Objective
To test whether the presence of structural entheseal lesions in psoriasis patients influences the risk of progression to psoriatic arthritis (PsA).
Methods
We conducted a prospective cohort study of psoriasis patients without clinical evidence of musculoskeletal involvement who underwent baseline assessment of structural entheseal lesions and volumetric bone mineral density (vBMD) at entheseal and intraarticular sites by high‐resolution peripheral quantitative computed tomography. Adjusted relative risks of developing PsA associated with baseline vBMD and the presence of structural entheseal lesions were calculated using multivariable Cox regression models.
Results
The cohort included 114 psoriasis patients (72 men and 42 women) with a mean ± SD follow‐up duration of 28.2 ± 17.7 months, during which 24 patients developed PsA (9.7 per 100 patient‐years [95% confidence interval (95% CI) 6.2–14.5]). Patients with structural entheseal lesions were at higher risk of developing PsA compared to patients without such lesions (21.4 per 100 patient‐years [95% CI 12.5–34.3]; hazard ratio [HR] 5.10 [95% CI 1.53–16.99], P = 0.008). With respect to vBMD, a 1‐SD increase in entheseal, but not intraarticular, vBMD was associated with an ~30% reduced risk of progression to PsA. Especially, higher cortical vBMD at entheseal segments was associated with a lower risk of developing PsA (HR 0.32 per 1 SD [95% CI 0.14–0.71]), and the association remained robust after multiple imputation of missing data (HR 0.64 [95% CI 0.42–0.98]).
Conclusion
The presence of structural entheseal lesions as well as low cortical vBMD at entheseal segments are associated with an increased risk of developing PsA in patients with psoriasis.
In this paper we discuss the possibility of computing unknotting number from minimal knot diagrams, Bernhard-Jablan Conjecture, unknown knot distances between non-rational knots and of searching minimal distances by using a graph with weighted edges representing knot distances. Since topoizomerazes are enzymes involved in changing crossing of DNA, knot distances can be used to study topoizomerazes actions. We compute some undecided knot distances 1 known from the literature, and extend the computations by computing knots with smoothing number one with at most n = 11 crossings and smoothing knot distances of knots with at most n = 9 crossings. All computations are done in the program LinKnot, based on Conway notation and nonminimal representations of knots.
Compared with betamethasone, ACS therapy improved joint function and reduced shoulder pain more effectively after 4 weeks of treatment; these improvements were sustained to week 24. Combined with its favorable safety profile, ACS appears to be a more effective treatment than glucocorticoids and could enhance the quality of life in patients with chronic rotator cuff tendinopathy.
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