scholarly journals Can spectral doppler high specificity and gray scale nail assessment suggest inflammation in psoriatic arthritis patients and control groups?

2021 ◽  
Vol 13 (5) ◽  
pp. 137-142
Author(s):  
José Alexandre Mendonça ◽  
Vânia Aparecida Leandro-Merhi, ◽  
José Luis Braga de Aquino
Keyword(s):  
Psoriatic Arthritis ◽  
Statistical Significance ◽  
Power Doppler ◽  
Resistance Index ◽  
Hand Osteoarthritis ◽  
Gray Scale ◽  
Control Groups ◽  
Cross Sectional ◽  
Study Results ◽  
Spectral Doppler

Introduction: The use of high resolution ultrasonography (US) has become a very important tool in nail assessment. This study evaluated nails clinical and ultrasound measurements in psoriatic arthritis (PsA) patients. Methods: A cross sectional study was performed with a total of 60 patients, PSA patients, 10 healthy individuals and 6 hand osteoarthritis patients (OA). Only PsA patients meeting the CASPAR criteria were included in the study. Results: Spectral Doppler (sD) was used to analyze 208 nail beds. Nail plates on the gray scale (GS) showed loss of the normal three-layered pattern in 89 nails (45.9%). Power Doppler (PD) signal was detected in 189 nail beds (92.2%), showing inflammatory activity in most of the patients and nails assessed. Resistance index (RI) was significantly lower in PsA patients as compared to control groups in both the longitudinal and transverse planes (p<0.001).Nail enthesitis was observed when RI values were below 0.4, characterizing 100% sensitivity and 96% specificity (p<0.01). Conclusions: Nail US scanning presented statistical significance in PsA patients. Future studies could show many inflammatory situations, requiring treatment assessment.

scholarly journals SAT0415 AGE RELATIONSHIP WITH ULTRASOUND ARTICULAR AND ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS: CROSS-SECTIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1160.2-1161
Author(s):  
I. Fairushina ◽  
D. Abdulganieva ◽  
E. Kirillova ◽  
R. Abdrakipov
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Blood Biomarkers ◽  
Cross Sectional ◽  
Age Related ◽  
Hs Crp ◽  
Axial Involvement

Background:Detection of subclinical enthesitis and synovitis in psoriatic arthritis (PsA) is prevalent and ultrasound (US) examination is informative tool for it diagnosing. Aging positively affects degenerative changes.Objectives:To study relationship between US articular and entheseal findings with age in patients with PsA.Methods:57 patients were enrolled to study with fulfilled PsA criteria (CASPAR, 2009). Data collection: demographical, clinical (current psoriasis, axial involvement, enthesitis, dactylitis), US (synovitis count (by Grey Scale), Power Doppler(PD)+ synovitis), thickening and hypoechogenicity at enthesis, PD+ enthesitis, entheses with structural components); biological (high sensitive C-reactive protein (hsCRP), Erythrocyte Sedimentation Rate (ESR).US examination included 798 joints and 3078 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number - 54). US entheseal findings were fixed according to consensus-based US definition and scoring for enthesitis in spondyloarthritis and PsA (OMERACT US)1.Results:In all 57 patients: male - 25 (43.9%), mean age 43.4±10.3(SD) years (y), PsA duration was 7 (3;10) y, Ps duration 10 (8; 22) y; 53 (41.1%) had axial involvement, 42 (73.7%) dactylitis, 8 (14%) clinical enthesitis, and 56 (98.2 %) skin psoriasis, Psoriasis Activity and Severity Index score 6.4 (2;14.4), Disease Activity in PsA score 18.1 (10.2;26.1), hsCRP 10.1(2.4;21.4), ESR 20 (11.3;31.5).Synovitis count increased with age noticeably (r=0.508, p<0.01), and weak correlation of PD+ synovitis (r=0.262, p=0.049) and age was found. The entheseal thickening and hypoechogenicity and structural findings increased with age respectively (r=0.345, p=0.009; r=0.337, p=0.01). There was no correlation between PD+ enthesitis and age. The assosiation between PD+ enthesitis and blood biomarkers of inflammation (hs-CRP (r=0.364, p=0.008); ESR (p=0.358, p=0.008) was found.Conclusion:Our study found significant relationship between age and US synovitis. Association between age and US entheseal involvement was noted. Only PD+ enthesitis was not related with age in comparison with other US entheseal findings. The presence of PD US signal at enthesitis in association with increased inflammatory blood biomarkers can be evaluated as the sign of disease activity regardless of age and not as age-related lesion in PsA patients.References:[1]Balint PV, Terslev L, Aegerter P et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis.;2018;77(12):1730-1735.Disclosure of Interests:None declared

Enthesitis

2013 ◽  
pp. 398-403
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents and other biologics have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2016 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2013 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritides (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term 'enthesis organ' has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

scholarly journals Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study

2019 ◽  
Vol 46 (8) ◽  
pp. 904-911 ◽  
Author(s):  
Pierluigi Macchioni ◽  
Carlo Salvarani ◽  
Niccolò Possemato ◽  
Marwin Gutierrez ◽  
Walter Grassi ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Examination ◽  
Clinical Evaluation ◽  
Multicenter Study ◽  
Clinical Assessment ◽  
Systemic Therapy ◽  
Fibromyalgia Syndrome ◽  
Power Doppler ◽  
Cross Sectional ◽  
Doppler Examination

Objective.The purpose of the ULISSE study was to evaluate the prevalence of clinical and ultrasonographic (US) entheseal involvement in patients with psoriatic arthritis (PsA), psoriasis, and fibromyalgia syndrome (FMS).Methods.In this cross-sectional multicenter study, patients with PsA and psoriasis (not taking systemic therapy) and FMS underwent a clinical evaluation of the entheses, and a B-mode and power Doppler examination of 6 pairs of entheses.Results.The study analyzed 140 patients with PsA, 51 with psoriasis, and 51 with FMS. Clinical and US examinations were performed in 1960 and 1680 entheses in the PsA group, and 714 and 612 entheses both in the psoriasis group and in the FMS group. In both per-patient and per-enthesis evaluation, the frequency of entheseal tenderness was higher in patients with FMS (92% of the patients and 46% of the entheses, compared with 66%/23% in the PsA group and 59%/18% in the psoriasis group). With US examination, signs of entheseal involvement were more frequent in both the per-patient and per-enthesis evaluation in PsA and psoriasis (about 90% of patients in both the PsA and psoriasis groups and 75% of patients in the FMS group had at least 1 site affected, and 54%, 41%, and 27% of the pairs of entheses in, respectively, PsA, psoriasis, and FMS patients showed at least 1 enthesis involved).Conclusion.The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

scholarly journals BARRIERS TO IMPLEMENTATION OF NURSING PROCESS AMONG NURSES WORKING IN NAROK COUNTY REFERRAL HOSPITAL

2020 ◽  
Vol 5 (4) ◽  
pp. 15
Author(s):  
Anna Saretin Lekenit ◽  
Ruth G. Gatere ◽  
Agnes K. Mutinda
Keyword(s):  
Work Experience ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Referral Hospital ◽  
Unique Contribution ◽  
Nursing Process ◽  
Chi Square ◽  
Cross Sectional ◽  
Process Implementation ◽  
Study Results

Purpose of the study: This study therefore assessed barriers of nursing process implementation by Narok County Referral Hospital nurses. Methodology: A descriptive cross sectional study design was used to collect data from 102 randomly sampled nurses in NCRH. The study instruments used were self-administered questionnaires and key informant interview. SPSS version 20.0 was used to analyze quantitative data and sample characteristics were analyzed using mean and median. Themes were used to analyze qualitative data and narratively presented. Association between the study variables was calculated using chi square at 95% level of significance while statistical significance of results obtained was calculated using p values of 0.05. Data analysis was presented using tables and graphs. Approval was sought from relevant authorities. Results: The study results revealed that female participants were the majority at (70.6%). Most participants (71.6%) had attained diploma level of education and among them, 92.2% had received training in nursing process. Majority 95 (93.2%) were observed not to implement nursing process and of those who implemented, only 1 (1%) correctly outlined all the steps, a sign of poor nursing process implementation. NP implementation was of statistical significance with age of nurses as 18 out of 29 of younger nurses aged 21-30 years were found to actively practice it (p =0.001, work experience (p = 0.001), training (p > 0.05): institutional factors (p = 0.001). Unique contribution to theory, practice and policy: Nursing process mainstreaming interventions such as regular staff refresher courses and mentorship On NP in the hospitals, availability of relevant resources: human resource and supplies can highly mitigate these barriers.

scholarly journals Can Rheumatoid factor and Anti-cyclic citrullinated peptides predict true remission in rheumatoid arthritis patients? Study of relationship between autoantibodies levels and muskuloskelatal ultrasound findings in a sample cohort of Egyptian patients in clinical remission

2021 ◽  
Author(s):  
Eman Hassan Al Sayed ◽  
Doaa Shaker Amin
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatoid Factor ◽  
Clinical Remission ◽  
Power Doppler ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Gray Scale ◽  
Cross Sectional

Abstract BackgroundTrue remission is the ultimate goal for rheumatoid arthritis (RA) therapy. Our aim was to investigate the relationship between serum levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (Anti-CCP) and ultrasonographic (US) findings in Egyptian RA patients in clinical remission.MethodsUsing data from a cross-sectional study on 50 RA patients in clinical remission or low disease activity (LDA) as defined by disease activity score (DAS28-ESR) cutoff points, performed in Alexandria University Hospital; we analyzed statistical relationships and correlations between RF, Anti-CCP) and Gray Scale (GS) and Power Doppler (PD) US using US7 score. US remission was defined as on a GS ≤ 1 and PD = 0. ResultsAmong 34 patients in clinical remission, 61.8% (21) of patients in clinical remission were in ultrasonographic remission, and 38.2% (13) of patients in clinical remission had subclinical ultrasonographic activity. Patients in clinical remission with US remission had significantly higher Anti-CCP (p= 0.006) but not RF (p= 0.086), than those in clinical remission with US subclinical activity. Anti-CCP positively correlated with synovitis score by power Doppler US (PDUS) (rs= 0.553, p= 0.001), and tenosynovitis/paratenonitis score by gray scale US(GSUS) (rs=0.389, p= 0.023).ConclusionWe demonstrated that patients in clinical RA remission with subclinical US activity had higher serum levels of Anti-CCP, but not RF. Such an association should guide further treatment decisions for those patients.

scholarly journals Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Samanta Daiana De Rossi ◽  
José Alexandre Mendonça ◽  
Penelope Ester Palominos ◽  
Charles Lubianca Kohem ◽  
Tania Ferreira Cestari ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Plate Thickness ◽  
Nail Plate ◽  
Resistance Index ◽  
Cross Sectional Study ◽  
Type I ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nail Bed ◽  
Nail Matrix

Abstract Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

scholarly journals FRI0424 PROGRESSION OF PAIN, STIFFNESS, FUNCTION CHANGES AND ULTRASOUND DETECTED CHANGES IN THE GROUP OF 151 PATIENTS WITH HAND OSTEOARTHRITIS OVER THREE YEARS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 810.1-810
Author(s):  
O. Sleglova ◽  
O. Růžičková ◽  
K. Pavelka ◽  
L. Šenolt
Keyword(s):  
Joint Pain ◽  
Clinical Symptoms ◽  
Power Doppler ◽  
Joint Stiffness ◽  
Hand Osteoarthritis ◽  
Gray Scale ◽  
Erosive Disease ◽  
Osteophyte Formation ◽  
The Third

Background:Hand osteoarthritis (HOA) is a common and frequent cause of pain. HOA is a heterogeneous group of disorders with two main subsets including non-erosive and erosive disease. Few studies demonstrated inflammatory ultrasound changes and more severe clinical symptoms in patients with erosive compared with non-erosive disease, however the results are inconsistent.Objectives:The aim of this study was to evaluate progression of pain, stiffness, physical impairment and ultrasound features in patients with erosive and non-erosive HOA in a three years longitudinal study.Methods:Consecutive patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint pain and swelling were assessed. Patients reported joint pain on 100 mm visual analogue scale (VAS). Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). Erosive disease was defined by at least one erosive interphalangeal joint. Synovial hypertrophy and power Doppler signal (PDS) were scored with ultrasound. Synovitis was graded on a scale of 0–3 and osteophytes were defined as cortical protrusions seen in two planes. Patients were examined at baseline and at the first, second and third year of follow-up.Results:Altogether, 151 patients (16 male) with symptomatic nodal HOA were included in this study and followed between April 2012 and January 2020. Out of these patients, 84 (4 male) had erosive disease. The disease duration (p<0.05) was higher in patients with erosive compared with non-erosive disease.Pain reported on VAS was significantly higher (p<0.01) in patients with erosive compared with non-erosive disease at baseline. Progression of pain after the third year of follow up was significantly higher in patients with erosive disease (p<0.01). The number of painful and clinically swollen joints (p<0.05) was significantly higher in patients with erosive compared with non-erosive disease at baseline. It fluctuated over the second and third year of follow up, but it still remained statistically higher (p<0.01) at the third year of follow up in patients with erosive disease.According to the AUSCAN, patients with erosive compared with non-erosive disease had more pain (p<0.01) and stiffness (p<0.01) at baseline. Pain (p<0.05), stiffness and also function (p<0.05) worsened in patients with erosive compared with non-erosive disease at the third year of follow up.US-detected pathologies such as gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) and number of osteophytes (p<0.01) were significantly higher in patients with erosive compared with non-erosive disease at baseline. There were improvements in gray-scale synovitis total score and intensity of PDS in patients with non-erosive disease while patients with erosive disease worsened after the second and third year of follow up. US-detected gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) remained significantly higher in patients with erosive compared with non-erosive disease after the third year of follow up. On the other hand, the progression of US-determined osteophyte formation was observed in both groups but was significantly higher (p<0.05) in patients with erosive compared with non-erosive disease after the third year of follow up. .Conclusion:The findings of this study show that pain and number of painful and clinically swollen joints associated with US-detected synovial changes and osteophyte formation is more severe in patients with erosive HOA than in patients with non-erosive disease. In addition, osteophyte formation is more likely to progress independent of synovial inflammation.References:[1]Meersseman P, Van de Vyver C, Verbruggen G, et al. Clinical and radiological factors associated with erosive radiographic progression in hand osteoarthritis. Osteoarthritis and Cartilage 2015;23:2129-2133.Acknowledgments:This work was supported by the project MHCR 023728 and AZV No. 18-00542.Disclosure of Interests:Olga Sleglova: None declared, Olga Růžičková: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ladislav Šenolt: None declared

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