In palindromic rheumatism, hand joint involvement and positive anti-CCP antibodies predict RA development after 1 year of follow-up

Abstract Objective This study evaluated anti-modified citrullinated vimentin (anti-MCV) performance in determining the clinical picture and outcomes of palindromic rheumatism (PR). Methods In a retrospective study, patients with PR with at least 1 year of follow-up diagnosed according to clinical criteria were enrolled. Anti-MCV antibodies were measured, and levels >20 IU/mL were considered positive. Disease prognosis was assessed according to patients acquiring remission and preventing PR from developing into rheumatoid arthritis (RA) or other diseases. Results Seventy-six patients with PR with a mean follow-up of 30.57 months (median = 21 months; minimum = 12 months; maximum = 48 months) were included in the study. Anti-MCV antibodies were positive in 69.7% of patients. Metacarpophalangeal (MCP) joint involvement and positive anti-cyclic citrullinated peptides were significantly higher in patients who were anti-MCV-positive, whereas ankle joint involvement was significantly lower. No significant correlation was observed between the anti-MCV titer and the severity of attacks. Remission in patients who were anti-MCV-positive and negative was 75.5% and 78.3%, respectively, with no significant difference. Evolution to RA was observed in only 3.8% of patients who were anti-MCV-positive. No patients who were anti-MCV-negative developed RA. Conclusion Except for MCP and ankle joint involvement, anti-MCV was not helpful in determining the clinical picture and outcome of PR.

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AB0806 DOES VITAMIN D INFLUENCE THE ACTIVITY OF THE DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4625 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1704.1-1705

Author(s):

L. Montolio-Chiva ◽

A. V. Orenes Vera ◽

M. Aguilar-Zamora ◽

C. Vergara-Dangond ◽

I. Vázquez-Gómez ◽

...

Keyword(s):

Vitamin D ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Functional Capacity ◽

Inverse Correlation ◽

Hypovitaminosis D ◽

Joint Involvement ◽

Average Value ◽

Vitamin D Levels

Background:Several studies have shown an inverse relationship between vitamin D levels (25OHD) and disease activity in patients with rheumatoid arthritis (RA). However, the existing data in patients with psoriatic arthritis (PsA) are poor, and they use the DAS28 index as a peripheral joint activity marker by extrapolation with RA.Objectives:To analyze the relationship between 25OHD levels, disease activity and functional capacity in patients with PsA.Methods:Transversal, observational, descriptive study. We included PsA patients with peripheral joint involvement. We collected demographic variables (gender, age), clinical variables [follow-up, received treatments, TJC (68), SJC (68), VAS] and analytical variables (25OHD, CRP, ESR). We usedDisease activity in psoriatic arthritis(DAPSA) score to measure disease activity, and theHealth assessment questionnaire(HAQ) to determine functional capacity. Levels of 25 OHD <20 ng/ml and between 20-30 ng/ml were considered deficient and insufficient, respectively. Statistical analysis was made with SPSS 22.0. The descriptive analysis results were expressed as percentage and mean ± SD. We used Pearson’s correlation to assess the association between quantitative variables and T test to compare means between dichotomous variables.Results:125 patients were included, the majority women (60.8%), with an average age of 55.4 (SD 12.2) years. The average follow-up was 75.5 (SD 68.3) months. 97.6% of patients had received DMARDs and 40.8% biologics, and almost half of the patients (42.7%) took calcium and 25OHD supplements. The average value of 25OHD was 27.1 (SD 12.1) ng/ml, with 30% of patients having 25OHD deficit and 63.3% insufficiency. The majority of patients had an acceptable disease control, with a mean DAPSA of 10.5 (SD 7,9); and mean of CRP, ESR, TJC and SJC was 6.1 (SD 3.7) mg/l, 10.2 (SD 9.9) mm/h, 1.3 (SD 2.5) and 0.7 (SD 2.1), respectively. The average value of HAQ was 0.6 (SD 0.7). We observed an inverse correlation between 25OHD levels and joint counts, TJC (p=0.02) and SJC (p=0.03). On the other hand, patients with hypovitaminosis D presented a tendency to get higher scores in DAPSA index (P=0.07). We do not observe any relationship between 25OHD and HAQ.Conclusion:As can be seen in our sample, low values of 25OHD are related to increased disease activity in patients with PsA.Disclosure of Interests:L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

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Surgical management of giant sacral schwannomas

Journal of Neurosurgery ◽

10.3171/jns.1986.65.3.0286 ◽

1986 ◽

Vol 65 (3) ◽

pp. 286-295 ◽

Cited By ~ 77

Author(s):

Chad D. Abernathey ◽

Burton M. Onofrio ◽

Bernd Scheithauer ◽

Peter C. Pairolero ◽

Thomas C. Shives

Keyword(s):

Preoperative Assessment ◽

Daily Activities ◽

Joint Involvement ◽

Complete Relief ◽

Minimal Risk ◽

Low Back ◽

Content Type ◽

Benign Schwannoma ◽

Anterior Aspect

✓ Thirteen cases of giant sacral schwannomas with erosion of the anterior aspect of the sacrum and associated intrapelvic extension are reviewed. These tumors showed no sex predilection; the patients' mean age was 38.6 years at the time of diagnosis, and their symptoms predated the diagnosis by an average of 5.2 years. The most common symptoms were low-back pain and lower-extremity dysesthesiae. Plain roentgenograms, myelography, and computerized tomography constituted essential and complementary studies in the preoperative assessment. Choice of surgical approach (anterior transabdominal vs. posterior transsacral) was dependent upon the amount of sacral destruction, intrapelvic extension, and sacroiliac joint involvement. Microscopic examination revealed classic features of benign schwannoma in all but three cases, which were classified as cellular schwannomas. Patients who presented with pain and dysesthesiae reported immediate and complete relief of symptoms following surgery. In addition, all 13 patients were ambulatory and able to resume their routine daily activities postoperatively. At the last reported follow-up examination, which ranged from 5 months to 33 years and 3 months (mean 9 years) after surgery, two patients had died of unrelated causes, two reported return of preoperative symptoms, and the remainder were asymptomatic. This experience suggests that these histologically benign but neurologically devastating tumors should be aggressively resected with the intent of complete extirpation, and that this goal may be accomplished with minimal risk and an excellent prognosis.

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AB0807 VITAMIN D ROLE IN VASCULAR DAMAGE PROGRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4583 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1705.2-1705

Author(s):

L. Montolio-Chiva ◽

M. Robustillo-Villarino ◽

A. V. Orenes Vera ◽

M. Aguilar-Zamora ◽

C. Vergara-Dangond ◽

...

Keyword(s):

Vitamin D ◽

Psoriatic Arthritis ◽

Vascular Damage ◽

Atherogenic Index ◽

Joint Involvement ◽

Type I ◽

Vascular Risk ◽

Damage Progression ◽

Atheromatous Plaques

Background:Psoriatic arthritis (PsA) is associated with insufficent levels of vitamin D (25OHD) and an increased cardiovascular risk. Several studies, have shown an inverse relationship between 25OHD levels and cardiovascular damage.Objectives:To study the relationship between 25OHD and vascular damage, as well as its possible influence on its progression, in patients with PsA.Methods:Pre-post longitudinal study with analytical components. PsA patients with peripheral joint involvement were included. Demographic (sex, age), clinical [follow-up time, DAPSA, current treatment, body mass index (BMI), classic vascular risk factors, vascular events] and analytical variables [atherogenic index, glomerular filtration (GF-MDRD), glycosylated hemoglobin (HbA1c), CRP, ESR, 25OHD] were collected. We considered deficient level of 25OHD <20 ng/ml and insufficient <30 ng/ml. Basal vascular risk was estimated through SCORE tool. Extracranial carotid artery was explored with an Esaote MyLab70XVG ultrasound with linear probe (7-12mHz) and an automated program that measures intima media thickness (IMT) by radiofrequency, and the presence of atheroma plaques was evaluated following Mannheim consensus. Pulse wave velocity (PWV) was measured through Mobil o graph® dispositive. IMT≥900 µ and PWV≥ 10m/s were considered as pathological values. We repeat vascular study 3 years later. Vascular damage progression was defined as the appearance of atheroma plaques during the follow-up and/or an increase in their number. Statistical analysis was performed using SPSS 22.0 program.Results:78 patients were included. Eighteen patients were excluded due to high vascular risk [previous event, diabetes type II or type I with target organ injury and/or GF-MDRD< 60 ml/min]. 57.5% were women with a mean age of 54.2 (SD 10.9) years. The mean follow-up time was 96.8 (SD 163.6) months and mean DAPSA was 10.2 (SD 8.3). 96.2% of patients had received DMARDs and 42.3% biologicals, and 42.3% took calcium and 25OHD supplements. Mean BMI was 27.5 (SD 4.7) kg/m2. 42.3% had tobacco exposure, 29.5% were hypertensive and 32% dyslipidemic. Mean SCORE was 1.6 (SD 1.8) and mean 25OHD was 27.6 (DSD 11.6) ng/ml. 28.2% patients had 25OHD deficit and 60.3 % insufficiency. At the beginning, 32.1 % of patients had atheromatous plaques with a number of plaques around 1.7 (SD 1.2), and 6.7% and 19.7% had a pathological IMT or PWV, respectively. Baseline, we had not observed any association between 25OHD and the presence of atheroma plaques, IMT or PWV. Three years later, we detected progression of vascular damage in 31.2% patients. In these patients, the existence of hypovitaminosis D was associate with the appearance of atheroma plaques (p=0.043). This association desappeared in the multivariate analysis, in which only the CRP influenced the appearance of atherome plaques (OR: 1.4, IC 95% 1.04-1.98, p=0.025).Conclusion:Low 25OHD levels are not related to vascular damage or influence a posible progression of it in our serie. As might be expected, the progression of vascular damage depends on the inflammatory load in these patients.Disclosure of Interests:L Montolio-Chiva: None declared, M Robustillo-Villarino: None declared, Ana V Orenes Vera: None declared, Marta Aguilar-Zamora: None declared, C Vergara-Dangond: None declared, I Vázquez-Gómez: None declared, Eduardo Flores: None declared, A Sendra-García: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, V Núñez-Monje: None declared, I Torner-Hernández: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

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Management of Brucellosis

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v3i1.8222 ◽

1970 ◽

Vol 3 (1) ◽

pp. 16-20

Author(s):

MA Samad Talukder ◽

ARE Mohamed ◽

MM Madkour ◽

Thur Y Albaage

Keyword(s):

Saudi Arabia ◽

High Temperature ◽

Diagnostic Criteria ◽

Clinical Presentation ◽

High Titre ◽

Agglutination Test ◽

Joint Involvement ◽

Slow Response ◽

Adequate Therapy

Experiences with management of 140 (82 males and 58 females) patients of brucellosis is presented. The diagnostic criteria was based on clinical presentation (fever, joint pains) and high titre positive brucella agglutination test. Forty-four (31.4%) patients responded in 2-9 days as evidenced by high temperature coming to normal on receipt of adequate therapy by tetracycline alone or in combination with streptomycin or other drugs. Inappropriate antibiotic in inappropriate doses was given to 23 (16.4%) patients resulting in a slow response. More than half 73 (52%) were not treated as they did not attend for follow up for result of investigation or misdiagnosis. The complications were bone and joint involvement and endocarditis. To give adequate therapy and avoid complications any patient with pyrexia in Saudi Arabia should be investigated for brucellosis.DOI: http://dx.doi.org/10.3329/bjms.v3i1.8222BJMS 1996; 3(1): 16-20

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Disability Related to Function of the Upper Extremities in Early Rheumatoid Arthritis – Course and Relation to Other Disease Parameters Over 10 Years: A Cohort Study

10.21203/rs.3.rs-67860/v1 ◽

2020 ◽

Author(s):

MARIA RYDHOLM ◽

INGEGERD WIKSTROM ◽

SOFIA HAGEL ◽

LENNART T.H. JACOBSSON ◽

CARL TURESSON

Keyword(s):

Rheumatoid Arthritis ◽

Early Rheumatoid Arthritis ◽

Grip Force ◽

Upper Extremities ◽

Joint Involvement ◽

Multivariate Linear Regression Analysis ◽

Clinical Parameters ◽

Early Ra ◽

Disease Parameters

Abstract Background: The objective of this study was to investigate the course of disability related to the upper extremities (UE) in early rheumatoid arthritis (RA), and to assess correlations between such disability and clinical parameters, including grip force. Methods: In an inception cohort of patients with early RA (N=222), disability of the UE was assessed using a subscore of the Health assessment questionnaire disability index (HAQ-DI), and average grip force of the dominant hand was measured. Changes between consecutive follow-up visits in the HAQ-DI-UE subscore were assessed using the paired samples t-test, and correlations with key disease parameters using Spearman’s rank test. The relation between joint involvement and HAQ-DI-UE was examined using multivariate linear regression analysis. Results: The HAQ-DI-UE decreased significantly from inclusion to the 6-month follow-up (mean change -0.26; 95% CI -0.18 to -0.34), and increased significantly after 2 years. There were fairly strong correlations for HAQ-DI-UE with grip force (r: -0.50 to -0.62), patient’s global assessment (r:0.58 to 0.64) and patient’s assessment of pain (r:0.54 to 0.60) at all time points up to 5 years, but only moderate to weak correlations with swollen joints, CRP and ESR. At inclusion wrist synovitis and tender PIP joints had both an independent impact on HAQ-DI-UE, whereas tenderness of the shoulder and the wrist had a greater importance at 6 months. Conclusions: Disability related to the upper extremities decreased significantly during the first 6 months, and increased again after 2 years. The correlations with clinical parameters underline the major impact of pain and impaired hand function in early RA.

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Successful treatment in a child with enthesitis-related arthritis involving the sternoclavicular joint: a case report

BMC Pediatrics ◽

10.1186/s12887-019-1770-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Po-Yu Huang ◽

Ling-Sai Chang ◽

Mindy Ming-Huey Guo ◽

Ho-Chang Kuo

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Bone Erosion ◽

Sternoclavicular Joint ◽

Joint Fluid ◽

Joint Involvement ◽

Rheumatic Arthritis ◽

Etanercept Treatment ◽

Limited Range Of Motion ◽

Uncommon Presentation

Abstract Background Although the sternoclavicular joint (SCJ) may be involved in ankylosing spondylitis, rheumatic arthritis, and Behçet’s disease and participates in the systemic inflammatory process of arthritis, it is often neglected during routine rheumatologic clinical examinations. To the best of our knowledge, this is the first study to report etanercept treatment in juvenile idiopathic arthritis (JIA) with SCJ involvement. Case presentation In this study, we describe an unusual case of a child with juvenile idiopathic arthritis with an initial presentation of sternoclavicular mass. The patient (age, 14 years 10 months) presented with an insidious onset atraumatic swelling of the left SCJ and complained of right hip and bilateral ankle tenderness without an apparent cause. Initial ultrasonography indicated a heterogeneous mass in the left SCJ, while computed tomography identified mild swelling of the left SCJ with a thickened synovial lining, mild bone erosion, and some turbid fluid. The patient ultimately underwent left SCJ arthrotomy, during which tapping of the SCJ revealed 2 cc of yellowish fluid, inflammation and necrosis of tissues within the SCJ. A clear yellow joint fluid was aspirated, and testing revealed a negative culture result. The patient was diagnosed with JIA. The joint tenderness improved and erythrocyte sedimentation rate decreased after administering anti-tumor necrosis factor etanercept. An additional ultrasonography demonstrated that the initial imaging findings have been resolved. At the end of a 2-year follow-up period, the patient was completely symptom-free. Conclusions JIA with SCJ involvement is an uncommon presentation in adolescents. Etanercept may be a beneficial treatment for SCJ involvement in patients with JIA. The upper limbs showed no signs of limited range of motion during the follow-up period. Further studies are warranted to elucidate the efficacy of etanercept in JIA with sternoclavicular joint involvement.

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Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age

Geriatrics ◽

10.3390/geriatrics6030065 ◽

2021 ◽

Vol 6 (3) ◽

pp. 65

Author(s):

Miguel Angel Martin-Ferrero ◽

Jose Maria Trigueros-Larrea ◽

Elsa Martin-de la Cal ◽

Begoña Coco-Martin ◽

Clarisa Simon-Perez

Keyword(s):

Long Term Results ◽

Joint Involvement ◽

Kaplan Meier ◽

Trapeziometacarpal Osteoarthritis ◽

Prevalent Disease ◽

Patient Selection Criteria ◽

Clinical And Radiological Results ◽

Surgical Treatments ◽

Joint Arthroplasties

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.

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The hemi-hamate autograft arthroplasty in proximal interphalangeal joint reconstruction: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414554356 ◽

2014 ◽

Vol 40 (1) ◽

pp. 24-32 ◽

Cited By ~ 25

Author(s):

F. S. Frueh ◽

M. Calcagni ◽

N. Lindenblatt

Keyword(s):

Systematic Review ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Fracture Dislocation ◽

Joint Involvement ◽

Level Of Evidence ◽

Systematic Analysis ◽

Joint Fracture ◽

Fracture Dislocations

Palmar lip injuries of the proximal interphalangeal joint with dorsal fracture-dislocation are difficult to treat and often require major reconstruction. A systematic review was performed and yielded 177 articles. Thirteen articles on hemi-hamate autograft were included in full-text analysis. Results of 71 cases were summarized. Mean follow-up was 36 months and mean proximal interphalangeal joint range of motion was 77°. Overall complication rate was around 35%. Up to 50% of the patients showed radiographic signs of osteoarthritis. However, few of those patients complained about pain or impaired finger motion. Based on this systematic analysis and review, hemi-hamate autograft can be considered reliable for the reconstruction of acute and chronic proximal interphalangeal joint fracture-dislocations with joint involvement >50%, but longer-term follow-up studies are required to evaluate its outcome, especially regarding the rate of osteoarthritis. Level of Evidence: II

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Atypical arthritis in a toddler: beware, save the heart

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201666 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1177

Author(s):

Sharani Boopathy ◽

Kanimozhi Thandapani ◽

Arulkumaran Arunagirinathan

Keyword(s):

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Age Of Onset ◽

Joint Involvement ◽

Cardiac Complications ◽

General Physical ◽

Systemic Examination ◽

High Index Of Suspicion ◽

Local Examination

Acute rheumatic fever still poses a dreadful threat to pediatric morbidity and mortality. A 2 year old toddler presented to us with non migratory polyarticular joint pain and swelling. General physical and systemic examination was normal. Local examination revealed swelling and tenderness of multiple small and large joints. Further evaluation fulfilled Modified Jones criteria and she was diagnosed to have acute rheumatic fever. Other close differentials were simultaneously ruled out. Child was started on naproxen because of aspirin toxicity. There was significant response for therapy and complete resolution of joint involvement was noted on follow up. We report this case to emphasize the fact that rheumatic fever might have bizarre clinical presentation and may also affect infants and toddlers deviating the typical age of onset. There is a need for earliest possible initiation of adequate management and follow up to prevent permanent cardiac complications. This warrants high index of suspicion even in uncommon age group.

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