ObjectivesTo investigate the diagnostic performance and reliability of ultrasonography (US) in detecting and grading common extensor tendon (CET) tear in patients with chronic lateral epicondylitis (LE), using magnetic resonance imaging (MRI) as the reference standard.Materials and methodsThe study comprised fifty-eight chronic LE patients. Each patient underwent US and MRI. CET status was classified as: high-grade tear (≥50% thickness), low-grade tear (<50% thickness), suspected tear (possible but not evident tear), no tear. Additionally, the following dichotomous scale was used: confirmed or unconfirmed CET tear. Relative US parameters (versus MRI) for detecting CET tear included: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. The agreement between US and MRI findings was measured using the weighted Cohen kappa coefficient (κ).ResultsUS showed moderate agreement with MRI in detecting and grading CET tear (κ = 0.49). Sensitivity, specificity, and accuracy in CET tear detecting by US were 64.52%, 85.19%, and 72.73%, respectively. PPV and NPV of US were 83.33% and 67.65%, respectively. No patient with unconfirmed CET tear on US had high-grade CET tear on MRI.ConclusionUltrasonography is a valuable imaging modality that can be used as a screening tool to exclude high-grade CET tear in chronic LE patients. Once a tear is evident on US, MRI should be considered to assess precisely the extent of tendon injury.
Purpose: The study aimed to evaluate and compare the efficacy of TNF-α inhibitors in the treatment of ankylosing spondylitis in everyday medical practice. Materials and methods: We analysed the data of 106 patients with ankylosing spondylitis treated in 2012–2019 with TNF-α inhibitors (etanercept, adalimumab or golimumab) under the drug program of the National Health Fund. The observation period for each patient was 18 months. The disease activity was assessed at 3-month intervals on the basis of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS (Ankylosing Spondylitis Disease Activity Score). Results: The study covered 80 men and 26 women. The mean age of the patients was 37 years. The group receiving etanercept included 50 patients, adalimumab – 39 patients, and golimumab – 17 patients. Due to coexisting offaxial symptoms such as uveitis (n = 20/106) and peripheral arthritis (n = 39/106), some patients were simultaneously receiving classic disease-modifying antirheumatic drugs, i.e. methotrexate (n = 32/106), sulfasalazine (n = 8/106), cyclosporine (n = 5/106), and glucocorticosteroids (n = 14/106). All subgroups showed a significant clinical improvement in the form of a decrease in inflammatory markers and a decrease in disease activity after 3 months of treatment, increasing up to the 6th month. The biological drug was discontinued due to remission (according to BASDAI) in 20/48 patients taking etanercept and in 19/36 patients receiving adalimumab. The observation period following drug discontinuation for both groups was similar and lasted about 7 months. The remission time (according to BASDAI) without treatment was short; 3.55 ± 2.28 months for etanercept vs. 5.21 ± 2.53 months for adalimumab (p = 0.038). Conclusions: The inclusion of TNF-α inhibitors in patients with an unsatisfactory response to treatment with non-steroidal anti-inflammatory drugs resulted in a major reduction of disease activity. There was no statistically significant difference in treatment efficacy between individual TNF-α inhibitors, i.e. etanercept, adalimumab, and golimumab. The group treated with adalimumab was found with a trend towards longer-lasting remission after drug discontinuation, but it was short-lived and a return to treatment was necessary.
Reumatoidalne zapalenie stawów (RZS) jest przewlekłą układową chorobą tkanki łącznej o podłożu autoimmunologicznym. Etiologia choroby nie jest znana. Charakteryzuje się ona nieswoistym zapaleniem symetrycznych stawów, a także występowaniem zmian pozastawowych i powikłań układowych. Przebiega z okresami zaostrzeń i remisji, prowadzi do niepełnosprawności i zwiększonej śmiertelności. Lekiem pierwszego rzutu w RZS jest metotreksat (MTX), który w erytrocytach ulega transformacji do poliglutaminianu metotreksatu (MTXPG). Aktywność procesu chorobowego RZS oraz wyniki leczenia są silnie skorelowane ze stężeniem MTXPG w erytrocytach. W artykule przedstawiono zależność między drogą podania leku, stężeniem MTXPG w erytrocytach a wynikami leczenia u chorych na RZS. Zwrócono także uwagę na badania dotyczące wpływu polimorfizmu genów kodujących szlaki biosyntezy puryn na efekt działania MTX. S u m m a r y Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology, characterized by inflammation of the symmetrical joints, multi-organ complications, flares and complete or partial remission periods, which results in disability and increased mortality. Methotrexate (MTX) remains the first-line therapy for active RA. In red blood cells (RBC) MTX is transformed into methotrexate polyglutamates (MTXPG). Disease activity and treatment results are strongly associated with methotrexate polyglutamate concentrations in red blood cells. The article presents the correlation between the route of administration of the treatment, RBC MTXPG concentration and disease activity in patients with rheumatoid arthritis. Also, the impact of genetic polymorphism in the folate-purine-pyrimidine pathway on effects of MTX therapy is stressed. A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i: :
Aim of the study: An assessment of short- and long-term efficacy of local corticosteroid injection in patients with lateral epicondylitis (tennis elbow) based on The Disabilities of the Aim, Shoulder and Hand (DASH) questionnaire and Visual Analogue Scale (VAS), as well as an assessment of long-term treatment efficacy depending on baseline ultrasound disease activity. Materials and methods: A total of 32 patients presenting with tennis elbow and increased blood flow on ultrasound who were treated with local corticosteroid injection were included in the study. Baseline increase in blood flow, pain severity, upper limb function and the subjective response to treatment at 2 weeks (short-term outcomes) and 6 months (long-term outcomes) were assessed. Results: Short-term improvement was achieved in all patients. Long-term improvement was observed in 24 (75%) patients with lower baseline DASH and VAS. Long-term improvement was achieved in 15 (94%) patients in the group with low to moderate baseline disease activity on power Doppler ultrasound (16 patients) and in only 9 (54%) patients in the group with high baseline Doppler disease activity (16 patients). Conclusions: Local corticosteroid injection in patients with tennis elbow who present with increased baseline vascularity on ultrasound seems show short-term efficacy. Negative long-term prognostic factors seem to include significantly increased baseline vascularisation and high baseline DASH and VAS scores. Therefore, it seems reasonable to evaluate these factors before treatment onset, and if abnormalities are found, intensification of treatment or switch to another therapeutic option should be considered.
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