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Ricci V, Ricci C, Tamborrini G, Chang KV, Mezian K, Zunica F, Naňka O, Kara M, Özçakar L. From histology to sonography in synovitis: EURO-MUSCULUS/USPRM approach. Pathol Res Pract 2023; 241:154273. [PMID: 36563558 DOI: 10.1016/j.prp.2022.154273] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the present study was to propose a methodologically innovative sonographic approach for optimal evaluation of synovial tissues (starting from histopathology). METHODS Using high-frequency ultrasound probes and high-level ultrasound machines, we matched the histological microarchitecture of synovial tissues with multiple sonographic patterns in physiological and pathological conditions. Likewise, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS Modern equipment allows for a macroscopic classification of synovial pathologies recognizing different morphological patterns; however, intimal and subintimal layers of the synovium cannot be distinguished from each other on ultrasound. High-sensitive Doppler imaging clearly defines the microvascular pattern, especially in patients with hypertrophic synovial pathologies. CONCLUSIONS In clinical practice, using adequate technological equipment i.e. high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of synovial tissues can be performed - defining the main sono-histological patterns.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland; Rheumatology Clinic, University Hospital of Basel, Basel, Switzerland
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Murat Kara
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine Ankara, Turkey
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine Ankara, Turkey
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An Q, Zhao J, Zhu X, Yang B, Wu Z, Su Y, Zhang L, Xu K, Ma D. Exploiting the role of T cells in the pathogenesis of Sjögren's syndrome for therapeutic treatment. Front Immunol 2022; 13:995895. [PMID: 36389806 PMCID: PMC9650646 DOI: 10.3389/fimmu.2022.995895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/17/2022] [Indexed: 08/19/2023] Open
Abstract
Sjögrens syndrome (SS) is caused by autoantibodies that attack proprioceptive salivary and lacrimal gland tissues. Damage to the glands leads to dry mouth and eyes and affects multiple systems and organs. In severe cases, SS is life-threatening because it can lead to interstitial lung disease, renal insufficiency, and lymphoma. Histological examination of the labial minor salivary glands of patients with SS reveals focal lymphocyte aggregation of T and B cells. More studies have been conducted on the role of B cells in the pathogenesis of SS, whereas the role of T cells has only recently attracted the attention of researchers. This review focusses on the role of various populations of T cells in the pathogenesis of SS and the progress made in research to therapeutically targeting T cells for the treatment of patients with SS.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dan Ma
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
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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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The effect of foot position on Power Doppler Ultrasound grading of Achilles enthesitis. Rheumatol Int 2016; 36:871-4. [PMID: 27002715 DOI: 10.1007/s00296-016-3461-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to determine whether foot position could modify power Doppler grading in evaluation of the Achilles enthesis. Eighteen patients with clinical Achilles enthesitis were studied with power Doppler ultrasound (PDUS) in five different positions of the foot: active and passive dorsiflexion, neutral position, active and passive plantar flexion. The Doppler signal was graded in any position and compared with the others. The Doppler signal was higher with the foot in plantar flexion and decreased gradually, sometimes till to disappear, while increasing dorsiflexion. The Doppler signal was always less during the active keeping of the position of the joint, than during the passive. The PDUS examination of the Achilles enthesis should be performed also with the foot in passive plantar flexion, in order not to underestimate the degree of vascularization.
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Kang T, Wakefield RJ, Emery P. Musculoskeletal ultrasound in rheumatology in Korea: targeted ultrasound initiative survey. Int J Rheum Dis 2014; 19:335-42. [PMID: 25351515 DOI: 10.1111/1756-185x.12508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM In collaboration with the Targeted Ultrasound Initiative (TUI), to conduct the first study in Korea to investigate current practices in ultrasound use among Korean rheumatologists. METHODS We translated the TUI Global Survey into Korean and added questions to better understand the specific challenges facing rheumatologists in Korea. To target as many rheumatologists in Korea as possible, we created an on-line version of this survey, which was conducted from March to April 2013. RESULTS Rheumatologists are in charge of ultrasound in many Korean hospitals. Rheumatologists in hospitals and private clinics use ultrasound to examine between one and five patients daily; they use ultrasound for diagnosis more than monitoring and receive compensation of about US$30-50 per patient. There are marked differences in the rates of ultrasound usage between rheumatologists who work in private practice compared with tertiary hospitals. Korean rheumatologists not currently using ultrasound in their practice appear eager to do so. CONCLUSION This survey provides important insights into the current status of ultrasound in rheumatology in Korea and highlights several priorities; specifically, greater provision of formal training, standardization of reporting and accrual of greater experience among ultrasound users. If these needs are addressed, all rheumatology departments in Korea are likely to use ultrasound or have access to it in the future.
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Affiliation(s)
- Taeyoung Kang
- Department of Rheumatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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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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Stramare R, Raffeiner B, Ciprian L, Scagliori E, Coran A, Perissinotto E, Fiocco U, Beltrame V, Rubaltelli L. Evaluation of finger joint synovial vascularity in patients with rheumatoid arthritis using contrast-enhanced ultrasound with water immersion and a stabilized probe. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:147-154. [PMID: 22287501 DOI: 10.1002/jcu.21887] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 12/14/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE.: To assess synovial microvascularity in finger joints with rheumatoid arthritis (RA) by contrast-enhanced ultrasound (CEUS), distinguishing between cases of active disease and those in remission; to standardize the technique for software analysis. METHODS.: Fifty-two finger joints of RA patients (26 with active disease and 26 in remission) were immersed in water and examined by CEUS using a fixed probe. Signal intensity curves were calculated with the software. RESULTS.: Contrast enhancement was detectable in all 26 patients with active RA (100%), but not in 25 of 26 patients in remission (96%); one of the latter patients (4%) showed minimal enhancement. The method's sensitivity and specificity in distinguishing active disease from remission were 100% and 96%. The grades of synovial enhancement correlated with clinical disease activity and software flow parameters. The peak contrast levels correlated with clinical activity, a peak of 9% representing the cutoff between remission and active disease. CONCLUSIONS.: CEUS with a fixed probe on finger joints immersed in water detected synovial vascularization in RA, producing results suitable for standardized software analysis and avoiding artifacts.
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Affiliation(s)
- Roberto Stramare
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy
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Zayat AS, Freeston JE, Conaghan PG, Hensor EMA, Emery P, Wakefield RJ. Does joint position affect US findings in inflammatory arthritis? Rheumatology (Oxford) 2012; 51:921-5. [PMID: 22253029 DOI: 10.1093/rheumatology/ker383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Musculoskeletal US is being increasingly used for the assessment of synovitis, although questions remain about its reliability. One potential factor affecting reliability is the lack of consensus of image acquisition methods such as using different joint positions. This may have an implication on the reproducibility of studies that use US as an outcome measure. The aim of this study was to determine whether a change in joint position might significantly alter the quantification of US-detected synovitis in patients with inflammatory arthritis (IA). METHODS IA patients with clinically swollen wrists, MCP and/or knee joints were recruited. These joints were assessed quantitatively for the presence of synovitis when they were placed in different positions. RESULTS Seventy-five patients with IA were assessed. The greatest grey scale (GS) and power Doppler (PD) scores for the MCP joints were found in the flat (0°) position (91 and 100% of cases, respectively) compared with other positions (P < 0.001). Similar results were found in the wrist joints. The greatest GS and PD scores for the knee joint were found in 30° flexion [100 and 95.6% of cases, respectively, compared with other positions (P < 0.001)]. The inter- and intra-reader reliability was good to excellent. CONCLUSION The position in which a joint is scanned for synovitis appears to significantly influence the US assessment of synovitis. Our study suggests that the standardized scanning of the hand joints in a flat position and the knees in a 30° position are associated with the highest GS and PD scores.
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Affiliation(s)
- Ahmed S Zayat
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine (LIMM), University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Second Floor, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
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MANDL PETER, NAREDO ESPERANZA, WAKEFIELD RICHARDJ, CONAGHAN PHILIPG, D’AGOSTINO MARIAANTONIETTA. A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter. J Rheumatol 2011; 38:2055-62. [DOI: 10.3899/jrheum.110424] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective.The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed.Methods.A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis.Results.Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination.Conclusions.Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.
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GUTIERREZ MARWIN, FILIPPUCCI EMILIO, GRASSI WALTER, ROSEMFFET MARCOS. Intratendinous Power Doppler Changes Related to Patient Position in Seronegative Spondyloarthritis. J Rheumatol 2010; 37:1057-9. [DOI: 10.3899/jrheum.090900] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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