Objective. To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent. Methods. A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated. Results. A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r ؍ 0.84 -0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables. Conclusion. A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.
Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.
To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.
BackgroundIdentification of fracture risk factors, Bone Mineral Densitometry (BMD) and FRAX application have helped to decrease the variability of the diagnosis and treatment in patients with osteoporosis (OP). More investigation is needed to identify the differences between patients that are susceptible to fractures.ObjectivesIdentify the differences in BMD and fracture risk factors (FRAX) between patients with and without fragility fractures.MethodsPatients attended a high resolution consultation of OP in the BMU of the Rheumatology Unit in the Hospital of Mérida, from July 2013 to June 2014, collecting information about fracture risk factors, lumbar-BMD (L2-L4) and hip-BMD, radiology of dorsolumbar spine and vitamin D. FRAX with and without BMD was calculated in all patients.ResultsWe studied 355 patients who had all the information needed. 81 patients presented clinical or morphometric fractures, with a mean age of 69.28±2,88 years, slightly higher than the 274 patients without fractures (62.61±1.31). The differences in the rates of densitometric OP between fractured and non-fractured patients were 23.4% and 21.1% in lumbar spine and 18.5% and 10.9% in hip with an OR 1.85 (0.94-3.64) and Ji2 3.24 (p=0.07). The rate of fractured patients with Major osteoporotic fracture >10% and hip fracture >3% in FRAX were 12.34% and 22.22%. When DMO is added to the calculation the rates increased to 16.04% and 23.45%, respectively. In non-fractured patients, the rate of major fracture of 20.43% and hip fracture of 25.18% decreased when DMO was added to the calculation of FRAX to 14.96% and 21.89%, respectively. The rate of patients with levels of vitamin D<20ng/ml was 19.75% in fractured patients and 16.05% in non-fractured patients.Fractured patients (n=81)Non-fractured patients (n=274)Age69.28±2.8862.61±1.31Vit OH-D3<20ng/ml16 (19.75%)44 (16.05%)T-Score L2-L4 <-2.519 (23.4%)58 (21.16%)T-Score hip <-2.515 (18.5%)30 (10.94%)FRAXWith DMOWithout DMOWith DMOWithout DMOMajor osteoporotic>10%10 (12.34%)56 (20.43%)13 (16.04%)41 (14,96%)Hip fracture >3%18 (22.22%)69 (25.18%)19 (23.45%)60 (21,89%)
ConclusionsThe Mean age in fractured patients was higher than in non-fractured patients, in accordance to other studies in the literature that age is an important risk factor for fractures.The rate of desitometric OP in patients with or without fractures was similar in lumbar spine, but we find higher rate of hip OP in fractured patients although without statistical differences. In our study, the calculation of FRAX without BMD underestimates the fracture risk in fractured patients respect to the non-fractured patients. However, when the BDM is added to the calculation of FRAX, this evaluation of the fracture risk in fractured patients improves. We didn't find any statistically difference between rates of patients with levels of vitamin D<20ng/ml and >20ng/ml.Disclosure of InterestNone declared
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