scholarly journals Radiographic scoring systems for psoriatic arthritis are insufficient for psoriatic arthritis mutilans: results from the Nordic PAM Study

2020 ◽  
Vol 9 (4) ◽  
pp. 205846012092079
Author(s):  
Leena Laasonen ◽  
Ulla Lindqvist ◽  
Lars Iversen ◽  
Leif Ejstrup ◽  
Thorarinn Jonmundsson ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Destruction ◽  
Health Assessment ◽  
Joint Damage ◽  
Scoring Systems ◽  
History Of ◽  
The Mean ◽  
And Gender ◽  
Hands And Feet ◽  
Arthritis Mutilans

Background Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA). Purpose To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM. Material and Methods Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA. Results At inclusion, 55 PAM patients (49% women, mean age 58 ± 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 ± 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 ± 90.1 vs. 79.1 ± 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 ± 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r2 = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values. Conclusions The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage.

scholarly journals POS0573 IMPACT OF JOINT DESTRUCTION IN THE HANDS, THE WRISTS AND THE ANKLES ON THE ULTRASOUND ASSESSMENT AND THE FUNCTIONAL OUTCOMES IN RHEUMATOID ARTHRITIS IN REMISSION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 521.1-521
Author(s):  
R. Fakhfakh ◽  
N. El Amri ◽  
K. Baccouche ◽  
H. Zeglaoui ◽  
E. Bouajina
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Outcomes ◽  
Bone Erosion ◽  
Joint Destruction ◽  
Power Doppler ◽  
Health Assessment ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Mean ◽  
Hands And Feet

Background:Joint destruction is a strong predictive factor for residual synovitis among rheumatoid arthritis (RA) patients in clinical remission. Both of them were associated with functional impairment.Objectives:To assess the ultrasound findings and functional outcomes of RA patients in remission according to the site of joint destruction.Methods:A Cross-sectional study including RA patients in remission DAS28 ESR≤ 2.6 for at least 6 months. A B-mode and power doppler (PD) ultrasound of 42 joints was performed. Synovitis was defined and scored using the combined OMERACT-PDUS (gray scale and power doppler (PD)) scoring system graded from 0 to 3. The health assessment questionnaire (HAQ) and the radiological Sharp score of the wrists, hands and feet were calculated.Results:Thirty-seven patients were included. The sex ratio was 0.37 and the mean age was 54.2 years ± 12.7. The mean disease duration was 8.1 years±5.1. The mean remission duration was 36.5 months ± 32.7. The mean DAS28vs was 2.1 ± 0.5. Rheumatoid factor and anti-citrullinated peptide antibodies were found in 62% and 75% of patients, respectively. The mean HAQ was 0.35 ± 0.38. Bone erosion was found in 81% of patients. In patients with hands and feet erosions (54%), synovitis was found in 90% of cases associated with PD in 70% of cases. The mean total score of synovitis was 7.8 ± 5.4. The mean HAQ was 0.37 ± 0.44. In patients with only erosions in the hands or wrists (18.9%), synovitis was found in 100% of cases associated with PD in 57% of cases. The mean total score of synovitis was 4.5±4.7. The mean HAQ was 0.48 ± 0.34. In patients with only feet erosions (8.1%), synovitis was found in 100% of cases associated with PD in 66.7% of cases. The mean total score of synovitis was 4.6±3.5. The mean HAQ was 0.31 ± 0.26. RA was not erosive in 18.9% of patients. In these patients, synovitis was found in 100% of cases associated with PD in 28.6% of cases. The mean total score of synovitis was 5.6±4.3. The mean HAQ was 0.21 ± 0.23. There is no significant difference between these groups(p>0.05).Conclusion:In RA in remission, PD synovitis and functional incapacity were less frequent in the absence of erosion. PD synovitis was more frequently found in patients with erosions, especially, in the feet. The HAQ was higher in patients with hands erosions.References:[1]Hamamoto Y, Ito H, Furu M, Hashimoto M, Fujii T, Ishikawa M, et al. Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study. PLoS One. 2015;10(8):e0136611.Disclosure of Interests:None declared

scholarly journals Radiographic development during three decades in a patient with psoriatic arthritis mutilans

2015 ◽  
Vol 4 (7) ◽  
pp. 205846011558809 ◽  
Author(s):  
Leena Laasonen ◽  
Björn Guðbjörnsson ◽  
Leif Ejstrup ◽  
Lars Iversen ◽  
Thomas Ternowitz ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Early Diagnosis ◽  
Effective Treatment ◽  
Typical Case ◽  
Rare Form ◽  
Pip Joint ◽  
Hands And Feet ◽  
Arthritis Mutilans ◽  
Ratingen Score

Psoriatic arthritis mutilans (PAM) is the most severe and rare form of psoriatic arthritis (PsA). We describe radiological development in a typical case of PAM covering three decades in order to elucidate the need for early diagnosis of PAM. Radiographs of hands and feet, taken from 1981 to 2010, were evaluated using the Psoriatic Arthritis Ratingen Score (PARS). When PsA was diagnosed, in 1981, gross deformity was observed in the second PIP joint of the left foot. Several pencil-in-cup deformities and gross osteolysis were present in the feet in the first decade of the disease. Over 10 years, many joints had reached maximum scores. During the follow-up, other joints became involved and the disease developed clinically. Reporting early signs suggestive of PAM, e.g. pencil-in cup deformities and gross osteolysis in any joint, should be mandatory and crucial. This would heighten our awareness of PAM, accelerate the diagnosis, and lead to improved effective treatment in order to minimize joint damages resulting in PAM.

The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis

2010 ◽  
Vol 16a (2) ◽  
pp. 9-16 ◽  
Author(s):  
Majed Khraishi ◽  
Ian Landells ◽  
Gerry Mugford
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Damage ◽  
Screening Questionnaire ◽  
Optimal Score ◽  
Short Disease Duration ◽  
Established Disease ◽  
History Of ◽  
Optimal Cutoff Point ◽  
Disease Analysis ◽  
Early Psoriatic Arthritis

Background Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course. Objective The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis. Methods Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis. Results In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity. Conclusion The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration.

scholarly journals Implantation of Cardioverter-Defibrillator in Children With Long-QT Syndrome: Assessment of Indications, Efficacy, and Safety Based on 10-Year Experience

Kardiologiia ◽  
2018 ◽  
Vol 58 (12) ◽  
pp. 52-58 ◽  
Author(s):  
R. A. Ildarova ◽  
M. A. Shkolnikova ◽  
S. A. Termosesov
Keyword(s):  
Sudden Cardiac Arrest ◽  
Efficacy And Safety ◽  
Primary And Secondary Prevention ◽  
Icd Implantation ◽  
Age And Gender ◽  
Before And After ◽  
History Of ◽  
The Mean ◽  
High Doses ◽  
And Gender

Purpose: to assess specificities of course of the long­QT syndrome in children before and after implantation of cardioverter­defibrillator (ICD), and optimization of indications to ICD­therapy.Materials and methods. We included in this study 48 children with long­QT syndrome from 44 unrelated families (28 boys and 20 girls), who underwent ICD implantation at the mean age 11.8±3.8 years. Mean duration of follow­up after implantation was 5.2±2.8 years. Data from these children were compared with those from 59 children of comparable age and gender with long­QT syndrome from 46 unrelated families receiving antiarrhythmic therapy (β­adrenoblockers). We assessed clinical and electrocardiographic characteristics of the disease obtained at initial visit and their dynamics thereafter.Results. Children with long­QT syndrome and ICD were mainly probands with interval QT longer than 500 ms, recurrent syncope and often history of sudden cardiac arrest requiring high doses of β­adrenoblockers for control of ventricular tachyarrhythmias.Conclusion. ICD implantation is an effective and safe method both of primary and secondary prevention of sudden cardiac death in children with long­QT syndrome.

scholarly journals A Multicenter Nominal Group Study to Rank Outcomes Important to Patients, and Their Representation in Existing Composite Outcome Measures for Psoriatic Arthritis

2017 ◽  
Vol 44 (10) ◽  
pp. 1445-1452 ◽  
Author(s):  
William Tillett ◽  
Emma Dures ◽  
Sarah Hewlett ◽  
Philip S. Helliwell ◽  
Oliver FitzGerald ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Group Discussion ◽  
Health Assessment ◽  
Nominal Group Technique ◽  
Well Being ◽  
Nominal Group ◽  
Single Measure ◽  
Composite Measures ◽  
The Mean ◽  
Future Work

Objective.To rank outcomes identified as important to patients with psoriatic arthritis (PsA) and examine their representation in existing composite measures.Methods.Seven nominal group technique (NGT) meetings took place at 4 hospital sites. Two sorting rounds were conducted to generate a shortlist of outcomes followed by a group discussion and final ranking. In the final ranking round, patients were given 15 points each and asked to rank their top 5 outcomes from the shortlist. The totals were summed across the 7 NGT groups and were presented as a percentage of the maximum possible priority score.Results.Thirty-one patients took part: 16 men and 15 women; the mean age was 54 years (range 24–77; SD 12.2), the mean disease duration was 10.3 years (range 1–40; SD 9.2), and mean Health Assessment Questionnaire was 1.15 (range 0–2.63; SD 0.7). The highest-ranked outcomes that patients wished to see from treatment were pain with 93 points (20.0%), fatigue 62 (13.3%), physical fitness 33 (7.1%), halting/slowing damage 32 (6.9%), and quality of life/well-being 29 (6.2%). Reviewing existing composite measures for PsA demonstrated that no single measure adequately identifies all these outcomes.Conclusion.Pain and fatigue were ranked as the outcomes most important to patients receiving treatment for PsA and are not well represented within existing composite measures. Future work will focus on validating composite measures modified to identify outcomes important to patients.

Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage

2009 ◽  
Vol 69 (01) ◽  
pp. 230-233 ◽  
Author(s):  
M Ahlmén ◽  
B Svensson ◽  
K Albertsson ◽  
K Forslind ◽  
I Hafström
Keyword(s):  
Disease Activity ◽  
Pain Perception ◽  
Joint Destruction ◽  
Joint Damage ◽  
Area Under The Curve ◽  
Joint Space ◽  
Joint Disease ◽  
Similar Degree ◽  
Sharp Score ◽  
Hands And Feet

Objective:To evaluate gender differences in score on 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and Signals Of Functional Impairment (SOFI) and to relate these scores to radiographic joint destruction.Methods:In all, 549 patients with early RA (62% women) from the BARFOT (for “Better Anti-Rheumatic FarmacOTherapy”) study were included. At baseline, 1, 2 and 5 years DAS28, HAQ and SOFI scoring, and radiographs of hands and feet were performed. The radiographs were scored using the van der Heijde–Sharp score.Results:In women the DAS28 was significantly higher than in men due to higher scores for general health and tender joints. Likewise, HAQ and VAS pain were rated significantly higher in women. The SOFI score was worse in men during the first 2 years, depending on higher upper limb scores. Total Sharp score (TotSharp), erosion score and joint space narrowing score did not differ between the sexes at any time point. The DAS28 area under the curve (AUC) correlated significantly with TotSharp at 5 years in both genders (r = 0.316, r = 0.313) mainly owing to swollen joints and erythrocyte sedimentation rate (ESR). The SOFI AUC correlated significantly with TotSharp in women (r = 0.135 to 0.220) but not in men.Conclusions:Despite a similar degree of radiographic joint destruction women had, compared with men, worse scores for DAS28 and HAQ, possibly due to higher pain perception and less muscular strength and perhaps because men overestimate their functional capacity.

scholarly journals Evaluation of Hearing Status in Employees of Dental Prosthodontics Laboratories in Yazd

2020 ◽  
Author(s):  
Seyed Mohammad Abrisham ◽  
Mohammad Shafiee ◽  
Mohsen Abediny Sanich
Keyword(s):  
Hearing Loss ◽  
Statistical Tests ◽  
Hearing Threshold ◽  
Dental Prosthesis ◽  
Control Group ◽  
History Of ◽  
The Mean ◽  
And Gender ◽  
The Right ◽  
Experimental Group

Introduction: Noise Induced Hearing Loss (NIHL) is the first cause of acquired hearing loss. Dentists and dental prosthodontics technicians are exposed to different sounds produced by a variety of devices in their occupations. In this study, we studied the effect of dental prosthesis sounds on the auditory power of the respective staff. Methods: This case-control study was carried out among all technicians of dental prosthesis laboratories in Yazd in 2018 selected by census sampling method. A total of 23 technicians who were willing to cooperate and met the inclusion criteria were included in the experimental group. Furthermore,  23 people who referred to the audiology clinic, were matched with the experimental group in terms of age and gender, and were not working in noisy environment, and had no congenital or acquired deafness were examined as the control group.  Finally, the collected data were analyzed by SPSS version 19 using statistical tests. Result: The mean hearing threshold of the right ear at frequencies of 3000 and 4000 Hz and the mean hearing threshold of the left ear at frequencies of 3000, 4000, 6000, and 8000 Hz was significantly higher in the experimental than the control group. The mean hearing threshold of the right ear at the frequency of 4000 Hz and the hearing threshold of the left ear at frequencies of 3000, 4000, and 6000 Hz in participants with job history>4 years was significantly higher. Furthermore, the mean hearing threshold of the right ear in the frequency of 4000 Hz and the hearing threshold of the left ear at frequencies of 3000, 4000, and 6000 Hz years was significantly higher in people with job history >30 years. Conclusion: According to findings, the staffs working in dental prosthodontics laboratories suffer from NIHL at frequencies of 3000 to 8000 Hz. The hearing loss in the left ear was more severe  in  people with job history of >30 years and in people with job history of > 4 years.Therefore, the use of hearing impaired and hearing protectors is recommended in these people.

scholarly journals Do Genetic Susceptibility Variants Associate with Disease Severity in Early Active Rheumatoid Arthritis?

2015 ◽  
Vol 42 (7) ◽  
pp. 1131-1140 ◽  
Author(s):  
Ian C. Scott ◽  
Frühling Rijsdijk ◽  
Jemma Walker ◽  
Jelmar Quist ◽  
Sarah L. Spain ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Severity ◽  
Genetic Risk Score ◽  
Joint Destruction ◽  
Health Assessment ◽  
Joint Damage ◽  
Joint Disease ◽  
Nucleotide Polymorphisms ◽  
Radiological Progression ◽  
Weighted Genetic Risk Score

Objective.Genetic variants affect both the development and severity of rheumatoid arthritis (RA). Recent studies have expanded the number of RA susceptibility variants. We tested the hypothesis that these associated with disease severity in a clinical trial cohort of patients with early, active RA.Methods.We evaluated 524 patients with RA enrolled in the Combination Anti-Rheumatic Drugs in Early RA (CARDERA) trials. We tested validated susceptibility variants — 69 single-nucleotide polymorphisms (SNP), 15 HLA-DRB1 alleles, and amino acid polymorphisms in 6 HLA molecule positions — for their associations with progression in Larsen scoring, 28-joint Disease Activity Scores, and Health Assessment Questionnaire (HAQ) scores over 2 years using linear mixed-effects and latent growth curve models.Results.HLA variants were associated with joint destruction. The *04:01 SNP (rs660895, p = 0.0003), *04:01 allele (p = 0.0002), and HLA-DRβ1 amino acids histidine at position 13 (p = 0.0005) and valine at position 11 (p = 0.0012) significantly associated with radiological progression. This association was only significant in anticitrullinated protein antibody (ACPA)-positive patients, suggesting that while their effects were not mediated by ACPA, they only predicted joint damage in ACPA-positive RA. Non-HLA variants did not associate with radiograph damage (assessed individually and cumulatively as a weighted genetic risk score). Two SNP — rs11889341 (STAT4, p = 0.0001) and rs653178 (SH2B3-PTPN11, p = 0.0004) — associated with HAQ scores over 6–24 months.Conclusion.HLA susceptibility variants play an important role in determining radiological progression in early, active ACPA-positive RA. Genome-wide and HLA-wide analyses across large populations are required to better characterize the genetic architecture of radiological progression in RA.

GRAPPA 2013 Annual Meeting, Rheumatology Updates: Psoriatic Arthritis (PsA) Biomarker Project, Arthritis Mutilans, PsA-Peripheral Spondyloarthritis Epidemiology Project

2014 ◽  
Vol 41 (6) ◽  
pp. 1244-1248 ◽  
Author(s):  
Oliver FitzGerald ◽  
Philip J. Mease ◽  
Philip S. Helliwell ◽  
Vinod Chandran
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Joint Damage ◽  
Classification Criteria ◽  
Undifferentiated Arthritis ◽  
Psoriatic Disease ◽  
Inflammatory Bowel ◽  
Peripheral Spondyloarthritis ◽  
Arthritis Mutilans ◽  
Made In

At the 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), several key GRAPPA projects on musculoskeletal aspects of psoriatic disease were reviewed. In this article, lead investigators summarize the progress made in a multicenter study, the PsA BioDam (Psoriatic Arthritis Biomarkers for Joint Damage), to identify soluble biomarkers for joint damage, as well as developing classification criteria for arthritis mutilans. Also reviewed are concepts and rationale behind a proposal to study classification criteria for peripheral spondyloarthritis, including PsA, reactive arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated arthritis.

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