BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by the presence of rheumatoid factor (RF) and anti-cyclic citrullined peptide (ACPA). ACPA have higher specificity than RF for RA, and are associated with joint radiographic damage and extra-articular manifestations.ObjectivesThe aim of this study was to evaluate the US RA activity whether the ACPA were present or not.MethodsA cross-sectional study of patients followed-up for RA was conducted. Demographic, clinical and biological data were collected. RF and ACPA mesures were collected from medical records. We calculated the US-DAS28 in order to evaluate accurate activity of RA. All patients had an ultrasound (US) examination of 22 joints of hands (wrists, metacarpophalangeal, proximal interphalangeal). US was performed by an operator blinded to clinical and laboratory data. RA activity was evaluated by US-DAS28 by replacing swollen joints of the hands by joints expressing synovial hypertrophy or hyper vascularization in US.ResultsOne hundred and eighteen patients were enrolled, 83% were females. The mean age was 53 years-old. The mean duration of the disease was 11.6 months. The RF was positive in 64 (55%) patients and the ACPA was positive in 31 (26%) patients. The median DAS28 was 5,52 [2,91-7,81]. The medianUS-DAS28 was 5.29 [1.98- 7.83]. The comparison between US-DAS28 according to immunological status is showed in table 1.Table 1.US-DAS28 depending on RF and ACPA statusUS-DAS28pRF (+)5,290,90RF (−)5,26ACPA (+)5,310,80ACPA (−)5,29ConclusionsWe conclude that there was no significant difference of RA activity between seropositive or seronegative RA and also whether ACPA was positive or not. The analysis of bone damages should be compared in another study order to determinate the prognostic value of ACPA.ReferencesJung C, Jisuk B. Relation of rheumatoid factor and anti cyclic citrullined peptide antobody with disease activity in rheumatoid arthritis: cross sectional study. Rheumatol Int 2013.Disclosure of InterestNone declared
Brown tumors (BTs) are due to a proliferation of multinucleated giant cells in osteolytic lesions. They complicate the course of hyperparathyroidism. Thanks to an early screening of bone metabolism disorders; BTs are nowadays rare bone manifestations. We demonstrate through these two cases reports unusual locations of BTs in hyperparathyroidism.
BackgroundIn rheumatoid arthritis (RA), tendon pathology is a well-recognized, but underestimated aspect of the disease, which may lead to irreversible functional impairment and consequent disability. Clinical joint examination is less time-consuming than ultrasound (US) but it may misdiagnosis tenosynovitis (TS).ObjectivesThe aim of this study was to compare clinical assessment of tenosynovitis detection with US examination.MethodsA cross sectional study was performed including patients followed-up for active recent RA (RA <2 years, DAS28 >2,6). Clinical examination was performed by a rheumatologist seeking signs suggestive of flexor of extensor TS. US was performed by an experienced radiologist blinded to clinical data. All tendons of the hands were scanned in the transverse view from the more proximal to the more distal portion at the tracts surrounded by synovial sheath. Totally 140 hands were assessed. Results of clinical examination were compared to US findings. The difference is considered significant if the P>0,05.ResultsSeventy patients were recruited, (56 females, 14 males). The mean age was 53 years-old [24-74 years-old]. The mean duration of the disease was 10 months [3-24 months]. The RA was active with a median DAS28 5,46 ranging from 2,91 to 7,81. Physical examination highlighted TS in 53 (38%) hands, it was bilateral in 50%. Flexor tendons were the most affected (52 hands). Both flexor and extensor tendons were detected affected in 4 hands. US showed TS in 89 (65%) patients. Flexor tendons showed US activity in 80 hands and extensor tendons in 78 hands. US revealed a significant high frequency of TS over clinical examination (p=0,02). The sensitivity of US to detect TS was 80.3% and the specificity was 50,4%.ConclusionsThe rationale of using US relies on the fact that physical examination provides only limited information on the presence of tenosynovitis. Since TS can be source of functional disagreement, US should be focused, in addition to analyze synovitis, on tendons in RA.ReferencesEmilio Filippucci, Alessandra Gabba and al. Hand Tendon Involvement in Rheumatoid Arthritis: An Ultrasound Study. Seminars in Arthritis and Rheumatism 2012;41:752-60.Backhaus M, Kamradt T and al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rhem. 1999;42:1232-45.Szkularek M, Court-Payen M and al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum.2003;48:955-62.Disclosure of InterestNone declared
Background:Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood that may lead to physical disability and reduced quality of life, thus hindering the ability of the patients to achieve a meaningful adult life.Objectives:The aim of this study was to assess the trends of the disease and socio-professional future.Methods:We conducted a retrospective study including adult patients aged > 18 years with a history of JIA according to the International League of Associations for Rheumatology (ILAR). Collected data included age, sex, the characteristics of the disease (subtype of JIA, disease duration). The level of education, marital status as well as the profession were recorded.Results:The study included 32 patients with a female perdominance: sex ratio was 1,5. The mean age was 29,5 years old [18-64]. The mean age of onset of the disease was 6 years and 2 months [2-17]. The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 14), polyarticular without rheumatoid factor (n=9), systemic (n= 2), enthesitis-related arthritis (n=7), oligoarthritis (n= 5). Four patients suffered from bilateral cataract due to corticosteroid intake. Polyarticular RF+ and RF- progressed into an authentic seropositive and seronegative RA in 71.4% and 66.7% respectively. Among oligoarticular subtype, an extension of the disease to a polyarticular FR+ form (n=1) and to a seronegative rheumatoid arthritis (n=1) was noted. Systemic JIA forms remained in remission with an articular involvement. All the patients with ERA developed spondylarthritis. Although forty–two percent of the patients were married, only half of them had children. Ten percent of patients stopped attending school because of disease flares and deformation. A university level was found in 16% of cases. Only Thirty patients had a profession. Of the patients, 74.4% had received disease-modifying anti-rheumatic drugs (DMARDs) and 36.3% of them were still taking a DMARD. Ten patients were on biologics. Severe disability was found in 20% of patients and concerned mainly the hip (57,2%), the wrist (28,5%) and the elbows (14,3%). Prosthetic joint replacement was found in 2% of cases with a revision of the latter in one patient.Conclusion:Adults with JIA often have significant levels of disability, usually related to severe joint complications. There is a clear requirement for a better transition to adulthood and a socio-professional rehabilitation.Disclosure of Interests:None declared
Background Musculoskeletal Ultrasound (US) is now becoming part of the daily practice of rheumatology. In fact, it is a useful tool in rheumatoid arthritis (RA) for detecting persisting infra-clinical synovitis in patients in remission. However, possible existence of a physiological effusion of the PIP was demonstrated in healthy subjects. Objectives The purpose of our study was to assess the presence of US effusion in proximal interphalangeal (PIP) joints of RA patients in remission and to compare it to healthy controls. Methods Thirty RA patients in remission (Disease Activity Score 28 joints <2,6 for at least 3 months) and 17 healthy control patients were prospectively enrolled. All of the patients had a musculoskeletal ultrasound (US) examination of the PIP of both hands from the second to the fifth. US (Esaote MyLab 60 machine and a 13-18 MHz linear array transducer) was performed by a rheumatologist with theoretical and practical training in musculoskeletal ultrasonography. The findings obtained by grey scale (GS) and PD were graded on a semi-quantitative scale from 0 to 3. Results The mean age of RA patients in remission was 48 years-old and for control group 45 years-old. For the 240 joints scanned of RA patients, 37 (15%) joints presented synovitis in B mode and 9 (4%) a PD activity. Concerning control group, 136 joints were examined. Among them, 57 (42%) joints expressed synovitis in B mode and none in PD. The mean US score was 0,2 for RA patients and 0,5 for control group. The difference between two groups was significant (p=0,04). Conclusions US activity can be detected in B mode but not in PD in PIP even in healthy subjects. Synovitis detected in PIP in RA patients even in remission must be taken into account when assessing the activity of the RA in order to avoid further damages and disabilities. References Rosenberg C. High frequency of ultrasonographic effusion in interphalangeal joints of healthy subjects: A descriptive study. BMJ 2009 Witt M. Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum. 2013 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5224
Background Enthesitis is categorized as inflammation of insertion of ligaments, tendons, joint capsule or fascia to bone and is a frequently under–diagnosed feature of spondylarthritis (Sp). In fact it has been demonstrated that clinical examination revealed enthesitis only in 5% in patients with inflammatory bowel disease (IBD). Detection of entheseal involvement is important to prevent disability and bone erosions in late disease. New imaging techniques such as ultrasonography (US) are performant tools to assess enthesitis in early phase. Objectives The aim of this study was to investigate US enthesitis abnormalities in IBD patients without symptoms of Sp. Methods A total of 19 patients followed-up for IBD were prospectively recruited for US examination. Only patients in inactive or low disease activity of IBD were screened. All patients showed no clinical evidence of arthritis or enthesitis. The Madrid Songraphic Enthesis Index (MASEI) was used to assess entheseal involvement. Six sites were bilaterally explored: distal quadricipital tendon (QT), proximal and distal patellar tendon insertion (PPT) and (DPT), distal Achilles tendon (AT), plantar fascia (PF) and distal brachial triceps tendon (TT). The US score evaluated enthesis thickness, structure, calcifications, power Doppler signals, erosions and bursae (for DPT and AT). US score for calcifications, Doppler and erosions ranged from 0 to 3, while scoring tendon thickness, structure and bursae was 0 (absent) or 1 (present). Results Of the 19 patients examined, four had ulcerative colitis and 15 Crohn disease. The mean age was 32,5 years, 8 males and 11 females. The mean disease duration at the moment of US exam was 4,6 years [1-19 years]. Only one patient has ocular abnormality as extra-digestive manifestation. At inclusion two patients had low disease activity and the rest of them an inactive disease. All patients (100%) presented at least one tendon alteration with mean MASEI 21,3 [4-56]. Enthesis thickness was noted in 84% and the PPT was the most affected. Structure damages were present in 21% of patients. Calcifications were found in 47% of patients and mean score was 1,1. The most frequent site was the AT. Power Doppler signals were detected in 16% of cases and erosions in 47% with a mean score at 3. Bursitis was noted in 36% of cases, one patient presented both retrocalcanel and infrapatellar bursitis. No significant correlation was found between MASEI and the disease duration (p=0,33) or the extension of the digestive disease (p=0,32). Conclusions The relevance of this study is to show the high subclinical frequency of enthesopathy in IBD patients without clinical signs of Sp. These findings might influence the choice of treatment and elucidate the importance of strict collaboration between gastro-enterologists and rheumatologists. References Ultrasound discloses entheseal involevement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondylarthropathy. Bandinelli F and Col. Rheumatology 2011 V...
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