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Baksa G, Czeibert K, Sharp V, Handschuh S, Gyebnar J, Barany L, Benis S, Nyiri G, Mandl P, Petnehazy O, Balint PV. Vascular supply of the metacarpophalangeal joint. Front Med (Lausanne) 2022; 9:1015895. [PMID: 36341235 PMCID: PMC9630748 DOI: 10.3389/fmed.2022.1015895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To describe in detail the arterial vasculature of metacarpophalangeal joints 2–5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects. Methods Eighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2–5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images. Results The arterial supply of MCP joints 2–5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2–3 than on 4–5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001). Conclusion Using morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2–5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2–3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.
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Affiliation(s)
- Gabor Baksa
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- *Correspondence: Gabor Baksa,
| | - Kalman Czeibert
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Veronika Sharp
- Division of Rheumatology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Stephan Handschuh
- VetCore Facility for Research, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Janos Gyebnar
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Szabolcs Benis
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Gabor Nyiri
- Laboratory of Cerebral Cortex Research, Institute of Experimental Medicine, Budapest, Hungary
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Ors Petnehazy
- Medicopus Non-profit Ltd, Kaposvar, Hungary
- Justanatomy Ltd, Kaposvar, Hungary
| | - Peter Vince Balint
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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2
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Costantino F, Carmona L, Boers M, Backhaus M, Balint PV, Bruyn GA, Christensen R, Conaghan PG, Ferreira RJO, Garrido-Castro JL, Guillemin F, Hammer HB, van der Heijde D, Iagnocco A, Kortekaas MC, Landewé RB, Mandl P, Naredo E, Schmidt WA, Terslev L, Terwee CB, Thiele R, D'Agostino MA. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2021; 80:840-847. [PMID: 33483318 DOI: 10.1136/annrheumdis-2020-219816] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To produce European League Against Rheumatism (EULAR) recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). METHODS Based on the literature reviews and expert opinion (through Delphi surveys), a taskforce of 23 members (12 experts in ultrasound in RMDs, 9 in methodology and biostatistics together with a patient research partner and a health professional in rheumatology) developed a checklist of items to be reported in every RMD study using ultrasound. This checklist was further refined by involving a panel of 79 external experts (musculoskeletal imaging experts, methodologists, journal editors), who evaluated its comprehensibility, feasibility and comprehensiveness. Agreement on each proposed item was assessed with an 11-point Likert scale, grading from 0 (total disagreement) to 10 (full agreement). RESULTS Two face-to-face meetings, as well as two Delphi rounds of voting, resulted in a final checklist of 23 items, including a glossary of terminology. Twenty-one of these were considered 'mandatory' items to be reported in every study (such as blinding, development of scoring systems, definition of target pathologies) and 2 'optional' to be reported only if applicable, such as possible confounding factors (ie, ambient conditions) or experience of the sonographers. CONCLUSION An EULAR taskforce developed a checklist to ensure transparent and comprehensive reporting of aspects concerning research and procedures that need to be presented in studies using ultrasound in RMDs. This checklist, if widely adopted by authors and editors, will greatly improve the interpretability of study development and results, including the assessment of validity, generalisability and applicability.
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Affiliation(s)
- Félicie Costantino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Maarten Boers
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Marina Backhaus
- Department of Internal Medicine-Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Berlin, Germany
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A Bruyn
- Rheumatology Department, MC Group Hospitals, Lelystad, The Netherlands.,Rheumatology Department, Reumakliniek Flevoland, Lelystad, The Netherlands
| | - Robin Christensen
- Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | | | | | | | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | | | - Robert Bm Landewé
- Rheumatology Department, Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Peter Mandl
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Wolfgang A Schmidt
- Rheumatology Department, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Caroline B Terwee
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ralf Thiele
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France .,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
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3
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Guillot X, Tordi N, Prati C, Verhoeven F, Pazart L, Wendling D. Cryotherapy decreases synovial Doppler activity and pain in knee arthritis: A randomized-controlled trial. Joint Bone Spine 2017; 84:477-483. [DOI: 10.1016/j.jbspin.2016.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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4
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Reliability of ultrasound grading traditional score and new global OMERACT-EULAR score system (GLOESS): results from an inter- and intra-reading exercise by rheumatologists. Clin Rheumatol 2017; 36:2799-2804. [DOI: 10.1007/s10067-017-3662-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/07/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
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5
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Lazaar H, Lhoste-Trouilloud A, Pereira B, Couderc M, Mathieu S, Soubrier M. Does rheumatoid synovitis activity vary during the day? Evaluation with color doppler sonography. BMC Musculoskelet Disord 2017; 18:98. [PMID: 28257635 PMCID: PMC5336684 DOI: 10.1186/s12891-017-1450-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background Clinical symptoms of rheumatoid arthritis (RA) improve in the course of the day, as can synovitis activity, reported via doppler ultrasound (US). The aim of the study was to establish whether the Color Doppler (CD) scores of synovitis in RA changes throughout the day. Methods In total, 27 patients with active RA, including 14 patients receiving corticosteroids were studied. US evaluation was performed twice in each patient, at 9 a.m. (T0) and after 4 p.m. (T1) on the same day by a single radiologist and using the same instrument. Overall, 30 joints were assessed, including grey scale and CD (S0 = no flow [no detectable CD)]; S1 = mild [CD <1/3 of the synovium]; S2 = moderate [CD <2/3]; S3 = pronounced [CD >2/3]). Results In the total population, synovitis was detected more often in the evening than in the morning (39% vs. 33%, p = 0.02). The difference remained significant only in patients without corticosteroid administration (44% vs. 37%, p = 0.04). Moreover, a greater number of CD-positive joints were likewise found (S0 vs. S1 + S2 + S3) in the evening (57% vs. 51%, p = 0.04) in patients not receiving corticosteroids (67% vs. 41%, p = 0.002). More moderate (S2) and pronounced (S3) than mild (S1) synovitis was observed at T1 vs. T0 (39% vs. 24%, p = 0.03) in patients not receiving corticosteroids. More synovitis (40% vs 36% p = 0.02) in the dominant hand were found in the evening than in the morning. Conclusion Synovitis and CD activity increase during the day in RA patients, especially in joints of the dominant hands and in patients without corticosteroids.
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Affiliation(s)
- Hakim Lazaar
- Clermont-Ferrand Teaching Hospital, Radiology A Department, Place H. DUNANT, Clermont-Ferrand, 63000, France.
| | - Agnes Lhoste-Trouilloud
- Clermont-Ferrand Teaching Hospital, Radiology A Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Bruno Pereira
- Clermont-Ferrand Teaching Hospital, Biostatistics Unit, Clermont-Ferrand, 63003, France
| | - Marion Couderc
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Sylvain Mathieu
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Martin Soubrier
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France.
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6
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Marks JL, Holroyd CR, Dimitrov BD, Armstrong RD, Calogeras A, Cooper C, Davidson BK, Dennison EM, Harvey NC, Edwards CJ. Does combined clinical and ultrasound assessment allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy? Arthritis Care Res (Hoboken) 2015; 67:746-53. [PMID: 25605045 DOI: 10.1002/acr.22552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/03/2014] [Accepted: 01/13/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti-tumor necrosis factor (anti-TNF) therapies. METHODS As part of a real-world approach, patients with RA receiving anti-TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti-TNF therapy dose by one-third. RESULTS Between January 2012 and February 2014, a total of 70 patients underwent anti-TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038). CONCLUSION Combined clinical and US assessment identifies individuals in remission who may be suitable for anti-TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.
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Affiliation(s)
| | | | | | | | | | - Cyrus Cooper
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University of Oxford, Oxford, UK
| | | | - Elaine M Dennison
- University Hospital Southampton and University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher J Edwards
- University of Southampton and University Hospital Southampton, Southampton, UK, and University of Oxford, Oxford, UK
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7
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Law RJ, Saynor ZL, Gabbitas J, Jones J, Kraus A, Breslin A, Maddison PJ, Thom JM. The Effects of Aerobic and Resistance Exercise on Markers of Large Joint Health in Stable Rheumatoid Arthritis Patients: A Pilot Study. Musculoskeletal Care 2015; 13:222-35. [PMID: 25962747 DOI: 10.1002/msc.1103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Exercise is beneficial for people with rheumatoid arthritis (RA). However, patients and health professionals have expressed concern about the possible detrimental effects of exercise on joint health. The present study investigated the acute and chronic effects of high-intensity, low-impact aerobic and resistance exercise on markers of large joint health in RA. METHODS Eight RA patients and eight healthy, matched control (CTL) participants performed 30 minutes' high-intensity, low-impact aerobic and lower-body resistance exercise, one week apart. Primary outcome measures assessing joint health were serum cartilage oligomeric matrix protein (sCOMP) and knee joint synovial inflammation (Doppler ultrasound colour fraction; CF). These measures were taken at baseline, immediately after and 0.5, one, two, six and 24 hours post-exercise. In a separate study, nine RA patients completed eight weeks of progressive exercise training. The same outcome measures were reassessed at baseline, and at one hour post-exercise of training weeks 0, 1, 4 and 8. RESULTS RA patients showed higher overall sCOMP [RA: 1,347 ± 421, CTL: 1,189 ± 562 ng/mL; p < 0.05; effect size (ES) = 0.32] and CF when scanned longitudinally (RA: 0.489 ± 0.30 × 10(-3) , CTL: 0.101 ± 0.13 × 10(-3) ; p < 0.01; ES = 1.73) and transversely (RA: 0.938 ± 0.69 × 10(-3) , CTL: 0.199 ± 0.36 × 10(-3) ; p < 0.01; ES = 1.33) than CTL. However, no acute effects on joint health were observed post-exercise. Similarly, no chronic effects were observed over eight weeks of combined aerobic and resistance training in RA, with positive effects on physical fitness and function. CONCLUSIONS RA patients on stable treatment with low disease activity were able to perform an individually prescribed high-intensity, low-impact aerobic and resistance exercise without changes in markers of large joint health. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Zoe L Saynor
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Julia Gabbitas
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeremy Jones
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.,Peter Maddison Rheumatology Centre, Betsi Cadwaladr University Health Board, Llandudno, UK
| | - Alexandra Kraus
- Radiology Department, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Anne Breslin
- Peter Maddison Rheumatology Centre, Betsi Cadwaladr University Health Board, Llandudno, UK
| | - Peter J Maddison
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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8
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Naredo E, Hinojosa M, Valor L, Hernández-Flórez D, Mata-Martínez C, Serrano-Benavente B, Del Río T, Bello N, Montoro M, Nieto-González JC, González CM, López-Longo FJ, Monteagudo I, Carreño L. Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis? Rheumatology (Oxford) 2014; 53:2088-94. [PMID: 24939676 DOI: 10.1093/rheumatology/keu248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients. METHODS Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)] and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1. RESULTS There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070-1). CONCLUSION Our results suggested that s.c. anti-TNF pharmacokinetics do not significantly influence US-scored synovitis in RA patients.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
| | - Michelle Hinojosa
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Lara Valor
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Diana Hernández-Flórez
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carmen Mata-Martínez
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Belén Serrano-Benavente
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Tamara Del Río
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Natalia Bello
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - María Montoro
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Carlos Nieto-González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carlos M González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Francisco Javier López-Longo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Indalecio Monteagudo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Luis Carreño
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
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9
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Guillot X, Tordi N, Mourot L, Demougeot C, Dugué B, Prati C, Wendling D. Cryotherapy in inflammatory rheumatic diseases: a systematic review. Expert Rev Clin Immunol 2013; 10:281-94. [PMID: 24345205 DOI: 10.1586/1744666x.2014.870036] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
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Affiliation(s)
- Xavier Guillot
- Department of Rheumatology, University Hospital of Besançon, boulevard Fleming, 25030 Besançon Cedex, France
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10
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Ng ES, Ng KW, Wilder-Smith EP. Provocation tests in doppler ultrasonography for carpal tunnel syndrome. Muscle Nerve 2012. [PMID: 23180630 DOI: 10.1002/mus.23637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Doppler ultrasonography (DU) has recently been shown to be useful in imaging carpal tunnel syndrome (CTS). In this study, we aim to characterize the changes seen after exercise and electrical stimulation. METHODS Five patients with CTS were recruited with 5 age-matched subjects. DU was used to visualize the median nerve, flexor tendon, and bone at base line and after 1 minute of: (a) median nerve motor stimulation, (b) median nerve sensory stimulation, (c) abductor pollicis brevis contraction, and (d) adductor digiti minimi contraction. RESULTS Blood flow in the median nerve was greater after APB exercise. Furthermore, blood flow in the median nerve was greater in cases than controls after APB exercise. At baseline, blood flow in the flexor tendon was greater in cases than controls. CONCLUSIONS While limited by sample size, this study demonstrates that exercise of median innervated muscles may be useful in enhancing diagnostic utility of DU for CTS.
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Affiliation(s)
- Esther S Ng
- Department of Medicine, National University Health System, Heidelberg, Germany
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11
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Bugatti S, Manzo A, Caporali R, Montecucco C. Assessment of synovitis to predict bone erosions in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2012; 4:235-44. [PMID: 22859922 DOI: 10.1177/1759720x12453092] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Although rheumatoid arthritis (RA) is traditionally considered as the prototype of destructive arthritis, the course of the disease varies considerably, with some patients experiencing more rapid progression of joint damage and disability than others. Given the increasing availability of treatment targets and options, timely recognition of individual's outcomes could allow therapeutic allocation according to personalized benefit-risk profiles. Research efforts are thus increasingly focused at discovering predictive markers that could identify patients with aggressive, rapidly progressive disease and poor prognosis. As joint destruction in RA is the result of the cumulative burden of inflammation, variables reflecting the severity of synovitis and its persistence over time might refine our ability to build early prognostic algorithms. The goal of this article is to review the clinical implications of the assessment of synovitis in relation to radiographic outcomes. Traditional and novel assessment tools will be discussed, including clinical measures, imaging techniques and tissue biomarkers. Achievements in the field of synovial tissue analysis and peripheral blood biomarkers of synovitis represent only the first steps of ongoing progress, which still need to be integrated into the phenotypic heterogeneity of RA.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, University of Pavia School of Medicine, IRCCS Policlinico San Matteo Fondation, Piazzale Golgi 2, 27100 Pavia, Italy
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Hammer HB, Kvien TK. Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther 2011; 13:R78. [PMID: 21619619 PMCID: PMC3218888 DOI: 10.1186/ar3341] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 03/07/2011] [Accepted: 05/27/2011] [Indexed: 11/14/2022] Open
Abstract
Introduction The primary objectives were to explore the associations between a comprehensive ultrasonographic (US) assessment of joints, tendons and bursae and previously described reduced joint counts (7-, 12-, 28- and 44-joint score) as well as to assess the sensitivity to change of these different US joint combinations during biological treatment. Methods Twenty patients with rheumatoid arthritis (RA) were examined by US (B-mode (BM) and power Doppler (PD)) with use of a semi-quantitative (0 to 3) score of 78 joints, 36 tendons/tendon groups and two bursae (hereafter described as the 78-joint score) at baseline and 1, 3, 6 and 12 months after initiating treatment with adalimumab. BM and PD scores for the different joint combinations were generated. Results The reduced joint scores had high correlation coefficients with the 78-joint score at all examinations (range 0.79 to 0.99 for BM and 0.77 to 0.99 for PD, each P < 0.001) and sum BM and PD scores of all the different joint combinations improved significantly during follow-up (P ≤ 0.05 to 0.001). Conclusions The reduced joint combinations were highly associated to the 78-joint score. Furthermore, all the joint combinations presently explored responded well to biological treatment. This indicates that an approach focusing on few joints and tendons gives equivalent information about the inflammatory activity in RA patients as a comprehensive US examination. The optimal combination of joints and tendons for a valid, reliable and feasible US measurement should be further explored to define a US score for follow-up of RA patients on biological treatment.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway.
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Cooney JK, Law RJ, Matschke V, Lemmey AB, Moore JP, Ahmad Y, Jones JG, Maddison P, Thom JM. Benefits of exercise in rheumatoid arthritis. J Aging Res 2011; 2011:681640. [PMID: 21403833 PMCID: PMC3042669 DOI: 10.4061/2011/681640] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/15/2010] [Indexed: 11/20/2022] Open
Abstract
This paper aims to highlight the importance of exercise in patients with rheumatoid arthritis (RA) and to demonstrate the multitude of beneficial effects that properly designed exercise training has in this population. RA is a chronic, systemic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence and progression of cardiovascular disease, and accelerated loss of muscle mass, that is, “rheumatoid cachexia”. These factors contribute to functional limitation, disability, comorbidities, and reduced quality of life. Exercise training for RA patients has been shown to be efficacious in reversing cachexia and substantially improving function without exacerbating disease activity and is likely to reduce cardiovascular risk. Thus, all RA patients should be encouraged to include aerobic and resistance exercise training as part of routine care. Understanding the perceptions of RA patients and health professionals to exercise is key to patients initiating and adhering to effective exercise training.
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Affiliation(s)
- Jennifer K Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, George Building, Holyhead Road, Bangor, Gwynedd LL57 2PZ, UK
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Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players. Knee Surg Sports Traumatol Arthrosc 2011; 19:30-7. [PMID: 20652535 DOI: 10.1007/s00167-010-1208-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
Abstract
Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler ≥ grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading.
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Hammer HB, Kvien TK. Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab. Scand J Rheumatol 2010; 40:178-82. [PMID: 21091275 DOI: 10.3109/03009742.2010.517549] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Tenosynovitis is common in rheumatoid arthritis (RA) but knowledge is limited regarding its response to anti-inflammatory treatment. This study used ultrasonography (US) to examine the distribution and responsiveness of tenosynovitis to anti-tumour necrosis factor (anti-TNF) treatment in RA patients. METHODS Twenty patients with RA were examined at baseline and 1, 3, 6, and 12 months after starting adalimumab treatment, and grey-scale (GS) and power Doppler (PD) US scoring (semi-quantitative range 0-3) of wrist and ankle tendons was performed in addition to assessment of the 28-joint Disease Activity Score (DAS28), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). RESULTS The extensor carpi ulnaris (ECU) tendon in the wrists and the closely related tendons tibialis posterior (TB) and flexor digitorum longus (FDL) in the ankles were most often inflamed. Median sum scores for this reduced number of tendons at baseline/12-month follow-up were 5/0.5 for GS (p < 0.001) and 4/0 for PD (p < 0.05), with reductions in the US scores during follow-up as large as those found for sum scores of all tendons. The standardized response means (SRMs) for sum GS or PD scores of the reduced number of tendons were higher (range -0.53 to -0.93) than for the sum scores of all tendons (-0.23 to -0.74), and showed larger responsiveness than CRP (-0.10 to -0.43) and ESR (-0.03 to -0.71). CONCLUSION Bilateral assessments of ECU, TB, and FDL tendons were as sensitive to change as the sum scores of all tendons, and scoring of this reduced number of tendons is suggested to be included in US scorings for follow-up of RA patients.
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Affiliation(s)
- H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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