Objective: Osteoporosis is the most common bone tissue disease and it is characterized by a reduced bone mineral density (BMD). The main physiopathological mechanisms converge on the uncoupling between bone formation and resorption, thus leading to an enhanced risk of fractures. Several papers have documented the inverse relationships linking high inflammatory cytokines, anticitrullinated protein antibodies, rheumatoid factor, and BMD in rheumatoid arthritis (RA). Rituximab (RTX) is a chimeric monoclonal antibody directed against the CD20 receptor of B cells. Since the Food and Drug Administration approved it for RA in 2006, there have been many clinical experiences regarding its use. Nevertheless, few studies evaluate the effect of rituximab on BMD. RA is a disease characterized by immune dysfunction with high levels of inflammatory cytokines, autoantibodies, and it is reasonable that a B cell depleting therapy could restore a physiological cytokine balance, thus exerting an osteoprotective effect on the bone tissue. The purpose of this paper is to highlight any difference in BMD and to assess differences in body composition over a retrospective 18-month follow-up period after RTX treatment with a B cell depleting therapy. Material and methods: We analyzed by dual energy X-ray absorptiometry BMD expressed as g/cm 2 and body composition modifications over 18 months with RTX treatment of 20 postmenopausal RA patients. Results: After eighteen months of therapy with RTX, a statistically significant increase in vertebral (L1-L4) BMD and the stability of femoral BMD were documented. Conclusions: Rituximab is associated with an improvement of vertebral and preservation of femoral BMD, suggesting a bone-sparing effect due to B cell depletion. Furthermore, patients displayed a redistribution of fat masses toward the hip region.
Objectives The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. Methods A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1–8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. Results PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). Conclusions PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.
Objectives No clear-cut guidelines exist about the use of diagnostic procedures for idiopathic inflammatory myopathies (IIM) and only scanty and conflicting data report the use of ultrasound (US). In this regard, we aimed to assess if grey-scale (GS) and Power Doppler (PD) US, graded with a 0-3-points-scale, may be a reliable tool in a cohort of patients affected by IIM. Methods All patients underwent US examination of both thighs in axial and longitudinal scans. Edema and atrophy, both assessed in GS, and PD, were graded with a 0-3-points-scale. Spearman test was used to identify the correlations between US and clinical and serological variables. Results A total of 20 patients was included. Six and 2 of them were evaluated twice and 3 times, respectively. Muscle edema was found to be directly correlated with physician global assessment (PhGA), serum myoglobin and PD and negatively with disease duration. PD score was positively correlated to PhGA and negatively to disease duration. Muscle atrophy directly correlated with Myositis Damage Index, disease duration and patients’ age. The single-thigh sub-analysis evidenced a direct correlation between PD score and Manual Muscle Test. Conclusions In our cohort, we found that edema and PD are strictly related to early, active myositis, suggesting that an inflamed muscle should appear swollen, thickened and with Doppler signal. Conversely, muscle atrophy reflects the age of the patient and the overall severity of the disease. Such findings shed a new, promising, light in the role of US in diagnosis and monitoring of IIMs.
Among the rheumatic diseases whose symptoms are more often associated with the possibility of cancer and other malignancies are systemic sclerosis, dermatomyositis and rheumatic polymyalgia. However, a differential diagnosis should be performed in each case of non-typical rheumatic disease and/or other neoplastic disease risk factors. The article’s aim was based on a literature review of this subject and presentation own a case description and discussion about arthritis as a paraneoplastic syndrome. The conclusions of our analysis were as follows: more often paraneoplastic arthritis occurs in men, in ages higher than 50 years old, in patients who poorly respond to treatment of arthritis with polyarticular symmetrical involvement of the limbs, seronegative type of inflammatory joint disease. In this group of patients, complete remission after treatment of the primary tumor and recurrence of the symptoms in the presence of metastasis was observed.
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