the case of upper limb joint involvement and inguinal nodes in lower limb joints) was a constant feature in patients with RA. Multiple other extra-articular lesions were also observed including thyroid glands (in associated thyroiditis) and in the subcutaneous nodules. Treatment response was better appreciated using SUVmax values than visual interpretation, when compared with clinical evaluation. Four patients showed a favourable response, while 3 had stable disease and 2 showed disease progression. The resolution of regional nodal uptake (axillary or inguinal nodes based on site of joint involvement) in RA following disease modifying anti-rheumatoid drugs was noteworthy, which could be regarded as an additional parameter for identifying responding patients. In the SSA group, uptake in the affected joint was heterogeneous, low grade and non-symmetrical. In particular, there was intense tendon and muscular uptake corresponding to symptomatic joints. The patients with psoriatic arthritis showed intense FDG uptake in the joints and soft tissue. CONCLUSION: (18)F-FDG PET accurately delineates the ongoing inflammatory activity in various rheumatic diseases (both at articular and extra-articular sites) and relates well to clinical symptoms. Different metabolic patterns on FDG-PET scanning in RA and SSA can have important implications for their diagnosis and management in the future with the support of larger studies. FDG-PET molecular imaging is also a sensitive tool in the early assessment of treatment response, especially when using quantitative information. With these benefits, FDG-PET could play a pivotal clinical role in the management of inflammatory joint disorders in the future.

RESUMEN

BACKGROUND: SERONEGATIVE SPONDYLOARTHROPATHY (SPA) IS A GROUP OF DISEASES INCLUDING: ankylosing spondylitis, psoriatic spondyloarthrithis, reactive arthritis, spondyloarthrithis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. One of the diagnostic criteria of SpA is the presence of sacroiliitis. Periarticular bone marrow oedema (histologically corresponding to osteitis) is a primary symptom of the active stage of inflammation, which can be identified by MR using T2-weighted images. Its presence is essential for the therapeutic decision. The aims of this study were: 1. to compare the diagnostic value of T2-weighted images with T1 gadolinium-enhanced fat saturation (FS) images. 2. to establish if T1 gadolinium-enhanced images increase the diagnostic value of the MRI examination. MATERIAL/METHODS: With the use of a 1.5T MRI scanner, 35 patients aged 19-67 years were examined. They were classified as having SpA or suspicious of SpA. The following findings were assessed: bone marrow oedema, synovitis, capsulitis/enthesistis. They were evaluated and compared on T2 and T1 gadolinium-enhanced FS images. RESULTS: Active sacroiliitis was identified in 21 patients, chronic in 1 patient. Two patients had signs of synovitis without any features of bone marrow oedema. One patient had fracture of the sacral bone. Ten patients had no signs of sacroiliitis. There was no significant difference in the diagnostic value between FSE T2 images and T1 gadolinium-enhanced images with FS in the evaluation of bone marrow oedema and capsulitis/enthesitis. However, T1 gadolinium-enhanced images were more sensitive than FSE T2 images in visualising synovitis. CONCLUSIONS: MRI is a very sensitive method to identify active sacroiliitis in SpA. MRI without contrast administration is sufficient to identify bone marrow oedema as a crucial finding in active sacroiliitis. The gadolinium-enhanced images make the diagnosis easier, especially in patients with minimal bone marrow oedema because they reveal or better depict synovitis, while they do not improve visualisation of capsulitis/enthesitis.