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
Introduction. Intensive exploration and processing of mineral raw materials in the Trans-Baikal territory has caused the accumulation of considerable amount of industrial mining waste with high content of chemical elements of different classes of hazard. Currently 33 tailings storage facilities (TSF) accumulating approximately 3 milliard tons of different industrial waste are located in the territory of the region. The aim of the research is the hygienic assessment of soil contamination in the residential areas adjacent to TSFs. Material and methods. Atomic absorption spectrophotometry method was used for the determination of heavy metals. The study presents the results of analyses of 444 samples of gross content of lead, zinc, copper, mercury, arsenic, and cadmium in the soil of Khapcheranga, Sherlovaya Gora, Kadaya, Vershino-Darasunsky, and Vershino-Shakhtaminsky mining villages throughout the duration of 2012 - 2015. Results. During the period of the study the total value of soil contamination with Zc calculated by the median concentrations in Khapcheranga Village amounted to 4.7 6.9, in Vershino-Shakhtaminaky - to 6.7 8.8, which corresponds to the «allowable» level of the contamination. Zc calculation by maximum concentrations has shown the soil to be referred to the category from “moderately dangerous” to “extremely dangerous”; this value in Khapcheranga Village amounted to 48.7 - 235.3, in Vershino-Shakhtaminsky Village - to 23.76 - 164.8. Discussion. In the residential areas the allowable degree of soil contamination was determined to be predominantly observed; Khapcheranga and Vershino-Shakhtaminsky villages are the exceptions. The results of the assessment give the evidence of tge increased lead, cadmium and arsenic content throughout the entire area of the villages, while the highest levels of accumulated toxic substances are registered in the areas located near the TSF Conclusion. Thus, several zones of natural and anthropogenous contamination with increased concentrations of heavy metals and arsenic have been formed in the Trans-Baikal Territory. This dictates the need to study the influence of geochemical anomalies on the health of population.
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
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.