Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue. It is characterized by symmetrical multiple joint involvement and extra-articular symptoms. Modern RA treatment methods place a particular emphasis on the earliest possible diagnosis and initiation of appropriate treatment. Currently, ultrasonography (US) is the key imaging test performed in RA patients. However, despite the general acknowledgement of its role in the assessment of disease activity, US was not included in the applicable ACR/EULAR criteria. This is due to the lack of strictly defined criteria for US evaluation and the interpretation of test results. In addition, the absence of a correlation between the common DAS/DAS28 disease activity score and ultrasound assessment of joints makes developing new diagnostic criteria difficult. The objective of this article is to review recent scientific reports on the use of ultrasonography in the diagnosis and monitoring of RA and to indicate current problems associated with the interpretation of test results and the comparison with applicable scores of disease activity.

ObjectiveRheumatoid arthritis (RA) is a condition that poses many diagnostic problems. As a result, it is often diagnosed too late, which makes effective treatment more difficult. The course of the disease is chronic, and it causes irreversible changes in the musculoskeletal system, as well as bone destruction, and this in turn impairs the proper monitoring of the treatment. Therefore, in order to assess the treatment’s efficacy, as well as a clinical examination of the patient and laboratory tests, diagnostic imaging is being used more frequently in routine practice. The aim of this paper is to assess the usefulness of power Doppler ultrasonography in the assessment of MCP joints in patients with chronic RA (LSRA), in comparison with DAS28, X-ray, and MRI.Material and methodsThe study involved 26 patients with LSRA, treated with biologics. It lasted for a year. At the moment of enrolment, the condition had lasted for a minimum of 5 years, and DAS28 was > 5.1. The patients had visits every three months. During every visit, a PDUS test was performed and the DAS28 was determined. In the first and last month of the study the patients underwent X-ray and MRI tests.ResultsAt the end of the study, the DAS28 of 26 (100%) patients was lower or equal to 3.2. Based on PDUS and MRI tests, no synovitis was found in 21 (81%) and 18 (69%) patients, respectively. According to the MRI results, radiological changes progressed in 5 (19%) of them. All patients who showed progress of radiological changes also had visible synovitis during their PDUS test.ConclusionsPDUS in patients with LSRA can be helpful in selecting patients, who are likely to develop a progression of radiological changes.

Introduction: Patient risk stratification is important in managing individuals with suspected acute pulmonary embolism (APE). The aim of this study was to determine risk factors for in-hospital mortality among real-world patients who had undergone computed tomography pulmonary angiography (CTPA) due to suspected APE.Material and methods: Retrospective analysis of clinical data extracted from the medical documentation of 700 consecutive patients in whom CTPA was performed due to APE suspicion.Results: APE was confirmed in 22.7% of the patients in the sample. In-hospital death was recorded in 10.1% and 12.4% of patients with and without APE confirmed in CTPA, respectively. APE-related death was diagnosed in 37.5% of the APE patients who died during hospitalization. Compared to patients who were discharged from hospital, those who died during hospitalization had a greater prevalence of comorbidities (e.g., neoplasm) and higher values of laboratory determinations and prognostic rule scores. An age-adjusted high-sensitivity troponin I (hs-TNI) cut-off and Pulmonary Embolism Severity Index (PESI) score were found to be independent risk factors of in-hospital death, but only in the whole study group and in patients without APE confirmed in CTPA. The area-under-the-curve value for all the parameters studied was lower than 0.6.Conclusions: Age-adjusted hs-TNI cut-off and PESI score were independent risk factors for in-hospital death in patients with APE suspicion. The predictive power of standard stratifying tools is insufficient in real-world patients with suspected APE. Patients with suspected APE require careful diagnosis and management of comorbidities because these may affect the in-hospital mortality rate.

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