1
|
Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
Collapse
Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
2
|
Geraldes R, Santos M, Ponte C, Craven A, Barra L, Robson JC, Hammam N, Springer J, Henes J, Hocevar A, Putaala J, Santos E, Rajasekhar L, Daikeler T, Karadag O, Costa A, Khalidi N, Pagnoux C, Canhão P, Melo TPE, Fonseca AC, Ferro JM, Fonseca JE, Suppiah R, Watts RA, Grayson P, Merkel PA, Luqmani RA. Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study. J Neurol 2024:10.1007/s00415-024-12251-1. [PMID: 38472397 DOI: 10.1007/s00415-024-12251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. METHODS Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. RESULTS The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. CONCLUSION CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.
Collapse
Affiliation(s)
- Ruth Geraldes
- Neurology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
- Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK.
| | - Monica Santos
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Anthea Craven
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Lillian Barra
- Lawson Health Research Institute, London, ON, Canada
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Jason Springer
- University of Kansas Medical Centre Institute, Lawrence, Kansas, KS, USA
| | - Jöerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases, Department of Internal Medicine II (Oncology, Haematology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Jukka Putaala
- Helsinki University Central Hospital, Helsinki, Finland
| | - Ernestina Santos
- Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Thomas Daikeler
- Department of Rheumatology and Clinical Research, University Hospital, Basel, Switzerland
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andreia Costa
- Centro Hospitalar Universitário de São João, Porto, Portugal
- Neuroscience and Mental Health Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Nader Khalidi
- Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
| | | | - Patrícia Canhão
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Pinho E Melo
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José M Ferro
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | | | | | - Peter Grayson
- National Institutes of Health, NIAMS Vasculitis Translational Research Program, Bethesda, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, USA
- Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Inanc N, Jousse-Joulin S, Abacar K, Cimşit Ç, Cimşit C, D'Agostino MA, Naredo E, Hocevar A, Finzel S, Pineda C, Keen H, Iagnocco A, Hanova P, Schmidt WA, Mumcu G, Terslev L, Bruyn GA. The Novel OMERACT Ultrasound Scoring System for Salivary Gland Changes in Patients With Sjögren Syndrome Is Associated With MRI and Salivary Flow Rates. J Rheumatol 2024; 51:263-269. [PMID: 37914219 DOI: 10.3899/jrheum.2023-0202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the construct validity of the novel Outcome Measures in Rheumatology (OMERACT) ultrasound (US) semiquantitative scoring system for morphological lesions in major salivary glands by comparing it with magnetic resonance imaging (MRI) and unstimulated whole salivary flow rates (U-WSFRs) in patients with primary Sjögren syndrome (pSS). METHODS Nine sonographers applied the OMERACT 0-3 grayscale scoring system for parotid (PGs) and submandibular glands (SMGs) in 11 patients with pSS who also had MRIs performed. These were evaluated by 2 radiologists using a semiquantitative 0-3 scoring system for morphological lesions. The agreement between US and MRI and the association between U-WSFRs and imaging structural lesions was determined. A score ≥ 2 for both US and MRI was defined as gland pathology. RESULTS The prevalence of US morphological lesions in 11 patients with a score ≥ 2 was 58% for PGs and 76% for SMGs, and 46% and 41% for PGs and SMGs, respectively, for MRI. The agreement between OMERACT US scores and MRI scores was 73-91% (median 82%) in the right PG and 73-91% (median 91%) in the left PG, 55-91% (median 55%) in the right SMG and 55-82% (median 55%) in the left SMG. When relations between the presence of hyposalivation and an US score ≥ 2 were examined, agreement was 91-100% (median 83%) in both PGs and 55-91% (median 67%) in both SMGs. CONCLUSION There is moderate to strong agreement between the OMERACT US and MRI scores for major salivary glands in patients with pSS. Similar agreement ratios were observed between the higher OMERACT US scores and presence of hyposalivation.
Collapse
Affiliation(s)
- Nevsun Inanc
- N. Inanc, MD, K. Abacar, MD, Rheumatology Department, Marmara University School of Medicine, Istanbul, Turkey;
| | - Sandrine Jousse-Joulin
- S. Jousse-Joulin, MD, CHU de Brest, University Brest, Inserm, LBAI, UMR 1227, Brest, France
| | - Kerem Abacar
- N. Inanc, MD, K. Abacar, MD, Rheumatology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Çagatay Cimşit
- Ç. Cimşit, MD, C. Cimşit, MD, Radiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Canan Cimşit
- Ç. Cimşit, MD, C. Cimşit, MD, Radiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Maria-Antonietta D'Agostino
- M.A. D'Agostino, MD, PhD, Hôpital Ambroise Paré, Boulogne-Billancourt, Versailles Saint Quentin University, Versailles, France
| | - Esperanza Naredo
- E. Naredo, MD, PhD, Rheumatology Department, Joint and Bone Research Unit. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Alojzija Hocevar
- A. Hocevar, MD, PhD, Rheumatology Department, University Medical Centre, Ljubljana, Slovenia
| | - Stephanie Finzel
- S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carlos Pineda
- C. Pineda, MD, PhD, Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Helen Keen
- H. Keen, MD, Medicine and Pharmacology Department, The University of Western Australia, Murdoch, Perth, Australia
| | - Annamaria Iagnocco
- A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Petra Hanova
- P. Hanova, MUDr, Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Wolfgang A Schmidt
- W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany
| | - Gonca Mumcu
- G. Mumcu, DDS, PhD, Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Lene Terslev
- L. Terslev, PhD, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - George A Bruyn
- G.A. Bruyn, MD, PhD Rheumatology, Reumakliniek Lelystad, Lelystad, and Tergooi MC Hospitals, Hilversum, the Netherlands
| |
Collapse
|
4
|
Karadag O, Bolek EC, Ayan G, Mohammad AJ, Grayson PC, Pagnoux C, Martín-Nares E, Monti S, Abe Y, Alberici F, Alibaz-Oner F, Cuthbertson D, Dagna L, Direskeneli H, Khalidi NA, Koening C, Langford CA, McAlear CA, Monach PA, Moroni L, Padoan R, Seo P, Warrington KJ, Hocevar A, Hinojosa-Azaola A, Furuta S, Emmi G, Ozen S, Jayne D, Merkel PA. Clinical Characteristics and Outcomes of Polyarteritis Nodosa: An International Study. Arthritis Rheumatol 2024. [PMID: 38343337 DOI: 10.1002/art.42817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/30/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE We describe the demographics, clinical features, disease course, and survival of polyarteritis nodosa (PAN) through an international collaboration (GLOBAL-PAN). METHODS Patients with PAN were recruited between 1990 and 2020 from observational cohorts of nine countries across Europe, Japan, and North America. Eligibility was retrospectively defined using the European Medicines Agency classification algorithm. Patients with PAN related to hepatitis B virus (n = 12) and two monogenic diseases mimicking PAN, deficiency of adenosine deaminase 2 enzyme (n = 16) or familial Mediterranean fever (n = 11), were excluded. Data regarding organ involvement, relapse, disease-related damage, and survival were analyzed. RESULTS Three hundred fifty-eight patients (female:male ratio 174:184), including those with systemic PAN (sPAN, n = 282) and cutaneous PAN (n = 76), were included. Twenty-five were pediatric onset. Mean ± SD age at diagnosis was 44.3 ± 18.1 years. Constitutional symptoms (71.5%), cutaneous involvement (70.5%), musculoskeletal findings (69.1%), and neurologic features (48.0%) were common manifestations. Among patients with sPAN, gastrointestinal involvement and proteinuria over 400 mg/day were reported in 52.2% and 11.2%, respectively. During a median (interquartile range) 59.6 (99.5) months of follow-up, relapse occurred in 48.5% of patients. One, 5- and 10-year survival rates for sPAN were 97.1%, 94.0%, and 89.0%, respectively. Predictors of death for sPAN included age ≥65 years at diagnosis, serum creatinine at diagnosis >140 μmol/L, gastrointestinal manifestations, and central nervous system (CNS) involvement. CONCLUSION The spectrum of PAN remains a complex, multifaceted disease. Relapse is common. Age ≥65 years and serum creatinine >140 μmol/L at diagnosis, as well as gastrointestinal and CNS involvement, are independent predictors of death in sPAN.
Collapse
Affiliation(s)
| | | | | | - Aladdin J Mohammad
- Skåne University Hospital, Lund, Sweden, and University of Cambridge, Cambridge, UK
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Eduardo Martín-Nares
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Yoshiyuki Abe
- Juntendo University School of Medicine, Tokyo, Japan
| | - Federico Alberici
- University of Brescia and Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Lorenzo Dagna
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | - Luca Moroni
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | - Phillip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Alojzija Hocevar
- University Medical Centre Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Andrea Hinojosa-Azaola
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | - David Jayne
- University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | |
Collapse
|
5
|
Adami G, Alarcon G, Albert D, Allen K, Aringer M, Arkema EV, Ashour HM, Atzeni F, Ayan G, Baer A, Baker J, Barber C, Bautista-Molano W, Beça S, Beamer B, Bergstra SA, Bermas B, Bilgin E, Boers M, Bolster M, Bosco J, Bowden JL, Buttgereit F, Calabrese L, Campochiaro C, Cappelli L, Carmona L, Carvalho J, Castañeda S, Chao Chao CM, Chatterjee S, Cherry L, Christensen R, Coates LC, Cohen SB, Collins JE, Cornec D, D'Agostino MA, Daikeler T, D'Angelo S, de Boysson H, de Jong P, de Wit M, Dellaripa P, Dessein P, Diekhoff T, Doumen M, Eckstein F, Elhai M, Fairley JL, Felson D, Amaro IF, Ferucci E, Fiorentino D, FitzGerald J, Fleischmann R, Galloway J, Salinas RG, Giorgi V, Golightly Y, Gono T, Gonzalez-Gay MA, Goules A, Gravallese E, Griffith M, Grosman S, Gupta L, Hamuryudan V, Hana C, Haschka J, Hawker G, Hervas-Perez JP, Hocevar A, Iudici M, Iyer P, Jasmin M, Judson M, Kerschbaumer A, Kiefer D, Kiltz U, Kivity S, Kremer JM, Kroon FPB, Kviatkovsky S, Lee BS, Liew D, Lim SY, Littlejohn G, Medina CL, Maksymowych W, March L, Marotte H, Navarro OM, Mavragani C, McInnes I, McMahan Z, Meara A, Mecoli C, Merriman T, Mikdashi J, Mikuls T, Misra DP, Mitchell BD, Moore T, Moutsopoulos H, Naredo E, Nash P, Nurmohamed M, Oddis C, Ojaimi S, Oliver M, Ozen S, Ozgocmen S, Palmowski A, Pascart T, Perelas A, Pile K, Pincus T, Poddubnyy D, Ramiro S, Reddy A, Regierer A, Roccatello D, Rookes T, Rosenthal A, Rubinstein T, Rudwaleit M, Rueda-Gotor J, Rus V, Saketkoo LA, Samson M, Schur P, Sepriano A, Shadmanfar S, Shmagel A, Sibbitt WL, de Souza AWS, Sims C, Singh N, Sjöwall C, Smith V, Song JJ, Soriano ER, Sparks J, Studenic P, Sugihara T, Suissa S, Szekanecz Z, Tascilar K, Taylor P, Terkeltaub R, Tiniakou E, Todd N, Vilarino GT, Treemarcki E, Tsuji H, Turesson C, Twilt M, Vassilopoulos D, Vojinovic T, Volkmann E, Vosse D, Wagner-Weiner L, Wallace ZS, Wallace D, Wang GC, Wei J, Weisman MH, Westhovens R, Winthrop K, Wysham KD, Xue J, Yang C, Yau M, Yazici Y, Yazici H, YIM ICW, Young J, Zhang W. Referees. Semin Arthritis Rheum 2024:152375. [PMID: 38245402 DOI: 10.1016/j.semarthrit.2024.152375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
|
6
|
De Miguel E, Macchioni P, Conticini E, Campochiaro C, Karalilova R, Monti S, Ponte C, Klinowski G, Monjo-Henry I, Falsetti P, Batalov Z, Tomelleri A, Hocevar A. Prevalence and characteristics of subclinical giant cell arteritis in polymyalgia rheumatica. Rheumatology (Oxford) 2024; 63:158-164. [PMID: 37129541 DOI: 10.1093/rheumatology/kead189] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE The main objective of this study was to analyse the prevalence and characteristics of subclinical GCA in patients with PMR. METHODS This was a cross-sectional multicentre international study of consecutive patients with newly diagnosed PMR without symptoms or signs suggestive of GCA. All patients underwent US of the temporal superficial, common carotid, subclavian and axillary arteries. Patients with halo signs in at least one examined artery were considered to have subclinical GCA. The clinical, demographic and laboratory characteristics of the PMR group without subclinical vasculitis were compared with subclinical GCA, and the pattern of vessel involvement was compared with that of a classical single-centre GCA cohort. RESULTS We included 346 PMR patients, 267 (77.2%) without subclinical GCA and 79 (22.8%) with subclinical GCA. The PMR patients with subclinical GCA were significantly older, had a longer duration of morning stiffness and more frequently reported hip pain than PMR without subclinical GCA. PMR with subclinical GCA showed a predominant extracranial large vessel pattern of vasculitic involvement compared with classical GCA, where the cranial phenotype predominated. The patients with PMR in the classical GCA group showed a pattern of vessel involvement similar to classical GCA without PMR but different from PMR with subclinical involvement. CONCLUSION More than a fifth of the pure PMR patients had US findings consistent with subclinical GCA. This specific subset of patients showed a predilection for extracranial artery involvement. The optimal screening strategy to assess the presence of vasculitis in PMR remains to be determined.
Collapse
Affiliation(s)
- Eugenio De Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology Department, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Rositsa Karalilova
- Rheumatology Department, Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
| | - Giulia Klinowski
- Department of Rheumatology, IRCCS-S.Maria Nuova, Reggio Emilia, Italy
| | - Irene Monjo-Henry
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Zguro Batalov
- Rheumatology Department, Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology Department, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
7
|
Zabotti A, Pegolo E, Giovannini I, Manfrè V, Lorenzon M, Hocevar A, Zandonella Callegher S, Dejaco C, Quartuccio L, Di Loreto C, Zuiani C, De Vita S. Usefulness of ultrasound guided core needle biopsy of the parotid gland for the diagnosis of primary Sjögren's syndrome. Clin Exp Rheumatol 2022; 40:2381-2386. [DOI: 10.55563/clinexprheumatol/5n49yj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Slovenia
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | | | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Carla Di Loreto
- Institute of Anatomic Pathology, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Italy.
| |
Collapse
|
8
|
Smiljanic Tomicevic L, Hocevar A, Sukara G, Cubelic D, Mayer M. The frequency and characteristics of ultrasonographic ankle joint involvement in systemic lupus erythematosus: A prospective cross-sectional single-center study. Medicine (Baltimore) 2022; 101:e29196. [PMID: 35945784 PMCID: PMC9351871 DOI: 10.1097/md.0000000000029196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).
Collapse
Affiliation(s)
- Ljiljana Smiljanic Tomicevic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- *Correspondence: Ljiljana Smiljanic Tomicevic, Kišpatićeva 12, 10000 Zagreb, Croatia (e-mail: ). , , ,
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Goran Sukara
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darija Cubelic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Mayer
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
9
|
Bajželj M, Hladnik M, Toluay TD, Sodin-Šemrl S, Hocevar A, Lakota K. AB0149 RNA SEQUENCING OF SKIN BIOPSY SAMPLES REVEALS UNIQUE BIOLOGICAL PROCESSES AMONG SPECIFIC GROUPS OF ADULT PATIENTS WITH IgA VASCULITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundImmunoglobulin A vasculitis (IgAV) is a small vessel leukocytoclastic vasculitis, characterized by vascular IgA deposits, and clinically by skin, join, kidney and bowel involvement. Renal involvement, present in up to 84% of adult patients, is associated with an increased risk of progression to chronic kidney failure. A skin or renal biopsy is still the golden standard for diagnosis. Omics data from NCBI-GEO and Array Express databanks are lacking from IgAV samples of adult patients.ObjectivesOur aim was to perform RNA sequencing and to identify differentially expressed genes and dysregulated molecular pathways in the affected skin of adult IgAV patients with renal involvement, patients with skin-limited IgAV and healthy controls (HC).MethodsSkin biopsy samples were collected from treatment-naive adult IgAV patients at time of diagnostic procedure: 1) skin-limited disease (n=3), 2), IgAV with renal involvement (n=3), and age-/sex-matched HC (n=3). RNA was isolated and 100 bp paired-end sequenced using the Illumina HiSeq 4000 platform (25.9 to 30.8 million reads were obtained per sample). Reads were mapped with Salmon tool against the human transcriptome (Ensemble Release 104). Differentially expressed genes (log2 fold change ≥ │1│, padj < 0.05) were computed using the R package DESeq2. Data were clustered using principal component analysis (PCA), and KEGG pathway over-representation analysis (ORA) was performed with R package clusterProfiler.ResultsWe identified 72 differentially expressed genes (34 up- and 38 down-regulated) between skin-limited IgAV and HC, while 686 genes were differentially expressed (421 up- and 265 down-regulated) in the affected skin between adult IgAV patients with renal involvement and healthy controls (HC). PCA distinguished between IgAV (renal and skin-limited) and healthy controls, suggesting specific transcriptome signatures in IgAV. 21 overlapping genes were differentially expressed in both groups of patients in comparison to HC. 196 genes were differentially expressed between IgAV patients with renal involvement compared to skin-limited IgAV.Genes, differentially expressed in patients with skin-limited disease were enriched in the oxidative phosphorylation (padj = 3.08 x 10-5) and cell adhesion molecules (padj = 6.32 x 10-4) KEGG Pathways. Differentially expressed genes in patients with renal involvement exhibited enriched KEGG Pathways involved in the ribosome (padj = 0 x 10-7), the regulation of lipolysis in adipocytes (padj 9,066 x 10-4), cell adhesion molecules (padj = 8.0008 x 10-3), renin secretion (padj = 4.2882 x 10-3), complement and coagulation cascades (padj = 3.58547 x 10-2), vascular smooth muscle contraction (padj = 3.76132 x 10-2) and aldosterone synthesis and secretion (padj = 3.76132 x 10-2).ConclusionDeregulated genes in skin of adult IgAV patients with renal manifestation could serve as biomarkers for organ-specific involvement. Further studies are needed that would support deciphering the involvement of perturbed molecular pathways and the contribution of individual cell types to skin manifestations of adult IgAV patients.AcknowledgementsThe authors also wish to thank all the patients who volunteered to participate into this study and the funding.Disclosure of InterestsNone declared
Collapse
|
10
|
Perdan-Pirkmajer K, Fortuna K, Teršek Z, Kramarič J, Hocevar A. POS0725 VALIDATION OF SJÖGREN’S SYNDROME SCREENING QUESTIONNAIRE (SSSQ) IN A COHORT OF PATIENTS WITH SICCA SYMPTOMS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundACR/EULAR 2016 classification criteria for Sjögren disease (SS) 1 use 5 standard questions on ocular and oral sicca symptoms as an entrance criteria. However, these questions do not differentiate between SS and non-SS sicca etiology. Recently, a new 5-item Sjögren’s Syndrome Screening Questionnaire based on SICCA study data was designed for the use in clinical practice, better differentiating SS from non-SS sicca patienents.2ObjectivesWe aimed to validate the SSSQ in our population with sicca symptoms.MethodsOur study cohort represented 535 patients referred to UMC Ljubljana during the 3-year period Jan/2016 to Dec/2019 with suspected SS. All subjects underwent at that time a standardized SS diagnostic procedure, including 5 standard sicca questions, Schirmer test, Rose Bengal test, unstimulated salivary flow test, salivary gland ultrasound, immunoserological and lip biopsy. In Sep - Oct 2021 all subjects were contacted by phone to fulfil the new SSSQ (5 questions resulting in 0-11 points: cut-off for SS ≥7 points). The performance of SSSQ recognizing SS was assessed using ACR/EULAR 2016 classification criteria as gold standard test for SS diagnosis.Results415 out of 525 subjects agreed to participate in the study (384 (92.5%) females, mean (SD) age 57.6(13.8)), the rests either declined (21), died (2) or could not be reached (97). Based on the ACR/EULAR 2016 criteria SS was diagnosed in 127 (30.6%) and excluded in 288 subjects. 376/415 (90.6%) subjects responded positively on 5 standard sicca questions (110 with and 266 without SS). In the new SSSQ 129 (31.1%) subjects (54 with and 75 without SS) responded positively (reached ≥7 points). The performance of SSSQ recognizing SS is presented in Table 1.Table 1.Diagnostic accuracy of SSSQ (Sjögren’s Syndrome Screening Questionnaire) and ACR/EULAR 2016 sicca questions in our cohort. PLR Positive Likelihood Ratio; NLR Negative Likelihood Ratio; PPV Positive Predictive Value; NPV Negative Predictive Value;StatisticsSSSQStandard sicca questionairreValue (95% CI)Value (95%CI)Sensitivity42.5% (33.8 to 51.6%)86.6% (79.4 to 92.0%)Specificity73.7% (68.5 to 78.9%)7.6% (4.9 to 11.3%)PLR1.4 (1.2 to 2.2)0.9 (0.9 to 1.0)NLR0.8 (0.7 to 0.9)1.8 (1.0 to 3.2)PPV41.9% (35.2 to 48.8%)29.3% (27.7 to 30.9%)NPV74.5% (71.2 to 77.5%)56.4% (41.6 to 70.2%)Accuracy64.3% (59.5 to 69.0%)31.8% (27.4 to 36.5%)AUC0.58 (0.52-0.64)0.52 (0.46-0.57)ConclusionSSSQ showed higher specificity and better diagnostic accuracy compared to current standard questionnaire in a cohort of sicca patients.References[1]Shiboski CH, et al. Arthritis Rheumatol. 2017;69:35–45.[2]Yu K, et al. J Clin Rheumatol 2021; doi: 10.1097/RHU.0000000000001760AcknowledgementsThis work was supported by Slovenian National Research Agency grants P3-0314 and J3-3153.Disclosure of InterestsNone declared
Collapse
|
11
|
De Miguel E, Macchioni P, Conticini E, Campochiaro C, Karalilova R, Monti S, Ponte C, Klinowski G, Monjo I, Falsetti P, Tomelleri A, Batalov Z, Hocevar A. POS0248 SUBCLINICAL GIANT CELL ARTERITIS IN PATIENTS WITH POLYMYALGIA RHEUMATICA SHOWS A DIFFERENT ULTRASONOGRAPHIC PATTERN THAN PATIENTS WITH CLASSICAL GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) can be associated with giant cell arteritis (GCA), even in the absence of clinical suspicions of vasculitis. In addition, some studies have shown an association of PMR with the predominantly large vessel involvement.ObjectivesThe objective of our study was to assess the presence of subclinical GCA in patients with PMR and to compare its pattern of vascular involvement to patients with classical GCA.MethodsEight rheumatology European centers participated in the study. Cohort A represented consecutive newly diagnosed patients with PMR who fulfilled the 2012 EULAR/ACR Provisional Classification Criteria for Polymyalgia Rheumatica2 and had no symptoms or signs suggestive of GCA. Ultrasound (US) examination of four vessel territories (i.e. temporal, carotid, subclavian and axillary arteries) was performed bilaterally. Cohort B included all consecutive patients with the diagnosis of GCA evaluated on the fast-track clinic of one of the hospitals (HULP). The halo sign was considered as positive US finding for GCA3. In addition, intima-media thickness of arteries was measured, with a cut-off ≥0.34 mm for temporal arteries (TA) frontal and parietal, 0.42mm for common TA, and ≥1 mm for common carotid, axillary and subclavian arteries for positive result. The clinical characteristics of PMR patients were recorded and the frequency of subclinical GCA determined.ResultsCohort A included 41 PMR patients with subclinical GCA. Cohort B was formed by 97 GCA. The characteristics of the patients are shown in the Table 1. Figure 1 shows the different subtypes of vessel involvement in patients with PMR and subclinical GCA and in patients of the fast-track clinic with the diagnosis of GCA in a single hospital.Figure 1.Subtypes of vessel affectation in Subclinical GCA in PMR and in classical GCATable 1.Clinical characteristics of patients of Cohort A (Subclinical GCA in PMR n = 41/216) and B (GCA in the fast-track clinic n = 97)Cohort A (n = 41)Cohort B (n = 97)Sex female (%)17 (41.5%)53 (54.6%)Age (years) mean ± SD74±6.779 ± 12CRP mg/L49.6±49.146 ± 81.6Polymyalgia rheumatica41 (100%)47 (48.5%)Constitutional symptoms19 (35.18%)35 (36.1%)Subclinical PMR has a predilection for affectation of large vessels, followed by isolated cranial pattern (ie. Isolated temporal artery involvement) and by the mixed (cranial and extra-cranial) form. On the contrary, in classical GCA an isolated cranial involvement represents the more common pattern, followed by the mixed and finally isolated large vessel involvement.ConclusionSubclinical GCA in PMR shows a principal isolated extra-cranial involvement and with clearly different pattern than classical GCA.AcknowledgementsTo the GCA/PMR study groupDisclosure of InterestsNone declared
Collapse
|
12
|
Zabotti A, Giovannini I, Manfrè V, Lorenzon M, Pegolo E, Dejaco C, Hocevar A, Quartuccio L, De Vita S. POS0778 THE USEFULNESS OF ULTRASOUND-GUIDED CORE NEEDLE BIOPSY OF THE PAROTID GLAND FOR THE DIAGNOSIS OF PRIMARY SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUltrasound-guided Core Needle Biopsy (US-guided CNB) of the parotid gland has proved to be a novel and safe technique for the diagnosis of lymphoma in Sjögren’s Syndrome (pSS) patients with salivary gland enlargement.1 The potential role of US-guided CNB for the diagnosis of pSS has been never reported, while only one group uses open surgical parotid biopsy to this end in pSS2.ObjectivesTo explore the value of US-guided CNB of the parotid gland as a diagnostic tool for pSS.MethodsFrom September 2019 to June 2021, 22 patients with a clinical diagnosis of pSS underwent US-guided CNB of the parotid gland due to persistent (≥2 months) parotid swelling and suspected glandular lymphoma. In 21/22 (95.4%) patients, the tissue sampling was adequate for the histopathological diagnosis. No persistent complications were reported. For the aim of this study, 2/21 (9.5%) patients were excluded for a different final diagnosis (i.e., IgG4-RD and sarcoidosis), and 13/21 (61.9%) patients for a diagnosis of parotid gland lymphoma. Six out of 21 (28.5%) were finally included for the evaluation of US-guided CNB in the histopathological diagnosis of pSS. The following histopathological features related to pSS were studied: focus score (FS); presence of germinal centres (GCs); presence of lymphoepithelial lesions (LELs); and presence of Myo-/Lympho-epithelial sialadenitis (MESA/LESA).ResultsAll 6 patients already satisfied the ACR/EULAR classification criteria for pSS and were females, with a mean age of 47.6 years (SD ±17.0) and a mean disease duration of 8.3 years (SD ±8.0). In all of them, specific findings of pSS were observed (Table 1). The FS could be calculated in 3/6 cases and was ≥1 in 2/3 cases, while in 3/6 cases it could be not calculated due to the evidence of MESA/LESA. GCs were found in 4/7 cases, while LELs were present in 3/7 cases (Table 1).Table 1.Histopathological features in the parotid gland biopsy.#PatientFocus scoreLELsGCsMESA/LESA#1 NINot applicable✗✗✓#2 BM≥1✓✓✗#3 CMNot applicable✓✓✓#4 RC<10✓✗#5 FRNot applicable✓✓✓#6 RV≥1✗✗✗ConclusionUS-guided CNB of the parotid gland could represent a potential novel tool for the diagnosis of pSS patients. When parotid swelling is present, it may be more convenient than lip biopsy. In addition, CNB can be ultrasound-guided in specific glandular areas showing different sonographic appearances, consistent with different histopathology, leading the way for the role as diagnostic tool for pSS, and not only as improved lymphoma detection tool.The next step is to evaluate US-guided CNB in pSS patients without glandular swelling, and to compare the results with labial biopsy.References[1]Zabotti A, Zandonella Callegher S, Lorenzon M, et al. Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome? Rheumatology. Published online September 17, 2020:keaa441. doi:10.1093/rheumatology/keaa441[2]Spijkervet FKL, Haacke E, Kroese FGM, Bootsma H, Vissink A. Parotid Gland Biopsy, the Alternative Way to Diagnose Sjögren Syndrome. Rheumatic Disease Clinics of North America. 2016;42(3):485-499. doi:10.1016/j.rdc.2016.03.007Disclosure of InterestsAlen Zabotti Speakers bureau: Not relevant for this study, Consultant of: Not relevant for this study, Ivan Giovannini Speakers bureau: Not relevant for this study, Valeria Manfrè: None declared, Michele Lorenzon Speakers bureau: Not relevant for this study, Enrico Pegolo Speakers bureau: Not relevant for this study, Christian Dejaco Speakers bureau: Not relevant for this study, Consultant of: Not relevant for this study, ALOJZIJA HOCEVAR Speakers bureau: Not relevant for this study, Consultant of: Not relevant for this study, Luca Quartuccio Speakers bureau: Not relevant for this study, Consultant of: Not relevant for this study, Salvatore De Vita Speakers bureau: Not relevant for this study, Consultant of: Not relevant for this study
Collapse
|
13
|
Zandonella Callegher S, Giovannini I, Zenz S, Manfrè V, Stradner MH, Hocevar A, Gutierrez M, Quartuccio L, De Vita S, Zabotti A. Sjögren syndrome: looking forward to the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100295. [PMID: 35634352 PMCID: PMC9131387 DOI: 10.1177/1759720x221100295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.
Collapse
Affiliation(s)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
- Rheumatology Center of Excellence, Mexico City, Mexico
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| |
Collapse
|
14
|
de Miguel E, Macchioni P, Conticini E, Campochiaro C, Karalilova R, Monti S, Ponte C, Klinowski G, Monjo I, Falsetti P, Tomelleri A, Batalov Z, Hocevar A. OP0184 PREVALENCE OF SUBCLINICAL GIANT CELL ARTERITIS IN PATIENTS WITH POLYMYALGIA RHEUMATICA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are closely related diseases. PMR occurs in approximately 50 % of patients with GCA1; however the prevalence of subclinical GCA in PMR has not yet been widely studied.ObjectivesThe aim of our multicenter, prospective study was to determine the prevalence of subclinical GCA in newly diagnosed PMR, using vascular ultrasound (US) as a diagnostic tool.MethodsEight European centers participated in the study. The studied cohort represented consecutive newly diagnosed patients with PMR who fulfilled 2012 EULAR/ACR Provisional Classification Criteria for Polymyalgia Rheumatica2 without symptoms or signs suggestive for GCA. All patients underwent ultrasound (US) of both hips and shoulders, as well as of four bilateral arterial territories (i.e. temporal, common carotid, subclavian and axillary arteries). Patients with positive halo signs were considered to have subclinical GCA 3. An intima-media thickness ≥0.34 mm for frontal and parietal TA, 0.42mm for common TA, and ≥1 mm for common carotid, axillary and subclavian arteries for positive result. Clinical demographic and laboratory characteristics of the PMR pure group were compared with the PMR/GCA patient group.ResultsA total of 258 patients were included, 137 (53.1%) females with a mean age of 73±8.4 years. Table 1 shows the main differences in PMR patients with and without subclinical GCA. The only statistical significant difference between the two groups was the higher prevalence of morning stiffness > 40 minutes in the pure PMR group (p<0.05). A halo sign was found on at least one of the examined arteries in 56/258 patients (21.7%).The different subtypes of vessel involvement were available in 216 cases. Data compatible with the diagnosis of GCA was found in 41 cases (19%): 10 (24.3%) had only temporal artery involvement (“cranial” GCA), 27 (65.8%) had an extra-cranial artery involvement and 4 (9.8%) a mixed form with both cranial and extra-cranial artery involvement (Figure 1).Table 1.Clinical and demographic characteristicsFigure 1.Subtypes of subclinical GCA in PMR in 216 patients with cranial and extra-cranial examinationConclusionOne fifth of PMR patients without symptoms or signs of GCA have ultrasound findings consistent with the diagnosis of GCA. Subclinical GCA in PMR shows a predilection for extra-cranial artery involvement.References[1]Buttgereit F et al. JAMA. 2016;315:2442-58.[2]Dasgupta B et al. Arthritis & Rheumatism. 2012; 64:943–954.[3]De Miguel E et al. Rheumatology 2018; 57:318-321.AcknowledgementsTo the GCA/PMR study groupDisclosure of InterestsNone declared
Collapse
|
15
|
Carmona EG, García-Giménez JA, López-Mejías R, Khor CC, Lee JK, Taskiran E, Ozen S, Hocevar A, Liu L, Gorenjak M, Potočnik U, Kiryluk K, Ortego-Centeno N, Cid MC, Hernández-Rodríguez J, Castañeda S, González-Gay MA, Burgner D, Martín J, Márquez A. Identification of a shared genetic risk locus for Kawasaki disease and immunoglobulin A vasculitis by a cross-phenotype meta-analysis. Rheumatology (Oxford) 2022; 61:1204-1210. [PMID: 33993232 PMCID: PMC10687354 DOI: 10.1093/rheumatology/keab443] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Combining of genomic data of different pathologies as a single phenotype has emerged as a useful strategy to identify genetic risk loci shared among immune-mediated diseases. Our study aimed to increase our knowledge of the genetic contribution to Kawasaki disease (KD) and IgA vasculitis (IgAV) by performing the first comprehensive large-scale analysis on the genetic overlap between them. METHODS A total of 1190 vasculitis patients and 11 302 healthy controls were analysed. First, in the discovery phase, genome-wide data of 405 KD patients and 6252 controls and 215 IgAV patients and 1324 controls, all of European origin, were combined using an inverse variance meta-analysis. Second, the top associated polymorphisms were selected for replication in additional independent cohorts (570 cases and 3726 controls). Polymorphisms with P-values ≤5 × 10-8 in the global IgAV-KD meta-analysis were considered as shared genetic risk loci. RESULTS A genetic variant, rs3743841, located in an intron of the NAGPA gene, reached genome-wide significance in the cross-disease meta-analysis (P = 8.06 × 10-10). Additionally, when IgAV was individually analysed, a strong association between rs3743841 and this vasculitis was also evident [P = 1.25 × 10-7; odds ratio = 1.47 (95% CI 1.27, 1.69)]. In silico functional annotation showed that this polymorphism acts as a regulatory variant modulating the expression levels of the NAGPA and SEC14L5 genes. CONCLUSION We identified a new risk locus with pleiotropic effects on the two childhood vasculitides analysed. This locus represents the strongest non-HLA signal described for IgAV to date.
Collapse
Affiliation(s)
- Elio G Carmona
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA
- Instituto de Parasitología y Biomedicina ‘López-Neyra’, CSIC, PTS Granada, Granada
| | | | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Jong-Keuk Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Ekim Taskiran
- Department of Medical Genetics, Faculty of Medicine, Hacettepe University
| | - Seza Ozen
- Department of Paediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lili Liu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mario Gorenjak
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Uroš Potočnik
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Norberto Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio
- School of Medicine, University of Granada, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada
| | - María C Cid
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona
| | | | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - David Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital
- Department of Paediatrics, University of Melbourne
- Department of General Medicine, Royal Children’s Hospital, Parkville
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Javier Martín
- Instituto de Parasitología y Biomedicina ‘López-Neyra’, CSIC, PTS Granada, Granada
| | - Ana Márquez
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA
- Instituto de Parasitología y Biomedicina ‘López-Neyra’, CSIC, PTS Granada, Granada
| | | |
Collapse
|
16
|
Giovannini I, Lorenzon M, Manfrè V, Zandonella Callegher S, Pegolo E, Zuiani C, Girometti R, Hocevar A, Dejaco C, Luca Q, De Vita S, Zabotti A. Safety, patient acceptance and diagnostic accuracy of ultrasound core needle biopsy of parotid or submandibular glands in primary Sjögren's syndrome with suspected salivary gland lymphoma. RMD Open 2022; 8:rmdopen-2021-001901. [PMID: 35131750 PMCID: PMC8823241 DOI: 10.1136/rmdopen-2021-001901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Enlargement of the major salivary glands (SGs) is a major risk factor for B-cell lymphoma among patients with primary Sjögren’s syndrome (pSS). Ultrasound-guided core needle biopsy (US-guided CNB) could be a novel technique to manage SG enlargement among patients with pSS. Objective Accordingly, this study’s main aim was to evaluate the safety, patient tolerance and diagnostic accuracy of US-guided CNB procedure for patients with pSS with major SG enlargement. Methods Patients with clinical diagnosis of pSS and a clinical indication for SG biopsy consecutively underwent US-guided CNB between September 2019 and June 2021. These patients were evaluated clinically 1, 2 and 12 weeks after US-guided CNB. Patients were asked to complete a questionnaire about postprocedural complications as well as periprocedural pain, using the Visual Analogue Scale. Complications were categorised as transient (<12 weeks) or persistent (≥12 weeks). Results US-guided CNB was performed on 30 major salivary glands (22 parotid glands and 8 submandibular glands). The procedure was well tolerated. Transient complications—such as haematoma, swelling—were observed among 43% of patients, and mean periprocedural pain was low. However, no persistent complications were reported during the study’s follow-up period. Conclusion US-guided CNB represents a novel approach for the management of patients with pSS with SG enlargement. The procedure showed remarkable patient safety and tolerance, allowing adequate glandular sampling and a definite diagnosis for almost all participating patients without long-term complications.
Collapse
Affiliation(s)
- Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy.,Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Quartuccio Luca
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| |
Collapse
|
17
|
Finzel S, Jousse-Joulin S, Costantino F, Hánová P, Hocevar A, Iagnocco A, Keen H, Naredo E, Ohrndorf S, Schmidt WA, D'Agostino MA, Terslev L, Bruyn GA. Patient-based reliability of the Outcome Measures in Rheumatology (OMERACT) ultrasound scoring system for salivary gland assessment in patients with Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2169-2176. [PMID: 33085747 DOI: 10.1093/rheumatology/keaa471] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/06/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To assess the reliability of the consensually agreed US definitions of major salivary gland lesions and the US scoring system for salivary gland assessment in patients with SS. METHODS Nine experienced sonographers scanned and read the US images of both parotid glands (PGs) and submandibular glands (SMGs) in eight patients with primary and secondary SS in two rounds. A consensually agreed four-grade semi-quantitative scoring was applied in B-mode for morphological lesions: grade 0, normal; grade 1, mild inhomogeneity without anechoic or hypoechoic areas; grade 2, moderate inhomogeneity with focal anechoic or hypoechoic areas; grade 3, severe inhomogeneity with diffuse an- or hypoechoic areas occupying the entire gland or fibrous gland. The presence or absence of typical SS lesions, i.e. the Sjögren's signature, was scored binary. Intra- and interreader reliabilities were computed using weighted and unweighted Cohen's and Light's κ coefficients. RESULTS The mean prevalence of grades 0-3 in PG were 43, 17, 23 and 31% and 28, 14, 33 and 32% for the SMGs, respectively. The weighted κ for intrareader reliability ranged from 0.44 to 1 for grading and 0.64 to 1 for the Sjögren's signature of PG and 0.59 to 1 and -0.09 to 0.6 for SMGs, respectively. The interreader reliability κ for grading in PG was 0.62 (95% CI 0.47, 0.74) and for Sjögren's signature it was 0.36 (95% CI 0, 0.43); in SMG it was 0.62 (95% CI 0.47, 0.72) and 0.03 (95% CI 0, 0.07) respectively. CONCLUSIONS The consensually agreed novel US scoring system for major salivary gland lesions showed substantial intra- and interreader reliability in patients with SS. The reliability of the Sjögren's signature was moderate.
Collapse
Affiliation(s)
- Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Félicie Costantino
- Department of Rheumatology, AP-HP Ambroise Paré Hospital, University of Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Petra Hánová
- Institute of Rheumatology, Prague, Czech Republic
| | - Alojzija Hocevar
- Rheumatology Department, University Medical Centre, Ljubljana, Slovenia
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Helen Keen
- Rheumatology Department, Royal Perth Hospital, Perth, WA, Australia
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, AP-HP Ambroise Paré Hospital, University of Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Lene Terslev
- Centre for Rheumatology and Spinal Diseases, Rigshospitalet, Copenhagen, Denmark
| | - George A Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
| |
Collapse
|
18
|
Trivioli G, Canzian A, Maritati F, Fenoglio R, Pillebout E, Urban ML, Mohammad A, Nogueira E, Silvestri E, Eriksson P, Segelmark M, Novikov P, Harris H, Smitienko I, Moiseev S, Farisogullari B, O'Sullivan D, Ponte C, Lamprecht P, Hocevar A, Karadag O, Little M, Emmi G, Jayne D, Mcadoo S, Roccatello D, Vaglio A. FC 039RENAL OUTCOME AFTER RITUXIMAB IN ADULT-ONSET IGA VASCULITIS AND CRESCENTIC IGA NEPHROPATHY: A MULTICENTRE STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab117.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Glucocorticoids (GC) and/or immunosuppressive agents are the mainstay of therapy for adult-onset IgA Vasculitis (IgAV), but their efficacy is often partial while their toxicity is relevant. Recently, rituximab (RTX) has been reported as a safe and effective option but only few data on renal outcome are available.1 RTX has also been used in a few cases of crescentic IgA Nephropathy (cIgAN), an IgAN subset with vasculitic lesions and poor response to conventional immunosuppressive regimens.2 We present the results of a multicentre cohort of patients with IgAV and cIgAN treated with RTX.
Method
The databases of 16 consorted European centres were investigated to screen for patients with adult-onset, biopsy-proven IgAV and cIgAN (crescents in ≥25% glomeruli and rapid eGFR worsening at presentation), who received RTX as induction therapy. We selected patients with active renal manifestations at the time of RTX. Remission was defined as a Birmingham Vasculitis Activity Score (BVAS)=0 or <5 if it was due to persistent proteinuria and relapse as an increase in BVAS requiring change in immunosuppressive therapy.
Results
We identified 38 patients with IgAV and 12 patients with cIgAN who received RTX and had active renal involvement at the time of treatment. The median age at onset was 40 years (interquartile range, IQR, 25-53) and more than two-thirds of patients were male (Table 1). The median follow-up after RTX was 41 months (IQR 18-60).
Renal outcomes are reported in Table 2. At the time of treatment, 24 patients (48%) had eGFR ≥60 mL/min/1.73 m2. All had IgAV and their median BVAS was 17 (IQR 10-22). Furthermore, all had microhaematuria and proteinuria. Renal histology showed mesangial or focal endocapillary proliferation in 12/17 (71%) patients who underwent biopsy (class II-IIIA according to Pillebout3). Twenty patients (83%) achieved remission; after a median of 12 months (range 9-14), four experienced a minor relapse and one had a major relapse with significant renal disease progression. Renal function remained stable in all but two patients who developed end-stage renal disease (ESRD). Micro-haematuria subsided in 14/24 (58%) and median 24h proteinuria decreased from 1750 mg (IQR 865-3275) to 175 mg (IQR 100-800) at last follow-up (p=0.029).
Of the 26 patients with eGFR <60 mL/min/1.73 m2, 14 had IgAV and 12 had cIgAN. All were biopsied and 20 (77%) had diffuse endo/extra-capillary proliferation (classes IIIB-IV). Five patients required dialysis but recovered soon after treatment start. Remission was achieved by 16/26 (61%); eight (50%) subsequently relapsed and two (12%) reached ESRD. At last follow-up, eGFR was ≥60 mL/min/1.73 m2 in 8/26 (31%), 10/26 (48%) had stable renal function as compared to the time of RTX, while 8/26 (31%) had developed ESRD. Median 24h proteinuria decreased from 3400 mg (IQR 2150-6500) to 770 mg (177-1315) (p=0.016).
Remission rate and ESRD-free survival were respectively 86% and 92% in patients with IgAV, while they were respectively 42% and 42% in cIgAN patients. Furthermore, 21/24 (87%) patients who received RTX alone or combined to glucocorticoids but not to immunosuppressive agents achieved remission and 22/24 (92%) were ESRD-free at last follow-up. Of the 26 patients receiving immunosuppressive agents, 17 (65%) obtained remission and 18 (69%) were ESRD-free at last assessment. Over the whole follow-up, only one patient reported a severe adverse effect related to RTX (pneumonia).
Conclusion
Renal involvement in adult-onset IgAV and cIgAN is frequently severe. RTX, combined or not with other immunosuppressive agents, may improve renal manifestations and is well tolerated. IgAV patients show higher remission rates and a longer ESRD-free survival as compared to cIgAN patients.
Collapse
Affiliation(s)
- Giorgio Trivioli
- Meyer Children's Hospital, Nephrology and Dialysis Unit, Florence, Italy
| | - Alice Canzian
- Parma University Hospital, Obstetrics and Gynecologic Unit, Parma, Italy
| | | | - Roberta Fenoglio
- San Giovanni Bosco Hospital, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
| | - Evangeline Pillebout
- Sant-Louis Hospital and University Paris Diderot, Department for Nephrology, Paris, France
| | - Maria Letizia Urban
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - Aladdin Mohammad
- Lund University, Department of Rheumatology, Clinical Science , Lund, Sweden
| | - Estela Nogueira
- Centro Hospitalar Universitário Lisboa Norte, Division of Nephrology and Renal Transplantation, Lisboa, Portugal
| | - Elena Silvestri
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - Per Eriksson
- Linkoeping University, 10. Department of Medical and Health Sciences, Linkoping, Sweden
| | - Mårten Segelmark
- Linkoeping University, Department of Nephrology, Linkoping, Sweden
| | - Pavel Novikov
- Sechenov First Moschow State Medical University, Clinic of Nephrology, Internal and Occupational Diseases, Moscow, Russia
| | - Helen Harris
- Whyteman’s Brae Hospital, Rheumatology Unit, Kirkcaldy, United Kingdom
| | | | - Sergey Moiseev
- Sechenov First Moschow State Medical University, Clinic of Nephrology, Internal and Occupational Diseases, Moscow, Russia
| | | | | | - Cristina Ponte
- Lisbon Academic Medical Centre, Rheumatology, Lisboa, Portugal
| | - Peter Lamprecht
- University of Lübeck, Department of Rheumatology and Clinical Immunology, Lübeck, Germany
| | - Alojzija Hocevar
- University Medical Centre Ljubljana, Department of Rheumatology, Ljubljana, Slovenia
| | - Omer Karadag
- Hacetteppe University, Vasculitis Research Centre, Ankara, Turkey
| | - Mark Little
- Tallgath Hospital, Trinity Health Kidney Centre, Dublin, Ireland
| | - Giacomo Emmi
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - David Jayne
- University of Cambridge, Department of Medicine, Cambridge, United Kingdom
- Addenbrooke’s Hospital, Vasculitis and Lupus Clinic, Cambridge, United Kingdom
| | - Stephen Mcadoo
- Imperial College London, Centre for Inflammatory Disease, London, United Kingdom
| | - Dario Roccatello
- San Giovanni Bosco Hospital, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
- University of Turin, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
| | - Augusto Vaglio
- Meyer Children's Hospital, Nephrology and Dialysis Unit, Florence, Italy
- University of Florence, Department of Biomedical Experimental and Clinical Sciences, Florence, Italy
| |
Collapse
|
19
|
Schäfer VS, Chrysidis S, Schmidt WA, Duftner C, Iagnocco A, Bruyn GA, Carrara G, De Miguel E, Diamantopoulos AP, Nielsen BD, Fredberg U, Hartung W, Hanova P, Hansen IT, Hocevar A, Juche A, Kermani TA, Lorenzen T, Macchioni P, Milchert M, Døhn UM, Mukhtyar C, Monti S, Ponte C, Seitz L, Scirè CA, Terslev L, Dasgupta B, Keen HI, Pineda C, Dejaco C. OMERACT definition and reliability assessment of chronic ultrasound lesions of the axillary artery in giant cell arteritis. Semin Arthritis Rheum 2021; 51:951-956. [PMID: 34140184 DOI: 10.1016/j.semarthrit.2021.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To define chronic ultrasound lesions of the axillary artery (AA) in long-standing giant cell arteritis (GCA) and to evaluate the reliability of the new ultrasound definition in a web-based exercise. METHODS A structured Delphi, involving an expert panel of the Large Vessel Vasculitis subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group was carried out. The reliability of the new definition was tested in a 2-round web-based exercise involving 23 experts and using 50 still images each from AA of long-standing and acute GCA patients, as well as 50 images from healthy individuals. RESULTS The final OMERACT ultrasound definition of chronic changes was based on measurement and appearance of the intima-media complex. The overall reliability of the new definition for chronic ultrasound changes in longstanding GCA of the AA was good to excellent with Light's kappa values of 0.79-0.80 for inter-reader reliability and mean Light's-kappa of 0.88 for intra-reader reliability. The mean inter-rater and intra-rater agreements were 86-87% and 92%, respectively. Good reliabilities were observed comparing the vessels with longstanding versus acute GCA with a mean agreement and kappa values of 81% and 0.63, respectively. CONCLUSION The new OMERACT ultrasound definition for chronic vasculitis of the AA in GCA revealed a good to excellent inter- and intra-reader reliability in a web-based exercise of experts.
Collapse
Affiliation(s)
- Valentin Sebastian Schäfer
- Clinic for Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany.
| | | | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Christina Duftner
- Department of Internal Medicine VI, Medical University Innsbruck, Innsbruck, Austria
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - George A Bruyn
- Department of Rheumatology, MC Hospital Group, Lelystad, The Netherlands
| | - Greta Carrara
- Epidemiology Research Unit, Italian Society for Rheumatology, Milano, Italy
| | | | | | | | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana; Slovenian Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aaron Juche
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles; David Geffen School of Medicine, California, USA
| | - Tove Lorenzen
- Department of Rheumatology, Silkeborg Hospital, Silkeborg, Denmark
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Specialistic Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology of Pomeranian Medical University in Szczecin, Poland
| | | | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
| | - Luca Seitz
- Department of Rheumatology and Immunology, University of Bern, Inselspital, Switzerland
| | - Carlo A Scirè
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy; Società Italiana di Reumatologia, Unità Epidemiologica, Milan, Italy
| | - Lene Terslev
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Essex, UK
| | | | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz; Austria and Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| |
Collapse
|
20
|
Vukicevic AM, Radovic M, Zabotti A, Milic V, Hocevar A, Callegher SZ, De Lucia O, De Vita S, Filipovic N. Deep learning segmentation of Primary Sjögren's syndrome affected salivary glands from ultrasonography images. Comput Biol Med 2020; 129:104154. [PMID: 33260099 DOI: 10.1016/j.compbiomed.2020.104154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
Salivary gland ultrasonography (SGUS) has proven to be a promising tool for diagnosing various diseases manifesting with abnormalities in salivary glands (SGs), including primary Sjögren's syndrome (pSS). At present, the major obstacle for establishing SUGS as a standardized tool for pSS diagnosis is its low inter/intra observer reliability. The aim of this study was to address this problem by proposing a robust deep learning-based solution for the automated segmentation of SGUS images. For these purposes, four architectures were considered: a fully convolutional neural network, fully convolutional "DenseNets" (FCN-DenseNet) network, U-Net, and LinkNet. During the course of the study, the growing HarmonicSS cohort included 1184 annotated SGUS images. Accordingly, the algorithms were trained using a transfer learning approach. With regard to the intersection-over-union (IoU), the top-performing FCN-DenseNet (IoU = 0.85) network showed a considerable margin above the inter-observer agreement (IoU = 0.76) and slightly above the intra-observer agreement (IoU = 0.84) between clinical experts. Considering its accuracy and speed (24.5 frames per second), it was concluded that the FCN-DenseNet could have wider applications in clinical practice. Further work on the topic will consider the integration of methods for pSS scoring, with the end goal of establishing SGUS as an effective noninvasive pSS diagnostic tool. To aid this progress, we created inference (frozen models) files for the developed models, and made them publicly available.
Collapse
Affiliation(s)
- Arso M Vukicevic
- Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, Kragujevac, Serbia; BioIRC R&D Center, Prvoslava Stojanovica 6, Kragujevac, Serbia.
| | - Milos Radovic
- BioIRC R&D Center, Prvoslava Stojanovica 6, Kragujevac, Serbia; Everseen, Milutina Milankovica 1z, Belgrade, Serbia.
| | - Alen Zabotti
- Azienda Ospedaliero Universitaria, Santa Maria Della Misericordia di Udine, Udine, Italy
| | - Vera Milic
- Institute of Rheumatology, School of Medicine, University of Belgrade, Serbia
| | - Alojzija Hocevar
- Department of Rheumatology, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | | | - Orazio De Lucia
- Department of Rheumatology, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
| | - Salvatore De Vita
- Azienda Ospedaliero Universitaria, Santa Maria Della Misericordia di Udine, Udine, Italy
| | - Nenad Filipovic
- Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, Kragujevac, Serbia; BioIRC R&D Center, Prvoslava Stojanovica 6, Kragujevac, Serbia
| |
Collapse
|
21
|
Zabotti A, Zandonella Callegher S, Tullio A, Vukicevic A, Hocevar A, Milic V, Cafaro G, Carotti M, Delli K, De Lucia O, Ernst D, Ferro F, Gattamelata A, Germanò G, Giovannini I, Hammenfors D, Jonsson MV, Jousse-Joulin S, Macchioni P, Parisi S, Perricone C, Stradner MH, Filipovic N, Tzioufas AG, Valent F, De Vita S. Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project. Front Med (Lausanne) 2020; 7:581248. [PMID: 33330537 PMCID: PMC7719819 DOI: 10.3389/fmed.2020.581248] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience. Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring. Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience. Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.
Collapse
Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Arso Vukicevic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vera Milic
- Institute of Rheumatology, Belgrade, Serbia
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Medical Sciences, Aziende Socio Sanitarie Territoriali (ASST) Centro Traumatologico Ortopedico G. Pini-Centri Traumatologici Ortopedici (CTO), Milan, Italy
| | - Diana Ernst
- Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Germanò
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Daniel Hammenfors
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Malin V Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire (CHU) de Brest, Univ Brest, Brest, France.,UMR 1227, Lymphocytes B et Autoimmunité (LBAI), Inserm, Univ Brest, Brest, France
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Simone Parisi
- Unit of Rheumatology, Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Nenad Filipovic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| |
Collapse
|
22
|
Hocevar A, Rotar Z, Krosel M, Plešivčnik Novljan M, Praprotnik S, Tomsic M. SAT0524 THE INCIDENCE RATE OF ADULT ONSET STILL’S DISEASE IN SLOVENIA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Adult Onset Still’s disease (AOSD) is an uncommon systemic inflammatory disease.Objectives:To determine for the first time the incidence rate of AOSD in our population.Methods:We retrospectively collected AOSD cases diagnosed between 1 January 2010 and 31 December 2019 at our secondary/tertiary rheumatology centre, which is the only referral centre for an average population of 704,000 adults. AOSD cases were identified by searching the electronic medical database both for ICD-10 code M06.1 and a full text search for »AOSD«. Patients’ records were analyzed and descriptive statistics was used to describe our study group. The adult population was obtained from the national statistics institute database. The annual incidence rate for AOSD was calculated.Results:During the 10-year observation period we identified 22 incipient AOSD cases. All 22 cases fulfilled Yamaguchi classification criteria for AOSD1. Five cases were excluded from analyses since they were referred to our department from regions served by other secondary/tertiary centres. Hence, we finally analyzed 17 AOSD cases (11 females; median (IQR) age 38.9 (29.9; 56.5) years, range 20-71 years), resulting in the average annual incidence rate of 2.4 (95%CI 1.5-3.8) cases per 106adults. Age specific incidence rate of AOSD is presented in Figure 1. Clinical characteristics of AOSD cases at presentation are shown in Table 1. AOSD was complicated with macrophage activating syndrome in 4/17 (23.5%) cases, and with pulmonary hypertension in one case. Patients were followed for a median (IQR) 31 (20; 58) months. Twelve (70.5%), 2 (11.8%), and 3 (17.6) patients had monophasic, relapsing, and chronic disease course, respectively.Table 1.Clinical characteristics of AOSD at presentationCharacteristicAOSD (%)CharacteristicAOSD (%)Female gender64.7Lung infiltrates23.5Age*38.9 (29.9;56.5)Pericardial effusion23.5Fever94.1Abdominal pain17.6Weight loss64.7Lymphadenopathy52.9Skin rash76.5Splenomegaly41.2Throat pain88.2Hepatomegaly17.6Arthralgia/Arthritis88.2/47.1Leukocytosis88.2Myalgia29.4Elevated AST/ALT88.2Pleural effusion23.5Ferritin >1000ng/ml94.1Legend: *median (IQR);Figure 1.Age specific incidence rate of AOSDConclusion:AOSD is rare in our population, with an average annual incidence rate of 2.4 cases per 106adults.References:[1]Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, et al. Preliminary criteria for classification of adult Still’s disease. J Rheumatol. 1992;19(3):424-30.Acknowledgments -Disclosure of Interests:ALOJZIJA HOCEVAR: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Monika Krosel: None declared, Martina Plešivčnik Novljan: None declared, Sonja Praprotnik: None declared, Matija Tomsic: None declared
Collapse
|
23
|
Jese R, Rotar Z, Tomsic M, Hocevar A. FRI0193 ULTRASONOGRAPHY IN THE DIAGNOSIS OF GIANT CELL ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Objectives:To evaluate the frequency of cranial and aortic arch artery involvement in GCA using color Doppler ultrasonography (CDS).Methods:We performed CDS of cranial and aortic arch arteries in 248 incipient, clinically diagnosed, GCA patients (64.9% females, median (IQR) age 75 (67-80) years) between October 2013 and September 2019, using a Philips IU22 with 5–17.5 MHz linear probe or Philips Epiq 7 with 5–18.5 MHz linear probe. Temporal, facial, occipital, carotid, vertebral, subclavian, and axillary arteries were examined bilaterally. A halo with positive compression sign was considered a positive finding. Additionally, the thickness of intima-media complex (IMT) of individual vessel was measured, and compared to the IMT of 97 consecutive suspected GCA cases (60.8% females median (IQR) age 74 (65-81) years), in whom GCA was excluded, that served as a control group.Results:The CDS was positive in 244 (98.4%) patients in at least one of the examined arteries. Temporal arteries were most commonly affected, and were involved in 192 (77.4%) patients, followed by facial and occipital arteries, involved in 122 (49.2) and 72 (29.0%) patients, respectively. Extracranial large vessel involvement (LVV) was found in 87 (35.1%) patients (32 patients had isolated LVV, and 55 concomitant cranial and LVV artery involvement). Among the 161 patients without LVV, 12 (4.8% of the studied cohort) had involvement of cranial arteries other than temporal arteries (we found facial and occipital artery involvement in 11 and 3 patients, respectively). Table 1 shows the frequency of individual vessel involvement in GCA, and the IMT of CDS inflamed and non-inflamed arteries in GCA, and in controls.Table 1.The involvement of cranial and aortic arch arteries in GCA assessed by CDS and intima-media thickness of inflamed and non-inflamed arteries in GCA, and controlsArteryGCA No (%)IMT (mm) in GCAIMT (mm) in ControlsPositive CDSPositive CDS*; minimalNegative CDSNegative CDS; maximalTemporal192 (77.4)0.71±0.19; 0.330.25±0.070.23±0.05; 0.46Facial122 (49.2)0.75±0.27; 0.410.29±0.070.26±0.07; 0.47Occipital72 (29.0)0.73±0.33; 0.450.26±0.060.23±0.05; 0.46Carotid34 (13.7)1.53±0.44; 0.880.78±0.180.72±0.15; 1.09Vertebral25 (10.1)1.33±0.47; 0.740.45±0.100.42±0.08; 0.63Subclavian67 (27.0)1.65±0.45; 0.910.70±0.140.70±0.13; 0.99Axillary59 (23.8)1.74±0.65; 1.000.61±0.170.57±0.13; 0.97Any artery244 (98.4)---Legend: GCA giant cell arteritis; IMT thickness of intima-media complex; * mean±SD;Conclusion:CDS of seven preselected cranial and aortic arch arteries provides a high diagnostic yield in GCA.Disclosure of Interests:Rok Jese: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Matija Tomsic: None declared, ALOJZIJA HOCEVAR: None declared
Collapse
|
24
|
Hocevar A, Perdan-Pirkmajer K, Tomsic M, Rotar Z. AB0483 INTERSTITIAL LUNG DISEASE IN PATIENTS WITH ANCA ASSOCIATED VASCULITIS – A PROSPECTIVE SINGLE CENTER STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Recently, an association between anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and interstitial lung disease (ILD) has been uncovered.Objectives:To determine the rate of ILD in our prospective AAV patient cohort and to compare clinical characteristics of AAV patients with and without associated ILD.Methods:We retrospectively analysed medical records of prospectively diagnosed and followed AAV patients at our secondary/tertiary rheumatology centre between January 2010 and December 2019. The diagnosis of ILD was based on lung HRCT findings.Results:During the 10-year observation, we identified 94 incipient AAV patients (46 had granulomatosis with polyangiitis, and 48 microscopic polyangiitis). Thirteen (13.8%) patients had ILD (ILD-AAV group). 12/13 had usual interstitial pneumonia (UIP) pattern and 1/13 non-specific fibrosis on HRCT. ILD was diagnosed in tandem with AAV in 9/13 patients, and 9 months to 5 years prior to AAV in 4/17 patients. Characteristics of ILD-AAV, and non-ILD-AAV groups are presented in Table 1. ILD-AAV patients more commonly reported of weight loss, less frequently had ENT involvement, and were predominantly a-MPO ANCA positive (92.3%). Follow up data were available for 85 AAV patients (90.4%; 13 ILD-AAV and 72 non-ILD-AAV). During the median (IQR) follow up of 22.1 (4.8; 50.0) months, 5/13 (38.5%) ILD-AAV patients died, compared to 6 (8.3%) deaths registered in non-ILD-AAV group during 26.4 (11.6; 70.0) months of follow up. The crude mortality rate evaluated by Cox proportional hazards regression was significantly higher for AAV-ILD group (HR 5.6 (95%CI 1.7-18.7), p=0.005).Table 1.Clinical characteristics of ILD-AAV and non-ILD-AAV groupCharacteristicILD-AAV (13)non-ILD- AAV (81)pCharacteristicILD-AAV (13)non-ILD-AAV (81)pFemale46.264.20.234ENT060.5<0.001Age*76 (67;77)66 (55;77)0.174Heart07.40.591Smoking61.539.50.226GI tract15.47.40.305Fever61.553.10.766Kidney53.863.00.552Weight loss84.651.90.035PNS38.529.60.531Arthritis15.414.81.0CNS02.51.0Myalgia15.427.20.504ANCA10091.40.588Skin7.719.80.451a-MPO92.344.40.002Eye024.70.063a-PR37.746.90.013Legend: * median (IQR)); ENT ear-nose-throat; GI gastrointestinal tract; PNS peripheral nervous system; CNS central nervous system;Conclusion:In our incipient AAV cohort 13% of patients presented with ILD. The AAV patients with ILD had a higher mortality rate than the rest of the cohort.References:Acknowledgments:Disclosure of Interests: :ALOJZIJA HOCEVAR: None declared, Katja Perdan-Pirkmajer: None declared, Matija Tomsic: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi.
Collapse
|
25
|
Karadag O, Bolek EC, Furuta S, Emmi G, Hocevar A, Hinojosa-Azaola A, Mohammad AJ, Ugurlu S, Alibaz-Oner F, Yazici A, Quartuccio L, Bozzolo E, Dagna L, Ramirez GA, Cantarini L, Gregorini G, Guido J, Monti S, Martin-Nares E, Schiavon F, Padoan R, Kono H, Vaglio A, Kiliçkap S, Ertenli Aİ, Direskeneli H, Özen S, Jayne D. SAT0243 SUBPHENOTYPES IN POLYARTERITIS NODOSA (PAN): TARGET ORGAN ASSOCIATIONS OF A WORLDWIDE COLLABORATION STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is a paucity of information on the current phenotypes, ethnic and geographic differences of PAN. A global PAN study group has been working for clinical subphenotype and GWAS studies.Objectives:This study is aimed to look for target organ associations in PAN.Methods:PAN patients fulfilling the EMA vasculitis classification algorithm were recruited. In addition to baseline characteristics, treatment and outcome data, occurrence of any of the clinical manifestations related to PAN during disease course was recorded.Factor analysis was used to analyse target organ associations of 306 patients. Five factors were identified by factor analysis of variables sex, paediatric-onset, HBV, monogenic disease relationship, cutaneous features, musculoskeletal symptoms, constitutional symptoms and involved areas (abdominal, renal, neurologic, ENT, cardiac, pulmonary).Results:PAN cohort from 7 countries were used (Italy: n=59, Japan: n=39, Mexico: n=29, Slovenia: n=14, Sweden:11, TUR: n=106, UK: n=48). 306 (M/F: 171/135 and Caucasian 77.1%, Asian 13.4%, and Hispanic 9.5%) patients were included. 8 were HBV-related, and 22 of TUR patients had a monogenic form of disease (FMF n=15, DADA2 n=7). 21.8% of patients were cutaneous-only PAN patients. 48.4% of patients had radiologic, 64% had biopsy-proven PAN. Median age at disease onset was 40 (IQR 27.0-57.5) years. During a median 57 (16-120) months follow-up, 39 (13%) patients died.Factor analysis revealed 5 factors that explained 54.1% of the original information on the matrix as follows:Factor 1,represented the association between gastrointestinal and renal involvement, male gender and negatively associated with cutaneous features;Factor 2,the association between monogenic relationship with paediatric onset disease;Factor 3,any of musculoskeletal findings with positive constitutional symptoms;Factor 4any neurologic involvement was associated with ENT and pulmonary findings;Factor 5cardiac involvement in non-HBV patients (Table).The eigenvalues of the 5 factors were 2.034, 1.470, 1.427, 1.079 and 1.030, in decreasing order, i.e., the highest contribution to the overall variance in the matrix came from the togetherness of the 4 clinical and demographic characteristics that made up Factor 1.Conclusion:Target organ associations could support distinctive subphenotypes in PAN. Factor 1 seems the most severe form. Patients with FMF or DADA2 have distinct target organ associations. The jury is out to decide whether these patients should be classified as ‘vasculitis associated with probable etiology’ just as HBV-related-PAN. Factor 4 might define a different subphenotype (ANCA- medium vessel vasculitis?).Disclosure of Interests:Omer Karadag: None declared, Ertugrul Cagri Bolek: None declared, Shunsuke Furuta: None declared, Giacomo Emmi: None declared, ALOJZIJA HOCEVAR: None declared, Andrea Hinojosa-Azaola: None declared, Aladdin J Mohammad Speakers bureau: lecture fees from Roche and Elli Lilly Sweden, PI (GiACTA study), Serdal Ugurlu: None declared, Fatma Alibaz-Oner: None declared, Ayten Yazici: None declared, Luca Quartuccio: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Giuseppe Alvise Ramirez: None declared, Luca Cantarini: None declared, Gina Gregorini: None declared, Jeannin Guido: None declared, Sara Monti: None declared, Eduardo Martin-Nares: None declared, Franco Schiavon: None declared, Roberto Padoan: None declared, Hajime Kono: None declared, Augusto Vaglio: None declared, Saadettin Kiliçkap: None declared, Ali İhsan Ertenli: None declared, Haner Direskeneli: None declared, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim
Collapse
|
26
|
Bolha L, Pižem J, Frank-Bertoncelj M, Hocevar A, Tomsic M, Jurcic V. THU0006 ASSOCIATION BETWEEN ALTERED MICRORNA EXPRESSION AND ARTERIAL WALL REMODELING IN GIANT CELL ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Immunopathology of giant cell arteritis (GCA) results from dysregulated interactions between arterial wall-resident non-immune cells, e.g. vascular smooth muscle cells (VSMCs), and components of the immune system [1]. In spite of several efforts at identifying microRNAs (miRNAs) implicated in the pathogenesis of GCA, the overall information on miRNA involvement in GCA and its related arterial fibro-sclerotic alterations remains scarce.Objectives:To analyze miRNA expression and identify target genes of dysregulated miRNAs in temporal arteries from GCA patients, and to determine their association with GCA-associated arterial wall remodeling.Methods:The study included formalin-fixed, paraffin-embedded temporal artery biopsies (TABs) from 71 clinically diagnosed treatment-naïve patients fulfilling the ACR 1990 classification criteria, and 22 non-GCA subjects (control group). Of GCA patients, 54 histologically positive and 17 histologically negative TABs were included. miRNA expression profiling was performed with quantitative real-time PCR (qPCR)-based miRNA PCR panels and qPCR. The miRDB database and STRING protein-protein network analysis were used for identification of miRNA gene targets and their pathway enrichment analysis, respectively.Results:Of 356 detected miRNAs, we determined significant under-expression of 78 and significant over-expression of 22 miRNAs (≥ 2-fold; p < 0.05) in TAB-positive GCA arteries compared to non-GCA controls, pointing to a strong dysregulation of miRNA expression in inflamed GCA arteries. Several dysregulated miRNAs targeted genes involved in the ubiquitin-proteasome system and the RNA silencing complex, suggesting a novel role of these pathways in GCA. qPCR validation confirmed a 1.9–14.2-fold (p < 0.001) over-expression of “pro-synthetic” (miR-21-3p/-21-5p/-146a-5p/-146b-5p/-424-5p) and 3.4–9.4-fold (p < 0.001) under-expression of “pro-contractile” (miR-23b-3p/-125a-5p/-143-3p/-143-5p/-145-3p/-145-5p/-195-5p/-365a-3p) VSMC phenotype-associated regulatory miRNAs in TAB-positive GCA arteries. These miRNAs targeted gene pathways involved in the arterial remodeling and regulation of the immune system, and their expression significantly correlated with the extent of intimal hyperplasia in TABs from GCA patients (p ≤ 0.015). Additionally, the expression of miR-21-3p/-21-5p/-146a-5p/-146b-5p/-365a-3p differentiated TAB-negative GCA arteries from non-GCA temporal arteries, making these miRNAs potential biomarkers of GCA.Conclusion:Our study demonstrated an extensive dysregulation of arterial miRNA networks in GCA, favoring the pathogenic switch in the VSMC phenotype and associated intimal hyperplasia. We identified several miRNAs, which could represent potential novel GCA biomarkers. Furthermore, our results imply that the ubiquitin-proteasome system and the RNA silencing complex are targets of dysregulated arterial miRNA networks in GCA lesions, providing new insight into the complexity of GCA pathogenesis.References:[1]Weyand CM, Goronzy JJ. Immune mechanisms in medium and large-vessel vasculitis. Nat Rev Rheumatol 2013;9:731–40.Acknowledgments:This work was supported by the Slovenian Research Agency [research core funding No. P3-0054].Disclosure of Interests:None declared
Collapse
|
27
|
Hocevar A, Tomsic M, Jurcic V, Perdan-Pirkmajer K, Rotar Z. FRI0206 THE RELEVANCE OF SERUM IGA LEVEL MEASUREMENT IN ADULT IGA VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Objectives:To evaluate the role of serum IgA level as a biomarker in adult IgA vasculitis (IgAV).Methods:This prospective study included large cohort of histologically proven adult IgAV cases diagnosed between January 2013 and December 2019 at our secondary/tertiary rheumatology centre. All patients underwent a detailed clinical evaluation and laboratory workup. Patients were then stratified based on baseline serum IgA level into two groups (elevated serum IgA vs. normal serum IgA), and clinical features were compared between the two groups. Next we used multivariable logistic regression analysis to determine factors predicting gastrointestinal (GI) or renal involvement in adult IgAV.Results:During the 84-month observation period, we identified 227 incipient adult IgAV cases (60.6% males, median (interquartile range) age 64 (47–76) years, 44 (19.4%) current smokers). One hundred and eleven (48.9%) patients had elevated serum IgA level at baseline, the rest had normal IgA level. None of the patients had subnormal serum IgA level. Skin involvement, constitutional symptoms, arthritis, GI tract and renal involvement developed in 227 (100%), 32 (14.1%), 30 (13.2%), 62 (27.3%), and 93 (41.0%) patients, respectively. Patients with elevated serum IgA less frequently developed constitutional symptoms (p=0.036) and GI tract involvement (p=0.017), but had more commonly renal involvement (p <0.001), compared to those with normal serum IgA. Results of univariate analysis are shown in Table 1. In the multivariable logistic regression model, elevated serum IgA level persisted as a factor associated with lower risk of GI tract involvement (OR 0.47 (95%CI 0.23–0.95), and a higher risk of renal involvement (OR 2.71 (95%CI 1.48–4.96). The other factors associated with risk of GI and renal involvement are presented in Table 2.Table 1.Clinical characteristic of IgAV patients with and without elevated serum IgACharacteristicAll IgAVElevated s++++IgANormal sIgAp valueNumber of patients (%)227111 (48.9)116 (51.1)–Males (%)60.867.654.30.043Age (years)#64 (47-76)58 (37-74)66 (55-77)0.289Prior infection (%)32.226.137.90.065Constitutional symptoms (%)14.19.019.00.036Generalized purpura* (%)52.055.049.10.426Necrotic purpura (%)46.353.239.70.046Arthritis (%)13.29.017.20.079GI involvement (%)27.319.834.50.017Renal involvement (%)41.053.229.3<0.001Legend: # median (IQR); GI gastrointestinal; * above the waistline;Table 2.Risk factors of GI and renal involvement, multiple logistic regressionCharacteristicGI involvementRenal involvementOR (95%CI)OR (95%CI)Age0.98 (0.96-1.0)1.02 (1.00–1.04)Current smoking–3.32 (1.56–7.07)Generalized purpura*5.86 (2.82–12.16)2.03 (1.13–3.66)↑ serum IgA0.47 (0.23–0.95)2.71 (1.48–4.96)NLR >3.53.37 (1.59–7.12)2.24 (1.19–4.23)Legend: * purpura above the waistline; NLR neutrophil to lymphocyte ratioConclusion:Serum IgA level might be a useful biomarker in IgA vasculitis, identifying patients at risk for visceral (GI and renal) involvement.Disclosure of Interests:ALOJZIJA HOCEVAR: None declared, Matija Tomsic: None declared, Vesna Jurcic: None declared, Katja Perdan-Pirkmajer: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi.
Collapse
|
28
|
Vukicevic AM, Milic V, Zabotti A, Hocevar A, De Lucia O, Filippou G, Frangi AF, Tzioufas A, De Vita S, Filipovic N. Radiomics-Based Assessment of Primary Sjögren's Syndrome From Salivary Gland Ultrasonography Images. IEEE J Biomed Health Inform 2019; 24:835-843. [PMID: 31329136 DOI: 10.1109/jbhi.2019.2923773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Salivary gland ultrasonography (SGUS) has shown good potential in the diagnosis of primary Sjögren's syndrome (pSS). However, a series of international studies have reported needs for improvements of the existing pSS scoring procedures in terms of inter/intra observer reliability before being established as standardized diagnostic tools. The present study aims to solve this problem by employing radiomics features and artificial intelligence (AI) algorithms to make the pSS scoring more objective and faster compared to human expert scoring. The assessment of AI algorithms was performed on a two-centric cohort, which included 600 SGUS images (150 patients) annotated using the original SGUS scoring system proposed in 1992 for pSS. For each image, we extracted 907 histogram-based and descriptive statistics features from segmented salivary glands. Optimal feature subsets were found using the genetic algorithm based wrapper approach. Among the considered algorithms (seven classifiers and five regressors), the best preforming was the multilayer perceptron (MLP) classifier (κ = 0.7). The MLP over-performed average score achieved by the clinicians (κ = 0.67) by the considerable margin, whereas its reliability was on the level of human intra-observer variability (κ = 0.71). The presented findings indicate that the continuously increasing HarmonicSS cohort will enable further advancements in AI-based pSS scoring methods by SGUS. In turn, this may establish SGUS as an effective noninvasive pSS diagnostic tool, with the final goal to supplement current diagnostic tests.
Collapse
|
29
|
Hocevar A, Rotar Z, Jurcic V, Tomsic M. 252. SMOKERS WITH GENERALIZED PURPURA HAVE AN INCREASED RISK FOR SEVERE IGA VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ziga Rotar
- University Medical Centre Ljubljana Ljubljana, Slovenia
| | - Vesna Jurcic
- Faculty of Medicine, Inst. of Pathology Ljubljana, Slovenia
| | - Matija Tomsic
- University Medical Centre Ljubljana Ljubljana, Slovenia
| |
Collapse
|
30
|
Hocevar A, Jese R, Rotar Z, Tomsic M. 015. PREDICTORS OF SEVERE CRANIAL ISCHEMIC COMPLICATIONS IN GIANT CELL ARTERITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez057.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Rok Jese
- University Medical Centre Ljubljana, Slovenia
| | - Ziga Rotar
- University Medical Centre Ljubljana, Slovenia
| | | |
Collapse
|
31
|
Schäfer VS, Chrysidis S, Dejaco C, Duftner C, Iagnocco A, Bruyn GA, Carrara G, D’Agostino MA, De Miguel E, Diamantopoulos AP, Fredberg U, Hartung W, Hocevar A, Juche A, Kermani TA, Koster MJ, Lorenzen T, Macchioni P, Milchert M, Døhn UM, Mukhtyar C, Ponte C, Ramiro S, Scirè CA, Terslev L, Warrington KJ, Dasgupta B, Schmidt WA. Assessing Vasculitis in Giant Cell Arteritis by Ultrasound: Results of OMERACT Patient-based Reliability Exercises. J Rheumatol 2018; 45:1289-1295. [DOI: 10.3899/jrheum.171428] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
Objective.To test the reliability of Outcome Measures in Rheumatology Clinical Trials (OMERACT) consensus-based ultrasound definitions for normal and vasculitic temporal and axillary arteries in patients with giant cell arteritis (GCA) and in controls.Methods.A preliminary 1-day meeting and a full 3-day meeting fulfilling OMERACT Ultrasound Group guidelines were held. Temporal and axillary arteries were examined at 2 timepoints by 12 sonographers on 4 patients with GCA and 2 controls. The aim was to test inter- and intrareader reliability for normal findings, halo sign, and compression sign. In both meetings, patients had established GCA. Pathology was more recent in the full meeting, which was preceded by 6 h of training. Scanning time was 15–20 min instead of 10–13 min.Results.In the preliminary exercise, interreader reliabilities were fair to moderate for the overall diagnosis of GCA (Light κ 0.29–0.51), and poor to fair for identifying vasculitis in the respective anatomical segments (Light κ 0.02–0.46). Intrareader reliabilities were moderate (Cohen κ 0.32–0.64). In the main exercise, interreader reliability was good to excellent (Light κ 0.76–0.86) for the overall diagnosis of GCA, and moderate to good (Light κ 0.46–0.71) for identifying vasculitis in the respective anatomical segments. Intrareader reliability was excellent for diagnosis of GCA (Cohen κ 0.91) and good (Cohen κ 0.71–0.80) for the anatomical segments.Conclusion.OMERACT-derived definitions of halo and compression signs of temporal and axillary arteries are reliable in recent-onset GCA if experienced sonographers (> 300 examinations) have 15–20 min for a standardized examination with prior training and apply > 15 MHz probes.
Collapse
|
32
|
Chrysidis S, Duftner C, Dejaco C, Schäfer VS, Ramiro S, Carrara G, Scirè CA, Hocevar A, Diamantopoulos AP, Iagnocco A, Mukhtyar C, Ponte C, Naredo E, De Miguel E, Bruyn GA, Warrington KJ, Terslev L, Milchert M, D'Agostino MA, Koster MJ, Rastalsky N, Hanova P, Macchioni P, Kermani TA, Lorenzen T, Døhn UM, Fredberg U, Hartung W, Dasgupta B, Schmidt WA. Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group. RMD Open 2018; 4:e000598. [PMID: 29862043 PMCID: PMC5976098 DOI: 10.1136/rmdopen-2017-000598] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives To define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based reliability exercise. Methods Potential definitions of normal and abnormal US findings of temporal and extracranial large arteries were retrieved by a systematic literature review. As a subsequent step, a structured Delphi exercise was conducted involving an expert panel of the Outcome Measures in Rheumatology (OMERACT) US Large Vessel Vasculitis Group to agree definitions of normal US appearance and key elementary US lesions of vasculitis of temporal and extracranial large arteries. The reliability of these definitions on normal and abnormal blood vessels was tested on 150 still images and videos in a web-based reliability exercise. Results Twenty-four experts participated in both Delphi rounds. From originally 25 statements, nine definitions were obtained for normal appearance, vasculitis and arteriosclerosis of cranial and extracranial vessels. The ‘halo’ and ‘compression’ signs were the key US lesions in GCA. The reliability of the definitions for normal temporal and axillary arteries, the ‘halo’ sign and the ‘compression’ sign was excellent with inter-rater agreements of 91–99% and mean kappa values of 0.83–0.98 for both inter-rater and intra-rater reliabilities of all 25 experts. Conclusions The ‘halo’ and the ‘compression’ signs are regarded as the most important US abnormalities for GCA. The inter-rater and intra-rater agreement of the new OMERACT definitions for US lesions in GCA was excellent.
Collapse
Affiliation(s)
- Stavros Chrysidis
- Department of Rheumatology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rhematology, Hospital of Bruneck, Bruneck, Italy
| | - Valentin S Schäfer
- III. Medical Clinic, Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Berlin, Germany
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, The Netherlands
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.,Department of Rheumatology, University of Ferrara, Ferrara, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Annamaria Iagnocco
- Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Torino, Italy
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Cristina Ponte
- Hospital de Santa Maria - CHLN, Lisbon Academic Medical Centre, Lisbon, Portugal
| | | | | | | | | | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark
| | - Marcin Milchert
- Department of Rheumatology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | | | | | | | - Petra Hanova
- Department of Rheumatology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | | | - Tanaz A Kermani
- Department of Rheumatology, University of California, Los Angeles, California, USA
| | - Tove Lorenzen
- Diagnostic Centre Region Hospital Silkeborg, Silkeborg, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre Region Hospital Silkeborg, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Bhaskar Dasgupta
- Southend University Hospital NHS Foundation Trust & Anglia Ruskin University, Southend-on-Sea, UK
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology, Immanuel Krankenhaus Berlin, Berlin, Germany
| |
Collapse
|
33
|
Jousse-Joulin S, Nowak E, Cornec D, Brown J, Carr A, Carotti M, Fisher B, Fradin J, Hocevar A, Jonsson MV, Luciano N, Milic V, Rout J, Theander E, Stel A, Bootsma H, Vissink A, Baldini C, Baer A, Ng WF, Bowman S, Alavi Z, Saraux A, Devauchelle-Pensec V. Salivary gland ultrasound abnormalities in primary Sjögren's syndrome: consensual US-SG core items definition and reliability. RMD Open 2017; 3:e000364. [PMID: 28879042 PMCID: PMC5575597 DOI: 10.1136/rmdopen-2016-000364] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives Ultrasonography (US) is sensitive for detecting echostructural abnormalities of the major salivary glands (SGs) in primary Sjögren’s syndrome (pSS). Our objectives were to define selected US-SG echostructural abnormalities in pSS, set up a preliminary atlas of these definitions and evaluate the consensual definitions reliability in both static and acquisition US-SG images. Methods International experts in SG US in pSS participated in consensus meetings to select and define echostructural abnormalities in pSS. The US reliability of detecting these abnormalities was assessed using a two-step method. First 12 experts used a web-based standardised form to evaluate 60 static US-SG images. Intra observer and interobserver reliabilities were expressed in κ values. Second, five experts, who participated all throughout the study, evaluated US-SG acquisition interobserver reliability in pSS patients. Results Parotid glands (PGs) and submandibular glands (SMGs) intra observer US reliability on static images was substantial (κ > 0.60) for the two main reliable items (echogenicity and homogeneity) and for the advised pSS diagnosis. PG inter observer reliability was substantial for homogeneity. SMGs interobserver reliability was moderate for homogeneity (κ = 0.46) and fair for echogenicity (κ = 0.38). On acquisition images, PGs interobserver reliability was substantial (κ = 0.62) for echogenicity and moderate (κ = 0.52) for homogeneity. The advised pSS diagnosis reliability was substantial (κ = 0.66). SMGs interobserver reliability was fair (0.20< κ ≤ 0.40) for echogenicity and homogeneity and either slight or poor for all other US core items. Conclusion This work identified two most reliable US-SG items (echogenicity and homogeneity) to be used by US-SG trained experts. US-PG interobserver reliability result for echogenicity is in line with diagnosis of pSS.
Collapse
Affiliation(s)
- Sandrine Jousse-Joulin
- Department of Rheumatology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - Emmanuel Nowak
- INSERM CIC 1412, Brest Medical University Hospital, Brest, France
| | - Divi Cornec
- Department of Rheumatology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - Jackie Brown
- Department of Dental and Maxillofacial Radiology, KCL Dental Institute, Guy's Hospital, London, UK
| | - Andrew Carr
- Dental Radiology, Dental Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, London, UK
| | - Marina Carotti
- Department of Radiology, Polytechnic University of the Marche, Ancona, Italy
| | - Benjamin Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Rheumatology, University Hospitals, Birmingham NHS Trust, Birmingham, UK
| | - Joel Fradin
- Department of Imaging, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Malin V Jonsson
- Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway
| | | | - Vera Milic
- Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - John Rout
- Department of Radiology, Birmingham Dental Hospital, St Chad's Queensway, Birmingham, UK
| | - Elke Theander
- Department of Rheumatology, Skane University Hospital, Malmö, Sweden
| | - Aaltje Stel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Alan Baer
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, USA
| | - Wan Fai Ng
- Institute of Cellular Medicine, Newcastle University & NIHR Newcastle Biomedical Research Centre, Tyne, UK
| | - Simon Bowman
- Department of Rheumatology, University Hospitals, Birmingham NHS Trust, Birmingham, UK
| | - Zarrin Alavi
- INSERM CIC 1412, Brest Medical University Hospital, Brest, France
| | - Alain Saraux
- Department of Rheumatology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | | |
Collapse
|
34
|
Pavic Nikolic M, Hocevar A. SAT0639-HPR The Most Frequent Inquiries of Patients on Subcutaneous anti -TNF Alpha Therapies: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
35
|
Hocevar A, Rotar Z, Jese R, Semrl SS, Pizem J, Hawlina M, Tomsic M. Do Early Diagnosis and Glucocorticoid Treatment Decrease the Risk of Permanent Visual Loss and Early Relapses in Giant Cell Arteritis: A Prospective Longitudinal Study. Medicine (Baltimore) 2016; 95:e3210. [PMID: 27057850 PMCID: PMC4998766 DOI: 10.1097/md.0000000000003210] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the incidence of permanent visual loss (PVL) in giant cell arteritis (GCA) and the GCA relapse rate during glucocorticoid (GC) tapering.This prospective, longitudinal single secondary/tertiary rheumatology centre study was conducted between September 2011 and September 2014 in Slovenia. Predetermined clinical and laboratory tests were performed at 12, 24, 48, 96, and 144 weeks after diagnosis.Sixty-eight GCA patients (72.1% female), with a median (IQR) age of 73.2 (67.3-76.1) years and a symptom duration before the diagnosis of a median (IQR) 30 (14-70) days were included. Thirty-nine of 68 patients had symptoms for less than 31 days (14 (10-28) days-early GCA) and 29/68 for 31 days or longer (90 (60-120) days-late GCA). Four (5.9%) patients presented with PVL (1 early GCA). The median (IQR) follow-up was (IQR) 104 (53-126) weeks. GCA relapsed in 17/39 (43.6%) and 14/29 (48.3%) in early and late GCA, respectively. The median (IQR) time to the first relapse was 24.8 (13.6-46.5) weeks (early GCA 14 (13-34) weeks; late GCA 25 (22-48) weeks, P = 0.117), at the methyl-prednisolone dose of 6.0 (4.0-12.0) mg. The patients who relapsed had significantly higher levels of inflammation parameters at the baseline (including ESR, CRP, serum amyloid A, haptoglobin, and fibrinogen).An early GCA diagnosis and prompt GC treatment decreased the PVL rate in comparison to historic controls, but seem to have no impact on the frequency of relapses, which are predicted by the high baseline levels of the biomarkers of inflammation.
Collapse
Affiliation(s)
- Alojzija Hocevar
- From the Department of Rheumatology (AH, ZR, RJ, SSS, MT); Department of Ophthalmology (MH); University Medical Centre Ljubljana, Institute of Pathology (JP); Faculty of Medicine (MT), University of Ljubljana, Ljubljana, Slovenia; and Faculty of Mathematics, Natural Science and Information Technology (SSS), University of Primorska, Koper, Slovenia
| | | | | | | | | | | | | |
Collapse
|
36
|
Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, Rachele P, Baldini C, Bootsma H, Vissink A, Hocevar A, De Vita S, Tzioufas AG, Alavi Z, Bowman SJ, Devauchelle-Pensec V. Is salivary gland ultrasonography a useful tool in Sjögren’s syndrome? A systematic review. Rheumatology (Oxford) 2015; 55:789-800. [DOI: 10.1093/rheumatology/kev385] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 11/12/2022] Open
|
37
|
Jousse S, Nowak E, Theander E, Hocevar A, Jonsson M, Milic V, Visink A, Saraux A, Bowman S, Devauchelle-Pensec V, Rout J, Brown J, Fradin J, Luciano N, Carotti M, Carr A, Fisher B. SAT0384 Multireader Reliability Using Us in Salivary Glands: An International Web Exercice to Evaluate a New Us Scoring (NUSC) in Primary Sjogren Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
38
|
Jese R, Rotar Z, Praprotnik S, Hocevar A, Tomsic M. AB0581 The Estimated Annual Incidence Rate of Polyarteritis Nodosa in Slovenia: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
39
|
Abstract
The salient feature of one-cell-thick epithelia is their en face view, which reveals the polygonal cross section of the close-packed prismatic cells. The physical mechanisms that shape these tissues were hitherto explored using theories based on cell proliferation, which were either entirely topological or included certain morphogenetic forces. But mitosis itself may not be instrumental in molding the tissue. We show that the structure of simple epithelia can be explained by an equilibrium model where energy-degenerate polygons in an entropy-maximizing tiling are described by a single geometric parameter encoding their inflation. The two types of tilings found numerically--ordered and disordered--closely reproduce the patterns observed in Drosophila, Hydra, and Xenopus and they generalize earlier theoretical results. Free of a specific cell self-energy, cell-cell interaction, and cell division kinetics, our model provides an insight into the universality of living and inanimate two-dimensional cellular structures.
Collapse
Affiliation(s)
- A Hocevar
- Department of Theoretical Physics, J. Stefan Institute, Jamova 39, SI-1000 Ljubljana, Slovenia
| | | |
Collapse
|
40
|
Hocevar A, Rainer S, Rozman B, Zor P, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjögren's syndrome. Eur J Radiol 2007; 63:379-83. [PMID: 17337148 DOI: 10.1016/j.ejrad.2007.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 10/11/2006] [Accepted: 02/01/2007] [Indexed: 11/24/2022]
Abstract
The aim of our study was to determine the reproducibility of a new semi-quantitative scoring system based on ultrasonographic (US) evaluation of structural changes of salivary glands in primary Sjögren's syndrome (SS). US evaluation of parotid and submandibular glands was performed in 28 SS patients and 29 control subjects independently by two blinded observers. Echogenicity, delineation of glandular borders and sonographic structure (homogeneity, hypoechoic areas, hyperechoic foci) of salivary glands were semi-quantitatively assessed and the final US score calculated. Inter-observer variability was determined by Cohen's test. A high degree of inter-observer agreement was found regarding the final US score (0.90) and in the assessment of glandular homogeneity (0.90), echogenicity (0.88) and hypoechoic areas (0.88). This study showed good reproducibility of the US evaluation of salivary glands using our novel scoring system. This may have important implications on the diagnostic algorithm in patients with SS.
Collapse
Affiliation(s)
- Alojzija Hocevar
- Department of Rheumatology, University Medical Centre, Vodnikova 62, 1000 Ljubljana, Slovenia
| | | | | | | | | |
Collapse
|
41
|
Ferkolj I, Hocevar A, Golouh R, Dolenc Voljc M. Infliximab for treatment of resistant pyoderma gangrenosum associated with Crohn's disease. Acta Dermatovenerol Alp Pannonica Adriat 2006; 15:173-177. [PMID: 17982610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present the case of an 18-year-old woman with Crohn's disease manifested by diffuse abdominal pain, bloody diarrhea accompanied by arthralgia, and swelling of large joints. On the lateral aspect of her right ankle there was an hemorrhagic, necrotic bullous lesion measuring 3 x 4 cm, surrounded by cutaneous inflammation and erythema. Biopsy showed a neutrophilic abscess-like ulcerative skin inflammation, which was diagnosed as pyoderma gangrenosum. The patient was treated with high doses of parenteral methylprednisolone, but her condition failed to improve and infliximab, a TNF-alpha blocking agent, was instituted. An immediate response of Crohn's disease was observed and, over the next 5 weeks, the ulcer on her right ankle also healed completely.
Collapse
Affiliation(s)
- Ivan Ferkolj
- Department of Gastroenterology, University Medical Centre, Division of Internal Medicine, Japljeva 2, 1000 Ljubljana, Slovenia.
| | | | | | | |
Collapse
|
42
|
Lainscak M, Hocevar A, Logar D, Beović B, Matos T, Tomsic M. Subcutaneous infection with Pseudallescheria boydii in an immunocompromised patient. Clin Rheumatol 2006; 26:1023-4. [PMID: 16572287 DOI: 10.1007/s10067-006-0263-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 02/16/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Abstract
With the broad employment of immunosuppressive therapy, the incidence of Pseudallescheria boydii infections is rising. We report a first case of the localized subcutaneous P. boydii infection in a patient with microscopic polyangiitis. Favorable outcome related to the treatment with voriconazole adds to the growing body of evidence supporting the use of this particular agent in P. boydii infections.
Collapse
Affiliation(s)
- Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, 9000, Murska Sobota, Slovenia.
| | | | | | | | | | | |
Collapse
|
43
|
|
44
|
|
45
|
Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjögren's syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford) 2005; 44:768-72. [PMID: 15741192 DOI: 10.1093/rheumatology/keh588] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To reveal typical ultrasonographic (US) changes in major salivary glands associated with Sjogren's syndrome (SS) and to determine the diagnostic value of a novel US scoring system. METHODS In 218 consecutive patients with suspected SS, US of both parotid and submandibular salivary glands was performed besides the regular diagnostic procedure following the American-European Consensus Group criteria of 2002. Five US parameters were assessed: echogenicity, inhomogeneity, number of hypoechogenic areas, the hyperechogenic reflections and clearness of the borders of the salivary gland. The grades of these five parameters for all four salivary glands were summed. The final US score ranged from 0 to 48. RESULTS SS was established in 68 patients. The remaining 150 subjects, in whom SS was not confirmed, constituted our control group. All five US parameters were significantly associated with SS. The patients with SS had significantly higher US scores than those not diagnosed with SS (P<0.01). Setting the cut-off US score at 17 resulted in the best ratio of specificity (98.7%) to sensitivity (58.8%). CONCLUSIONS Well-defined US changes in the major salivary glands summarized in our novel scoring system were typical of SS patients. Advanced structural changes found on US imaging almost invariably represent SS salivary gland involvement.
Collapse
Affiliation(s)
- A Hocevar
- Department of Rheumatology, University Clinical Centre, Vodnikova 62, 1000 Ljubljana, Slovenia
| | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE To determine the annual incidence of primary Sjögren's syndrome (pSS) in Slovenia. METHODS All patients admitted to our department of rheumatology or referred to our outpatient clinic between 1 January 2000 and 31 December 2002 owing to sicca symptoms or because of a suspicion of SS were examined. Our rheumatological department is the only tertiary referral centre for the Ljubljana region, which has a population of 599 895 Caucasian people. All patients were evaluated by the validated European criteria for SS. The exact 95% confidence interval (CI) based on binomial distribution was created for the incidence estimate. RESULTS 248 patients were examined; 71 of them (28.6%; 65 women, 6 men) were diagnosed as having pSS. Their mean (SD) age was 51.3 (14.5) years (range 19-78). The average annual incidence for pSS in our study population was calculated as 3.9 cases per 100 000 inhabitants (95% CI 1.1 to 10.2). CONCLUSION The estimated annual incidence of pSS in Slovenia is 3.9/100 000.
Collapse
Affiliation(s)
- M Plesivcnik Novljan
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | |
Collapse
|
47
|
Rozman B, Novljan MP, Hocevar A, Ambrozic A, Zigon P, Kveder T, Tomsic M. Epidemiology and diagnostics of primary Sjögren's syndrome. Reumatizam 2004; 51:9-12. [PMID: 15554369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This review paper contains selected aspects of Sjögren's syndrome. It consists of epidemiology, ultrasound of salivary glands and antimuscarinic antibodies. The first part present studies aimed to determine the prevalence and the incidence of the disease with special emphasize on epidemiological studies performed in Slovenia. This is followed by the demonstration of the role of ultrasound of salivary glands in the diagnosis of Sjögren's syndrome and the value of antimuscarinic antibodies in global assesment of the secretory failure.
Collapse
Affiliation(s)
- Blaz Rozman
- Klinicni center Ljubljana, Bolnica dr. Petra Driaja, KO za revmatologijo Vodnikova 62, 1000 Ljubljana, Slovenija
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
In the past sicca syndromes were attributed to destruction of glandular tissue. It is now thought that cytokines, autoantibodies, and parasympathetic nervous system dysfunction all have an important role in the xerostomia and xerophthalmia in Sjögren's syndrome.
Collapse
Affiliation(s)
- A Hocevar
- Department of Rheumatology, Medical Centre Ljubljana, SI 1000 Ljubljana, Slovenia
| | | | | | | | | | | |
Collapse
|
49
|
|