AB0501 CORRELATION BETWEEN AXIAL AND PERIPHERAL ENTHESIS IN SPONDYLARTHRITIS

Background:Enthesitis is the clinical hallmark of spondylarthritis. It refers to the inflammation of joint attach in the bone. Several sites enthesitis may be affected, and a wide variety of scoring systems were available.Objectives:We aimed to determine the prevalence of axial enthesitis in the anterior chest wall (ACW), and its correlation with peripheral sites especially, the Achilles tendon (AT).Methods:We conducted a prospective study including patients with SpA according to the ASAS criteria. Sociodemographic data, as well as disease characteristics, were recorded. The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess clinical entheses (first and seventh costochondral joints, posterior superior iliac spine, anterior superior iliac spine, iliac crest, and Achilles tendon insertion). The presence of enthesitis on the US was then assessed in the right and left sternoclavicular (SCJ), manubriosternal (MSJ) joints, as well as in the AT, using Esaote My Lab 50.Results:The study included 47 patients with SpA: axial (n=26), axial and peripheral (n=21). There was a female predominance (sex ratio: 0.2). The mean age was 42.2 years ± 12.6 [11-70]. The age of onset of the disease was <40 years in 59.6% of cases. Tenderness in entheseal sites was found in 63.8% of patients, especially in the plantar fascia and AT (32.7%, 6%, respectively). The mean MASES score was 2.9 [0-13]. Clinical ACW involvement (29.1%) was at follows: 1st right chondro-sternal joint (CSJ) (19.1%), 1st left CSJ (25.5%), 7th right CSJ (27.7%) and 7th left CSJ (31.9%).US involvement of the ACW was 14.3%. Enthesitis of the AT was found in 70% of cases on US examination. ACW US involvement was correlated neither to the BMI nor to MASES score (p=0.16, p=0.6 respectively). Similarly, there was no correlation between the presence of US ACW enthesitis and clinical nor the US AT enthesitis (p=0.09, p=0.209, respectively).Conclusion:Our study showed that ACW enthesitis is frequent in SpA, especially by US screening. This axial enthesitis, don’t necessarily reflect a simultaneous clinical or US involvement of the peripheral entheses. Further studies are needed to characterize this subtype of SpA.References:[1]Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol. 2015;42(1):87-92Disclosure of Interests:None declared.

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AB0797 ULTRASONOGRAPHIC ASSESSMENT OF ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6535 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1698.2-1699

Author(s):

I. Mahmoud ◽

S. Rahmouni ◽

A. Ben Tekaya ◽

S. Bouden ◽

R. Tekaya ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Achilles Tendon ◽

Patellar Tendon ◽

Clinical Examination ◽

Disease Duration ◽

Plantar Fascia ◽

Quadriceps Tendon ◽

The Mean ◽

Triceps Tendon ◽

Nail Involvement

Background:Entheseal involvement is a frequent and distinctive feature of psoriatic arthritis (PsA), often under diagnosed. It is especially associated with nail involvement. Because clinical examination is not sensitive enough for the detection of early signs of this involvement, US may be considered as an alternative imaging technique in the diagnosis of enthesopathy.Objectives:The aim of the present study is to evaluate US entheses abnormalities in PsA and their correlation with clinical characteristicsMethods:The study included patients diagnosed with PsA according to the CASPAR criteria. They underwent a thorough clinical examination with special regard to the presence of enthesitis using the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index.The US study bilaterally explored entheses at six sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon. We evaluated the following elemental lesions of enthesis at each site: thickness and structure of the tendon, calcifications, bursae, erosions, power Doppler signal in bursa or enthesis full tendon.Results:Of the 33 patients, 39.4 % were male. The mean age was 51.2±12.5 years. The mean disease duration was 13.5±10.2 years.The mean DAPSA was 22.8± 19.7 [0.1-84.5]: remission(n=9), low activity (n=5),moderate activity (n=11),high activity(n=8).At inclusion, 11 patients (33.4%) patients presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1±16. Out of the 528 entheseal sites, 92 were tender at the palpation (17,4%) with a mean SPARCC at 2.87.A total of 396 entheseal sites were examined by US. In 140 of them (35.35%), US found at least 1 sign indicative of enthesopathy. The most affected tendon was the distal Achilles tendon (42/396), followed by proximal plantar fascia (32/396), distal patellar tendon (20/396), quadriceps tendon (20/396), distal brachial triceps tendon(14/396) and finally proximal patellar tendon (12/396).The most common elemental lesions were enthsophytes (176), erosions (114) and calcifications (50).We found a positive correlation between age and both calcification (r=0,4, p=0.021) and enthesophytes (r=0.479, p=0.005).We found a positive correlation between enthesophyte and the tender and swollen joints count (r= 0.352, p=0.045, r=0.378, p=0.03) and the SPARCC score (r=0.397, p=0.022).Patients with higher BASDAI had thicker tendons (r=0.355, p=0.05).Patients with nail dystrophy had more bursitis and erosions.US scores did not correlate with sexe, disease duration and disease activity measures (ASDAS, DAPSA, DAS28 and PASI). Patients with subclinical entheseal involvement didn’t have higher inflammatory biomarkers (ESR, CRP).Conclusion:US subclinical enthesopthy are not rare in psoriatic arthritis, in particular in patients with active disease.Clinical nail involvement was associated with bursitis and erosions. New studies including larger study groups are required to verify the findings of the present studyDisclosure of Interests:None declared

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Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

Surgical Innovation ◽

10.1177/15533506211057633 ◽

2021 ◽

pp. 155335062110576

Author(s):

Islam A. Elzahaby ◽

Mosab Shetiwy ◽

Amr Hossam ◽

Amr Elafy

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Chest Wall ◽

Anterior Chest Wall ◽

Selective Neck Dissection ◽

Open Approach ◽

Primary Tumors ◽

Estimated Blood Loss ◽

The Mean ◽

Neurovascular Structures

Introduction This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Methods From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Results The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10–50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. Conclusion Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.

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Ultrasonographic Evaluation of the Anterior Chest Wall in Spondyloarthritis: A Prospective and Controlled Study

The Journal of Rheumatology ◽

10.3899/jrheum.140409 ◽

2014 ◽

Vol 42 (1) ◽

pp. 87-92 ◽

Cited By ~ 9

Author(s):

Frank Verhoeven ◽

Xavier Guillot ◽

Marie Godfrin-Valnet ◽

Clément Prati ◽

Daniel Wendling

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Chest Wall ◽

Disease Duration ◽

Activity Index ◽

Power Doppler ◽

Anterior Chest Wall ◽

Joint Effusion ◽

Controlled Study ◽

Control Subjects

Objective.To determine the prevalence and type of ultrasonographic (US) lesions of the anterior chest wall (ACW) in cases of spondyloarthritis (SpA).Methods.This monocentric, prospective, and controlled study included patients consulting for SpA (Assessment of Spondyloarthritis International Society criteria) and control subjects. Clinical (pain and swelling) and US assessments (synovitis, joint effusion, erosion, ankylosis, margin narrowing, or Doppler signal) were performed on the sternoclavicular (SCJ) and the manubriosternal (MSJ) joints. The main characteristics of SpA were recorded [disease duration, biologic features, Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), radiographic and extraarticular involvement].Results.The study included 131 patients with SpA and 49 control subjects (same age and sex ratio). Clinical and US involvement of ACW were found in, respectively, 39% and 35.5% of SpA and in 12% and 14.3% of controls (p < 0.01). US highlighted erosions (34 vs 0), margin narrowing (12 vs 0), power Doppler activity (18 vs 2; p < 0.05), and ankylosis of the MSJ (24 vs 3). US involvement was associated with disease duration (14.9 vs 11.1 years; p = 0.04), age (45 vs 41 years; p = 0.004), radiographic change of sacroiliac joint (p = 0.05), and presence of inflammatory bowel disease (IBD; p = 0.03). No associations were found with HLA-B27, psoriasis, enthesitis, uveitis, or clinical involvement of ACW. Clinical involvement is associated with a higher BASDAI (47 vs 32; p = 0.0009) and ASDAS (2.9 vs 2.2; p = 0.006).Conclusion.US involvement of ACW is frequent in SpA (36.5%), mainly with erosion of SCJ and ankylosis of MSJ. It is associated with disease duration, radiographic sacroiliitis, and IBD.

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Anterior Chest Wall in Axial Spondyloarthritis: Imaging, Interpretation, and Differential Diagnosis

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0038-1639472 ◽

2018 ◽

Vol 22 (02) ◽

pp. 197-206 ◽

Cited By ~ 5

Author(s):

Lennart Jans ◽

Anne Jurik ◽

Iwona Sudoł-Szopińska ◽

Claudia Schueller-Weidekamm ◽

Iris Eshed ◽

...

Keyword(s):

Chest Wall ◽

Disease Burden ◽

Axial Spondyloarthritis ◽

Scoring Systems ◽

Anterior Chest Wall ◽

Clinical Findings ◽

Imaging Modalities ◽

Response To Treatment ◽

Cross Sectional ◽

Cross Sectional Imaging

AbstractAnterior chest wall (ACW) inflammation is not an uncommon finding in patients with axial spondyloarthritis (ax-SpA) and reportedly occurs in 26% of these patients. Radiologists may only be familiar with spinal and peripheral joint imaging, possibly due to the inherent challenges of ACW imaging on some cross-sectional imaging modalities. Knowledge of relevant joint anatomy and the location of sites of inflammation allows the interpreting radiologist to better plan appropriate imaging tests and imaging planes. Accurate assessment of disease burden, sometimes in the absence of clinical findings, may alert the treating rheumatologist, allowing a better estimation of disease burden, increased accuracy of potential imaging scoring systems, and optimize assessment and response to treatment. This article reviews salient anatomy and various imaging modalities to optimize diagnosis, important differential diagnoses, and the interpretation of ACW imaging findings in ax-SpA.

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AB0919 WHAT IS LOWER EXTREMITY ENTHESEAL INVOLVEMENT IN ACUTE GOUT ATTACK? AN ULTRASOUND-STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4138 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1760.2-1761

Author(s):

H. Cao ◽

G. Xu ◽

J. Lin

Keyword(s):

Lower Extremity ◽

Achilles Tendon ◽

Patellar Tendon ◽

Gouty Arthritis ◽

Power Doppler ◽

Plantar Fascia ◽

Controlled Study ◽

Acute Gout ◽

Tophaceous Gout ◽

Ultrasound Study

Background:Articular involvement in acute gout attack is extremely common and mainly characterized by arthritis, which are usually transient, severe, reversible and well responsive to treatment. The involvement of tendons and entheses in lower extremity in monosodium urate-related disease through US (ultrasound) assessment have been described1,2. US findings in gout raising the hypothesis that entheseal involvement could be a missing target in the clinical evaluation of gout patients.Objectives:To evaluate by ultrasound (US) the frequency and characteristics of lower extremity entheseal involvement in acute gout attack patients.Methods:US assessment were performed by independent rheumatologist on 31 patients with acute gout attack. Presence of lower extremity entheseal involvement were evaluated by grey-scale (GS) and power Doppler (PD). US assessment contain quadriceps, patellar and Achilles tendons, and plantar fascia entheses according to the OMERACT definitions.Results:US revealed one or more abnormalities in at least one enthesis in 22 out of 31 gout patients (71.0%) and 47 out of 310 entheses (15.2%). Among the affected entheses, the patellar insertion of quadriceps tendon was most commonly involved (57.4%) during acute gout attack, followed by the calcaneal insertion of the Achilles tendon (17.0%) and distal insertion of the patellar tendon (14.9%). The proximal insertion of the patellar tendon and calcaneal insertion of the plantar fascia were involved in 8.5% and 2.1%, respectively. Bone erosions and osteophytes were found in affected entheses (10.6% and 25.5%, respectively).Conclusion:Our study identifies that lower extremity entheseal involvement is a missing target in the evaluation of patients with acute gout attack. US plays a key role in the assessment of both clinical and subclinical enthesitis in gout patients.References:[1]Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and Tendon Subclinical Involvement Suggestive of Gouty Arthritis in Asymptomatic Hyperuricemia: an Ultrasound Controlled Study.J Rheumatol.2011;38(6):1195-1195.[2]Carroll M, Dalbeth N, Allen B, et al. Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls.J Rheumatol.2017;44(10):1487-1492.Disclosure of Interests:None declared

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Relation of Statistically Significant, Abnormal, and Typical WAIS-R VIQ-PIQ Discrepancies to Full Scale IQs

European Journal of Psychological Assessment ◽

10.1027//1015-5759.16.2.107 ◽

2000 ◽

Vol 16 (2) ◽

pp. 107-114 ◽

Cited By ~ 3

Author(s):

Louis M. Hsu ◽

Judy Hayman ◽

Judith Koch ◽

Debbie Mandell

Keyword(s):

Graphical Method ◽

The United States ◽

Full Scale ◽

True Score ◽

Absolute Value ◽

Normative Population ◽

The Us ◽

The Mean ◽

And Performance ◽

Quadratic Models

Summary: In the United States' normative population for the WAIS-R, differences (Ds) between persons' verbal and performance IQs (VIQs and PIQs) tend to increase with an increase in full scale IQs (FSIQs). This suggests that norm-referenced interpretations of Ds should take FSIQs into account. Two new graphs are presented to facilitate this type of interpretation. One of these graphs estimates the mean of absolute values of D (called typical D) at each FSIQ level of the US normative population. The other graph estimates the absolute value of D that is exceeded only 5% of the time (called abnormal D) at each FSIQ level of this population. A graph for the identification of conventional “statistically significant Ds” (also called “reliable Ds”) is also presented. A reliable D is defined in the context of classical true score theory as an absolute D that is unlikely (p < .05) to be exceeded by a person whose true VIQ and PIQ are equal. As conventionally defined reliable Ds do not depend on the FSIQ. The graphs of typical and abnormal Ds are based on quadratic models of the relation of sizes of Ds to FSIQs. These models are generalizations of models described in Hsu (1996) . The new graphical method of identifying Abnormal Ds is compared to the conventional Payne-Jones method of identifying these Ds. Implications of the three juxtaposed graphs for the interpretation of VIQ-PIQ differences are discussed.

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Atypical Type of Descending Necrotizing Fasciitis Spreading into the Anterior Chest Wall

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2009.52.9.767 ◽

2009 ◽

Vol 52 (9) ◽

pp. 767

Author(s):

Seung Kyun Kim ◽

Jun Ho Lee ◽

Chan Hum Park ◽

Jae Jun Lee

Keyword(s):

Necrotizing Fasciitis ◽

Chest Wall ◽

Anterior Chest Wall

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Effect of High Plane of Nutrition on Blood Biochemical Profile and Onset of Puberty in Prepubertal HF X Kankrej Crossbred Heifers

THE INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY ◽

10.21887/ijvsbt.15.2.4 ◽

2019 ◽

Vol 15 (02) ◽

pp. 14-17

Author(s):

K K Hadiya ◽

A J Dhami ◽

D V Chaudhari ◽

P M Lunagariya

Keyword(s):

Body Weight ◽

Treatment Group ◽

Plasma Levels ◽

Age Of Onset ◽

The Body ◽

Monthly Interval ◽

Control Group ◽

Blood Biochemical ◽

Lower Protein ◽

The Mean

This study was initiated on 24 prepubertal Holstein x Kankrej crossbred heifers of nearly identical age (7-9 months) and body weight (130-140 kg) at University farm to evaluate the effect of high plane of nutrition on blood biochemical and minerals profile and the age at puberty. Twelve heifers were managed under routine farm feeding (control) and the rest 12 under ideal optimum feeding regime (treatment) that included extra 1 kg concentrate, 30 g min mix and ad-lib dry fodder. The body weight and ovarian ultrasonography together with blood sampling was carried out at monthly interval from 10 to 18 months of age to study the ovarian dynamics and blood biochemical changes. High plane of nutrition to growing heifers was beneficial in reducing the age of onset of puberty (by 2-3 months) compared to routine farm fed group. The mean plasma total protein and cholesterol concentrations showed a rising trend with significant variations from 10 to 16 months of age, where it got mostly stabilized indicating adult profile. The activity of enzymes GOT and GPT also rose gradually and significantly from 10 months till 14-15 months of age, and thereafter it remained more or less static till 18 months of age. The levels of both these enzymes were higher, with lower protein and cholesterol, in control than the treatment group from 15-16 months of age onwards. The mean plasma levels of both calcium and phosphorus increased gradually and significantly with advancing age till 16-17 months of age, with little higher values in supplemented than a control group. The plasma levels of zinc, iron, copper, and cobalt also showed rising trend with significant differences between 10th and 12th-14th months of age, and from 15th to 18th months of age the levels were statistically the same in all the groups with slightly higher values in the treatment group.

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