scholarly journals THE ROLE OF CONTRAST-ENHANCED ULTRASONOGRAPHY IN EARLY RHEUMATOID ARTHRITIS

2015 ◽  
Vol 24 (3) ◽  
pp. 132-140
Author(s):  
Maria-Magdalena Tamas ◽  
◽  
Nicolae Rednic ◽  
Simon Siao-Pin ◽  
Simona Rednic ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Therapy Monitoring ◽  
Severe Disease ◽  
Power Doppler ◽  
Ultrasound Contrast Agents ◽  
Small Vessels ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography

The diagnosis of rheumatoid arthritis (RA) is, most often, challenging, due to the variety of clinical features and to the absence of gold standard tests for diagnosing this disease. Early diagnosis as well as the identification of poor prognostic markers will lead to an early, appropriate treatment that will prevent the evolution towards a severe disease, offering the chance for a complete remission. Ultrasonography (US), used as an extension of clinical examination, helps in the early classification of the disease. Power Doppler is important for quantification of synovial inflammation, both at diagnosis and during therapy monitoring, but has limits in detecting blood flow in small vessels. Ultrasound contrast-agents improve visualization of vascularity and allow a better characterization and quantification of synovial pannus inflammation. We aim to discuss the role of contrast-enhanced ultrasonography (CEUS) in the diagnosis and follow-up of early RA.

scholarly journals POS0677 THE ROLE OF MUSCULOSKELETAL ULTRASOUND IN PREDICTING THE RESPONSE TO JAK INHIBITORS: RESULTS FROM A LARGE MONOCENTRIC COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 583-583
Author(s):  
C. Garufi ◽  
F. Ceccarelli ◽  
F. R. Spinelli ◽  
S. Mancuso ◽  
C. Pirone ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Structural Damage ◽  
Power Doppler ◽  
Response To Treatment ◽  
Jak Inhibitors ◽  
Inflammatory Score ◽  
Inflammatory Status

Background:In the management of chronic arthritis, such as Rheumatoid Arthritis (RA), Ultrasound (US) assessment can provide relevant information about the joint inflammatory status in the diagnostic phase and even more in the monitoring of disease activity and structural damage1,2.Objectives:In this longitudinal study, we aimed to assesse the role of US in predicting the efficacy of JAK-inhibitors (JAKi) in RA patients.Methods:We enrolled RA patients starting baricitinib or tofacitinib. All patients were evaluated at baseline and after 4, 12, 24, 48 weeks. Disease activity was calculated by DAS28CRP. US examination in 22 joints (I–V MCPs and PIPs, wrists) aimed at evaluating inflammatory features (synovial effusion and hypertrophy, power Doppler-PD), through a semi-quantitative scale (0-3). The total US (0-198) and PD (0-66) scores were calculated. We scanned bilateral flexor (I–V fingers of hands) and extensor compartments (1-6) tendons: tenosynovitis was scored as absent/present (0/1), resulting in a total score (0-22).Results:We studied 102 patients (M/F 15/87; median age 59.2 years, IQR 17.75; median disease duration 144 months, IQR 126), 61 treated with baricitinib and 41 with tofacitinib. At baseline, the median total US score was 18 (IQR 19) and the median PD score 2 (4). We observed a significant reduction in both total and PD US scores at all time-points (p<0.0001) (Figure 1). At baseline, 75.4% of patients showed tenosynovitis involving at least one tendon, with a median score of 2 (IQR 3.5) significantly decreasing after 24 weeks (p=0.02). Multivariate analysis, adjusted for baseline DAS28CRP and other concomitant treatments (including glucocorticoids and methotrexate treatment), confirmed the independent association between baseline US (PD and tenosynovitis) scores and the reduction of disease activity at follow-up evaluations.Conclusion:The present study confirmed the early efficacy of JAKi in RA patients by using US evaluation. Furthermore, power doppler and tenosynovitis scores could play a predictive role in response to treatment.References:[1]MUELLER RB, HASLER C, POPP F, et al. Effectiveness, Tolerability, and Safety of Tofacitinib in Rheumatoid Arthritis: A Retrospective Analysis of Real-World Data from the St. Gallen and Aarau Cohorts. J Clin Med. 2019;8(10):1548.[2]COLEBATCH AN, EDWARDS CJ, ØSTERGAARD M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804-14.Figure 1.Ultrasound inflammatory score (a) and Ultrasound Power Doppler (PD) score (b) at baseline and follow-up.Table 1.Baseline characteristics of 414 RA patients.WEEKS04122448US inflammatory score18 (19)11 (15.5)9.5 (11.7)7.5 (8)6 (11)US PD score2 (4)0 (2)0 (1)0 (1)0 (0.7)Disclosure of Interests:Cristina Garufi: None declared, Fulvia Ceccarelli: None declared, Francesca Romana Spinelli Speakers bureau: Abbvie, Eli Lilly, Consultant of: Gilead/Galapagos, Eli Lilly, Grant/research support from: Pfizer, Silvia Mancuso: None declared, Carmelo Pirone: None declared, Fabrizio Conti Speakers bureau: Abbvie, Eli Lilly, Sanofi, Pfizer, Consultant of: Gilead/Galapagos

The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A review article

2021 ◽  
Vol 17 ◽  
Author(s):  
Mustafa J. Musa ◽  
Mohamed Yousef ◽  
Mohammed Adam ◽  
Awadalla Wagealla ◽  
Lubna Boshara ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Point Of Care ◽  
Power Doppler ◽  
Doppler Imaging ◽  
Point Of Care Ultrasound ◽  
Institute Of Medicine ◽  
Pubmed Central ◽  
Contrast Enhanced ◽  
Ultrasound Findings

: Lung ultrasound [LUS] has evolved considerably over the last years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of [LUS] and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted including the national library of medicine, and the national institute of medicine, PubMed Central [PMC] to identify the articles depended on [LUS] to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the pandemic [11], clinical articles before COVID-19 [14], review studies during the pandemic [27], clinical cases during the pandemic [5] and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of [LUS] for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis

2021 ◽  
pp. annrheumdis-2020-218744
Author(s):  
Irina Gessl ◽  
Mihaela Popescu ◽  
Victoria Schimpl ◽  
Gabriela Supp ◽  
Thomas Deimel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Joint Damage ◽  
Joint Space ◽  
Early Arthritis ◽  
Damage Score ◽  
Established Disease ◽  
Active Inflammation

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).ConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

Role of Power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid arthritis

2007 ◽  
Vol 28 (6) ◽  
pp. 573-578 ◽  
Author(s):  
C. Shanmugavel ◽  
Kushaljit Singh Sodhi ◽  
Manavjit Singh Sandhu ◽  
R. Sidhu ◽  
Surjit Singh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Juvenile Rheumatoid Arthritis ◽  
Doppler Sonography ◽  
Therapeutic Response ◽  
Power Doppler ◽  
Power Doppler Sonography

scholarly journals An Algorithmic Approach to Minimally Invasive Management of Nontraumatic Chylothorax

2020 ◽  
Vol 37 (03) ◽  
pp. 269-273
Author(s):  
Luis D. Goity ◽  
Maxim Itkin ◽  
Gregory Nadolski
Keyword(s):  
Treatment Options ◽  
Treatment Algorithm ◽  
Rare Condition ◽  
Pleural Space ◽  
Positive Outcomes ◽  
Algorithmic Approach ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Invasive Management

AbstractChylothorax is a rare condition characterized by lymph accumulation in the pleural space. When it occurs independent of trauma, it is even more rare and difficult to treat as identification of lymphatic leak is unpredictable. In addition, treatment of this condition with conventional lymphangiography and thoracic duct embolization may not result in positive outcomes. As such, the role of contrast-enhanced dynamic magnetic resonance lymphangiography to guide treatment is key to maximizing success with the advantage of localizing the site of lymphatic leak. Herein, we summarize etiologies of nontraumatic chylothorax, offer an updated treatment algorithm to stratify affected patients and determine appropriate treatment options, and review procedural techniques critical to efficient and effective treatment.

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