Hands and feet radiologic involvements in systemic sclerosis

Aim Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients identified disease–phenotype associations. Methods 43 SSc patients (41 women and 2 men), with a median age of 44.79 years (ranges 26 to 70 years) and a mean disease duration of 11.78 years (ranges 2 to 28 years) were studied in this cross-sectional study. Results 42 patients had radiological changes both in hands and feet. Only one patient had changes just in hand. The most frequent changes that we found in hand was Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis were higher in subjects with active skin involvement (modified Rodnan skin score (mRSS)>14) (16/21 v 4/16 for patients with inactive skin involvement (mRSS<14); p = 0.002). The most frequent changes that we found in foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients. Conclusion This study corroborates that an arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies. in order to define the appropriate prognosis and treatment of patients.

Clinical Features of Behçet’s Disease Patients with Joint Symptoms in Japan: A National Multicenter Study

Objectives Approximately 30%–60% of Behçet’s disease patients exhibit joint symptoms. The aim of this study was to determine the clinical characteristics of such patients in Japan. Methods This study retrospectively analyzed 151 Behçet’s disease patients with joint symptoms who had been treated at seven cooperative medical institutions from 2007 to 2017. We investigated their clinical characteristics and treatments. Results The most commonly affected joints were the knee, ankle, and proximal interphalangeal joints. Of the cases with pain and swelling, 18 of 293 joints (11 cases) displayed narrowing of the cleft or deformity by Xray analysis. Improvement in their arthritis was observed in 80% of the patients who received steroids as initial treatment; however, the rate of improvement was lower in patients who had received prednisolone (PSL) at &lt;10 mg/day. The recurrence of joint symptoms was significantly less common in the colchicine group than in the PSL group. Conclusions These results suggest that PSL is effective for remission induction for the treatment of joint symptoms of Behçet’s disease, though it may not be effective at low doses. Additionally, colchicine is effective in preventing the recurrence of joint symptoms in Behçet’s disease. Furthermore, joint damages like joint space narrowing or with any deformity can often be observed in Behçet’s disease patients in Japan.

Relationship between Body Mass Index (BMI) and Knee Osteoarthritis at the UKI General Hospital, Jakarta in 2017

Knee osteoarthritis is a degenerative joint disease usually suffered by elderly patients, contributing to the high risk of disability. The risk factors that affect the severity of knee osteoarthritis are obesity, age, sex, occupation, patient's history of the disease, trauma and other factors. Excessive body weight is a factor that exacerbates the disease of Osteoarthritis. Generally, this research is aimed to examine the correlation between Body Mass Index (BMI) and knee osteoarthritis at UKI General Hospital in 2017. The researcher used a descriptive-analytic study with a cross-sectional approach. In this study, the researcher used 30 samples. The results showed that there was a relationship between BMI and the incidence of knee osteoarthritis. This study indicates that BMI values above average (more than 24.9) can affect the occurrence of joint space narrowing in patients. Patients with abnormal BMI have a risk of 6,429 times the risk of joint space narrowing compared to patients with normal BMI. The mean BMI value of patients with knee osteoarthritis at UKI General Hospital is 25.6. Therefore, the researcher concluded that there is a correlation between BMI and knee osteoarthritis, in which a high BMI value (>24.9) may affect the occurrence of joint space narrowing among the patients. The mean BMI value among the osteoarthritis patients at UKI General Hospital is 25.6, indicating that most osteoarthritis patients are pre-obese/overweight. Key words: Knee osteoarthritis, Body Mass Index (BMI), joint space narrowing

Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis

Objectives A considerable proportion of patients with rheumatoid arthritis (RA) also suffer from hand osteoarthritis (OA). We here assess the association between conventional synthetic (cs) and biological (b) disease-modifying antirheumatic drugs (DMARDs) and radiographic distal interphalangeal-(DIP) OA in patients with RA. Methods Adult RA patients from a longitudinal Swiss registry of rheumatic diseases who had ≥ 2 hand radiographs were included at the first radiograph and followed until the outcome or the last radiograph. Patients were grouped into two cohorts based on whether DIP OA was present or absent at cohort entry (cohorts 1 and 2, respectively). Modified Kellgren-Lawrence scores (KLS) were obtained by evaluating DIP joints for the severity of osteophytes, joint space narrowing, subchondral sclerosis, and erosions. KLS ≥ 2 in ≥ 1 DIP joint indicated incident or existing OA, and increase of ≥ 1 in KLS in ≥ 1 DIP joint indicated progression in existing DIP OA. Time-varying Cox regression and generalized estimating equation (GEE) analyses were performed. We estimated hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) of DIP OA incidence (cohort 2), or progression (cohort 1), in bDMARD monotherapy, bDMARD/csDMARD combination therapy, and past or never DMARD use, when compared to csDMARD use. In post hoc analyses, we descriptively and analytically assessed the individual KLS features in cohort 1. Results Among 2234 RA patients with 5928 radiographs, 1340 patients had DIP OA at baseline (cohort 1). Radiographic progression of DIP OA was characterized by new or progressive osteophyte formation (666, 52.4%), joint space narrowing (379, 27.5%), subchondral sclerosis (238, 17.8%), or erosions (62, 4.3%). bDMARD monotherapy had an increased risk of radiographic DIP OA progression compared to csDMARD monotherapy (adjusted HR 1.34 [95% CI 1.07–1.69]). The risk was not significant in csDMARD/bDMARD combination users (HR 1.12 [95% CI 0.96–1.31]), absent in past DMARD users (HR 0.96 [95% CI 0.66–1.41]), and significantly lower among never DMARD users (HR 0.54 [95% CI 0.33–0.90]). Osteophyte progression (HR 1.74 [95% CI 1.11–2.74]) was the most significantly increased OA feature with bDMARD use compared to csDMARD use. In 894 patients without initial DIP OA (cohort 2), the risk of incident OA did not differ between the treatment groups. The results from GEE analyses corroborated all findings. Conclusions These real-world RA cohort data indicate that monotherapy with bDMARDs is associated with increased radiographic progression of existing DIP OA, but not with incident DIP OA.

Origins of the threshold for surgical intervention in intra-articular distal radius fractures

Aims The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. Methods A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. Conclusion Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457–1461.

Risk Assessment of the Progression of Early Knee Osteoarthritis by Collagen Neoepitope C2C: A Longitudinal Study of an Estonian Middle-Aged Cohort

One of the unmet needs to be addressed is prognostic biomarkers for early knee osteoarthritis (kOA). We aimed to study the association of urinary collagen type-II C-terminal cleavage neoepitope (uC2C) with the emergence and progression of kOA. The longitudinal data of 330 subjects (aged 32–60 years) from an Estonian population-based cohort were used. The radiographic progression was evaluated by the grading system of Nagaosa et al. of knee compartments at baseline and three years later. The emerging kOA consisted of subjects with developing osteophytes or joint space narrowing, whereas kOA progressors showed aggravation of radiographic grade. Baseline uC2C levels were measured by the IBEX-uC2C assay. At baseline, the subjects were middle-aged (mean age, 47.6 years) and overweight (mean BMI, 28.0 kg/m2), and the majority of them (51.2%) had a diagnosis of kOA grade 1. Multiple logistic regression models adjusted for sex, age, and BMI were used for risk calculations. We demonstrate that increased uC2C accurately predicted the risk of emerging of kOA (OR = 5.87 (1.71–20.22); AUC = 0.79) compared with controls without radiographic kOA over 12 years. However, the most accurate prediction of progression by the biomarker was found in women (OR = 23.0 (2.2–245), AUC = 0.91). In conclusion, uC2C may be a promising candidate as a prognostic biomarker for kOA progression, particularly of emerging kOA in women.

Application of ImageJ software for quantification of Hand Joint Space Narrowing in Patients with Rheumatoid Arthritis

Background: ImageJ software is used to quantify the joint space width (JSW) of hand and wrist in patients with rheumatoid arthritis (RA) as well as in the healthy control group. Method: Forty-one RA patients and 31 healthy controls are included in this study. All of 72 participants underwent digital radiography of the bilateral hand and wrist, then all the images were opened by ImageJ software to measure the width of wrist and hand joint space (total 2160 joints). Joint space narrowing (JSN) was defined if the width was less than the mean - 2SD of the control group. Result: The mean JSW of all sites of wrist and hand joints of RA patients was significantly reduced as compared to those in the control group (p<0.001). There were 37/41 (90.24%) RA patients who had JSN in at least one joint in hand or wrist. In total, 70.89% of joints on the right and 68.46% of joints on the left wrist and hand had JSN. Conclusion: ImageJ software was simple and convenient , which helps rheumatologists quantify the width of joint space for diagnosis and follow-up in RA patients.