RESUMEN
INTRODUCTION: Arthralgias are prevalent in systemic autoimmune rheumatic diseases (SARD), emphasizing the need for early recognition. This study aimed to estimate SARD frequency and compare clinical, laboratory, and imaging findings among SARD, non-inflammatory arthralgia (NIA), and RA in patients with hand arthralgias. METHODS: A prospective evaluation program included individuals aged ≥18 with hand arthralgias. Baseline assessments covered clinical, laboratory, ultrasound, and radiography. Follow-up diagnoses categorized patients into SARD, NIA, and RA groups. Comparison between groups was performed using parametric and non-parametric tests. Two multivariate logistic regression analyzes were performed using the final diagnosis of SARD as the dependent variable (NIA and RA). ROC curves were calculated in those variables that presented an independent association in the multivariate analysis. RESULTS: Among 1053 patients, 9.6% were SARD (SLE 47%). Comparing SARD with NIA revealed higher CRP levels, power Doppler, less rhizarthrosis in ultrasound, and more ANA positivity in SARD patients. Distinct differences were observed between SARD and RA patients in terms of pain levels, swollen joints, metacarpophalangeal involvement and morning symptoms. Diagnostic markers demonstrated specific sensitivities and specificities: ANA for SARD versus NIA (82%, 34%), US not finding rhizarthrosis for SARD versus NIA (66%, 85%), CRP (cut-off >2.5 mg/L) sensitivity 52%, specificity 60%, AUC 0.62, RA antibodies (RF, 11 IU/mL) sensitivity 76%, specificity 74%, AUC 0.8, ACPA (1.25) sensitivity 50%, specificity 98%, AUC 0.7, ANA+ sensitivity 95%, specificity 32%, AUC 0.7, and US absence of synovitis sensitivity 82%, specificity 34%, AUC 0.75. CONCLUSION: This study highlights distinct clinical, laboratory, and imaging features differentiating SARD-related hand arthralgia from non-SARD hand arthralgia and RA.
Asunto(s)
Artralgia , Enfermedades Autoinmunes , Articulaciones de la Mano , Valor Predictivo de las Pruebas , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Artralgia/diagnóstico , Adulto , Articulaciones de la Mano/diagnóstico por imagen , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/epidemiología , Enfermedades Autoinmunes/inmunología , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/epidemiología , Anciano , Diagnóstico Diferencial , Biomarcadores/sangre , PrevalenciaRESUMEN
SUMMARY: The human hand can make precise movements utilizing several joints of various articular types. To understand hand movements more accurately, it is essential to view the actual movements of bones and muscles considering the X, Y, and Z axes in the joints. This study aimed to investigate the joint movements in a hand using movable surface models, including these axes. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints. To achieve this aim, 70 surface models were adopted from a Visible Korean model. Using Maya software, 20 virtual joints with X, Y, and Z axes included nine distal and proximal interphalangeal joints, five metacarpophalangeal joints, five carpometacarpal joints, and one wrist joint were created. Bone surface models were elaborately polished to maintain their original shape during movement. Muscle surface models were also processed to display the deformation of the muscle shape during movement. The surface models of the hand joints were moved by virtual control of the joints. We saved 87 movable surface models of the hand, including bones, muscles, and joint axes in stereolithography format, and compiled a Portable Document Format (PDF) file. Using the PDF file, the joint movements in a hand could be observed considering the X, Y, and Z axes alongside the stereoscopic shapes of the bones and muscles. These movable surface models of the hand will improve medical students' understanding of hand movements around the joints.
RESUMEN: La mano humana puede realizar movimientos precisos utilizando varias articulaciones de diferentes tipos articulares. Para comprender los movimientos de las manos con mayor precisión, es esencial ver los movimientos reales de los huesos y los músculos considerando los ejes X, Y y Z de las articulaciones. Este estudio tuvo como objetivo investigar los movimientos articulares en una mano utilizando modelos de superficies móviles, incluidos estos ejes. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina de los movimientos de la mano alrededor de las articulaciones. Para lograr este objetivo, se adoptaron 70 modelos de superficie de un modelo coreano visible. Con el software Maya, se crearon 20 articulaciones virtuales con ejes X, Y y Z que incluyeron nueve articulaciones interfalángicas distales y proximales, cinco articulaciones metacarpofalángicas, cinco articulaciones carpometacarpianas y una articulación de muñeca. Los modelos de superficie ósea se pulieron minuciosamente para mantener su forma original durante el movimiento. También se procesaron modelos de superficie muscular para mostrar la deformación de la forma del músculo durante el movimiento. Los modelos de superficie de las articulaciones de las manos se movieron mediante el control virtual de las articulaciones. Guardamos 87 modelos de superficies móviles de la mano, incluidos huesos, músculos y ejes articulares en formato de estereolitografía, y compilamos un archivo en formato de documento portátil (PDF). Usando el archivo PDF, los movimientos de las articulaciones en una mano se pueden observar considerando los ejes X, Y y Z junto con las formas estereoscópicas de los huesos y músculos. Estos modelos de superficie móvil de la mano mejorarán la comprensión de los estudiantes de medicina sobre los movimientos de la mano alrededor de las articulaciones.
Asunto(s)
Articulaciones de la Mano/anatomía & histología , Articulaciones de la Mano/fisiología , Articulaciones de la Mano/diagnóstico por imagenRESUMEN
La Artritis Reumatoide (AR) es una enfermedad crónica y autoinmune cuyo primer año de evolución es considerado por el Colegio Americano de Reumatología como su fase temprana. Con el objetivo de describir los hallazgos ultrasonográficos en las articulaciones de muñecas y manos de pacientes con sospecha clínica de AR en fase temprana referidos de la consulta de Reumatología del Hospital Central Universitario Dr. Antonio María Pineda durante el lapso junio-agosto de 2018, se realizó un estudio descriptivo transversal evaluando 126 articulaciones de 21 pacientes según la escala modificada del OMERACT. Los pacientes se caracterizaron por un promedio de edad de 51,4 ± 11,1 años, siendo el grupo etario más afectado el de 41-50 años y 51-60 años. Hubo un predominio del sexo femenino (85,7%) y una media de inicio de síntomas de 5,2 ± 2,8 meses. Las principales alteraciones encontradas fueron derrame sinovial (54,7%), engrosamiento sinovial (28,5%), tenosinovitis en el grupo extensor (28,5%), erosiones óseas (11,1%) y tenosinovitis en flexores (9,5%). Los hallazgos mostraron mayor afectación de las articulaciones radiocarpianas; 12,7% y 7,9% mostraron hipertrofia sinovial y sinovitis grado I, 15% derrame sinovial grado 1 y 2 y 7,9% erosiones óseas pequeñas. El 8,7% de las II metacarpofalángicas mostraron hipertrofia sinovial grado I, 6,3% sinovitis, 13,4% derrame sinovial y 1,5% erosiones óseas medianas; el 0,79% de las II interfalángicas proximales presentaron derrame sinovial grado 1. Se observó tenosinovitis grado 1 en 25,4% de extensores y 7,9% de flexores. En conclusión, la ultrasonografía es una herramienta complementaria en el diagnóstico y seguimiento de la enfermedad reumatoide en fase temprana por lo que se sugiere fomentar su uso evitando gastos innecesarios y retrasos en el inicio del tratamiento(AU)
Rheumatoid Arthritis (RA) is a chronic and autoimmune disease whose first year of clinical manifestations is considered the early phase of the disease according to the American College of Rheumatology. With the aim of describing the ultrasonographic findings in the wrists and hands of patients with clinical suspicion of early phase RA referred to the Rheumatology Service of the Hospital Central Universitario Dr. Antonio Maria Pineda during the period June-August 2018, a cross-sectional descriptive study was conducted evaluating 126 joints of 21 patients according to the modified scale of the OMERACT. Patients had an average age of 51.4 ± 11.1 years and the most affected age groups was the 41-50 years and 51-60 years. Predominance of female sex (85.71%) as well as an average of 5.2 ± 2.8 months of time of symptoms onset was observed. The main alterations observed were synovial effusion (54.7%), synovial thickening (28.5%), tenosynovitis in extensor tendons (28.5%), bone erosions (11.1%) and tenosynovitis in flexor tendons (9.52%). The radiocarpal joints were the most affected showing grade 1 synovial hypertrophy and synovitis in 12.7% and 7.9% of joints, respectively; grade 1 and 2 synovial effusion was observed in 15% of joints and small bone erosions in 7.9%. For the second metacarpophalangeal joint, grade I synovial hypertrophy was found in 8.7% of joints, synovitis in 6.3%, synovial effusion in 13.4% and medium-sized bone erosions in 1.5%; in 0.79% of the proximal interphalangeal joints grade I synovial effusion was observed. Tenosynovitis grade 1 was observed in 25.4% of extensor tendons and 7.9% flexors. The use of ultrasonography should be encouraged as a complementary tool for the diagnosis of RA, avoiding unnecessary expenses and delay in treatment(AU)
Asunto(s)
Humanos , Masculino , Femenino , Artritis Reumatoide , Ultrasonografía , Articulaciones de la Mano/diagnóstico por imagen , Líquido Sinovial , Enfermedades del Sistema InmuneRESUMEN
INTRODUCTION: Kashin-Beck disease (KBD) is a chronic osteochondral disorder primarily associated with cartilage degeneration. The bone texture structure in KBD was also changed but it was not identical to primary knee osteoarthritis (OA). This study investigates the differences in microRNA (miRNA) profiles of subchondral bone collected from patients suffering from KBD in comparison with those with primary knee osteoarthritis (OA). METHODS: Subchondral bone tissues were taken from four patients with KBD and four patients with primary knee OA undergoing total knee replacement. The miRNA array profiling was performed using an Affymetrix miRNA 4.0 Array, and then the target gene predictions and function annotations of the predicted targets were performed. RESULTS: Our results showed that 124 miRNAs had lower expression levels in the subchondral bone sampled from KBD patients in comparison with OA patients. Gene ontology (GO) and KEGG pathway analyses of the predicted targets demonstrated numerous significantly enriched GO terms and signal pathways essential for bone development and integrity, such as metabolic processes, PI3K-Akt, and MAPK signaling pathways. CONCLUSIONS: Our study confirms that a large set of miRNAs are differentially expressed in the subchondral bone of patients with KBD and OA and contributes new insights into potential pathological changes in the subchondral bone of KBD patients.
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Huesos/metabolismo , Enfermedad de Kashin-Beck/metabolismo , MicroARNs/metabolismo , Osteoartritis de la Rodilla/metabolismo , Huesos/diagnóstico por imagen , Femenino , Ontología de Genes , Articulaciones de la Mano/diagnóstico por imagen , Articulaciones de la Mano/metabolismo , Humanos , Enfermedad de Kashin-Beck/diagnóstico por imagen , Enfermedad de Kashin-Beck/genética , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/metabolismo , Masculino , MicroARNs/genética , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/genética , Transducción de Señal/genéticaRESUMEN
This study aims to test the reliability of ultrasound to graduate synovitis in static and video images, evaluating separately grayscale and power Doppler (PD), and combined. Thirteen trained rheumatologist ultrasonographers participated in two separate rounds reading 42 images, 15 static and 27 videos, of the 7-joint count [wrist, 2nd and 3rd metacarpophalangeal (MCP), 2nd and 3rd interphalangeal (IPP), 2nd and 5th metatarsophalangeal (MTP) joints]. The images were from six patients with rheumatoid arthritis, performed by one ultrasonographer. Synovitis definition was according to OMERACT. Scoring system in grayscale, PD separately, and combined (GLOESS-Global OMERACT-EULAR Score System) were reviewed before exercise. Reliability intra- and inter-reading was calculated with Cohen's kappa weighted, according to Landis and Koch. Kappa values for inter-reading were good to excellent. The minor kappa was for GLOESS in static images, and the highest was for the same scoring in videos (k 0.59 and 0.85, respectively). Excellent values were obtained for static PD in 5th MTP joint and for PD video in 2nd MTP joint. Results for GLOESS in general were good to moderate. Poor agreement was observed in 3rd MCP and 3rd IPP in all kinds of images. Intra-reading agreement were greater in grayscale and GLOESS in static images than in videos (k 0.86 vs. 0.77 and k 0.86 vs. 0.71, respectively), but PD was greater in videos than in static images (k 1.0 vs. 0.79). The reliability of the synovitis scoring through static images and videos is in general good to moderate when using grayscale and PD separately or combined.
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Artritis Reumatoide/diagnóstico por imagen , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Ultrasonografía/métodos , Humanos , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Ultrasonografía Doppler/métodosRESUMEN
OBJECTIVE: This study assessed the use of scintigraphy and magnetic resonance imaging (MRI) in identifying the presence and amount of tumour necrosis factor-α (TNF-α) in the joint or skin of patients with psoriatic arthritis, to guide the course of treatment more efficiently. METHOD: We compared the results of scintigraphy and MRI in two patients with psoriatic arthritis who underwent technetium-99m (99mTc)-anti-TNF-α scintigraphy, and MRI 5 days later. RESULTS: Greater uptake of 99mTc-anti-TNF-α was observed in the left wrist and right second metacarpal in patient 1, and in the left ulnocarpal joint and distal interphalangeal joint of the left first metacarpal in patient 2. These results correlated with the MRI findings. CONCLUSIONS: 99mTc-anti-TNF-α scintigraphy may recognize the molecule involved in the inflammatory process. This may provide crucial information to help physicians make decisions about which drugs to use based on biological evidence, and which are cost-effective and appropriate for the treatment of choice. To the best of our knowledge, this is the first time that TNF-α has been shown in the skin of a patient using diagnostic imaging methods.
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Artritis Psoriásica , Articulaciones de la Mano , Inflamación , Imagen por Resonancia Magnética/métodos , Cintigrafía/métodos , Piel , Factor de Necrosis Tumoral alfa/análisis , Artritis Psoriásica/diagnóstico por imagen , Artritis Psoriásica/metabolismo , Artritis Psoriásica/fisiopatología , Brasil , Articulaciones de la Mano/diagnóstico por imagen , Articulaciones de la Mano/metabolismo , Humanos , Inflamación/diagnóstico , Inflamación/metabolismo , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Piel/diagnóstico por imagen , Piel/metabolismoRESUMEN
OBJECTIVE: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. METHODS: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0-1) and semi-quantitatively (grades 0-3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). RESULTS: Mean duration of symptoms was 7.58±3.59 months. Significant correlations (p<0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p<0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. CONCLUSION: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.
Asunto(s)
Artritis Reumatoide/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Ultrasonografía/métodos , Articulación de la Muñeca/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Humanos , Índice de Severidad de la Enfermedad , TenosinovitisRESUMEN
ABSTRACT Objective: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Methods: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0–1) and semi-quantitatively (grades 0–3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Results: Mean duration of symptoms was 7.58 ± 3.59 months. Significant correlations (p < 0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p < 0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. Conclusion: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.
RESUMO Objetivo: Propor um novo sistema de escore ultrassonográfico das articulações da mão e punho (US10) para a avaliação de pacientes com artrite reumatoide (AR) e correlacionar o US10 com variáveis clínicas, laboratoriais e funcionais. Métodos: Foram submetidos 48 pacientes com AR em fase inicial a avaliações clínicas e laboratoriais, bem como a exames cegos de ultrassom (US) no início do estudo e com 3, 6 e 12 meses. O sistema US10 proposto envolveu a avaliação do punho e das articulações metacarpofalângicas e interfalângicas proximais do segundo e terceiro dígitos. O escore consistiu em parâmetros inflamatórios (proliferação sinovial [PS], Power Doppler [PD] e tenossinovite [TN]) e parâmetros de danos articulares (erosão óssea [EO] e danos na cartilagem [DC]). PS, PD, EO e DC foram pontuados qualitativamente (0 a 1) e semiquantitativamente (graus 0 a 3). A tenossinovite foi pontuada como presença/ausência. A avaliação envolveu também o escore 28-Joint Disease Activity (DAS28), o Health Assessment Questionnaire (HAQ) e o nível de proteína C-reativa (PCR). Resultados: A duração média dos sintomas foi de 7,58 ± 3,59 meses. Foram encontradas correlações estatisticamente significativas (p < 0,05) entre os parâmetros de inflamação e a PCR no início do estudo e entre as mudanças nessas variáveis ao longo do estudo. Foram encontradas também correlações significativas (p < 0,05) entre o escore DAS28 e a PD e TN no início do estudo e entre as mudanças no escore DAS28 e PS e TN em todo o seguimento. Além disso, foram encontradas correlações significativas entre as mudanças no escore dos parâmetros de inflamação e no escore HAQ ao longo do seguimento. Conclusão: O sistema de escore US10 proposto provou ser uma ferramenta útil para monitorar a inflamação e o dano articular em pacientes com AR em fase inicial, demonstra correlações significativas com as alterações longitudinais na atividade da doença e no estado funcional.
Asunto(s)
Humanos , Artritis Reumatoide/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Ultrasonografía/métodos , Tenosinovitis , Índice de Severidad de la Enfermedad , Articulaciones de la Mano/diagnóstico por imagenAsunto(s)
Deformidades Adquiridas de la Mano/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Lupus Eritematoso Sistémico/diagnóstico por imagen , Femenino , Deformidades Adquiridas de la Mano/etiología , Humanos , Lupus Eritematoso Sistémico/complicaciones , Persona de Mediana Edad , RadiografíaRESUMEN
OBJECTIVES: The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients. METHODS: Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include "lupus", "ultrasound imaging", "ultrasonography", "synovitis", "tenosynovitis", and "arthritis". RESULTS: A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination. CONCLUSION: US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud's Arthropathy. KEY POINTS: ⢠Musculoskeletal involvement occurs in more than 90% of SLE cases. ⢠Arthralgia or tender/swollen joints found on physical examination showed more US findings. ⢠Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings. ⢠US became a useful tool for rheumatologists. ⢠A substantial number of asymptomatic patients show abnormalities at musculoskeletal US.
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Articulación del Tobillo/ultraestructura , Articulaciones de la Mano/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Lupus Eritematoso Sistémico/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Hipertrofia/complicaciones , Hipertrofia/diagnóstico por imagen , Artropatías/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Masculino , Estudios Prospectivos , Sinovitis/complicaciones , Sinovitis/diagnóstico por imagen , Tenosinovitis/complicaciones , Tenosinovitis/diagnóstico por imagen , Ultrasonografía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
UNLABELLED: The objective of the study was to evaluate work disability and its main associated factors in patients with early arthritis. Argentine Consortium for Early Arthritis (CONAART) is the first early arthritis cohort in Argentina. Patients with one or more swollen joints and less than 2 years of symptoms duration were followed up prospectively in 13 departments of rheumatology. Social, demographic, familiar, clinical, and laboratory data were recollected. At first year and every year, X-rays of hands and feet were performed and working status and pharmaco-economic data were recollected. Work status (employed, unemployed, retired) and type of work were assessed by direct interview using a predesigned questionnaire. Eight hundred forty-eight patients were included, rheumatoid arthritis (RA) = 483 (57 %)and undifferentiated arthritis (UA) = 365 (43 %), 694 (81.8 %) were women, median age was 46 years (interquartile range (IQR) 35-55.7) and median symptoms duration 7 months (IQR 3-12). Patients with RA had significantly higher disease activity, worse functional capacity and quality of life, and more severe radiological damage compared to UA patients. However work disability (unemployed patient) was comparable between groups (RA = 21 % versus UA = 18.6 % p = NS). In both groups, unemployed patients had higher disease activity score of 28 joints (DAS28), worse Health Assessment Questionnaire (HAQ) values, and less years of formal education (p value <0.005 in all comparisons). Radiological damage was greater in unemployed patients but this difference did not reach statistical significance. In multivariate analysis, disease activity was the main variable associated with unemployment in both groups. Joint involvement was the main cause of work disability in this cohort of patients with early arthritis, independently of the final diagnosis. KEY MESSAGES: 1. Work disability is higher in patients with inflammatory arthritis as compared to the general population. 2. Prevalence of work disability is comparable among patients with undifferentiated and rheumatoid arthritis. 3. Disease activity is the main disease variable associated with work disability.
Asunto(s)
Artritis Reumatoide/epidemiología , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Desempleo/estadística & datos numéricos , Adulto , Argentina , Artritis/diagnóstico por imagen , Artritis/epidemiología , Artritis Reumatoide/diagnóstico por imagen , Estudios de Cohortes , Evaluación de la Discapacidad , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Radiografía , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Our objective was to analyze the effects of cigarette smoking on disease activity, functional capacity, radiographic damage, serology and presence of extraarticular manifestations in patients with rheumatoid arthritis and undifferentiated arthritis. This is a cross-sectional study of 1,305 patients (729 with rheumatoid arthritis and 576 with undifferentiated arthritis) from CONAART, the Argentine Consortium for Early Arthritis that includes patients older than 16 years with <2 years of disease. Sociodemographic data, clinical characteristics of the disease and smoking history were collected. In patients with rheumatoid arthritis the disease activity score of 28 joints was 5.4 ± 1.3 in current smokers, 5.2 ± 1.4 in former smokers and 5.1 ± 1.4 in never smokers (p = 0.011). The simple erosion narrowing score was higher in current smokers and former smokers than in never smokers (M 14.0, R Q 6.0-21.0; M 15.0, R Q 7.0-24.0; M 10.0, R Q 5.0-17.0; p = 0.006). Current smokers had higher rheumatoid factor titer (M 160.0, R Q 80.0-341.0) than former smokers (M 146.8, R Q 6.03-255.5) and never smokers (M 15.0, R Q 9.0-80.0) (p = 0.004). The variable independently associated with tobacco exposure was simple erosion narrowing score (OR = 1.03, 95 % CI 1.00-1.05; p = 0.012). In patients with undifferentiated arthritis, an association between smoking status and parameters of activity or radiographic damage was not observed. Neither was tobacco exposure related to the presence of extraarticular manifestations or to the degree of disability in any of the two groups of patients. No relation was found between disease activity and severity, and number of packs smoked per year. Tobacco.
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Artritis Reumatoide/epidemiología , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Fumar/epidemiología , Adulto , Factores de Edad , Anciano , Argentina/epidemiología , Artritis/diagnóstico por imagen , Artritis/epidemiología , Artritis/inmunología , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/inmunología , Sedimentación Sanguínea , Proteína C-Reactiva/inmunología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factor Reumatoide/inmunología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Fumar/inmunologíaRESUMEN
Ultrasound is outstripping other diagnostic imaging techniques in the evaluation of osteoarthritis (OA). Due to its sub-millimetric resolution, ultrasound has the ability to detect minimal morphostructural abnormalities, even from preclinical or asymptomatic disease stages located in the main joint structures predominantly affected by OA: articular cartilage, synovial membrane, and subchondral bone. As of today, ultrasound has proven to be a useful tool for the detection of abnormalities occurring within soft tissues, including synovial hypertrophy, fluid accumulation, and synovial cysts, as well as bony abnormalities, such as osteophyte formation. Additionally, power Doppler signal correlated with histologic evidence of synovial membrane vascularization. In order to describe the ultrasonographic findings of OA, its utility, reliability, and validity as a diagnostic and monitoring tool, a critical review of the literature of hand, hip, and knee OA is provided.
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Osteoartritis/diagnóstico por imagen , Enfermedades de los Cartílagos/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Humanos , Osteoartritis de la Cadera/diagnóstico por imagen , Quiste Poplíteo/diagnóstico por imagen , Reproducibilidad de los Resultados , UltrasonografíaRESUMEN
Schistosomiasis or bilharzia is a parasitic disease found in tropical countries. Most infections are subclinical but may progress to chronic form characterized most frequently by the presence of liver involvement and portal hypertension. We report a patient that presented chronic polyarthritis with positive rheumatoid factor. During investigation, increased liver enzymes, negative hepatitis serologies and signs of portal hypertension on an ultrasound examination raised suspicion of S. mansoni infection. We will discuss pathophysiology and clinical manifestations of S. mansoni infection with special attention to articular involvement.
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Artritis/inmunología , Enfermedades del Complejo Inmune/inmunología , Esquistosomiasis mansoni/inmunología , Adulto , Alanina Transaminasa/sangre , Artritis/sangre , Artritis/diagnóstico , Artritis/parasitología , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Enfermedad Crónica , Femenino , Articulaciones de la Mano/diagnóstico por imagen , Humanos , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/inmunología , Hipertensión Portal/parasitología , Enfermedades del Complejo Inmune/sangre , Enfermedades del Complejo Inmune/diagnóstico , Enfermedades del Complejo Inmune/parasitología , Praziquantel/uso terapéutico , Valor Predictivo de las Pruebas , Radiografía , Factor Reumatoide/sangre , Esquistosomiasis mansoni/sangre , Esquistosomiasis mansoni/diagnóstico , Esquistosomiasis mansoni/tratamiento farmacológico , Esquistosomiasis mansoni/parasitología , Esquistosomicidas/uso terapéutico , Resultado del Tratamiento , UltrasonografíaRESUMEN
To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.
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Artritis Reumatoide/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Articulaciones de la Mano/patología , Sinovitis/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Adulto , Anciano , Artritis Reumatoide/complicaciones , Artritis Reumatoide/fisiopatología , Femenino , Articulaciones de la Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sinovitis/etiología , Sinovitis/fisiopatologíaRESUMEN
This study evaluates prospectively whether baseline scores [Health Assessment Questionnaire (HAQ) and SF-36] can predict clinical and radiographic evolution in a cohort of early rheumatoid arthritis (RA) during a 3-year follow-up. Forty consecutive early RA patients were followed for 3 years, while receiving standardized treatment according to a pre-established protocol. HAQ and SF-36 were administered at the initial evaluation and at 3, 6, 12, 18, 24 and 36 months. Hands and feet radiographs were obtained at the initial evaluation and at 12, 24 and 36 months. Preselected outcomes were the occurrence of radiographic erosions, the achievement of an EULAR remission, low disease activity status and the need for biological therapy. The mean age at onset was 45 years with a 90% female predominance. Erosions were found in 42% of patients at T0 and in 70% after 3 years (P < 0.001). At T0, the proportion of patients in remission, low, moderate or high disease activity was 0, 0, 7.5 and 92.5% and 22.5, 7.5, 32.5 and 37.5%, respectively, at 3 years. The mean baseline HAQ score was 1.89 and 0.77 by the third year (P < 0.0001). Most SF-36 domains showed significant improvement except for general state and vitality. Biological therapy was deemed necessary in 22.5% of patients. The initial HAQ and SF-36 scores were not associated with clinical remission, bone erosions or the need for biological therapy at 36 months. The HAQ and SF-36 scores measured at baseline could not predict at 3 years, the preselected outcomes in a Brazilian cohort.
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Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Adulto , Brasil , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Calidad de Vida , Radiografía , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: Analyze disability determinants in a cohort of Argentine patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Consecutive patients with RA, according to ACR'87 criteria, were recruited from 6 rheumatology centers. Demographic and socioeconomic data, family history, comorbid diseases, extra-articular manifestations and information about received treatments were provided. Disease activity was assessed using Disease Activity Score 28 (DAS 28) and the Health Assessment Questionnaire (HAQ)-A was used for the functional capacity. Hand and feet radiographs were assessed using Sharp-van der Heijde score. RESULTS: A total of 640 patients with RA were included, of which 85.2% were females. Mean age was 53 years (interquartile range [IQR], 44-62) and mean disease duration was 8 years (IQR, 4-14). DAS 28 mean was 2.72 (IQR, 1.7-3.7) and HAQ-A mean was 0.62 (IQR, 0.13-1.25). Multiple linear regression showed that the main variables associated with disability were DAS 28, radiologic damage and age. Main predictors of functional disability in the multiple logistic regression using severe HAQ (>2) as dependent variable were DAS 28 (OR, 2; P < 0.0001); age (OR, 1; P = 0.008); and structural damage (OR, 1; P = 0.001). CONCLUSIONS: In this population, the disease activity was the variable that showed the highest impact on the physical function. Radiologic damage affected HAQ as the disease progressed.
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Artritis Reumatoide/fisiopatología , Evaluación de la Discapacidad , Índice de Severidad de la Enfermedad , Adulto , Antirreumáticos/uso terapéutico , Argentina , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Estudios de Cohortes , Comorbilidad , Progresión de la Enfermedad , Femenino , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
Se presenta la evolución clínica y radiográfica de una artrosis de mano seguida durante 25 años. Se hace énfasis en los buenos resultados obtenidos con un nuevo programa de ejercicios. Se analizan detalladamente losproblemas de alineación e inestabilidad del carpo y su colapso, tanto en las radiografías simples como en la escanografía.