Objective To determine whether there is an additive effect of anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) on the number and size of bone erosions in patients with rheumatoid arthritis (RA) Methods 242 patients with RA received highresolution peripheral quantitative CT (HR-pQCT) scans of the metacarpophalangeal joints. Demographic and disease-specific parameters including ACPA and RF levels were recorded from all patients. Erosion numbers and their size were assessed in 238 patients at 714 individual joints (MCP 2, 3 and 4) and 5712 sites (each 4 quadrants in metacarpal heads and phalangeal bases). The volume of erosions was calculated by a semiellipsoid formula. Results Of the 238 patients, 112 patients showed RF and ACPAs (ACPAs+RF+), 28 only RF (RF+), 29 only ACPAs (ACPA+) and 69 were antibody negative (NEG). Erosion number and size were highest in RF+ACPAs+ patient group with significant differences compared with NEG patients with respect to erosion number ( p=0.001) and to ACPA-negative patients with respect to erosion size ( p<0.001). Results maintained significance in a linear mixed model showing ACPAs+RF+ status and disease duration being associated with higher number ( p=0.017 and p=0.005, respectively), and larger size ( p=0.014 and p=0.013, respectively) of bone erosions. Furthermore, erosion size was influenced by the presence and titre of RF only in ACPA-positive patients with RA but not in ACPA-negative patients. Conclusions ACPAs and RF show an additive effect on erosion number and erosion size. Concomitant presence of ACPAs and RF is associated with higher erosive disease burden in patients with RA. Furthermore, RF influences erosion size only in ACPA-positive but not in ACPA-negative patients.

Conjoined twins(CT) are a rare complication of monozygotic twinning(MT) in which one or more organs are joined in utero. Although the embryopathogenesis of these cases remains a lively focus of interest, the impact on the development of the umbilical cord(UC) and its vessels in CT remains still poorly investigated . This article is protected by copyright. All rights reserved.

In their letter, Van Steenbergen and colleagues present data on the radiographic progression in rheumatoid arthritis (RA) patients stratified for anti-citrullinated protein antibody (ACPA) and rheumatoid factors (RFs) in two different patient cohorts.

Background: Patients naïve to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) questionnaires and those with spondyloarthritis other than ankylosing spondylitis (AS) have voiced confusion in our clinic over the use of the term "AS" (ankylosing spondylitis), as it appears in these instruments. It is unclear whether the current construction of these tools may be applied to other spondyloarthritis-(SpA) associated conditions. The time required to complete the BASFI and BASDAI is also unknown. Objectives: To validate slightly modified versions of the BASDAI and BASFI questionnaires that replace references to "AS" with the term "inflammatory arthritis" for use in SpA. We also determined the time to complete these questionnaires, and patients' assessment of the difficulty in completing the questionnaires. Methods: Adult patients with SpA-associated conditions from three U.S. Department of Veterans Affairs medical centers associated with the Program to Understand the Longterm outcomes of SpondyloARthritis (PULSAR) completed both traditional BASDAI and BASFI questionnaires and modified versions of these instruments (PULSAR-modified Bath Disease Activity Index [PuBaDAI] and PULSAR-modified Bath Functional Index and [PuBaFI]) during visits with health care providers. The order of completing each set of questionnaires (one set prior to the provider encounter and one immediately following the encounter) was randomized. Time to complete each set of forms was recorded and patients rated the difficulty of completing each set of questionnaires on a 10-point Likert scale. Scores from the traditional and modified versions of the questionnaires were compared using Spearman correlations. The association of BASFI and PuBaFI scores with disability status (according to federal institutions) was determined using logistic regression. Results: Patients (n=62) participating in the study required similar time to complete the questionnaires (3.33 vs. 3.27 minutes, p=0.82) and reported similar levels of difficulty in completing the traditional and alternate versions of the questionnaires (1.95 vs. 1.78, p=0.31). The correlation between BASDAI and PuBaDAI total scores was high (Spearman's rho=0.92, p<0.001), and the correlation of BASFI and PuBaFI total scores was also high (Spearman's rho=0.92, p<0.001). The alternate version (PuBaFI) performed at least as well (OR 2.12, 95% C.I. 1.22-3.66) as the traditional BASFI (OR 1.66, 95% C.I. 1.12-2.47) in predicting federally-determined disability. Conclusions: Preliminary data suggest that the PuBaDAI and PuBaFI may be used in non-ankylosing spondylitis SpA and that scores from these instruments correlate well with traditional forms of these questionnaires. The time and difficulty in completing these modified questionnaires do not differ from traditionally-worded BASDAI and BASFI. Background:Recently the ASAS modification of the Berlin algorithm (ASAS algorithm) for diagnosing axial spondyloarthritis (aSpA) was published 1 . T...