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These results provide an explanation on the cellular level for the anticatabolic effect of TNF neutralisation on bone. The variation in the kinetics of bone resorption by the OCPs in patients with RA and AS suggests disease-specific differences in the type or in the preactivation of OCPs.

Knuckle pads are rare harmless subcutaneous nodules that must be differentiated from joint disease of the proximal interphalangeal or rarely of the metacarpophalangeal joints as well as from other masses of the paraarticular tissues. We present a case of an otherwise healthy 36-year-old woman presenting with bilateral knuckle pads located at the dorsal aspect of the proximal interphalangeal joints. No predisposition to a specific musculoskeletal disorder was noted. Ultrasound revealed well-delimited subcutaneous hypoechoic masses without internal flow signals at color Doppler. Histology showed proliferation of myofibroblasts with a decrease of elastic filaments in the deep dermis. The clinical picture, the family history in addition to the histology allowed us to make the diagnosis of knuckle pads. We present the ultrasound findings of knuckle pads and discuss the differential diagnosis of a “swelling” in the dorsal region of proximal interphalangeal joints and metacarpophalangeal joints.

In this study, serum levels of biochemical nutritional parameters in acutely ill elderly patients with stage III to IV pressure ulcers are lower than those of acutely ill elderly subjects with no pressure ulcers, indicating a worse nutritional status of the PU patients. These findings, while not documenting a causal relationship, suggest the need for routine nutritional assessment and support in older patients, especially those with pressure ulcers.

Zusammenfassung Zur Qualit?tssicherung und Verlaufsdokumentation einer Therapie bei R?ckenschmerzen (Low Back Pain, LBP) wurde der Activity-Index (AI), als einfach verst?ndlicher und Internet basierender Patientenfragebogen entwickelt. Der AI kann jederzeit vom Patienten selbst?ndig ausgef?llt werden und die Resultate werden sofort berechnet und sind sofort einsehbar. Die Gewichtung der Fragen auf die subjektiv empfundenen Einschr?nkungen in der Partizipation (Beruf, Haushalt, Freizeit) beruht auf der Erkenntnis, dass diese Parameter die beste Korrelation f?r den Therapieerfolg einer muskuloskeletalen Rehabilitations-Behandlung darstellen. Es wurden 66 Probanden mit LBP und einem Internetzugang eingeschlossen, davon waren die Daten von 49 Probanden zur Validierung verwertbar. Zu Beginn und nach 4 Wochen wurde der AI und zeitgleich der SF-12 durchgef?hrt. Bei mittlerer bis hoher Korrelationen wird gezeigt, dass mit beiden Instrumenten ?hnliche Dimensionen erfasst werden und dies als eine indirekte Validierung des AI interpretiert werden kann.

BackgroundVacation can present a major problem to patients with rheumatoid arthritis (RA) treated with weekly subcutaneous biologics, including subcutaneous (SC) abatacept. Therefore, the replacement of four SC doses of abatacept by a single dose of intravenous (IV) abatacept may present an acceptable alternative to cover a 4-week interval needed for vacations. In the study presented, we analyzed the efficacy and safety of this intervention followed by a switch back to SC abatacept after 4 weeks.MethodThis open-label, prospective, single-arm, 24-week trial recruited patients with established RA in low disease activity (LDA) or in remission on treatment with SC abatacept for at least 3 months to receive a single dose of IV abatacept (baseline) followed by a break of 4 weeks and then continuation of weekly SC abatacept from day 28 on. Disease-modifying anti-rheumatic drug (DMARD)-inadequate or biologic-inadequate responders (or both) were included.ResultsThe baseline characteristics of the 49 patients (per protocol) were typical for a cohort of RA patients with established disease (mean disease duration of 8.31 years) in LDA under treatment with synthetic DMARDs and a biologic. Two patients (one flare and one patient decision) dropped out of the study. The proportions of patients with disease activity score in 28 joints (DAS-28) of not more than 3.2 at day 28 were 93.9 % (95 % confidence interval (CI) 83.5–97.9) and 93.6 % (95 % CI 82.8–97.8) at the end of the study (day 168). The average DAS-28 values were 1.74 (standard deviation (SD) ± 0.72) at baseline, 2.03 (SD ± 1.03) at day 28, and 1.96 (SD ± 0.92) at the end of the study (day 168). Pre-exposure to IV abatacept and having failed methotrexate or anti-tumor necrosis factor (anti-TNF) did not influence the average DAS-28 or the proportion of patients maintaining LDA over time. The average health assessment questionnaire disability index (HAQ-DI) was stable throughout the study. Adverse events (AEs) occurred in 75 % of subjects. Four serious AEs were described during the study. None of them was related to the investigational product, and all serious AEs could be resolved during hospitalization.ConclusionThis prospective, open-label study of abatacept shows for the first time that switching from weekly SC to IV abatacept and back after 4 weeks is an effective and safe way to bridge vacations in RA patients in LDA or remission. (NCT1846975, registered April 19, 2013.)

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Background Even though hospitalization is a major cost driver in patients with rheumatic disorders there is limited information and analysis of reasons for their hospitalization Objectives To analyze the reasons for hospitalization of rheumatologic patients in divisions of rheumatology in emergency hospitals in Switzerland based on questionnaires sent to the heads of all 30 departments of rheumatology in the country Methods The questionnaires contained 51 open questions on 8 different topics: Which criteria are important for hospitalization? What defines a severe course of the disease? Which threatening organic damage or pain level require hospitalization? How does the complexity of diagnostics or interventions influence the decision for hospitalization? Are costs or primary patient care relevant factors for hospitalization? The questions were asked in separate for inflammatory arthritis/spondyloarthritides (Art), connective tissue diseases/vasculitis (Vasc), and degenerative or other musculoskeletal disease. (Degen). Results 25 of the 30 heads of divisions (83.3%) have answered the questionnaires. Two additional ones have sent letters stating that such questionnaires are too limiting for adequately reflecting the clinical reality. The overall majority of responders stated that acute organic problems 79.6% (Art), 81.2% (Vasc), and 73.5% (Degen) are an important factor for hospitalization. These manifestations were closely associated with other primary diseases (Art, 81.8%), with organic manifestations of the primary disease (Vasc, 64.2%), and with complex interventions (Degen, 66.9%). The most important other diagnoses in association with a rheumatologic diagnosis were pneumologic (16.8%), neurologic (13.0%), and cardiological (13%) for Art patients, pneumologic (16.8%), neurologic (13.0%), and renal (13%) for Vasc patients, and neurologic (74.2%) for Degen patients. Primary care problems were understood to be more important for Art (52.6%) and Vasc patients (54.1%), but less important for Degen patients (28.6%). Conclusions Acute medical rather than chronic problems are the major factor for the hospitalization of rheumatic patients. These acute problems are mainly associated with primary manifestations of other diseases for patients with inflammatory arthritis/spondyloarthritides, with organ manifestations of the primary disease for patients with connective tissue diseases/vasculitis, and with interventions for patients with degenerative or other musculoskeletal disease. Discussion Since many rheumatologic diseases are closely associated with other diseases, especially of internal organs, it is possible that many of these patients are not seen by a rheumatologist during their hospitalization. Disclosure of Interest None Declared