ObjectivesThis study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),—related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement.Methods126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson’s correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis.ResultsSubjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods.ConclusionsAlthough a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.
To develop and to test in a preliminary way a new self-administered screening tool, called DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire, in patients suffering from inflammatory bowel disease (IBD) not previously diagnosed as having a spondyloarthritis (SpA). DETAIL questionnaire was realized through the interrogation of 95 experts. They were asked to rate the importance of a list of items, derived from a review of the referral models of SpA, to detect the SpA manifestations in IBD patients. The six top-rated items composed the questionnaire, tested in IBD patients not already diagnosed having a SpA. One-hundred and twenty-eight patients were tested with the DETAIL questionnaire in the gastroenterology setting. After the rheumatologic assessment, in 21 (16.4%) subjects was diagnosed a SpA according to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Of the six items of the DETAIL questionnaire, the best positive likelihood ratio (LR+) was found in item 2 (LR+ 3.82), exploring dactylitis, and in item 6 (LR+ 3.82) and item 5 (LR+ 3.40), two questions exploring inflammatory low back pain. Enthesitis (item 3-LR+ 2.87) and peripheral synovitis (item 1 - LR+ 2.81) gave similar results, while item 4, exploring the duration of low back pain, resulted in the worst performance (LR+ 1.99). Three of the six items answered in affirmative way gave a post-test probability ≥ 75%. The presence of a fibromyalgia represents a major confounder. The DETAIL questionnaire showed good screening properties that need to be confirmed in broader cohorts.
Objectives. To determine the prevalence and distribution of US-detected qualitative cartilage damage at metacarpal heads of patients with rheumatoid arthritis (RA) and hand osteoarthritis (OA).Methods. Fifty-two RA patients and 34 patients with hand OA were enrolled. US examination of the metacarpal head cartilage from the II to V finger of both hands was performed. A total of 414 metacarpophalangeal (MCP) joints in RA and 266 MCP joints in OA patients were scanned with a linear probe up to 22 MHz.Qualitative assessments using a previously described scoring system for cartilage damage were performed. The prevalence and distribution of cartilage damage were analysed. Multivariate regression analysis was used to determine the predictive value of age, gender, body mass index (BMI), disease duration and the presence of rheumatoid factor and anti-CCP antibodies for US-detected cartilage damage.Results. The metacarpal head cartilage was positive for cartilage damage in 35.7% (148/414) of MCP joints in RA and in 43.6% (116/266) of MCP joints in OA patients. In RA, the hyaline cartilage of the II and III metacarpal heads (bilaterally) was the most frequently affected. In OA, cartilage damage was more homogeneously distributed in all MCP joints. Multivariate regression analysis showed that age and disease duration, but not gender, BMI or autoantibody status, were independent predictors of US-detected cartilage damage in RA. Conclusion.Cartilage damage was found in more than one third of the MCP joints in both RA and OA patients, and in RA patients, the II and III MCP joints were the most damaged.
Objective To develop and validate in a preliminary way a novel radiographic scoring system for psoriatic arthritis (PsA), called Simplified Psoriatic Arthritis Radiographic Score (SPARS). Materials and methods Radiographs of hands and feet were obtained from consecutive PsA patients and assessed by two readers. For each joint (30 joints in the hands, ten joints in the feet), the combination of the erosions, joint narrowing space (JNS) and bony proliferation (BP) has been assessed, giving a value of 1 for erosions presence, 1 for JNS presence, and 1 for BP presence (SPARS score range, 0-120). Reliability was assessed by calculating the intraclass correlation coefficient (ICC) and smallest detectable difference (SDD) of the readings. To determine the convergent validity, SPARS was compared to the modified Sharp/van der Heijde Score (mSvdHS) and to the Ratingen scoring system (PARS). Results One-hundred and five hands and feet radiographs have been assessed. The inter-and intra-rater reliability were excellent (inter-rater reliability 0.934, and intra-rater reliability for both readers 0.845 and 0.876). The SDD for the average SPARS scores of the two readers was 8.0. SPARS correlated strongly with mSvdHS (r = 0.926; p < 0.0001), and PARS (r = 0.904; p < 0.0001). The mean time to score each of the mSvdHS, PARS, and SPARS was 14.4, 10.1, and 4.5 min, respectively. Conclusions The SPARS properties are close to those of the mSvdHS and PARS and is quicker to calculate.
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