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Naredo E, D'Agostino MA, Terslev L, Pineda C, Miguel MI, Blasi J, Bruyn GA, Kortekaas MC, Mandl P, Nestorova R, Szkudlarek M, Todorov P, Vlad V, Wong P, Bakewell C, Filippucci E, Zabotti A, Micu M, Vreju F, Mortada M, Mendonça JA, Guillen-Astete CA, Olivas-Vergara O, Iagnocco A, Hanova P, Tinazzi I, Balint PV, Aydin SZ, Kane D, Keen H, Kaeley GS, Möller I. Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis. Ann Rheum Dis 2024:ard-2023-225278. [PMID: 38531611 DOI: 10.1136/ard-2023-225278] [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: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - M Isabel Miguel
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - Joan Blasi
- Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - George A Bruyn
- Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands
- Reumakliniek Flevoland, Lelystad, Netherlands
| | - Marion C Kortekaas
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands
| | - Peter Mandl
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria
| | | | - Marcin Szkudlarek
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Zealand's University Hospital, Køge, Denmark
| | - Plamen Todorov
- Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Violeta Vlad
- Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania
| | - Priscilla Wong
- Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania
| | - Florentin Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Mohamed Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - José Alexandre Mendonça
- Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil
| | | | - Otto Olivas-Vergara
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
- Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Helen Keen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ingrid Möller
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
- Instituto Poal de Reumatología, Barcelona, Spain
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Gossec L, Kerschbaumer A, Ferreira RJO, Aletaha D, Baraliakos X, Bertheussen H, Boehncke WH, Esbensen BA, McInnes IB, McGonagle D, Winthrop KL, Balanescu A, Balint PV, Burmester GR, Cañete JD, Claudepierre P, Eder L, Hetland ML, Iagnocco A, Kristensen LE, Lories R, Queiro R, Mauro D, Marzo-Ortega H, Mease PJ, Nash P, Wagenaar W, Savage L, Schett G, Shoop-Worrall SJW, Tanaka Y, Van den Bosch FE, van der Helm-van Mil A, Zabotti A, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024:ard-2024-225531. [PMID: 38499325 DOI: 10.1136/ard-2024-225531] [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: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. METHODS Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. RESULTS The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. CONCLUSION These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dennis McGonagle
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kevin L Winthrop
- Division of Infectious Diseases, School of Medicine, School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Andra Balanescu
- Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Peter V Balint
- Medical Imaging Centre, Semmelweis University, 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic Barcelona, Barcelona, Spain
- FCRB, IDIBAPS, Barcelona, Spain
| | - Pascal Claudepierre
- Rheumatology, AP-HP, Henri Mondor University Hospital, Creteil, France
- EA Epiderme, UPEC, Creteil, France
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Hospital, Toronto, Toronto, Canada
| | - Merete Lund Hetland
- The Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche Biologiche, Università di Torino - AO Mauriziano Torino, Turin, Italy
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark
- Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias, Oviedo University School of Medicine, Oviedo, Spain
| | - Daniele Mauro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Helena Marzo-Ortega
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip J Mease
- Rheumatology Research, Providence Swedish, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Wagenaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Young PARE Patient Research Partner, EULAR, Zurich, Switzerland
| | - Laura Savage
- School of Medicine and Dermatology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology and Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie J W Shoop-Worrall
- Children and Young Person's Rheumatology Research Programme, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Zabotti A, De Marco G, Gossec L, Baraliakos X, Aletaha D, Iagnocco A, Gisondi P, Balint PV, Bertheussen H, Boehncke WH, Damjanov NS, de Wit M, Errichetti E, Marzo-Ortega H, Protopopov M, Puig L, Queiro R, Ruscitti P, Savage L, Schett G, Siebert S, Stamm TA, Studenic P, Tinazzi I, Van den Bosch FE, van der Helm-van Mil A, Watad A, Smolen JS, McGonagle DG. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Ann Rheum Dis 2023; 82:1162-1170. [PMID: 37295926 DOI: 10.1136/ard-2023-224148] [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: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transition from psoriasis (PsO) to psoriatic arthritis (PsA) and the early diagnosis of PsA is of considerable scientific and clinical interest for the prevention and interception of PsA. OBJECTIVE To formulate EULAR points to consider (PtC) for the development of data-driven guidance and consensus for clinical trials and clinical practice in the field of prevention or interception of PsA and for clinical management of people with PsO at risk for PsA development. METHODS A multidisciplinary EULAR task force of 30 members from 13 European countries was established, and the EULAR standardised operating procedures for development for PtC were followed. Two systematic literature reviews were conducted to support the task force in formulating the PtC. Furthermore, the task force proposed nomenclature for the stages before PsA, through a nominal group process to be used in clinical trials. RESULTS Nomenclature for the stages preceding PsA onset, 5 overarching principles and 10 PtC were formulated. Nomenclature was proposed for three stages towards PsA development, namely people with PsO at higher risk of PsA, subclinical PsA and clinical PsA. The latter stage was defined as PsO and associated synovitis and it could be used as an outcome measure for clinical trials evaluating the transition from PsO to PsA. The overarching principles address the nature of PsA at its onset and underline the importance of collaboration of rheumatologists and dermatologists for strategies for prevention/interception of PsA. The 10 PtC highlight arthralgia and imaging abnormalities as key elements of subclinical PsA that can be used as potential short-term predictors of PsA development and useful items to design clinical trials for PsA interception. Traditional risk factors for PsA development (ie, PsO severity, obesity and nail involvement) may represent more long-term disease predictors and be less robust for short-term trials concerning the transition from PsO to PsA. CONCLUSION These PtC are helpful to define the clinical and imaging features of people with PsO suspicious to progress to PsA. This information will be helpful for identification of those who could benefit from a therapeutic intervention to attenuate, delay or prevent PsA development.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Gabriele De Marco
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Nemanja S Damjanov
- Rheumatology, University of Belgrade Faculty of Medicine, Beograd, Serbia
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Enzo Errichetti
- Department of Medical and Biological Sciences University Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Helena Marzo-Ortega
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Lluis Puig
- Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Piero Ruscitti
- University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
| | - Laura Savage
- Chapel Allerton Hospital Department of Dermatology, Leeds, UK
| | - Georg Schett
- Rheumatology, Erlangen University Hospital, Erlangen, Germany
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Ilaria Tinazzi
- Unit of Rheumatology, Don Calabria Sacred Heart Hospital, Negrar, Italy
| | | | - Annette van der Helm-van Mil
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Abdulla Watad
- Internal Medicine, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Dennis G McGonagle
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Dejaco C, Machado PM, Carubbi F, Bosch P, Terslev L, Tamborrini G, Sconfienza LM, Scirè CA, Ruetten S, van Rompay J, Proft F, Pitzalis C, Obradov M, Moe RH, Mascarenhas VV, Malattia C, Klauser AS, Kent A, Jans L, Hartung W, Hammer HB, Duftner C, Balint PV, Alunno A, Baraliakos X. EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2022; 81:760-767. [PMID: 34893469 DOI: 10.1136/annrheumdis-2021-221261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria
- Department of Rheumatology (ASAA-SABES), Brunico Hospital, Brunico, Italy
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Universita degli Studi di Milano, Milano, Italy
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany
| | - Jef van Rompay
- Patient Research Partners, Patient Research, Antwerpen, Belgium
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Marina Obradov
- Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Vasco V Mascarenhas
- UIME (Unidade de Imagem Musculo-esquelética), Hospital da Luz Imaging Center, Lisbon, Portugal
- Rheumatic Diseases Lab, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Sabine Klauser
- Radiology II, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Alison Kent
- Salisbury Hospital NHS Foundation Trust, Salisbury, UK
| | - Lennart Jans
- Radiology, Ghent University Hospital Radiology Department, Gent, Belgium
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
| | - Xenofon Baraliakos
- Rheumatology, Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany
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Balint PV, Poddubnyy D. Controversies in rheumatology: Imaging of enthesitis in spondyloarthritis - does it mean anything for treatment decisions? Rheumatology (Oxford) 2022; 61:3547-3551. [PMID: 35212727 DOI: 10.1093/rheumatology/keac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Enthesitis is considered a hallmark manifestation of spondyloarthritis including axial spondyloarthritis and psoriatic arthritis. Detection of enthesitis might be challenging in both diagnostic and classification processes. In this debate, we discuss the controversy on the role of imaging in the detection of enthesitis including the relevance for treatment decisions in spondyloarthritis.
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Affiliation(s)
- Peter V Balint
- National Institute of Rheumatology and Physiotherapy/National Musculoskeletal Institute, 3rd Rheumatology Department, 25-29 Frankel St, Budapest, 1023 Hungary
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
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Gessl I, Balint PV, Filippucci E, Keen HI, Pineda C, Terslev L, Wildner B, D'Agostino MA, Mandl P. Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group. Semin Arthritis Rheum 2021; 51:627-639. [PMID: 33810864 DOI: 10.1016/j.semarthrit.2021.02.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify and synthesize the evidence for the use and measurement properties of musculoskeletal ultrasound in assessing structural joint damage in patients with rheumatoid arthritis (RA). METHODS A systematic literature search (SLR) of the PubMed, Embase and Cochrane Library was performed. Original articles were included published in English reporting on ultrasound of bone erosion, cartilage damage and the measurement properties of ultrasound according to the OMERACT filter 2.1. RESULTS Of the 1.495 identified articles 149 were included in the final review, most of which reported on cross-sectional studies and used the OMERACT definitions for ultrasonographic pathology. Among these, bone erosions were assessed in 139 (93.3%), cartilage damage in 24 (16.1%), enthesophytes in 8 (5.4%), osteophytes in 15 (10.1%) and malalignment and ankylosis in a single (0.9%) study, respectively. Most studies (126/149, 84.6%) assessed the joints of the hands. The overwhelming majority of studies (127/149, 85.2%) assessed structural joint damage bilaterally. Validity, reliability and responsiveness were assessed in 21 (14.1%), 34 (22.8%) and 17 (11.4%) studies, respectively. CONCLUSION While the results of this SLR suggest that ultrasound is a sensitive, reliable and feasible tool to detect damage in RA, they also highlight the need for further research and validation. Findings of this SLR will inform the next steps of the OMERACT Ultrasound Working Group in developing an ultrasound score for assessing structural joint damage in patients with RA.
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Affiliation(s)
- I Gessl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria
| | - P V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - E Filippucci
- Department of Rheumatology, Universita` Politecnica delle Marche, Jesi, Ancona, Italy
| | - H I Keen
- Medical School, University of Western Australia, Perth, Australia
| | - C Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - L Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - B Wildner
- University Library, Medical University of Vienna, Vienna, Austria
| | - M A D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy; UFR Simone Veil, Versailles-Saint-Quentin-Paris Saclay University, Versailles, France
| | - P Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria.
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7
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Costantino F, Carmona L, Boers M, Backhaus M, Balint PV, Bruyn GA, Christensen R, Conaghan PG, Ferreira RJO, Garrido-Castro JL, Guillemin F, Hammer HB, van der Heijde D, Iagnocco A, Kortekaas MC, Landewé RB, Mandl P, Naredo E, Schmidt WA, Terslev L, Terwee CB, Thiele R, D'Agostino MA. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2021; 80:840-847. [PMID: 33483318 DOI: 10.1136/annrheumdis-2020-219816] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To produce European League Against Rheumatism (EULAR) recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). METHODS Based on the literature reviews and expert opinion (through Delphi surveys), a taskforce of 23 members (12 experts in ultrasound in RMDs, 9 in methodology and biostatistics together with a patient research partner and a health professional in rheumatology) developed a checklist of items to be reported in every RMD study using ultrasound. This checklist was further refined by involving a panel of 79 external experts (musculoskeletal imaging experts, methodologists, journal editors), who evaluated its comprehensibility, feasibility and comprehensiveness. Agreement on each proposed item was assessed with an 11-point Likert scale, grading from 0 (total disagreement) to 10 (full agreement). RESULTS Two face-to-face meetings, as well as two Delphi rounds of voting, resulted in a final checklist of 23 items, including a glossary of terminology. Twenty-one of these were considered 'mandatory' items to be reported in every study (such as blinding, development of scoring systems, definition of target pathologies) and 2 'optional' to be reported only if applicable, such as possible confounding factors (ie, ambient conditions) or experience of the sonographers. CONCLUSION An EULAR taskforce developed a checklist to ensure transparent and comprehensive reporting of aspects concerning research and procedures that need to be presented in studies using ultrasound in RMDs. This checklist, if widely adopted by authors and editors, will greatly improve the interpretability of study development and results, including the assessment of validity, generalisability and applicability.
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Affiliation(s)
- Félicie Costantino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Maarten Boers
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Marina Backhaus
- Department of Internal Medicine-Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Berlin, Germany
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A Bruyn
- Rheumatology Department, MC Group Hospitals, Lelystad, The Netherlands.,Rheumatology Department, Reumakliniek Flevoland, Lelystad, The Netherlands
| | - Robin Christensen
- Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | | | | | | | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | | | - Robert Bm Landewé
- Rheumatology Department, Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Peter Mandl
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Wolfgang A Schmidt
- Rheumatology Department, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Caroline B Terwee
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ralf Thiele
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France .,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
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8
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Christiansen SN, Filippou G, Scirè CA, Balint PV, Bruyn GA, Dalbeth N, Dejaco C, Sedie AD, Filippucci E, Hammer HB, Iagnocco A, Keen HI, Kissin EY, Koski J, Mandl P, Martin J, Miguel ED, Möller I, Naredo E, Pineda C, Schmidt WA, Stewart S, Antonietta D'Agostino M, Terslev L. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum 2021; 51:644-649. [PMID: 33468347 DOI: 10.1016/j.semarthrit.2020.11.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.
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Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy; Rheumatology Unit, Luigi Sacco University Hospital of Milan, Milan, Italy
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Aw Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - Nicola Dalbeth
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria and Hospital of Brunico (SABES-ASDAA), Department of Rheumatology, Brunico, Italy
| | | | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, DSCB Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | | | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Julia Martin
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz and Universidad Autónoma de Madrid. Madrid, Spain
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Berlin, Germany
| | - Sarah Stewart
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Ambroise Pare´ Hospital, and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, Primdahl J, McGonagle DG, Aletaha D, Balanescu A, Balint PV, Bertheussen H, Boehncke WH, Burmester GR, Canete JD, Damjanov NS, Kragstrup TW, Kvien TK, Landewé RBM, Lories RJU, Marzo-Ortega H, Poddubnyy D, Rodrigues Manica SA, Schett G, Veale DJ, Van den Bosch FE, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020; 79:700-712. [PMID: 32434812 PMCID: PMC7286048 DOI: 10.1136/annrheumdis-2020-217159] [Citation(s) in RCA: 501] [Impact Index Per Article: 125.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). METHODS According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. RESULTS The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. CONCLUSION These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
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Affiliation(s)
- Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP.Sorbonne Universite, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3; 2nd Department of Medicine, Hietzing Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dennis G McGonagle
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Andra Balanescu
- Research Center of Rheumatic Diseases, Sf Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Juan D Canete
- Arthritis Unit, Department of Rheumatology and IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Nemanja S Damjanov
- Institute of Rheumatology, Belgrade University School of Medicine, Belgrade, Serbia
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Rik Jozef Urbain Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Flanders, Belgium
- Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Helena Marzo-Ortega
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Santiago Andres Rodrigues Manica
- Rheumatology, Hospital de Egas Moniz, Lisboa, Portugal
- Universidade Nova de Lisboa Centro de Estudos de Doencas Cronicas, Lisboa, Portugal
| | - Georg Schett
- Internal Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Douglas J Veale
- Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | - Désirée van der Heijde
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Wien, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Wien, Austria
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10
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Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, Bruyn GAW, Collado P, Damjanov N, Dejaco C, Delle-Sedie A, De Miguel E, Duftner C, Gessl I, Gutierrez M, Hammer HB, Hernandez-Diaz C, Iagnocco A, Ikeda K, Kane D, Keen H, Kelly S, Kővári E, Möller I, Møller-Dohn U, Naredo E, Nieto JC, Pineda C, Platzer A, Rodriguez A, Schmidt WA, Supp G, Szkudlarek M, Terslev L, Thiele R, Wakefield RJ, Windschall D, D'Agostino MA, Balint PV. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford) 2020; 58:1802-1811. [PMID: 31034077 DOI: 10.1093/rheumatology/kez153] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/12/2019] [Revised: 03/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. METHODS A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa. RESULTS The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. CONCLUSION Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Emilio Filippucci
- Department of Rheumatology, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Artur Bachta
- Department of Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee Academic Hospital of the Charité, Berlin, Germany
| | - David Bong
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | | | - Paz Collado
- Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute for Rheumatology, Belgrade, Serbia
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | | | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken, Innsbruck, Austria
| | - Irina Gessl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Cristina Hernandez-Diaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Annmaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - David Kane
- Department of Rheumatology, School of Medicine, Trinity College Dublin, Ireland
| | - Helen Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | - Stephen Kelly
- Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Eszter Kővári
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Uffe Møller-Dohn
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University
| | - Juan C Nieto
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Alex Platzer
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Ana Rodriguez
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Wolfgang A Schmidt
- Medical Center for Rheumatology, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Gabriela Supp
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital at Køge, Denmark
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
| | - Maria-Antonietta D'Agostino
- Department of Rheumatology, APHP, Hopital Ambroise Paré, Paris, France.,Department of Rheumatology, INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Versailles, France
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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11
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Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, Collado P, Filippou G, Schmidt WA, Jousse-Joulin S, Mandl P, Conaghan PG, Wakefield RJ, Keen HI, Terslev L, D'Agostino MA. OMERACT Definitions for Ultrasonographic Pathologies and Elementary Lesions of Rheumatic Disorders 15 Years On. J Rheumatol 2019; 46:1388-1393. [PMID: 30709946 DOI: 10.3899/jrheum.181095] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group (WG) operates research activities for the validation of US as an outcome measurement instrument according to the Filter 2.0 framework. METHODS Original publications on definitions and scoring systems for pathophysiological manifestations and elementary lesions of various rheumatic disorders were reviewed from the onset of the WG research in 2005. RESULTS Definitions and scoring systems according to new terminology are provided. CONCLUSION We have redefined OMERACT US pathology and elementary lesions as well as scoring systems, which are now proposed for OMERACT approval for application in clinical trials.
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Affiliation(s)
- George A Bruyn
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Annamaria Iagnocco
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Esperanza Naredo
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter V Balint
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Marwin Gutierrez
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Hilde B Hammer
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Paz Collado
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Georgios Filippou
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Wolfgang A Schmidt
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Sandrine Jousse-Joulin
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter Mandl
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Philip G Conaghan
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Richard J Wakefield
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Helen I Keen
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Lene Terslev
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
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Kovari E, Kaposi A, Bekes G, Kiss Z, Kurucz R, Mandl P, Balint GP, Poor G, Szendroi M, Balint PV. Comorbidity clusters in generalized osteoarthritis among female patients: A cross-sectional study. Semin Arthritis Rheum 2019; 50:183-191. [PMID: 31522761 DOI: 10.1016/j.semarthrit.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/06/2019] [Revised: 08/10/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the prevalence of comorbidities among female patients with generalized osteoarthritis (GOA) in comparison to an age- and sex matched control group. To identify clusters of comorbidities in both groups. METHODS An observational, cross-sectional study was conducted. Consecutive female patients with hand and knee osteoarthritis according to the American College of Rheumatology (ACR) classification criteria were invited to participate in the study. A control group of participants without musculoskeletal symptoms, history or evidence of osteoarthritis or inflammatory rheumatic disease were also included. Cardiovascular, obstructive pulmonary, gastrointestinal, endocrine, neurological, malignant diseases and depression were recorded in both groups. In both study groups comorbidity cluster and factor analysis was performed. RESULTS The study population included 200 GOA and 200 control participants. The following comorbidities were observed adjusted to Bonferroni correction with a significantly higher prevalence among individuals with GOA: hypertension, uterine leiomyoma, gastroesophageal reflux disease, diverticulosis, upper gastrointestinal tract ulcers, depression, diseases with vertigo (benign paroxysmal positional vertigo and vertebrobasilar insufficiency) and surgery due to otoclerosis. In the GOA group 5 clusters were identified with different comorbidity patterns. CONCLUSION We report a high comorbidity rate in GOA. Cluster analysis allowed us to identify different comorbidity subsets for vascular, gastrointestinal and malignant gynaecological disorders. Further research is required to understand the links between GOA and non-musculoskeletal comorbidities.
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Affiliation(s)
- E Kovari
- School of PhD Studies, Semmelweis University, Üllői út 26. fszt 9., Budapest 1085, Hungary.
| | - A Kaposi
- Department of Programming Languages and Compilers, Eötvös Loránd University, Budapest, Hungary
| | - G Bekes
- Central European University, Budapest, Hungary; Hungarian Academy of Sciences, Budapest, Hungary
| | - Z Kiss
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - R Kurucz
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - P Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - G P Balint
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - G Poor
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - M Szendroi
- Department of Orthopedics, Semmelweis University, Budapest, Hungary
| | - P V Balint
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F, Iagnocco A, Jousse-Joulin S, Möller I, Naredo E, Schmidt WA, Wakefield RJ, D'Agostino MA. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis 2018; 77:1730-1735. [PMID: 30076154 DOI: 10.1136/annrheumdis-2018-213609] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 04/17/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the reliability of consensus-based ultrasound (US) definitions of elementary components of enthesitis in spondyloarthritis (SpA) and psoriatic arthritis (PsA) and to evaluate which of them had the highest contribution to defining and scoring enthesitis. METHODS Eleven sonographers evaluated 40 entheses from five patients with SpA/PsA at four bilateral sites. Nine US elementary lesions were binary-scored: hypoechogenicity, thickened insertion, enthesophytes, calcifications, erosions, bone irregularities, bursitis and Doppler signal inside and around enthesis. Kappa statistics were used to evaluate reliability. Sonographers were also asked to state which lesions can be considered as inflammatory or structural and should be included in the final definition of enthesitis. Only the lesions, scored as present in at least 75% of the entheses considered as having an enthesitis, were included in the final definition. RESULTS The prevalence of detected lesions was quite low except for enthesophytes (55%) and bone irregularities (54%). Reliability ranged from poor to good (the lowest for thickened enthesis (kappa 0.1 (95% CI 0 to 0.7)) and the highest for enthesophytes (kappa 0.6 (95% CI 0.5 to 0.7)). When adjusted for low prevalence, kappa values increased for all lesions, with the best result observed for detecting Doppler signal at insertion (0.9) and for bursitis (0.8). The US components included in the final definition were hypoechogenicity, increased thickness at enthesis, erosions and calcifications/enthesophytes and Doppler signal at insertion. CONCLUSION By using a consensus-based stepwise approach, a final reliable US score and definition of enthesitis in SpA/PsA were produced. Further studies are sought for implementing this score in clinical trials and practice.
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Affiliation(s)
- Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Philippe Aegerter
- Department of Public Health and Biostatistics, UMR 1168 INSERM Université Versailles St-Quentin en Yvelines, GIRCI IdF, Paris, France
| | | | | | | | - Annamaria Iagnocco
- Dipartimento di Scienze Cliniche e Biologiche, University of Turin, Turin, Italy
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - Ingrid Möller
- Department of Rheumatology, Instituto Poal de Reumatología and University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Maria-Antonietta D'Agostino
- Rheumatology Department, APHP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France
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Mandl P, Bong D, Balint PV, Hammer HB, Miguel M, Naredo E, Terslev L, Möller I. Sonographic and Anatomic Description of the Subtalar Joint. Ultrasound Med Biol 2018; 44:119-123. [PMID: 29122317 DOI: 10.1016/j.ultrasmedbio.2017.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
Our study provides a detailed anatomic and sonographic description of the subtalar joint, a single joint that, anatomically, is divided into the anterior subtalar joint (ASTJ) and the posterior subtalar joint (PSTJ). Cadaver specimens of the ankle and foot were examined in detail by ultrasound (US), and the subtalar joints of all the specimens were injected with colored latex of a contrasting color under US guidance. Compatible with other studies, examination of the sections revealed lack of communication between the ASTJ and the PSTJ and communication between the PSTJ and the posterior recess of the tibiotalar joint. A recommended list of standardized ultrasound scans was developed using a Delphi consensus process, which allows sonographers to evaluate both the ASTJ and PSTJ from the medial, lateral and posterior aspects. The recommended ultrasound scans were found to be applicable based on a test of agreement between images acquired in cadaver specimens and images acquired in four centers using healthy patients.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
| | - David Bong
- Department of Rheumatology, Universitat de Barcelona, Instituto Poal de Reumatologia, Barcelona, Spain
| | - Peter V Balint
- Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | - Maribel Miguel
- Department of Experimental Pathology and Therapeutics, Universitat de Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Lene Terslev
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Ingrid Möller
- Department of Rheumatology, Universitat de Barcelona, Instituto Poal de Reumatologia, Barcelona, Spain
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Mandl P, Baranauskaite A, Damjanov N, Hojnik M, Kurucz R, Nagy O, Nemec P, Niedermayer D, Perić P, Petranova T, Pille A, Rednic S, Vlad V, Zlnay M, Balint PV. Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries. Rheumatol Int 2016; 36:845-54. [PMID: 26923691 PMCID: PMC4873522 DOI: 10.1007/s00296-016-3442-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/10/2016] [Indexed: 12/01/2022]
Abstract
The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0–85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6–99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria. .,3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
| | - Asta Baranauskaite
- Department of Rheumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Maja Hojnik
- Global Medical Affairs Rheumatology, AbbVie, Ljubljana, Slovenia
| | - Reka Kurucz
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | - Petr Nemec
- Department of Rheumatology, St. Anne's University Hospital, Brno, Czech Republic
| | - Dora Niedermayer
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Porin Perić
- Department of Rheumatology, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Tzvetanka Petranova
- Department of Rheumatology, UMHAT St.Iv.Rilsky, Medical University, Sofia, Bulgaria
| | | | - Simona Rednic
- Department of Rheumatology, Clinical County Emergency Hospital, Cluj-Napoca, Romania
| | - Violeta Vlad
- Department of Rheumatology, Sf. Maria Clinical Hospital, Bucharest, Romania
| | - Martin Zlnay
- Department of Rheumatology, National Institute of Rheumatic Diseases, Piestany, Slovak Republic
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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16
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Szkudlarek M, Terslev L, Wakefield RJ, Backhaus M, Balint PV, Bruyn GAW, Filippucci E, Gandjbakhch F, Iagnocco A, Mandl P, Möller I, Naredo E, Schmidt WA, d'Agostino MA. Summary Findings of a Systematic Literature Review of the Ultrasound Assessment of Bone Erosions in Rheumatoid Arthritis. J Rheumatol 2015; 43:12-21. [PMID: 26628596 DOI: 10.3899/jrheum.141416] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Bone erosions in rheumatoid arthritis (RA) have been studied in an increasing amount of research. Both earlier and present classification criteria of RA contain erosions as a significant classification component. Ultrasound (US) can detect bone changes in accessible surfaces. Therefore, the study group performed a systematic literature review of assessment of RA bone erosions with US. METHODS A systematic search of PubMed and Embase was performed. Data on the definitions of RA bone erosions, their size, scoring, relation to synovitis, comparators, and elements of the OMERACT (Outcome Measures in Rheumatology Clinical Trials) filter were collected and analyzed. RESULTS The selection process identified 58 original research papers. The assessed joints were most frequently metacarpophalangeal (MCP; 41 papers), proximal interphalangeal (19 papers), and metatarsophalangeal joints (MTP; 18 papers). The OMERACT definition of RA bone erosion on US was used most often (17 papers). Second and fifth MCP and fifth MTP were recommended as target joints. Conventional radiography was the most frequently used comparator (27 papers), then magnetic resonance imaging (17 papers) and computed tomography (5 papers). Reliability of assessment was presented in 20 papers and sensitivity to change in 11 papers. CONCLUSION This paper presents results of a systematic literature review of bone erosion assessment in RA with US. The survey suggests that US can be a helpful adjunct to the existing methods of imaging bone erosions in RA. It analyzes definitions, scoring systems, used comparators, and elements of the OMERACT filter. It also presents recommendations for a future research agenda based on the results of the review.
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Affiliation(s)
- Marcin Szkudlarek
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Lene Terslev
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Richard J Wakefield
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Marina Backhaus
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Peter V Balint
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - George A W Bruyn
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Emilio Filippucci
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Frederique Gandjbakhch
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Annamaria Iagnocco
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Peter Mandl
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Ingrid Möller
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Esperanza Naredo
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Wolfgang A Schmidt
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Maria Antonietta d'Agostino
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
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Terslev L, Gutierrez M, Christensen R, Balint PV, Bruyn GA, Delle Sedie A, Filippucci E, Garrido J, Hammer HB, Iagnocco A, Kane D, Kaeley GS, Keen H, Mandl P, Naredo E, Pineda C, Schicke B, Thiele R, D'Agostino MA, Schmidt WA. Assessing Elementary Lesions in Gout by Ultrasound: Results of an OMERACT Patient-based Agreement and Reliability Exercise. J Rheumatol 2015; 42:2149-54. [PMID: 26472419 DOI: 10.3899/jrheum.150366] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. METHODS Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first metatarsophalangeal joint and the knee bilaterally. The patients were examined twice using B-mode US to test agreement and inter- and intraobserver reliability of the elementary components. RESULTS The prevalence of the lesions were DC 52.8%, tophus 61.1%, aggregates 29.8%, and erosions 32.4%. The intraobserver reliability was good for all lesions except DC, where it was moderate. The best reliability per lesion was seen for tophus (κ 0.73, 95% CI 0.61-0.85) and lowest for DC (κ 0.53, 95% CI 0.38-0.67). The interobserver reliability was good for tophus and erosions, but fair to moderate for aggregates and DC, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). CONCLUSION This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying the definition in patients on all elementary lesions while interobserver reliability was moderate to low. Further studies are needed to improve the interobserver reliability, particularly for DC and aggregates.
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Gutierrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo E, Iagnocco A, Bruyn GA, Balint PV, Filippucci E, Mandl P, Kane D, Pineda C, Delle Sedie A, Hammer HB, Christensen R, D'Agostino MA, Terslev L. International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 2015; 54:1797-805. [PMID: 25972391 DOI: 10.1093/rheumatology/kev112] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [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: 07/17/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. METHODS The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert international consensus. This collated information resulted in four statements defining US elementary lesions: double contour (DC), tophus, aggregates and erosion. The Delphi questionnaire was sent to 35 rheumatology experts in US, asking them to rate their level of agreement or disagreement with each statement. The second step tested the reliability by a web-exercise. US images of both normal and gouty elementary lesions were collected by the participants. A facilitator then constructed an electronic database of 110 images. The database was sent to the participants, who evaluated the presence/absence of US elementary lesions. A group of 20 images was displayed twice to evaluate intra-reader reliability. RESULTS A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader κ values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader κ values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. CONCLUSION This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.
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Affiliation(s)
- Marwin Gutierrez
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy,
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus, Medical Centre for Rheumatology, Berlin, Germany
| | - Ralf G Thiele
- Department of Medicine, Allergy/Immunology and Rheumatology Division, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | - Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Esperanza Naredo
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annamaria Iagnocco
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome
| | - George A Bruyn
- Rheumatology Department, MC Groep Hospitals, Lelystad, Netherlands
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - David Kane
- Rheumatology Department, Trinity College, Dublin, Ireland
| | - Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | | | | | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Maria Antonietta D'Agostino
- INSERM U1173, Rheumatology Department, Laboratoire d'excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France and
| | - Lene Terslev
- Rheumatology Department, Center for Rheumatology and Spine diseases, Copenhagen University Hospital, Copenhagen, Denmark
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Bruyn GA, Naredo E, Iagnocco A, Balint PV, Backhaus M, Gandjbakhch F, Gutierrez M, Filer A, Finzel S, Ikeda K, Kaeley GS, Manzoni SM, Ohrndorf S, Pineda C, Richards B, Roth J, Schmidt WA, Terslev L, D'Agostino MA. The OMERACT Ultrasound Working Group 10 Years On: Update at OMERACT 12. J Rheumatol 2015; 42:2172-6. [PMID: 25774059 DOI: 10.3899/jrheum.141462] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Musculoskeletal ultrasound (US) now thrives as an established imaging modality for the investigation and management of chronic inflammatory arthritis. We summarize here results of the Outcome Measures in Rheumatology (OMERACT) US working group (WG) projects of the last 2 years. These results were reported at the OMERACT 12 meeting at the plenary session and discussed during breakout sessions. Topics included standardization of US use in rheumatic disease over the last decade and its contribution to understanding musculoskeletal diseases. This is the first update report of WG activities in validating US as an outcome measure in musculoskeletal inflammatory and degenerative diseases, including pediatric arthritis, since the OMERACT 11 meeting.
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Mandl P, Supp G, Baksa G, Radner H, Studenic P, Gyebnar J, Kurucz R, Niedermayer D, Aletaha D, Balint PV, Smolen JS. Relationship between radiographic joint space narrowing, sonographic cartilage thickness and anatomy in rheumatoid arthritis and control joints. Ann Rheum Dis 2014; 74:2022-7. [DOI: 10.1136/annrheumdis-2014-205585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/01/2014] [Indexed: 11/04/2022]
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Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GAW, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D'Agostino MA. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014; 66:741-8. [PMID: 24151222 DOI: 10.1002/acr.22191] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/24/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To standardize ultrasound (US) in enthesitis. METHODS An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability. RESULTS Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63). CONCLUSION This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.
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Affiliation(s)
- L Terslev
- Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
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Mandl P, Kurucz R, Niedermayer D, Balint PV, Smolen JS. Contributions of ultrasound beyond clinical data in assessing inflammatory disease activity in rheumatoid arthritis: current insights and future prospects. Rheumatology (Oxford) 2014; 53:2136-42. [PMID: 24836013 DOI: 10.1093/rheumatology/keu211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Appropriate measures of disease activity need to be valid, reliable and sensitive to change for use in clinical studies while remaining at the same time feasible and practicable for utilization in daily clinical practice. Ultrasonography was shown to be a valid, sensitive and reliable imaging modality for the detection of synovitis in RA, however, it has so far failed to demonstrate superior sensitivity to change as compared with clinical examination. This review examines the current evidence for the use of established measures and/or US, either as an alternative or as a supplementary measure to clinical examination, as tools for monitoring synovitis in RA. It also includes a summary of results of recent studies evaluating clinical examination-based as well as clinical- and US-based multimodal disease activity indices. We review the rationale and limitations of incorporating US into composite disease activity indices and suggest a research roadmap for further studies in this field.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
| | - Reka Kurucz
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Dora Niedermayer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Peter V Balint
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria. Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
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Iagnocco A, Naredo E, Wakefield R, Bruyn GA, Collado P, Jousse-Joulin S, Finzel S, Ohrndorf S, Delle Sedie A, Backhaus M, Berner-Hammer H, Gandjbakhch F, Kaeley G, Loeuille D, Moller I, Terslev L, Aegerter P, Aydin S, Balint PV, Filippucci E, Mandl P, Pineda C, Roth J, Magni-Manzoni S, Tzaribachev N, Schmidt WA, Conaghan PG, D’Agostino MA. Responsiveness in Rheumatoid Arthritis. A Report from the OMERACT 11 Ultrasound Workshop. J Rheumatol 2013; 41:379-82. [DOI: 10.3899/jrheum.131084] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Task Force on the validity of different US measures in rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) presented during the OMERACT 11 Workshop.Methods.The Task Force is an international group aiming to iteratively improve the role of US in arthritis clinical trials. Recently a major focus of the group has been the assessment of responsiveness of a person-level US synovitis score in RA: the US Global Synovitis Score (US-GLOSS) combines synovial hypertrophy and power Doppler signal in a composite score detected at joint level. Work has also commenced examining assessment of tenosynovitis in RA and the role of US in JIA.Results.The US-GLOSS was tested in a large RA cohort treated with biologic therapy. It showed early signs of improvement in synovitis starting at Day 7 and increasing to Month 6, and demonstrated sensitivity to change of the proposed grading. Subsequent voting questions concerning the application of the US-GLOSS were endorsed by > 80% of OMERACT delegates. A standardized US scoring system for detecting and grading severity of RA tenosynovitis and tendon damage has been developed, and acceptable reliability data were presented from a series of exercises. A preliminary consensus definition of US synovitis in pediatric arthritis has been developed and requires further testing.Conclusion.At OMERACT 11, consensus was achieved on the application of the US-GLOSS for evaluating synovitis in RA; and work continues on development of RA tenosynovitis scales as well as in JIA synovitis.
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Bruyn GAW, Hanova P, Iagnocco A, d'Agostino MA, Möller I, Terslev L, Backhaus M, Balint PV, Filippucci E, Baudoin P, van Vugt R, Pineda C, Wakefield R, Garrido J, Pecha O, Naredo E. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Ann Rheum Dis 2013; 73:1929-34. [PMID: 23940212 DOI: 10.1136/annrheumdis-2013-203596] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop the first ultrasound scoring system of tendon damage in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability. METHODS We conducted a Delphi study on ultrasound-defined tendon damage and ultrasound scoring system of tendon damage in RA among 35 international rheumatologists with experience in musculoskeletal ultrasound. Twelve patients with RA were included and assessed twice by 12 rheumatologists-sonographers. Ultrasound examination for tendon damage in B mode of five wrist extensor compartments (extensor carpi radialis brevis and longus; extensor pollicis longus; extensor digitorum communis; extensor digiti minimi; extensor carpi ulnaris) and one ankle tendon (tibialis posterior) was performed blindly, independently and bilaterally in each patient. Intraobserver and interobserver reliability were calculated by κ coefficients. RESULTS A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B mode. The mean intraobserver reliability for tendon damage scoring was excellent (κ value 0.91). The mean interobserver reliability assessment showed good κ values (κ value 0.75). The most reliable were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons. An ultrasound reference image atlas of tenosynovitis and tendon damage was also developed. CONCLUSIONS Ultrasound is a reproducible tool for evaluating tendon damage in RA. This study strongly supports a new reliable ultrasound scoring system for tendon damage.
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Affiliation(s)
- George A W Bruyn
- Rheumatology Department, MC Groep Hospitals, Lelystad, The Netherlands
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | | | - Maria-Antonietta d'Agostino
- Department of Rheumatology, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Ingrid Möller
- Department of Rheumatology, Instituto Poal, Barcelona, Spain
| | - Lene Terslev
- Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
| | - Marina Backhaus
- Department of Rheumatology, Charite University Hospital, Berlin, Germany
| | - Peter V Balint
- Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Emilio Filippucci
- Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy
| | - Paul Baudoin
- Rheumatology Department, MC Groep Hospitals, Lelystad, The Netherlands
| | - Richard van Vugt
- Department of Rheumatology, VU Medisch Centrum, Amsterdam, The Netherlands
| | - Carlos Pineda
- Department of Rheumatology, National Institute of Rehabilitation, Mexico City, Mexico
| | - Richard Wakefield
- Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Jesus Garrido
- Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain
| | | | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Colebatch AN, Edwards CJ, Østergaard M, van der Heijde D, Balint PV, D'Agostino MA, Forslind K, Grassi W, Haavardsholm EA, Haugeberg G, Jurik AG, Landewé RBM, Naredo E, O'Connor PJ, Ostendorf B, Potočki K, Schmidt WA, Smolen JS, Sokolovic S, Watt I, Conaghan PG. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72:804-14. [DOI: 10.1136/annrheumdis-2012-203158] [Citation(s) in RCA: 409] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. ACTA ACUST UNITED AC 2012; 64:943-54. [PMID: 22389040 DOI: 10.1002/art.34356] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.
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Naredo E, D'Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E, Iagnocco A, Karim Z, Terslev L, Bong DA, Garrido J, Martínez-Hernández D, Bruyn GAW. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 2012; 72:1328-34. [PMID: 22984169 DOI: 10.1136/annrheumdis-2012-202092] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA). METHODS We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (κ value 0.72 for B-mode; κ value 0.78 for PD mode). Interobserver reliability assessment showed good κ values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate κ values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45). CONCLUSIONS US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, and Hospital Universitario Severo Ochoa, Madrid, Spain.
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Mandl P, Brossard M, Aegerter P, Backhaus M, Bruyn GA, Chary-Valckenaere I, Iagnocco A, Filippucci E, Freeston J, Gandjbakhch F, Jousse-Joulin S, Möller I, Naredo E, Schmidt WA, Szkudlarek M, Terslev L, Wakefield RJ, Zayat A, D'Agostino MA, Balint PV. Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res (Hoboken) 2012; 64:773-9. [PMID: 22232128 DOI: 10.1002/acr.21598] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various methods are utilized in daily practice to obtain optimal information on effusion in the knee. Our aim is to investigate which scanning position provides the best information about synovial fluid in the knee by using ultrasound and to evaluate the magnitude of difference for measuring synovial fluid in 3 major recesses (suprapatellar, medial parapatellar, and lateral parapatellar) of the knee according to various degrees of flexion. METHODS Sonographers in 14 European centers documented bilateral knee joint ultrasound examinations on a total of 148 knee joints. The largest sagittal diameter of fluid was measured in scans corresponding to the 3 major recesses at different (0°, 15°, 30°, 45°, 60°, and 90°) degrees of flexion of the knee. The difference of measurement of effusion according to transducer position, knee position, and the interaction between them was investigated by analysis of variance followed by Tukey's test. RESULTS No correlation was noted between patient characteristics and ultrasound detection of effusion. The sagittal diameter of synovial fluid in all 3 recesses was greatest at 30° flexion. Analysis of variance and Tukey's test revealed that the suprapatellar scan and 30° flexion is the best combination for detecting effusion as confirmed by receiver operator characteristic curve analysis. CONCLUSION The suprapatellar scan of the knee in 30° flexion was the most sensitive position to detect fluid in knee joints. Sagittal diameter of fluid in all 3 recesses increased with the knee in the 30° flexed position as compared to the extended position.
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Affiliation(s)
- P Mandl
- Division of Rheumatology, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria.
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Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71:484-92. [PMID: 22388996 PMCID: PMC3298664 DOI: 10.1136/annrheumdis-2011-200329] [Citation(s) in RCA: 302] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.
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Affiliation(s)
- Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Marco A Cimmino
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Wolfgang A Schmidt
- Department of Rheumatology, Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin–Buch Berlin, Berlin, Germany
| | - Michael Schirmer
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Carlo Salvarani
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Artur Bachta
- Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Christina Duftner
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
- Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
| | | | | | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Novák Pál Kaposi
- Radiology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter Mandl
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter V Balint
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Zsuzsa Schmidt
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Annamaria Iagnocco
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | | | | | | | - Nicolò Pipitone
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | | | - Georgina Espígol-Frigolé
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Víctor M Martínez-Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Sibel Zehra Aydin
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Khalid Ahmed
- Department of Rheumatology, Princess Alexandra Hospital, Harlow, UK
| | - Brian Hazleman
- Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
| | | | - Colin Pease
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Richard J Wakefield
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Andy Abril
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Clement J Michet
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ralph Marcus
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Neil J Gonter
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Mehrdad Maz
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Matteson EL, Maradit-Kremers H, Cimmino MA, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Slott Jensen H, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Cantini F, Nannini C, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazelman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Marcus R, Gonter NJ, Maz M, Crowson CS, Dasgupta B. Patient-reported outcomes in polymyalgia rheumatica. J Rheumatol 2012; 39:795-803. [PMID: 22422492 DOI: 10.3899/jrheum.110977] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To prospectively evaluate the disease course and the performance of clinical, patient-reported outcome (PRO) and musculoskeletal ultrasound measures in patients with polymyalgia rheumatica (PMR). METHODS The study population included 85 patients with new-onset PMR who were initially treated with prednisone equivalent dose of 15 mg daily tapered gradually, and followed for 26 weeks. Data collection included physical examination findings, laboratory measures of acute-phase reactants, and PRO measures. Ultrasound evaluation was performed at baseline and Week 26 to assess for features previously reported to be associated with PMR. Response to corticosteroid treatment was defined as 70% improvement in PMR on visual analog scale (VAS). RESULTS At baseline, 77% had hip pain in addition to shoulder pain and 100% had abnormal C-reactive protein or erythrocyte sedimentation rate. On ultrasound, 84% had shoulder findings and 32% had both shoulder and hip findings. Response to corticosteroid treatment occurred in 73% of patients by Week 4 and was highly correlated with percentage improvement in other VAS measures. Presence of ultrasound findings at baseline predicted response to corticosteroids at 4 weeks. Factor analysis revealed 6 domains that sufficiently represented all the outcome measures: PMR-related pain and physical function, an elevated inflammatory marker, hip pain, global pain, mental function, and morning stiffness. CONCLUSION PRO measures and inflammatory markers performed well in assessing disease activity in patients with PMR. A minimum set of outcome measures consisting of PRO measures of pain and function and an inflammatory marker should be used in practice and in clinical trials in PMR.
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Affiliation(s)
- Eric L Matteson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Bruyn GAW, Pineda C, Hernandez-Diaz C, Ventura-Rios L, Moya C, Garrido J, Groen H, Pena A, Espinosa R, Möller I, Filippucci E, Iagnocco A, Balint PV, Kane D, D'Agostino MA, Angulo M, Ponte R, Fernandez-Gallardo JM, Naredo E. Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard. Arthritis Care Res (Hoboken) 2010; 62:1079-86. [PMID: 20235183 DOI: 10.1002/acr.20175] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard. METHODS Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI. RESULTS The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant. CONCLUSION Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.
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Kissin EY, Nishio J, Yang M, Backhaus M, Balint PV, Bruyn GAW, Craig-Muller J, D'Agostino MA, Feoktistov A, Goyal J, Iagnocco A, Ike RW, Moller I, Naredo E, Pineda C, Schmidt WA, Swen N, Tabechian D, Wakefield RJ, Wells AF, Kaeley GS. Self-directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States. Arthritis Care Res (Hoboken) 2010; 62:155-60. [PMID: 20191513 DOI: 10.1002/acr.20063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS. METHODS A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis. RESULTS Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (kappa = 0.43 versus kappa = 0.34; P = 0.001). CONCLUSION Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.
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Affiliation(s)
- Eugene Y Kissin
- Boston University Medical Center, Boston, Massachusetts, USA.
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Affiliation(s)
- Peter Mandl
- National Institute of Rheumatology and Physiotherapy, 25-29 Frankel Leo str., H-1023, Budapest, Hungary.
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35
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Balint PV, Mandl P, Kane D. “All that glistens is not gold”—Separating artefacts from true Doppler signals in rheumatological ultrasound. Ann Rheum Dis 2008; 67:141-2. [DOI: 10.1136/ard.2007.081554] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GAW, Bruyn G, Kane D, O'Connor PJ, Manger B, Joshua F, Koski J, Grassi W, Lassere MND, Swen N, Kainberger F, Klauser A, Ostergaard M, Brown AK, Machold KP, Conaghan PG. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32:2485-7. [PMID: 16331793] [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: 05/05/2023]
Abstract
Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.
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Abstract
Felty's syndrome (FS) comprises a triad of rheumatoid arthritis (RA), neutropenia and splenomegaly, occurring in less than 1% of RA patients. Clinically it is characterized by severe joint destruction contrasting with moderate or absent joint inflammation and severe extra-articular disease, including a high frequency of rheumatoid nodules, lymphadenopathy, hepatopathy, vasculitis, leg ulcers, skin pigmentation etc. Recurrent bacterial infections are mostly due to the severe, otherwise unexplained neutropenia. The cause of neutropenia lies in both decreased granulopoiesis and increased peripheral destruction of granulocytes. Recurrent infections may lead to increased mortality. Spontaneous remission of the syndrome also occurs. Over 95% of FS patients are positive for rheumatoid factor (RF), 47-100% are positive for antinuclear antibody (ANA), and 78% of patients have the HLA-DR4*0401 antigen. Some 30% of FS patients have large granular lymphocyte (LGL) expansion. LGL expansion associated with uncomplicated RA is immunogenetically and phenotypically very similar to but clinically different from FS. Neutropenia of FS can be effectively treated with disease-modifying anti-rheumatic drugs (DMARDs), the widest experience being with methotrexate (MTX). Results of treatment with granulocyte colony-stimulating factor (G-CSF) are encouraging, but there is no experience with other biological agents. Splenectomy results in immediate improvement of neutropenia in 80% of the patients, but the rate of infection decreases to a lesser degree.
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Affiliation(s)
- Geza P Balint
- Fourth General Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, 25-29 Frankel L. St, 1023 Hungary.
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38
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Kane D, Grassi W, Sturrock R, Balint PV. Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 2004; 43:829-38. [PMID: 15161981 DOI: 10.1093/rheumatology/keh215] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [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: 01/09/2023] Open
Abstract
Rheumatologists remain divided on whether they should introduce musculoskeletal ultrasound (MSUS) into their clinical practice. A central issue in the application of MSUS in clinical rheumatology is the need for proof of clinical relevance and improved patient care. There is now accumulating evidence that MSUS improves clinical diagnosis and intervention skills. High-resolution ultrasound is superior to clinical examination in the diagnosis and localization of joint and bursal effusion and synovitis. MSUS is the imaging modality of choice for the diagnosis of tendon pathology. MSUS is seven times more sensitive than plain radiography in the detection of rheumatoid erosions, allowing earlier diagnosis of progressive rheumatoid arthritis. Ligament, muscle, peripheral nerve and cartilage pathology can also be readily demonstrated by MSUS. There is exciting evidence that MSUS may potentially be used by rheumatologists to non-invasively diagnose and monitor not just joint and muscle disease but also nerve compression syndromes, scleroderma, vasculitis and Sjögren's syndrome. Joint aspiration and injection accuracy can be improved by MSUS, with initial evidence confirming improved efficacy. As the number of rheumatologists performing MSUS increases and the technical capabilities of MSUS improve, there is likely to be a growing number of proven clinical indications for the application of MSUS in rheumatology practice. This paper reviews the evidence for the application of MSUS in rheumatology.
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Affiliation(s)
- D Kane
- School of Clinical and Medical Sciences (Rheumatology), Cookson Building, Framlington Place, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE2 4HH, UK.
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Kane D, Lockhart JC, Balint PV, Mann C, Ferrell WR, McInnes IB. Protective effect of sensory denervation in inflammatory arthritis (evidence of regulatory neuroimmune pathways in the arthritic joint). Ann Rheum Dis 2004; 64:325-7. [PMID: 15155371 PMCID: PMC1755348 DOI: 10.1136/ard.2004.022277] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/03/2022]
Abstract
OBJECTIVE To investigate the direct effect of joint innervation on immune mediated joint inflammation in a patient with psoriatic arthritis (PsA). CASE REPORT The patient developed arthritis mutilans in all digits of both hands with the exception of the left 4th finger, which had prior sensory denervation following traumatic nerve dissection. Plain radiography, ultrasonography and nerve conduction studies of the hands confirmed the absence of articular disease and sensory innervation in the left 4th digit. METHODS This relationship between joint innervation and joint inflammation was investigated experimentally by prior surgical sensory denervation of the medial aspect of the knee in six Wistar rats in which carrageenan induced arthritis was subsequently induced. Prior sensory denervation--with preservation of muscle function--prevented the development of inflammatory arthritis in the denervated knee. DISCUSSION Observations in human and animal inflammatory arthritis suggest that regulatory neuroimmune pathways in the joint are an important mechanism that modulates the clinical expression of inflammatory arthritis.
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Affiliation(s)
- D Kane
- School of Clinical and Medical Sciences (Rheumatology), 4th Floor, Cookson Building, Framlington Place, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE2 4HH, UK.
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Kane D, Balint PV, Sturrock R, Grassi W. Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 1: Current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 2004; 43:823-8. [PMID: 15138330 DOI: 10.1093/rheumatology/keh214] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [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: 11/14/2022] Open
Abstract
As we begin the 21st century, musculoskeletal ultrasound (MSUS) is routinely used by an increasing number of rheumatologists throughout Europe and there is a growing interest in the application of MSUS in rheumatological practice in the UK. MSUS allows high-resolution, real-time imaging of articular and periarticular structures and has the advantages of being non-radioactive, inexpensive, portable, highly acceptable to patients and repeatable. There are a number of critical issues that need to be addressed in order to develop the role of MSUS within rheumatology. These include issues of equipment costs, training and certification and the relationship of rheumatologists and radiologists in advancing the field of MSUS. Rheumatologists must demonstrate the relevance of MSUS in their clinical practice through high-quality research. Emerging technologies such as power Doppler and 3D imaging will further improve imaging capabilities and the range of clinical applications of MSUS systems. This paper reviews how MSUS in rheumatology has evolved and the controversies and issues that rheumatologists must now address in developing MSUS as an indispensable, everyday clinical tool.
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Affiliation(s)
- D Kane
- School of Clinical and Medical Sciences (Rheumatology), Cookson Building, Framlington Place, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE2 4HH, UK.
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Affiliation(s)
- D Kane
- Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK.
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Affiliation(s)
- D Kane
- Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK.
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Kane D, Balint PV, Wood F, Sturrock RD. Early diagnosis of pyomyositis using clinic-based ultrasonography in a patient receiving infliximab therapy for Behçet's disease. Rheumatology (Oxford) 2003; 42:1564-5. [PMID: 14645859 DOI: 10.1093/rheumatology/keg378] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- P V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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Kane D, Balint PV, Sturrock RD. Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol 2003; 30:966-71. [PMID: 12734890] [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: 03/02/2023]
Abstract
OBJECTIVE Musculoskeletal ultrasonography allows real-time imaging of joint structures and may be used to complement clinical examination in rheumatological practice. We compared ultrasonography (US) with clinical examination (CE) in the detection of effusion, suprapatellar bursitis, and Baker's cyst of the knee in rheumatoid arthritis (RA) in order to determine whether US provided additional clinical information. METHODS A total of 22 patients with RA (ACR criteria) underwent independent clinical and US examination of both knees for suprapatellar bursitis, knee effusion, and presence of Baker's cyst. US was performed using an ATL HDI 3000 machine with L7-4 MHz and CL10-5 MHz probes. Clinical examination was performed using standard techniques by an experienced rheumatologist. Patients with previous knee surgery were excluded from the study. RESULTS A total of 44 knees were examined at a total of 130 sites (one patient was unable to lie prone for US of popliteal fossae). US detected soft tissue abnormality (suprapatellar bursitis, knee effusion, or Baker's cyst) at 54/130 (42%) sites, while CE detected soft tissue abnormality at 36/130 (28%) sites. US detected 17 (39%) cases of suprapatellar bursitis in 44 knees, 7 (16%) of which were detected on CE. US detected 27 (61%) knee joint effusions in 44 knees, 16 (36.36%) of which were detected on CE. US detected 10 (23.81%) Baker's cysts in 42 knees, 2 (4.76%) of which were detected on CE. Taking US of the knee as the gold standard, CE was specific but not sensitive in the detection of soft tissue abnormality of the knee in RA. CONCLUSION US is more sensitive than CE in the detection of suprapatellar bursitis, knee effusion, and Baker's cyst in RA. CE underestimates knee inflammation in RA. This has implications for the use of CE as a component of standardized disease activity scores and in guiding knee joint aspiration.
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Affiliation(s)
- David Kane
- Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Scotland, UK
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Balint PV, Kane D, Hunter J, McInnes IB, Field M, Sturrock RD. Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J Rheumatol 2002; 29:2209-13. [PMID: 12375335] [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: 02/26/2023]
Abstract
OBJECTIVE To compare joint and soft tissue aspiration using a conventional technique with an ultrasound (US) guided technique. METHODS In the conventional group, 32 joints in 30 consecutive patients referred for joint aspiration and injection to an experienced consultant rheumatologist were aspirated. In the US guided group, 31 consecutive patients were examined by US to confirm the presence and location of fluid. Following US examination, aspiration was performed by a second rheumatologist based on the US localization of fluid or under direct US guidance. RESULTS In the conventional group, successful aspiration was achieved in 10 (32%) joints. In the US guided group, successful aspiration was achieved in 31 (97%) joints. The mean volume of fluid obtained from successful aspirations was similar in both groups (11.7 ml in the US group and 14 ml in the conventional group). CONCLUSION The use of US to localize joint and soft tissue fluid collection greatly improves the rate of diagnostic synovial fluid aspiration, particularly in small joints. This has important implications for accurate administration of local steroid therapy and emphasizes the importance of US as a useful tool in clinical rheumatological practice.
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Affiliation(s)
- Peter V Balint
- Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland.
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Abstract
OBJECTIVE To compare ultrasonography (US) with clinical examination in the detection of entheseal abnormality of the lower limb in patients with spondyloarthropathy (SpA). METHODS 35 patients with SpA (ankylosing spondylitis 27; psoriatic arthritis 7; reactive arthritis 1) underwent independent clinical and ultrasonographic examination of both lower limbs at five entheseal sites-superior pole and inferior pole of patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis. US was performed using an ATL (Advanced Technology Laboratories, Bothell, Washington, USA) high definition imaging 3000 machine with linear 7-4 MHz and compact linear 10-5 MHz probes to detect bursitis, structure thickness, bony erosion, and enthesophyte (bony spur). An enthesitis score was formulated from these US findings giving a possible maximum total score of 36. RESULTS On clinical examination 75/348 (22%) entheseal sites were abnormal and on US examination 195/348 (56%) sites were abnormal. In 19 entheseal sites with bursitis on US, only five were detected by clinical examination. Compared with US, clinical examination had a low sensitivity (22.6%) and moderate specificity (79.7%) for the detection of enthesitis of the lower limbs. There was no significant correlation between the US score of enthesitis and acute phase parameters such as erythrocyte sedimentation rate (ESR) or C reactive protein (CRP). The intraobserver kappa value for analysis of all sites was 0.9. CONCLUSIONS Most entheseal abnormality in SpA is not detected at clinical examination. US is better than clinical examination in the detection of entheseal abnormality of the lower limbs in SpA. A quantitative US score of lower limb enthesitis is proposed but further studies are required to validate it in SpA.
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Affiliation(s)
- P V Balint
- Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Scotland, UK.
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Balint PV, McEntegart A, Jackson R, Forrester AW, Simpson RG. Epitrochlear lymphadenopathy in rheumatoid arthritis caused by silicone particles. J Rheumatol 2002; 29:1097-9. [PMID: 12022330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Peter V Balint
- Centre for Rheumatic Diseases, University Department of Medicine, QEB, Glasgow Royal Infirmary, UK.
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