BackgroundAssessment of synovitis in Rheumatoid Arthritis (RA) is a major issue for a proper treatment administration; it has been proven that ultrasound (US) examination could be of valuable help and it is currently being investigated as a possible outcome measure for the disease. It is, though, of greatest importance to accurately establish the place of US scores among the already validated outcome measures, according to Outcome Measures for Rheumatoid Arthritis in Clinical Trials (OMERACT) filter. The present study is designed to compare the results of gray-scale ultrasound (GSUS) and Power Doppler ultrasound (PDUS) additive scores, separately calculated for volar and dorsal aspects of the hand, with physical examination, patient's evaluation of disease pain and global activity on Visual Analogic Scale (VAS) and traditional scores for disease activity assessment (DAS28, CDAI, SDAI, HAQ). The final aim is to prove the advantages of volar US evaluation in RA patients.Methods42 RA patients have been clinically evaluated for pain and swelling of their hand joints, completed VAS and HAQ questionnaires and underwent both volar and dorsal sonography of the hands during the same day. The US examiner was blinded to clinical assessments and lab results. For each patient 20 joints were assessed by sonography (radiocarpal, intercarpal, metacarpophalangeal (MCP) 2-5, proximal interphalangeal (PIP) 2-5). Carpal joints were only evaluated from dorsal view, while MCPs and PIPs were evaluated both from dorsal and volar aspect resulting a total of 36 distinct evaluations for each patient. GSUS synovial hypertrophy was assessed both by quantitative measurement and semiquantitative scale (0-3 grades); Doppler signal (PDUS) was recorded on a semiquantitative scale (0-3 grades). The semiquantitative grades for both GSUS and PDUS evaluation of each joint were added and the sum was defined as the Echographic Score (ES) of each patient. Separately, we added the semiquantitative grades for volar and dorsal side, resulting in Volar ES (VES) and Dorsal ES (DES) of each patient.ResultsWe found ESs correlated with other activity scores: DAS28, CDAI, SDAI, HAQ. Correlations with clinical indices as CDAI and SDAI were stronger for VES than for DES. US discovered more synovitis than clinical examination.ConclusionVES is a suitable reflection of RA activity and volar US examination should accompany the dorsal one both in clinical practice and in clinical trials.

Background: This study aims to investigate willingness to pay for a potential vaccine against SARS-CoV-2 / COVID-19 among adult persons in Romania. The study was conducted during the peak period of the pandemic curve in Europe and Romania, too.Methods: An online survey was developed and delivered to Romanian general population by using two of the largest social networking web services (Facebook and LinkedIn). The questionnaire included demographic data, description of the responder’s financial situation and their willingness to pay for a hypothetical anti COVID-19 vaccine. The study was based on the Van Westendorp Price Sensitivity Meter method.Results: A total of 203 adult subjects participated in the survey; 42.4% male and 55,2% members of a family with at least one child. Mean participants’ age was 44.12 ± 8.9 (mean ± SD). The acceptable price range for a vaccine against SARS-CoV-2 / COVID-19 was situated between 20 and 200 EUR. Subgroup analyses revealed similar price range in all groups with the notable exception of those with excellent financial situation who selected a 50 to 400 EUR interval. These results match the existing optional various vaccination schemes offered in the private health care sector: 43.2 ± 32.1 EUR. Conclusions: Despite substantial social impact of SARS-CoV-2, potential patients would pay for a perfect vaccination scheme against COVID-19 a price in the same range with the prices of existing vaccination schemes. Our findings could impact the way a vaccination policy will be developed in this context both in terms of general acceptance of vaccine and personal and social costs.

Aims: Doppler ultrasonography assessment is mandatory nowadays for the complete description of rheumatic disease activity. Initially it was performed in semi quantitative way but recently the (fully) quantitative assessment is gaining more interest. In quantitative assessment, the ratio between total colorized and total pixels (CTR) is computed for the whole image or just for the region of interest (ROI). The frame with the highest amount of Doppler signal (also called worst case scenario image – WCSI) is usually the only one analyzed. The technique requires a very precise identification of WCSI from a certain number of consecutive frames, captured from the same position of the US probe, (and in most cases this is done manually). Our study examined the ability of both experienced and in-training sonographers to identify WCSI using a computerized analytical system as the gold standard.Materials and methods: The study analyzed 480 frame selections done in two distinct exercises. The WCSI and other 3 images with a 5%, 10% and respectively 20% lower level of CTR compared with WCSI were packed in one selection. All frames emerging from the same video clip were randomly presented to six experienced and six in training sonographers; the request was to select the frame with the highest CTR (WCSI) from each package (twenty packages in total). A similar exercise was performed with CTRs decreasing in steps of 2%.Results: In the first exercise the WCSI was correctly identified in 79.1% cases and in 67% of cases in the 2nd exercise. The interobserver agreement between experienced and in-trainer evaluators for the 1st exercise was 0.78 and 0.4 in the 2nd exercise.Conclusion: Using computerized analysis as the gold standard, we demonstrated a large heterogeneity across sonographers regarding their ability to identify the best Doppler image even from a small group of frames.

Background Epidemiological evidence indicates a significant association between vitamin D deficiency and an increased incidence of several autoimmune diseases. Low vitamin D levels have also been reported in patients with systemic sclerosis (SSc), but the number of studies is limited with conflicting data. Objectives To investigate 25-OH vitamin D concentrations in a group of systemic sclerosis (SSc) patients and establish connections between a deficient vitamin D status and SSc disease activity and severity or on the clinical consequences that such deficiency might cause. Methods 44 scleroderma patients were evaluated during June 2010 - June 2012 in InternalMedicine and Rheumatology Department of Sf. Maria Hospital, Bucharest, Romania. All patients gave informed consent for all procedures, which were carried out with the local ethics committee’s approval. We performed a complete evaluation of all patients following: MEDS evaluation sheets; disease activity was evaluated with the Disease Activity Score (DAS) according to the European Scleroderma Study Group guidelines, HAQ (Health assessment questionnaires) have been also completed. Vitamin D was measured with the RIA Diasorin kit or expressed as“RIA Diasorin equivalent”. According to current recommendations, vitamin D concentrations < 30 ng/ml were considered as indicating insufficiency, while values < 10 ng/ml were classified as deficiency Results 95,45% of all patients were women, 56,81% had diffuse skin involvement, mean age 35,9 years, medium disease duration 12,5 years+/- 3,4. mean Rodnan 9,5+/-2,4, mean activity score=3,13+/- 0,8, mean Medsger 6,66+/- 1,1. 36,36% had interstitial lung disease, 18,7% had pulmonary hypertension. Only 3 patients had optimal levels of 25(OH)2 D; most of the patients had an insufficient (65,9%) or deficient (27,27%)level, mean vitamin D serum concentration was/18,6+/-3,5ng/ml. A negative correlation between patients’ age and vitamin D concentration was observed. A significant correlations were found between low vitamin D levels and age, Rodnan score, European disease activity score, Medsger score, pulmonary fibrosis and low DLCO., distal joint contracture, muscular weakness/myalgia. Conclusions Most of the patients of the group had suboptimal low levels of vitamnin D. Some clinical correlations were indentified. We are aware of the limitations of the study that are : small group, lack of control group and the fact that measurements of vitamin D were not done in the same period of the year. Given the most recent findings, we consider further research would be clinically important to elucidate the causes of hypovitaminosis D in SSc, its relevance to disease progression, its influence on immune functions, and the potential effects of supplementation References Rios-Fernández R et al Bone mass and vitamin D in patients with systemic sclerosis from two Spanish regions. Clin Exp Rheumatol. 2012 Nov-Dec;30(6):905-11. Vacca A, Cormier C, Mathieu A, Kahan A, Allanore Y. Vitamin D levels and potentialimpact in systemic scler...

BackgroundPsoriatic arthritis (PsA) is associated with important comorbidities: cardiovascular, gastro-intestinal, infectious, malignant, and psychiatric [1, 2]. However, they are less studied in PsA compared to other chronic inflammatory arthritis.ObjectivesThe objective of this study was to calculate the prevalence of comorbidities and risk factors in a cohort of PsA patients.MethodsThis was an observational cross-sectional study, including consecutive, unselected adult patients, with a diagnosis of PsA according to their rheumatologist. Data collected: demographical, clinical (affected joints, current psoriasis, axial involvement, enthesitis, dactylitis), biological (acute phase reactants), and treatment related (nonsteroidal anti-inflammatory drugs, synthetic remissive drugs and biologics). Data on comorbidities and risk factors were collected according to the European League Against Rheumatism (EULAR) recommendations on reporting comorbidities in chronic inflammatory rheumatic diseases in daily practice [3].ResultsIn all, 129 PsA patients were included: 77 (59.7%) women, mean age ± standard deviation 53.5±11.8 years, disease duration 7±7.4 years; 53 (41.1%) had axial involvement, 33 (25.6%) dactylitis, 18 (14%) enthesitis, and 24 (18.6%) current moderate/severe psoriasis. Most of them had low or moderate disease activity and almost a quarter of them (32; 24.8%) were taking a biologic.The most prevalent comorbidities were: dyslipidaemia 103 patients (79.8%), hypertension 67 (51.9%), obesity 44 (34.1%), diabetes 21 (16.3%) and ischemic heart disease 15 (11.6%). Almost a third of patients (42, 32.6%) suffered a cardiovascular event after their PsA diagnosis, of which heart attack 2 patients, stroke 4, cardiac failure 4 and peripheral arterial disease one patient. Cardiovascular events correlated with smoking (r=0.893, p<0.001) and current moderate/severe psoriasis (r=0.218, p=0.013).Regarding infectious comorbidities: 11 patients (8.5%) had a history of tuberculosis after being diagnosed with PsA, 7 (5.4%) chronic viral hepatitis, of which 4 with B virus and 3 with C virus, and 5 patients (3.9%) developed severe infections. Five patients (3.9%) were diagnosed with neoplasia, but no correlation was identified with any of the clinical, biological or treatment related included variables. Only 11 patients (8.5%) were diagnosed with depression, but the prevalence is probably underestimated, since not all patients were screened to this end.ConclusionsPsA is associated with a high prevalence of comorbidities, especially cardiovascular diseases. This should be taken into consideration in the therapeutic and the global management of PsA patients.References Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep 2010;12(4):281–7.Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: apopulation-based cohort study. Ann Rheum Dis 2015;74(2):326–32.Baillet A, Gossec L, Carmona L, et al. Points...