Joint involvement in patients affected by systemic lupus erythematosus: application of the swollen to tender joint count ratio

Cipriano, Enrica; Ceccarelli, Fulvia; Massaro, Laura; Alessandri, Cristiano; Perricone, Carlo; Valesini, Guido; Conti, Fabrizio

doi:10.4081/reumatismo.2015.828

Cited by 11 publications

(6 citation statements)

References 12 publications

(9 reference statements)

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“…Even so, we found a positive correlation between STR and DAS28-ESR values; moreover, SLE patients without joint activity defined by SLEDAI-2k had a moderate STR in 9% of cases. 14…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of composite indices in the assessment of joint involvement in systemic lupus erythematosus patients: correlation with ultrasonographic score

Ceccarelli

Perricone

Cipriano

et al. 2019

Lupus

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Specific indices are not available to evaluate systemic lupus erythematosus (SLE) joint involvement; indeed, the application of indices validated for rheumatoid arthritis has been suggested. We evaluated the usefulness of organ specific composite indices, i.e. the Disease Activity Score on 28 joints (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and the ratio of swollen to tender joints (STR), to assess SLE joint activity by analyzing the correlation between these indices and ultrasonography (US) inflammatory status. We evaluated SLE patients with arthralgia and/or arthritis: the above-mentioned indices were calculated and the SLE Disease Activity Index 2000 (SLEDAI-2k) was applied to assess global disease activity. US of I–V metacarpophalangeal, I–V proximal interphalangeal, wrist, and knee bilateral was performed. Synovial effusion/hypertrophy and power Doppler findings were scored according to a semi-quantitative scale (0–3) to obtain an inflammatory total score (0–216). One hundred and six patients (M/F 7/99, median age 49.5 years (IQR 17.0), median disease duration 8.5 years (IQR 17.0)) were enrolled. We identified a positive correlation between US score and DAS28-CRP ( r = 0.3, p = 0.007), STR ( r = 0.42, p = 0.0005), SDAI ( r = 0.33, p = 0.02), CDAI ( r = 0.29, p = 0.03); US score reflected different levels of clinimetric joint activity. In conclusion, we suggest the ability of composite indices in detecting SLE joint inflammation and their possible real-life use.

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“…Even so, we found a positive correlation between STR and DAS28-ESR values; moreover, SLE patients without joint activity defined by SLEDAI-2k had a moderate STR in 9% of cases. 14…”

Section: Discussionmentioning

confidence: 99%

“…We have previously attempted to apply some of these indices – DAS28-ESR and STR – to the SLE-related joint involvement. 13,14 Of note, DAS28 and STR seem to be more sensitive than global indices, in particular SLEDAI-2k, to identify the different activity degrees of this manifestation. 13,14…”

Section: Introductionmentioning

confidence: 94%

Usefulness of composite indices in the assessment of joint involvement in systemic lupus erythematosus patients: correlation with ultrasonographic score

Ceccarelli

Perricone

Cipriano

et al. 2019

Lupus

View full text Add to dashboard Cite

show abstract

“…The activity of joint involvement was assessed with the swollen-to-tender ratio (STR), previously applied in a SLE cohort [ 22 ]. The SLE Disease Activity Index 2000 (SLEDAI-2 k) was used to assess disease activity, while chronic damage was evaluated by the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI) [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Anti-carbamylated protein antibodies as a new biomarker of erosive joint damage in systemic lupus erythematosus

et al. 2018

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BackgroundThe application of more sensitive imaging techniques, such as ultrasonography (US), changed the concept of non-erosive arthritis in systemic lupus erythematosus (SLE), underlining the need for biomarkers to identify patients developing the erosive phenotype. Anti-citrullinated peptide antibodies (ACPA), associated with erosions in inflammatory arthritis, have been identified in about 50% of patients with SLE with erosive arthritis. More recently, anti-carbamylated proteins antibodies (anti-CarP) have been associated with erosive damage in rheumatoid arthritis. We aimed to assess the association between anti-CarP and erosive damage in a large SLE cohort with joint involvement.MethodsWe evaluated 152 patients (male/female patients 11/141; median age 46 years, IQR 16; median disease duration 108 months, IQR 168). All patients underwent blood draw to detect rheumatoid factor (RF) and ACPA (commercial enzyme-linked immunosorbent assay (ELISA) kit), and anti-CarP (“home-made” ELISA, cutoff 340 aU/mL). The bone surfaces of the metacarpophalangeal and proximal interphalangeal joints were assessed by US: the presence of erosions was registered as a dichotomous value (0/1), obtaining a total score (0–20).ResultsThe prevalence of anti-CarP was 28.3%, similar to RF (27.6%) and significantly higher than ACPA (11.2%, p = 0.003). Erosive arthritis was identified in 25.6% of patients: this phenotype was significantly associated with anti-CarP (p = 0.004). Significant correlation between anti-CarP titer and US erosive score was observed (r = 0.2, p = 0.01).ConclusionsSignificant association was identified between anti-CarP and erosive damage in SLE-related arthritis, in terms of frequency and severity, suggesting that these antibodies can represent a biomarker of severity in patients with SLE with joint involvement.

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“…Joint counts and visual analogue scales (VAS) have also been used in many SLE trials, but with limited independent validation [11]. Musculoskeletal US provides an objective measure of synovitis that has already been shown to have face and construct validity in SLE [12].…”

Section: Introductionmentioning

confidence: 99%

Responsiveness of clinical and ultrasound outcome measures in musculoskeletal systemic lupus erythematosus

et al. 2019

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Objective To assess the responsiveness of clinical outcome measures in musculoskeletal SLE compared with US. Methods A prospective pilot study was conducted in consecutive SLE patients with inflammatory musculoskeletal symptoms. Clinical assessments including SLEDAI, BILAG, 28 tender and swollen joint counts, physician and patient visual analogue scales (VAS), and US were performed at 0, 2 and 4 weeks following 120 mg i.m. methylprednisolone acetate. Responsiveness was analysed using changes and effect sizes using Cohen’s criteria. Results Twenty patients were recruited. Fifteen out of 20 had clinical swelling at baseline. All clinical and US parameters were significantly improved at week 4 (all P ⩽ 0.01). Musculoskeletal-BILAG score improved in 16/20. Musculoskeletal-SLEDAI improved in 7/20. SLE responder index 4 criteria were assessed in 19 patients with SLEDAI ⩾4 at baseline and were met in 9/19 at 4 weeks. Effect sizes at 4 weeks were large (>0.5) for US, physician VAS and BILAG, and medium (>0.3) for joint counts and SLEDAI. Large effect sizes for improvement in US grey-scale and power Doppler were observed in both SLE responder index 4 responders (r = −0.51 and −0.56, respectively) and non-responders (r = −0.62 and −0.59, respectively) at 4 weeks. Conclusion This is the first study to measure the responsiveness of clinical outcome measures in musculoskeletal SLE against an objective inflammation measure. BILAG and physician VAS were the most responsive clinical instruments. US was highly responsive in musculoskeletal SLE, while SLEDAI and joint counts appeared suboptimal for detection of improvement. These results suggest that clinical trials based on the SLEDAI and SLE responder index 4 may underestimate the efficacy of therapy in SLE.

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Joint involvement in patients affected by systemic lupus erythematosus: application of the swollen to tender joint count ratio

Cited by 11 publications

References 12 publications

Usefulness of composite indices in the assessment of joint involvement in systemic lupus erythematosus patients: correlation with ultrasonographic score

Usefulness of composite indices in the assessment of joint involvement in systemic lupus erythematosus patients: correlation with ultrasonographic score

Anti-carbamylated protein antibodies as a new biomarker of erosive joint damage in systemic lupus erythematosus

Responsiveness of clinical and ultrasound outcome measures in musculoskeletal systemic lupus erythematosus

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