BackgroundPotential input of inflammation induced by calcium pyrophosphate crystals into further progression of osteoarthritis (OA) have been widely speculated [1], but casual association between OA progression and calcium pyrophosphate deposition disease (CPPD) development remains unclear.ObjectivesTo compare radiographic progression of knee osteoarthritis between patients with different clinical types of CPPD and patients with OA.MethodsPreliminary data from 2-year prospective study of 120 pts are presented. 76 pts had CPPD (33 m, 43 f) (I group), 44 – knee OA (13 m, 31 f) (II group). Mean age of pts was 60.8±10.7 years in the I group and 62.0±9.4 years in the II group. According to EULAR terminology CPPD patients were grouped into 3 clinical arms: chronic arthritis (n=43), acute arthritis (n=7) and OA with CPPD (n=26). CPPD was diagnosed based on McCarty criteria, OA diagnosis fulfilled ACR criteria. X-ray of the knee joints was performed in all pts in anterior-posterior and lateral projections. Using radiographs of the knees we assessed joint space narrowing, osteophytes, presence of osteosclerosis and cysts in the tibiofemoral (medial and lateral) and patellofemoral compartments. Kellgren and Lawrence (KL) score (0-4) was also determined. Progression was defined as an increase in ≥1 in the radiographic features assessed or total KL score in either knee during follow-up. Routinely were also measured and calculated: body mass index (BMI), WOMAC, self-assessment questionnaire the Lequesne survey, HAQ and pain on VAS. Serum levels of hsCRP were also performedResultsAt baseline pts were comparable by age, BMI, number of affected joints, radiographic stage of knee osteoarthritis, pain level, Womac, Lequesne and HAQ scores. Radiographic progression was observed in 30 (39%) pts in I group and in 10 (22%) pts of the II group (p=0.06). Among pts with different CPPD types radiographic progression was registered in 23 (46%) pts with chronic or acute arthritis and in 7 (27%) with OA with CPPD (p=0.10). Radiographic progression rate in OA with CPPD pts was similar to that in pts with OA (p=0.69), but in pts with chronic or acute arthritis in CPPD this rate was higher than in pts with OA (p=0.018).Mean serum hsCRP level in pts with CPPD and OA was similar (3.98±2.1 mg/l vs 2.52±1.33 mg/l, correspondingly) (p=0.78). Serum hsCRP levels in pts with acute or chronic arthritis in CPPD was higher than in pts with OA (12.32±8,01 mg/l vs 2.52±1.33 mg/l, correspondingly) (p=0.002) and in pts with OA and CPPD (12.32±8.01 mg/l vs 2.16±1.32 mg/l, correspondingly) (p=0.003). Knee replacement surgery was required in 5 (6%) pts with CPPD and in 4 (9%) – with OA (p=0.61).ConclusionsRate of radiographic progression of knee osteoarthritis is comparable between pts with OA and CPPD. Although in pts with acute or chronic arthritis in CPPD radiographic progression of knee osteoarthritis was more significant if compared to OA or OA with CPPD. The potential cause for this discrepancy may be chronic inflammation induced by CPP crystalsReferencesLi...
The postmenopausal women with SDS were found to have a lower BMD in 80% of cases. In this category of women, the reduction in BMD was significantly commoner and more pronounced than in the age-matched healthy women. Low BMI, diffuse SDS, disease duration, and GCS use are risk factors for reduced BMD and OP.
Background:Rheumatoid arthritis (RA) is the chronic inflammatory joint disease, and it is responsible for structural damage. Several studies have shown that ACPA + patients were more likely than ACPA− patients to develop erosive changes on radiography. Ultrasound (US) is a well-established method of diagnosis and follow-up in RA, which at the moment may have a prognostic value in assessing the outcomes of the disease.Objectives:to identify the prognostic role of US in radiologic progression in RA patients.Methods:85 RA pts, mean age 53,0 [44,0; 61,0] yrs, mean disease duration 8 [4; 24] months were treated with MTX and biologics according to Treat-To-Target concept. Among them 56 patients with early RA, mean age 53,5 [45,5; 61,0], disease duration 5 [3; 7,5] months. Hands and feet ultrasound (US) with gray scale (GS), power Doppler (PD) and destructive changes (erosion), according to the criteria of OMERACT, were analyzed before initiation of treatment and in 3, 6, 9 and 12 months after. A binary scoring system (presence/absence of erosions) of the joints examined was used. Radiographs were obtained at baseline and 4 years, radiographic changes were assessed using Sharp/van der Heijde modified scoring method. Radiographic progression was documented based on Sharp/Van der Heijde modified score changes during the follow up.Results:71 ACPA+ (84%) and 14 ACPA− (16%) patients presented among the 85 patients with RA, among them 49 ACPA+ (87%) and 7 ACPA− (13%) with early RA.RA progression by 4 years the follow-up period was identified in 39% of pts.During the follow-up period 33 of 85 patients had radiographic progression: the count of erosion increased from 0 [0; 3] to 2 [0; 6]. At the same time, on the background of therapy, a decrease in ultrasound signs of inflammation was determined according to the GS and PD: from 6 [4; 9] to 1 [0; 2] p = 0.000 and from 2 [1; 6] to 0 [0; 1] p = 0.000, respectively, and increase in the number of joints with erosions (from 1 [0; 2] to 2 [0; 4], p = 0.000).In the group with early RA, the changes were similar.In ACPA+ general group the count of erosion at 4 years was significantly higher than in ACPA− general group (3 [0; 7] and 0 [0; 1], respectively, p=0.0026).In ACPA+ early RA group the number of joints with erosions by US at baseline was significantly higher than in ACPA− early RA group (1 [0; 1] and 0 [0; 0], respectively, p=0.017). In ACPA+ early RA group the count of erosion at 4 years was significantly higher than in ACPA− early RA group (2 [0; 4] and 0 [0; 0], respectively, p=0.009) (Table 1)Table 1.Characteristic of the groups (general group)at baselineACPA+(71 pts)ACPA- (14 pts)pThe number of joints with erosions by US1 [0; 2]0 [0; 1]0,36The number of erosions by X-ray1 [0; 4]0 [0; 1]0,06after 4 years follow upThe number of joints with erosions by US2 [0; 4]1 [0; 2]0,16The number of erosions by X-ray3 [0; 7]0 [0; 1]0,0026Characteristic of the groups (early RA group)at baselineACPA+(49 pts)ACPA- (7 pts)pThe number of joints with erosions by US1 [0; 1]0 [0; 0]0,017The number of erosions by X-ray0 [0; 2]0 [0; 0]0,11after 4 years follow upThe number of joints with erosions by US2 [0; 3]1 [0; 1]0,22The number of erosions by X-ray2 [0; 4]0 [0; 0]0,009Conclusion:Thus, in early RA is advisable to perform an US of the hands and feet to select a group of patients with potentially rapid radiological progression. US evaluation of patients with non-early stage RA is not very important for assessing the prognosis.Disclosure of Interests:None declared
Objectivesto outline specific biochemical and imaging features of metabolic phenotype of knee osteoarthritis (OA) in a multicenter prospective study.Methods284 female patients with knee OA (according to the ACR criteria) aged 40-78 were included in this prospective multicenter study. OA radiologic stages in the study group varied from I to III (Kellgren & Lawrence) and all the patients signed an informed consent. Mean age was 58.5 ± 9.5 years, disease duration was 5 (2-10) years. BMI was 29.6 ± 5.6 kg/m2, with hip (HC) – 109.3 ± 10.4 cm and waist circumference (WC) – 92.5 ± 12.5 cm. Physicians filled out individual case report forms, which included anthropometric information, history and physical assessment data. All patients performed lab tests, ultrasonography and x-ray of the knee, as well as proximal femur and lumbar spine DEXA.ResultsMetabolic phenotype was diagnosed in 52.4% of patients. Participants were then divided in two groups. Patients with metabolic phenotype of osteoarthritis were older (61 (57-68) vs 52 (43-58), respectively, p<0.0001), had higher BMI (31.6 (28.6-35.4) vs 26.4 (23.4-30.3), p<0.0001) and had more intense VAS knee pain while walking on flat surface (50 (40-60) vs 35 (10-50), p<0.0001). There were also statistically significant differences when we analyzed the imaging results (Table 1). Patients with metabolic phenotype of knee OA had higher chances of grade III K&L (ОR=4.4, 95% CI 1.3-14.2, р=0.01) and more significant medial joint space narrowing, bigger tibial osteophytes; knee ultrasound revealed thinner cartilage and thicker synovium. DEXA showed higher total hip BMD. Patients with metabolic phenotype had higher levels of CRP, HbA1c, uric acid, cholesterol, LDL, triglycerides, ALT, AST, glucose, leptin and COMP.Table 1.Comparison of patients depending on phenotypeIndexMetabolic phenotype(n=149)No metabolic phenotype(n=135)pK&L radiologic grade0.01I grade13.6%56.7%II grade62.7%36.7%III grade23.7%6.6%Posterior lateral tibial cartilage, mm, Me1.5 (1.4-1.8)1.7 [1.6;1.8]0.05Posterior medial tibial cartilage, mm, Me1.6 (1.3-1.8)1.7 [1.6;1.8]0.014Medial knee joint space, mm, Me2.6 (1-4.6)3.6 [3;4.3]0.023Osteophytes of the medial tibial condyle, mm, Me1 (1-2)0 [0;0]0.025Osteophytes of the lateral tibial condyle, mm, Me1 (1-2)0[0;1]0.042Synovium thickness, mm, Me3.1 (2.9-3.5)2.9 (2.6-3.1)0.02Total hip BMD, (g/cm2), mm, Me0.95 (0.87-1.02)0.87 (0.77-0.99)0.03CRP, mg/l, Me2.8 (1.4-5.1)1.1 (0.49-2.0)0.0001HbA1c, %, Me5.7 (5.4-5.9)5.2 (4.9-5.6)0.0001Uric acid, mcmol/l, Me312 (268-391)269.7 (233.9-324.5)0.0002Cholesterol, mmol/l, Me6.4 (5.33-6.85)5.4 (4.78-5.82)0.002LDL, mmol/l, Me4 (3.38-4.59)3.1 (2.6-3.89)0.0009Triglycerides, mmol/l, Me1.6 (1.19-2.44)1.1 (0.76-1.48)<0.0001ALT/AST, units/l, Me21 (17.15-28.9)/ 20.6 (17.6-25)15.9 (11.4-19.8)/ 18.1(14.9-21.6)0.0006Glucose, mmol/l, Me5.6 (5.1-6,155)5.2 (4.97-5.53)0.001Leptin, ng/ml, Me35.6 (25.5-55.6)20 (14.7-31)<0.001COMP, ng/ml, Me1415 (1115-2100)712.2 (484.5-1015)<0.001IL-6, pg/ml, Me0.55 (0.25-0.8)0.03 (0.01-0.4)<0.005Spearman correlation analysis showed positive correlations (p <0.05) between the metabolic phenotype and OA radiologic stage (r=0.44), size of tibial osteophytes (r=0.31), synovium thickness (r=0.28), hsCRP (r=0.44), HbA1c (r=0.45), cholesterol (r=0.29), LDL (0.3), triglycerides (r=0.36), uric acid (r=0.3), leptin (r=0.46), IL-6 (r=0.38), COMP (r=0.51). Negative correlations (p <0.05) were established with medial joint space (via X-ray): (r=-0.24) and cartilage thickness (via ultrasound) (r=-0.25).ConclusionComprehensive examination of patients with the use of imaging and biochemical methods showed that metabolic phenotype of osteoarthritis is more severe (with correction for age taken into account). Patients with metabolic phenotype showed higher levels of hsCRP, leptin, IL-6, COMP, which possibly demonstrate a more active form of low-grade inflammation (the underlying mechanism of OA pathogenesis) and more significant cartilage damageDisclosure of InterestsNone declared
Background:The most severe phenotype of osteoarthritis (OA) is currently considered to be an inflammatory or erosive phenotype (EOA). There is currently no reliable x-ray picture of this disease in the literature, and the question of whether it is an independent form of OA, a natural more pronounced stage of progression, or a separate nosology is debated in the literature.Objectives:To identify the localization, frequency, and severity of pain and radiological symptoms in patients with EOA and non-erosive (NOA) disease in the interphalangeal (DIP and PIP) and metacarpal (MCP) joints of the hands.Methods:64 women with diagnosis of OA of the hand (HOA) joints according to the ACR criteria were included into study after signing the informed consent form. Mean age was 65.28 ± 6.82 years (48-77), mean BMI 27,7 ± 4,4 kg/m2, mean disease duration 12 ± 8,1 years. Individual patient’s medical record included relevant anthropometric data, records from case history and clinical examination, AUSCAN scores, patient’s articular status. Instrumental diagnostic methods included plain radiography of the hand joints in an anterior-posterior projection. The images were described in accordance with the Kellgren&Lawrence (K&L) system.When evaluating radiographs of 64 patients with HOA, the most common was stage II (49%) according to K&L, and the most common symptoms in distal (DIP), proximal (PIP) interphalangeal and MCP were joint space narrowing (JSN) (100%, 100%, and 95%, respectively) and osteophytes (OP) (88%, 70%, and 45%, respectively). Subchondral osteosclerosis (SO) (5%), erosions (8%), and subluxations (3%) in MCP, as well as subluxation in PIP (6%) were less common. Statistica 10.0 was used for statistical analysis.23 patients had EOA, 37 had NOA. Depending on the presence of erosions in interphalangeal joints patients were divided into 2 groups comparable in terms of age, age of OA onset and duration of disease (the average age of patients with EOA interphalangeal joints was 68 + 6.15 years, and mean disease duration 18,34 + 7.11 years; in the group without erosive changes in the average age amounted to 65,13±5.43 years, mean disease duration of 16.56±8.4 years).Results:EOA DIP and PIP was detected in 15 (23%) with radiological changes corresponding to stages III-IV of HOA and in 8 people (12%) with stage II on the K&L scale. Patients with stage I according to standard radiography had no erosive process.In DMFs OP (100% and 78%, OR=1.28, 95%, CI [1.08-1.5], p=0.02), SO (74% and 11%, OR=6.8, 95%, CI [2.6-17.8], p<0,0001), subchondral cysts (SC) (61% and 24%, OR=2.5, 95%, CI [1.3-4.82], p=0.005) and subluxations (43% and 14%, OR=3.2, 95%, CI [1.3-8.23], p=0.01) were significantly more often found in patients with EOA. In PIPs SO (43% AND 5%, OR=8.04, 95%, CI [1.93-33.5], p=0.0005), SC (52% and 27%, OR=1.93, 95%, CI [0.1-3.73], p=0.045) and subluxations (17% and 0%, p=0.01) were significantly more frequently detected in patients with EOA compared to the non-erosive group. According to the results of the AUSCAN questionnaire, a significantly greater severity of pain was found in patients with EOA (65%) in comparison with the non-erosive (30%) form of HOA (OR=2.19, 95%, CI [1.23-3.9], p=0.008).Conclusion:DIPs is most often affected in OA of interphalangeal joints, less often PIPs, the most common symptoms are JSN and OP. At EOA in addition to more frequent detection OP, cysts, SO, subluxations in DIPs, SO, cysts and subluxations in PIPs, there is also significantly more pronounced pain according to AUSCAN data, it can be concluded that EOA is more severe in comparison with the non-erosive form of HOA.Disclosure of Interests:Danil Kudinsky: None declared, Ludmila Alekseeva Grant/research support from: Bayer, Alexander Smirnov: None declared, Alexander Volkov: None declared, Olga Alekseeva: None declared, Elena Taskina: None declared, Anastasiia Sukhinina: None declared
Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to destructive changes and dysfunction of the joints. Ultrasound (US) is used in current practice as an early diagnostic method for detecting structural damage to articular surfaces. US changes in early RA are considered as one of the ways of predicting disease outcomes.Objectives:to detect power doppler (PD) contribution in evaluation of radiographic RA progression in long term.Methods:85 RA pts, mean age 53,0 [44,0; 61,0] yrs, mean disease duration 8 [4; 24] months were treated by Treat-To-Target concept. After first year of therapy management was following real clinical practice rules until the termination of the study (4 years FUP). The wrist, MCP2 and MCP3, PIP2, PIP3, MTP2 and MTP5 joints of the clinically dominant side were examined by US (GS and PD). Clinical, laboratory parameters and US examination was performed at baseline, at Mo 3, 6, 9 and 12. The X-ray was conducted before treatment and in the end of the study. Structural damage progression was evaluated by change in the Sharp van der Heijde score (ΔSHS) between baseline and 4 year.We categorized pts into 5 groups according to the occurrence of positive PD: 1) without PD throughout the observational period [the negative (N)], 2) positive PD limited to the period from the baseline to Mo 3 [the therapeutic response (R)], 3) positive PD limited to the period from the baseline to Mo 6-9 [the therapeutic late-response (LR)], 4) intermittent occurrence of PD in the observational period [the intermittently positive (IP)] and 5) with persistent positive PD throughout the observational period [the persistently positive (PP)].Results:80% of pts had PD synovitis at baseline. PD-synovitis dropped from 2 [1,0; 6,0] to 0 [0,0; 2,0] scores at Mo 12. RA progression by 4 years FUP was identified in 13% of pts. The X-ray erosion score at 4 years FUP in these groups – N, R, LR, IP and PP - were dependent by PD from baseline to Mo 12 (mean level 1 [0; 2]; 2 [0; 4], 3 [0; 5], 1 [0; 2] and 4,5 [1; 10] respectively), but statistically significant differences were found between N and PP groups.Cox multivariate analysis identified that presence PD-synovitis at baseline was associated with risk of radiographic progression at 4 years (HR 3,68 95% CI 1,03 – 13,15, р = 0,045).Conclusion:Thus, PD-synovitis has a prognostic value for increasing destructive radiographic changes.References:noDisclosure of Interests:None declared
BackgroundUltrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and X-ray are the alternative diagnostic modalities used to identify affected joints and surrounding tissues (tophi, erosions and synovitis) in gout patients, but the potential of each method for sequential assessment of disease regression in pts receiving urate-lowering therapy is not sufficiently studied [1]ObjectivesComparison of US, CT, X-ray and MRI efficacy for sequential assessment of affected joints in pts treated with urate-lowering agents.MethodsThe open prospective study was conducted in 2013–2015 yy at V.A. Nasonova Research Institute of Rheumatology. 22 pts with crystal-verified gout (4 (15%) f and 18 (85%) m), mean age – 54,5±12,7 years, were included. The dose of allopurinol administered in all pts was adjusted by titration starting from 100 mg/day. Instrumental diagnostic examination (US, MRI, CT and plain X-ray of knee joints) was performed at baseline and after one year of follow up. US of knee joints was performed using multi-frequency linear array transducer, at 7 to 17 MHz frequencies; for MRI examination “Esaote Artrosan 0.25TI” was used, GE “Light Speed” - for CT scans, and Stephanix – for plain X-ray examination. Applied descriptive statistics STATISTICA 10.0 (StatSoft/Inc., USA) package was used for statistical analysis.ResultsMean serum level of uric acid decreased from 568±115 μmol/l to 302±135 μmol/l. The target level (<360 μmol/l) was achieved in 20 pts (91%), (<300 μmol/l) was achieved in 11 pts (50%). Median allopurinol dose was 400 [300; 600] mg/day, 9 (45%) pts had to take 600 mg/day and more. At baseline US examination detected periarticular tophi in 13 (59%) pts, MRI - in 6 (28%) pts, CT in 3 (14%), X-ray - 1 (5%) pts, after one year - by US in 9 (41%) pts and MRI - 3 (14%) pts, CT in 2 (9%), X-ray - 1 (5%) pts. At baseline intraosseous tophi were detected only by CT and X-ray in 18 (81%) and 2 (9%) pts respectively, after one year 17 (77%) pts and 3 (14%) pts respectively. At baseline erosions were detected in 19 (86%) pts by MRI, in 11 (50%) pts – by US, in 14 (65%) pts – by CT, and in 9 pts (41%) – by X-ray, after one year in 14 (64%) pts by MRI, 10 (45%) pts by US, 12 (54%) pts by CT, 8 (36%) pts by X-ray. At baseline synovitis was reliably diagnosed by MRI and US: in 15 (68%) pts and 17 (77%) pts, after one year in 2 (9%) pts and 3 (14%) pts respectivelyConclusionsMRI and US, as for synovitis, erosions and tophi dynamics, are comparable, at that for erosions MRI is more accurate. CT is the most informative approach to monitor intraosseous tohhi regression. X-ray is low- informative modality for sequential assessment of gout.References Grainger R, Dalbeth N, Keen H, et al. Imaging as an outcome measure in gout studies: report from the OMERACT gout working group. J Rheumatol 2015; 42(12):2460e4. Disclosure of InterestNone declared
The article discusses the treatment of patients with primary generalized osteoarthritis (OA), a common joint lesion of different localization. Clinical guidelines are presented that provide guidance on various drug and non-drug approaches in the treatment of primary generalized OA. In accordance with the modern understanding of the pathogenesis of OA, the role of inflammation and the influence of various pro-inflammatory factors, the priority of anti-inflammatory therapy, primarily non-steroidal anti-inflammatory drugs (NSAIDs), is justified. A clinical case of a 5-year observation of a patient with primary generalized OA and low compliance to treatment with symptom-modifying slowacting drugs is described. For articular syndrome exacerbations etoricoxib (Kostarox®) was mainly used as an analgesic and anti-inflammatory agent at a dose of 60 mg / day for 7–14 days with a good effect. Due to self-isolation and inability to visit a doctor during COVID-19 pandemic, the patient took etoricoxib for a long time (up to 200 days) for severe neck- and backpain relief, the duration of some courses was up to3 months. We discuss the possibility of etoricoxib use not only in the «on demand» mode, but also for a long time – until the effect is achieved.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.