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
BackgroundChildren with juvenile idiopathic arthritis (JIA) frequently experience impairments in one or more body systems. These may include pain, fatigue, muscle weakness, and poor exercise capacity. Functional disability can be evaluated by means of questionnaires and observed performance tests. Only the Juvenile Arthritis Functional Assessment Scale (JAFAS) and the Childhood Health Assessment questionnaire (CHAQ) were developed specifically for children with juvenile arthritis.ObjectivesThe aim of this study was to investigate the relationship between JAFAS and CHAQ in the evaluation of physical function.MethodsThis is a cross sectional study including patients with JIA. Assessment of disease activity (DAS28), number of tender joints (NTJ) and swollen joints (NSJ) were determined. The JAFAS (range 0-20) includes 10 items of activities of daily living (dressing, cutting food, getting in and out of bed, picking up an object from the floor while standing, moving from standing to the floor and returning to standing, walking 50 feet unaided, and walking up a flight of 5 steps). The score range for each item is 0–2, based on the time in seconds the child takes to complete each task. Higher scores indicate greater activity limitation (1). The original CHAQ including 30 activities in eight different domains, with a total score ranging from 0 (no limitation) to 3 (maximal limitation) was completed by interviewing the patient (2). Spearman correlation test and Cohen’s kappa coefficient (k) were used. Significance level was set at p⩽0.05.ResultsTwenty-nine patients with a median age of 25 years [8-40] and median disease duration of 16 years, were included. Age of onset of the disease was 8 years [2-16] years. The median JAFAS score was 3 [0-12] and the median CHAQ score was 0.05 [0-3]. There was a slight agreement between JAFAS and CHAQ k=0.1 (p = 0.05). A positive correlation was found between NTJ and CHAQ (r=0.54, p=0.03) and JAFAS (r=0.5, p=0.05). A correlation was noticed also between NSJ and CHAQ(r=0.51, p=0.05). Both the JAFAS and CHAQ scores correlated with DAS28 (r=0.55, p=0.01and r=0.44, p=0.02, respectively). At the level of the individual joints, coxitis was the most frequent complication (13 patients out of 28), six of them had surgery of total hip prosthesis. There was a linear relationship between JIA complicated with coxitis and the level of functional disability measured with JAFAS (p=0.027).ConclusionOur study shows that, even though JAFAS had a slight agreement with CHAQ, both were correlated with the level of disease activity and the number of swollen and tender joints.References[1]klepper. S E. Measures of Pediatric Function Child Health Assessment Questionnaire (C-HAQ), Juvenile Arthritis Functional Assessment Scale (JAFAS), Pediatric Outcomes Data collection instruments. Arthritis Care & Research 2011; 63: S371-S82[2]Bekkering. W P et al. A comparison of the measurement properties of the Juvenile Arthritis Functional Assessment Scale with the childhood health assessment questionnaire. Clin Rheumatol 2007; 26: 1903–07[3]Bekkering. W P et al. The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis. J Rheumatol 2001; 28:1099-105Disclosure of InterestsNone declared
BackgroundFortunately, management of RA at the early stage has become possible thanks to both the emergence of new biotherapies and the strategy treat to target. Musculoskeletal ultrasound (US) is a potent tool for the detection of synovitis, effusion and bone erosion in RA.ObjectivesThe aim of this study was to assess the contribution of US in diagnosing RA at the early stage of the disease.MethodsA cross-sectional study was performed during 2 years. Patients with a history of inflammatory joint pain for ≥6 weeks and ≤2 years with synovitis of at least one joint were enrolled in this study. All patients underwent clinical assessement, laboratory tests and plain radiography of hands and feet.US was assessed within one week of clinical examination. Synovitis and erosion were defined according to the OMERACT.ResultsOne hundred patients were included in this study with an average age of 51,8±14,6 years-old. Female outnumbered male with a sex ratio of 3,8. The mean duration of the disease was 10,9±7,4 months. When admitted to our department and after clinical examination it was found that 31% of patients presented polyarthritis, 4% had oligoarthritis and 7% suffered from monoarthritis. US findings: US was found to be more sensitive than clinical examination to detect synovitis. Among the 2200 joints assessed by US, a synovitis was detected in 81% patients, an intra-articular effusion in 36% patients and PD signals in 51% patients. Also, flexor tenosynovitis were present in 55% patients and extensor tenosynovitis in 59% patients. Erosions were more detected in plain radiography (70%) than in US (41%). Clinical parameters (VAS, duration of morning stiffness, number of night awakens, TJC) were not correlated with most US findings. Nevertheless, correlation was detected for US effusion (r=0,250, p=0,028) and for US Doppler (r=0,289, p=0,011) with SJC. PDUS examination correlated with CRP results (r=0,302, p=0,023) but not with ESR results. A significant, positive correlation was observed between erosions in X-rays or US assessment (r=0,342, p=0,002). The US detected synovitis in 25% of patients who had no swollen joint at the clinical examination when admitted to our department and had detected erosions in 9% of patients having negative plain X rays.ConclusionsUltrasound appears as a sensitive tool to detect subclinical synovitis (25%) and infra- radiological erosions (9%). It helps us to make an early diagnosis and start appropriate treatment before the onset of irreversible joint destruction.Disclosure of InterestNone declared
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