Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound

OBJECTIVE

The purpose of this study was to determine the prevalence of joint, enthesis, bursa, and tendon ultrasound findings in large and medium joints of young, healthy individuals.

METHOD

Ultrasound assessment of large and medium joints, bursae, tendons, and entheses was performed in healthy individuals below the age of 30 years. Participants also underwent bioelectrical impedance analysis and conducted supervised weight training to determine maximum strength. The prevalence of ultrasound findings was calculated and a binary logistic regression model was applied to evaluate factors associated with the present findings.

RESULTS

Fifty-one healthy individuals (52.9% female) with a mean age of 23.7 years were included in this study. Joint effusion in at least one joint was observed in 72.6% of the individuals (n = 37) and entheseal pathology in at least one enthesis was detected in 27.5% (n = 14). A binary logistic regression model indicated a significant association between reported hours of sports activity per week and the prevalence of effusion in the knee (p = 0.017). In addition, associations were observed between entheseal pathology in at least one entheseal site and body mass index (BMI) (p = 0.015) as well as fat mass index (p = 0.026).

CONCLUSION

Joint effusion in large and medium joints, as well as entheseal hyperperfusion, bursal effusion, and tendon sheath effusion, are found in healthy individuals. Hours of sports activity per week, BMI and fat mass index showed significant associations with the findings in joints and entheses.

POS1387 ULTRASOUND FINDINGS OF JOINTS AND ENTHESES FOLLOWING ONE HOUR OF AGE AND GENDER ADJUSTED WEIGHT TRAINING

Background

Joint effusion and enthesitis are common ultrasound findings in rheumatologic diseases like rheumatoid arthritis or spondyloarthritis. Physically active individuals and athletes were also found to exhibit structural and vascular changes in their entheses, as well as joint effusion through different imaging approaches [1, 2].

Objectives

The aim of this study was to evaluate the development of joint and entheseal ultrasound findings in large and medium joints of young healthy individuals after one hour of standardised weight training.

Methods

A total of three musculoskeletal ultrasound examinations were performed in healthy individuals under the age of 30 years. The first examination was carried out before the individuals conducted one hour of standardized weight training, the second examination 24 hours later and the third examination 48 hours later. The examination comprised shoulder, elbow, wrist, hip, knee, and ankle joints, as well as associated entheseal sites. Poisson mixed effects models were applied to analyse the development of the ultrasound findings within 48 hours after the weight training.

Results

Fifty-one healthy individuals with a mean age of 23.7 years (± 2.5, range: 19-30) (52.9% female) were enrolled in this study. Fourteen participants (27.5%) presented with at least one abnormal enthesis at baseline, increasing to 24 (47.1%) after 24 hours and to 29 (56.9%) 48 hours after the weight training. Hyperperfusion was the only entheseal pathology detected by ultrasound after the training.

The number of individuals with at least one joint effusion increased from 37 (72.6%) at baseline to 45 (88.2%) after 24 hours and to 48 (94.1%) 48 hours after the weight training. The Poisson mixed effects models showed a significant increase of the number of joints with effusion and entheses with pathologies with time after the weight training (p < 0.001, Exp(b) = 1.63 and p < 0.001, Exp(b) = 1.58).

Conclusion

Prevalence of joint effusion in large and medium joints as well as the prevalence of entheseal pathology increase significantly within 48 hours after one hour of weight training. As a result, the individual’s physical activity should be considered when performing a musculoskeletal ultrasound examination.

References

[1]Méric J-C, Grandgeorge Y, Lotito G, Pham T. Walking Before an Ultrasound Assessment Increases the Enthesis Score Significantly. J Rheumatol. 2011 May;38(5):961–961.

[2]Lohman M, Kivisaari A, Vehmas T, Kallio P, Malmivaara A, Kivisaari L. MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal Radiol. 2001 Mar 5;30(2):61–6.

Disclosure of Interests

None declared

POS1271 PREVALENCE OF JOINT EFFUSION, HYPERPERFUSION AND ENTHESITIS IN YOUNG HEALTHY INDIVIDUALS

Background:

The European League Against Rheumatism (EULAR) recommends using ultrasound (US) in patients with rheumatoid arthritis and psoriatic arthritis in diagnosis (1). In addition, US examination is crucial for detecting enthesitis in the above mentioned rheumatic diseases. However, abnormal findings on US may also occur in healthy individuals as indicated by recent studies focusing on small joints like metacarpophalangeal joint, metatarsophalangeal joint or the elbow. (2,3)

Ultrasound assessment of large joints in healthy individuals has not been extensively studied so far, causing a lack of information concerning normal values in musculoskeletal US examination.

Objectives:

The purpose of this study was to determine the prevalence of joint effusion, hyperperfusion of the synovia and enthesitis in large and medium-sized joints of healthy individuals.

Methods:

Ultrasound assessment of shoulder, elbow, wrist, hip, knee and ankle joints as well as corresponding entheseal sites including the Achilles tendon and the plantar aponeurosis was performed in healthy individuals below the age of 30 years. Additionally, participants filled out a survey on their physical activity level, underwent a bioelectrical impedance analysis (BIA) and conducted a supervised weight training to determine their training volume. Prevalence of US findings was calculated, and a binary logistic regression model was applied to determine the association between the present findings and sex, age, handedness, hours of sports activity per week, BMI, amount of skeletal muscle mass (SMM) or training volume of strength training.

Results:

We included 51 healthy individuals with a mean age of 23.7 years, 52.9% were female with a mean BMI of 22.5 kg/m2. Ultrasound examination detected joint effusion in one joint in 25.5% (n=13), 29.4% (n=15) showed effusion in two of twelve examined joints. Joint effusion in three, four and five joints was detected in 9.8% (n=5), 3.9% (n=2) and 3.9% (n=2) of the cases, respectively. In 27.5% (n=14) of the individuals no joint effusion was observed. The most frequently affected joint was the elbow joint. Synovial hyperperfusion was not detected in any participant. Enthesitis was observed in one, two and three examined entheseal sites in 19.5% (n=10), 5.9% (n=3) and 2% (n=1), respectively. In 72% (n=37) of the examined individuals no pathology of the entheseal sites was found. Hyperperfusion presented to be the most frequent pathology observed in enthesitis (23%), followed by calcification (6%).

Binary logistic regression model demonstrated a significant association between reported hours of sports activity per week and the prevalence of effusion in the knee (p = 0.017). The odds of joint effusion in the knee increased with the hours of sports activity by 34.1% (Exp(B)= 1.341, 95%-CI(1.054, 1.705)). Additionally, the odds of enthesitis in any entheseal site increased with BMI (p= 0.015, Exp(B) = 1.407, 95%-CI(1.068, 1.852).

Binary logistic regression model did not show any significant association between sex, age, handedness, amount of SMM or training volume of strength training and the prevalence of joint effusion or enthesis pathology in the examined participants.

Conclusion:

Joint effusion in large and mid-sized joints as well as enthesitis are not only detected in patients with rheumatic diseases but also in healthy individuals. Hours of sports activity and BMI have a significant association with the findings and should be considered during ultrasound examination.

References:

[1]Colebatch AN, Edwards CJ, Østergaard M, van der Heijde D, Balint PV, D’Agostino M-A, u. a. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. Juni 2013;72(6):804–14.

[2]Padovano I, Costantino F, Breban M, D’Agostino MA. Prevalence of ultrasound synovial inflammatory findings in healthy subjects. Ann Rheum Dis. Oktober 2016;75(10):1819–23.

[3]Schäfer VS, Recker F, Vossen D, Ge I, Matuschek E, Hartung W. Prevalence of Elbow Joint Arthritis and Enthesitis in Rheumatoid Arthritis. 2020;11.

Disclosure of Interests:

Julia Konstanze Schreiner: None declared, Dennis Scheicht: None declared, Pantelis Karakostas: None declared, Charlotte Behning: None declared, Peter Preuss: None declared, Peter Brossart: None declared, Valentin Schäfer Speakers bureau: AbbVie, Novartis, BMS, Chugai, Celgene, Medac, Sanofi, Lilly, Hexal, Pfizer, Janssen, Roche, Schire, Onkowissen, Royal College London, Consultant of: Novartis, Chugai, AbbVie, Celgene, Sanofi, Lilly, Hexal, Pfizer, Amgen, BMS, Roche, Gilead, Medac, Grant/research support from: Novartis, Hexal, Lilly, Roche, Celgene, Universität Bonn

Tissue characterization of atherosclerotic plaques by intravascular ultrasound radiofrequency signal analysis: an in vitro study of human coronary arteries

BACKGROUND

Conventional gray-scale images of intravascular ultrasound (IVUS) cannot accurately differentiate histologic subtypes of sonolucent coronary plaques with or without a lipid core.

METHODS

We analyzed radiofrequency signals obtained in vitro from 24 regions of interest (ROI) of noncalcified (sonolucent) plaques in 10 atherosclerotic coronary artery specimens pressure-fixed by formalin. Radiofrequency signals were sampled with a 30-MHz IVUS catheter and digitized at 500 MHz in 8-bit resolution. The ROIs were histologically categorized into 12 plaques with a lipid core and 12 plaques without it. Integrated backscatter and statistical parameters of the radiofrequency envelope (mean/SD ratio [MSR], skewness, and kurtosis) within the ROI were calculated offline, and their ability to detect a lipid core was compared with visual analysis of the IVUS video images. In the group with lipid cores, percent area of a lipid core in each ROI was measured in a digitized histologic image by a computerized planimeter.

RESULTS

Sensitivity and specificity of MSR, skewness, and kurtosis for lipid core detection were substantially greater than visual video image analysis (83.3% and 91.7%, 100% and 91.7%, 100% and 91.7% vs 53.3% and 71.7%). Furthermore, the parameters of integrated backscatter, MSR, skewness, and kurtosis were significantly correlated to percent of core area (r = -0.64, -0.73, 0.78, and 0.63, respectively; P<.05).

CONCLUSIONS

Compared with IVUS video images, the parameters of radiofrequency signal analysis may be used to aid in more accurate detection and quantitative evaluation of a lipid core, which is one of the major factors of a vulnerable coronary plaque.

High levels of circulating adrenomedullin in severe illness: correlation with C-reactive protein and evidence against the adrenal medulla as site of origin

Adrenomedullin (AM) is a novel vasorelaxing peptide which was originally isolated from the extracts of human pheochromocytoma. It is produced by a number of organs among which the adrenal gland exhibits by far the highest concentrations. The peptide circulates in blood and its plasma levels have been reported to be increased in several diseases such as renal failure and sepsis. In the present study plasma concentrations of AM were measured in various forms of severe illness and compared to clinical and biochemical parameters in order to gain an insight into the factors controlling the plasma levels of this peptide. The highest concentrations of AM were found in patients with sepsis (344.4 +/- 60.4 pg/ml, n = 16) who exhibited up to 12-fold higher levels than a group of healthy subjects (74.1 +/- 4.1 pg/ml, n = 20). Markedly elevated levels were also measured in hemorrhagic (250.1 +/- 37.9 pg/ml, n = 9) and cardiogenic (216.2 +/- 29.4 pg/ml, n = 7) shock as well as in patients with cancer of the gastrointestinal tract (155.6 +/- 32.5 pg/ml, n = 11) or the lungs (146.5 +/- 19.1 pg/ml, n = 22). Plasma AM levels were positively correlated with serum creatinine concentrations in shock (r = 0.06, p < 0.001) and with C-reactive protein levels in patients with cancer (r = 0.64, p < 0.001) or sepsis (r = 0.63, p < 0.01). In order to examine the potential role of the adrenal gland as a site of AM release, hypoglycemia was induced in a group of healthy volunteers by graded infusion of insulin. Despite a more than 20-fold increase in plasma adrenalin indicating maximal stimulation of the adrenal medulla, no significant alterations of the plasma AM levels were observed. The study demonstrates that not only sepsis but also various forms of cancer and shock are associated with high levels of circulating AM. The correlation with C-reactive protein levels suggests a role of cytokines in mediating the elevations in plasma AM observed in sepsis and cancer. Reduced clearance of the peptide by the kidneys may be one of the mechanisms involved in the accumulation of AM in shock. The adrenal gland appears not to be a major source for circulating AM.

[Head lice infestation in the Cottbus district]

670 children of infant-schools and 109 children of schools were examined for head-lice. Also the existence of nits was valued. The identified infestation of 9.9% is to stimulate examinations in other districts of GDR and measures to form the search and the control of these ectoparasites with more effects.

Cytostatic extravasations

Sixty-six cases of cytostatic extravasation referred to a plastic surgery department between 1977 and mid-1985 are discussed. Doxorubicin was the most common drug involved, but a number of other drugs also caused lesions requiring surgical intervention. Operative treatment, consisting of excision of drug-infiltrated tissue followed by skin transplantation, was performed in half the patients. Significant residual damage was seen in 12 patients who had all received the drug at the elbow joint, wrist, or back of the hand. Fourteen patients were operated on late in the course of the disease, on average 10 weeks after the accident because of delayed referral. In 1983 prophylaxis was undertaken and first-aid treatment was administered, consisting of aspiration via the administration catheter. The nature of patient referrals then improved considerably. It is recommended that cytostatic treatment be given at the antebrachium, if possible, and that aspiration be attempted promptly after an accident. Manifest lesions should be operated on early, i.e., within the first week. The indication for early operation is particularly strong if a highly irritative drug has been deposited in a critical region and has caused a severe local reaction.