Development of clinically apparent synovitis: a longitudinal study at the joint level during progression to inflammatory arthritis

IntroductionSubclinical inflammation, detected by MRI, in patients with arthralgia is predictive for development of inflammatory arthritis (IA). However, within patients that develop IA, the course of inflammation at the joint level during this transition is unknown. This longitudinal study assessed progression of inflammation at the joint level.Methods350 joints (unilateral metacarpophalangeals (MCPs), wrist, metatarsophalangeal (MTP) joints) of 35 patients presenting with clinically suspect arthralgia (CSA) that progressed to IA were studied at presentation with CSA and subsequently when clinical synovitis was first identified at joint examination (median time interval 17 weeks). At both time points, subclinical inflammation (bone marrow oedema, synovitis, tenosynovitis) was evaluated with MRI and joint examination was performed.ResultsAt presentation with CSA, 71 joints showed subclinical inflammation. During progression to IA, 20% of these joints had resolution of inflammation, 60% had persistent inflammation and 20% progressed to clinical synovitis. Of all joints that had developed clinical synovitis (n = 45), no prior subclinical inflammation was detected in 69%. Similar results were observed for anticitrullinated protein antibodies (ACPA)-positive and ACPA-negative patients.ConclusionsThis longitudinal study demonstrated moderate correlations between joints with subclinical inflammation and joints that developed clinical synovitis. These data imply that IA development is a more systemic rather than a locally outgrowing process.

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SAT0091 Is clinical arthritis always preceded by subclinical inflammation? a longitudinal study at joint level in patients with arthralgia that developed arthritis

10.1136/annrheumdis-2017-eular.4693 ◽

2017 ◽

Author(s):

RM Ten Brinck ◽

HW van Steenbergen ◽

AH van der Helm-van Mil

Keyword(s):

Longitudinal Study ◽

Subclinical Inflammation ◽

Joint Level ◽

Clinical Arthritis

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Abstract 13248: The Impact of Instructions for Covering the Mouth and the Nose on Dispatch-Assisted Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.144.suppl_2.13248 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Hidetada Fukushima ◽

Hideki Asai ◽

Koji Yamamoto ◽

Yasuyuki Kawai

Keyword(s):

Cardiopulmonary Resuscitation ◽

Median Time ◽

Chest Compression ◽

Fire Department ◽

Emergency Call ◽

Time Interval ◽

Time Intervals ◽

Median Time Interval ◽

Study Results ◽

The Impact

Introduction: Under the SARS-CoV-2 pandemic, rescuers are recommended to cover their mouth and nose with a facemask or a cloth as well as victim’s mouth and nose when performing cardiopulmonary resuscitation (CPR). However, its impact on dispatch-assisted CPR (DACPR) has not been investigated well. Hypothesis: DACPR including the instruction for covering the rescuer’s and the victim’s mouth and nose can significantly delay the start of the first chest compression. Methods: We retrospectively analyzed DACPR records of the Nara Wide Area Fire Department, covering population of 853,000/3361km 2 , in Japan. We investigated the key time intervals of 505 DACPR records between May 2020 and March 2021. We also compared the results to that of the same period in 2019 (535 records). Results: Dispatchers failed to provide mask instruction in 322 cases (63.8%). The median time interval from the emergency call and the start of CPR instruction was longer in 2020 (197 seconds vs 190 seconds, p=0.641). The time to the first chest compression was also delayed in 2020 (264 seconds vs 246 seconds, p=0.015). Among the cases that dispatchers successfully provided mask instruction (183 cases, 36.2%), median time intervals to the start of instruction and the first chest compression were relatively faster than cases without mask instruction (177 seconds vs 211 seconds and 254 seconds vs 269.5 seconds, respectively). Conclusions: Dispatchers failed to provide mask instruction in the majority of CA cases. However, our study results indicate that the impact of mask instruction on DACPR can be minor in terms of immediate CPR provision.

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Carotid Endarterectomy: Are We Meeting the Two Week Target?

Scottish Medical Journal ◽

10.1258/rsmsmj.54.2.27 ◽

2009 ◽

Vol 54 (2) ◽

pp. 27-29 ◽

Cited By ~ 9

Author(s):

RV Guest ◽

JMJ Richards ◽

SCA Fraser ◽

RTA Chalmers

Keyword(s):

Health Services ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Median Time ◽

Retrospective Review ◽

Stroke Prevention ◽

Time Interval ◽

Median Time Interval ◽

Timing Of Onset ◽

Prevention Benefit

Objective It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred. Methods This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis. Results The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days. Conclusion The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.

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Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

Epidemiology and Infection ◽

10.1017/s0950268818000407 ◽

2018 ◽

Vol 146 (5) ◽

pp. 594-599 ◽

Cited By ~ 1

Author(s):

I. A. Turiac ◽

F. Fortunato ◽

M. G. Cappelli ◽

A. Morea ◽

M. Chironna ◽

...

Keyword(s):

Laboratory Investigation ◽

Median Time ◽

Surveillance System ◽

Case Reports ◽

Quality Data ◽

Time Interval ◽

System Sensitivity ◽

Apulia Region ◽

Median Time Interval ◽

Capture Recapture

AbstractThis study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

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Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-206734 ◽

2020 ◽

pp. jclinpath-2020-206734

Author(s):

Max G Mentink ◽

Frans C H Bakers ◽

Casper Mihl ◽

Max J Lahaye ◽

Roger J M W Rennenberg ◽

...

Keyword(s):

Daily Practice ◽

Postmortem Examination ◽

Time Interval ◽

Implementation Study ◽

Autopsy Rate ◽

Postmortem Ct ◽

Next Of Kin ◽

Median Time Interval ◽

Mortality Review ◽

Postmortem Examinations

AimThe aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.MethodsFor a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.ResultsThe postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.ConclusionsOur study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

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Does Drug Allergy Workup in Children Satisfy Their Parents?

International Archives of Allergy and Immunology ◽

10.1159/000518583 ◽

2021 ◽

pp. 1-7

Author(s):

Pinar Gokmirza Ozdemir ◽

Velat Celik ◽

Burcin Beken ◽

İbrahim Arcanlı ◽

Mehtap Yazicioglu

Keyword(s):

Drug Allergy ◽

Pediatric Patients ◽

Time Interval ◽

Procedure Time ◽

Multiple Choice Questions ◽

Pediatric Allergy ◽

Provocation Tests ◽

Median Time Interval ◽

Drug Provocation Tests ◽

Telephone Questionnaire

Introduction: Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming. The aim of this study was to assess parents’ perception of and satisfaction with their child’s drug allergy workup. Further, to evaluate parents’ tendency to use the tested drug following a negative DPT and the consequences of re-exposure. Methods: Parents of children that underwent drug allergy workup from January 2017 to August 2020 in the Pediatric Allergy Department of Trakya University Medical Faculty were included. Satisfaction levels were assessed via a telephone questionnaire (3 open-ended, 7 multiple-choice questions). Satisfaction was scored on a Likert scale (1: very unsatisfied and 5: very satisfied). Results: A total of 102 parents participated the study. Fifty-two (51%) of patients were male, and median age was 6.2 years and a median time interval between admission and test appointment of 1 month; 16.7% had a positive drug allergy workup, with 88.3% reporting being satisfied (56.9%) or very satisfied (31.4%) with the workup. Satisfaction levels were inversely related to the time between admission and test appointment (rho: −0.254, p = 0.01), with 8.2% reporting they did not use the tested drug when necessary despite a negative result. The tested drug was used by 35 individuals (41.1%), 33 (94.2%) tolerating without reaction. Conclusion: Most parents were satisfied with the workup, but levels were inversely related to the admission and procedure time interval. Drug allergy workup should be performed as soon as possible to relieve parents’ anxiety and achieve more patient satisfaction.

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Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis?

Arthritis Research & Therapy ◽

10.1186/s13075-018-1587-y ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Aleid C. Boer ◽

Robin M. ten Brinck ◽

Andrea W. M. Evers ◽

Annette H. M. van der Helm-van Mil

Keyword(s):

Psychological Stress ◽

Inflammatory Arthritis ◽

Subclinical Inflammation

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Anticitrullinated Protein Antibodies and Rheumatoid Factor Fluctuate in Early Inflammatory Arthritis and Do Not Predict Clinical Outcomes

The Journal of Rheumatology ◽

10.3899/jrheum.120736 ◽

2013 ◽

Vol 40 (8) ◽

pp. 1259-1267 ◽

Cited By ~ 29

Author(s):

Lillian Barra ◽

Vivian Bykerk ◽

Janet E. Pope ◽

Boulos P. Haraoui ◽

Carol A. Hitchon ◽

...

Keyword(s):

Rheumatoid Factor ◽

Clinical Outcomes ◽

Inflammatory Arthritis ◽

Health Assessment ◽

Erosive Disease ◽

Course Of Disease ◽

Number Of Patients ◽

Study Population ◽

Early Inflammatory Arthritis ◽

Anticitrullinated Protein Antibodies

Objective.In inflammatory arthritis, rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe clinical outcomes. Our objective was to determine whether ACPA and RF remain stable in early inflammatory arthritis and whether their trajectories over time or baseline levels predicted clinical outcomes.Methods.The study population consisted of patients enrolled in the Canadian Early Arthritis Cohort Study with baseline and at least 12-month followup values of RF and ACPA. Primary outcomes were Disease Activity Score (DAS) remission and the presence of erosions at 12 and 24 months. Other objectives included swollen joint count, Health Assessment Questionnaire score, and DAS.Results.At baseline, 225/342 (66%) patients were ACPA-positive and 334/520 (64%) were RF-positive. At 24 months, 15/181 (8%) ACPA-positive patients became negative. A larger number of patients changed from ACPA-negative to positive: 13/123 (11%). For RF, fluctuations were more common: 67/240 (28%) reverted from positive to negative and 21/136 (18%) converted from negative to positive. RF and ACPA fluctuations did not predict disease outcomes. Patients who remained ACPA-positive throughout followup were more likely to have erosive disease (OR 3.86, 95% CI 1.68, 8.92).Conclusion.RF and ACPA have the potential to revert and convert during the early course of disease. Fluctuations in RF and ACPA were not associated with clinical outcomes.

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Association between bacterial vaginosis and partner concurrency: a longitudinal study

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052652 ◽

2016 ◽

Vol 94 (1) ◽

pp. 75-77 ◽

Cited By ~ 9

Author(s):

Chris R Kenyon ◽

Jozefien Buyze ◽

Mark Klebanoff ◽

Rebecca M Brotman

Keyword(s):

Longitudinal Study ◽

Bacterial Vaginosis ◽

Mixed Effects ◽

Time Interval ◽

Vaginal Smears ◽

Nugent Score ◽

Time Period ◽

Partner Concurrency ◽

The Relationship ◽

Amsel Criteria

ObjectivesThe study aimed to test if there was an association between prevalent bacterial vaginosis (BV) and women reporting that their partner had other partners at the same time (partner concurrency). This association has not been assessed in a longitudinal cohort.MethodsThe Longitudinal Study of Vaginal Flora recruited a cohort of 3620 non-pregnant women aged 15–44 years who presented for routine primary healthcare at 12 clinics in Birmingham, Alabama. Behavioural questionnaires and vaginal smears were obtained quarterly for a year and BV was defined by a Nugent score 7 or higher as well as Amsel criteria. Mixed effects logistic regression was used to assess the relationship between prevalent BV and reporting that one's partner had other partners in the preceding 3–6 months time interval.ResultsNugent score prevalent BV was associated with both reporting that one's partner definitely (adjusted OR (aOR) 1.5; 95% CI 1.2 to 1.8) and possibly (aOR 1.5; 95% CI 1.2 to 1.8) engaged in partner concurrency in the preceding 3–6 months time period. Prevalent BV diagnosed by Amsel criteria was similar.ConclusionsA diagnosis of prevalent BV was associated with reporting that one's partner possibly or definitely engaged in partner concurrency.

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