Clinical significance of quantitative bone SPECT/CT in the evaluation of hand and wrist pain in patients with rheumatic disease

We investigated the diagnostic value of the maximum standardized uptake value (SUV) at hand and wrist joints for differentiating rheumatic diseases via bone single-photon emission computed tomography (SPECT)/computed tomography (CT). A total of 84 patients manifesting hand and wrist pain (58 women; age, 49.8 ± 15.4 years) were finally diagnosed with rheumatoid arthritis (RA, n = 42), osteoarthritis (OA, n = 16), fibromyalgia (FM, n = 2), and other rheumatic diseases (n = 24). The SUV of each patient was measured in 32 joints including the distal interphalangeal (DIP), proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints bilaterally. Differences in pain and SUVs between specific rheumatic diseases were assessed using the chi-squared test or one-way analysis of variance. Using the highest SUV (hSUV) in each patient, the diagnostic performance in differentiating specific diseases was evaluated by receiver operating characteristic (ROC) curve analysis. Pain symptoms were present in 886 (33.0%) sites in a total of 2688 joints. In four joint groups (DIP, PIP, MCP, and wrist), the SUVs of joints with pain were significantly higher than those of pain-free joints (all P < 0.001). Active joint sites with higher SUVs than the median value of each joint group were the most common in RA (55.1%). RA showed the greatest hSUV in the PIP (3.0 ± 2.4), MCP (3.5 ± 3.4), and wrist (3.3 ± 1.9) joint groups. FM was characterized by the lowest hSUV of all joint groups. In ROC curve analysis, the cumulative hSUV of the PIP, MCP, and wrist joint groups showed good performance for evaluating RA (area under the curve (AUC), 0.668; P = 0.005). The summation of the hSUVs at all joint groups had an excellent predictive performance for FM (AUC, 0.878; P < 0.001). Consequently, the arthritic activity of the hand and wrist joints based on SUV differed according to specific rheumatic diseases. Quantitative SPECT/CT may provide objective information related to arthritic activity for differentiating specific rheumatic diseases.

CNN-LSTM Hybrid Model for Kinematic Feature Analysis and Parabolic Radian Prediction in Basketball Videos

With the improvement of living standards around the world, people's love for sports has also increased; basketball is especially loved by people. It is of great importance to provide sound motor instruction for basketball. To this end, this paper comprehensively investigates the dependence between the optimal release conditions and the corresponding shooting arm movements in basketball players. We carry out kinematic feature analysis of basketball sports videos, propose a hybrid CNN-LSTM model that can predict the arc of the shooting parry, and identify the key movements of the arm joint that produce optimal release velocity, angle, and backspin in short-, mid-, and long-range shots. The experiment demonstrates that the model has three rigid planar links with rotational joints that mimic the shoulder, elbow, and wrist joints of the upper arm, forearm, and hand, which are better at guiding the optimal ball release speed, angle, and backspin for different players with the fastest ball speed being about 4.6 m/s and the slowest being about 1.7 m/s.

Longstanding Complicated Wrist Swelling: A Typical Presentation of Primary Tuberculosis a Case Report and Mini Review

Tuberculosis of the wrist joints is an uncommon clinical entity that most frequently presents with insidious pain and swelling. Isolated carpal bones involvement due to tuberculosis is a relatively uncommon event. In this report, the authors describe the case of a 36-year-old female patient presenting with fracture of the scaphoid bone. The diagnosis of tuberculosis was suspected based on the ultrasound and magnetic resonance imaging findings of the wrist joint, and confirmed by joint fluid culture. Introducing anti-tuberculous drugs under appropriate supervision resulted in clinical improvement and optimal regain of function. No reactivation of the disease was noted after 2 years of follow‑up. This case report describes a rare presentation of wrist joint tuberculosis.

Discovery of sensorineural hearing loss and ossicle deformity in a Chinese Li nationality family with spondyloepiphyseal dysplasia congenita caused by p.G504S mutation of COL2A1

Background Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant chondrodysplasia characterized by disproportionate short stature, abnormal epiphyses, and flattened vertebral bodies. COL2A1 has been confirmed as the pathogenic gene. Hearing loss represents an infrequent manifestation for 25–30% of patients with SEDC. The characteristics of the hearing impairment were rarely documented. Methods Audiological, ophthalmic, imaging examinations were conducted on the family members. The whole exome sequencing (WES) was performed to detect the candidate gene, and the Sanger sequencing was used to confirm the causative variation. Results COL2A1 c.1510G>A (p.G504S), a hot spot variation, was identified as the disease-causing mutation of the Chinese Li nationality family with SEDC. This variation was co-segregated with the SEDC phenotype in the family and was absent in the 1000 Genomes Project, ESP and ExAC. Clinically, several manifestations were first demonstrated in SEDC patients caused by p.G504S, including sensorineural hearing loss, auditory ossicles deformity, retinal detachment, sacrum cracked and elbow and wrist joints deformity. Other classical SEDC manifestations such as bones and joints pain, midfacial dysplasia, disproportionate short stature, spinal deformity, thoracocyllosis, coxa arthropathy, myopia and waddling gait were also showed in the family patients. Conclusion We first identified the mutation p.G504S in COL2A1 gene as the pathogenesis in a Chinese Li nationality family and reported the correlation between p.G504S and atypical clinical phenotypes including sensorineural hearing loss, auditory ossicles deformity, retinal detachment, sacrum cracked and elbow and wrist joints deformity. Our findings would extend the phenotypic spectrum of SEDC and deepen clinicians' understanding of genotype–phenotype correlation of the disease.

POS1399 ALGORITHM FOR DIFFERENTIAL DIAGNOSIS OF ARTHROPATHIES USING OSTEOSCINTIGRAPHY

Background:Joint bone scintigraphy is a promising method for diagnosing of inflammatory joint diseases. However, its scintigraphic semiotics remains to be developed.Objectives:To develop an algorithm for the differential diagnosis of the most common arthropathies based on quantitative osteoscintigraphy.Methods:This single-center study included inpatients with clinical diagnoses of rheumatoid arthritis (RA), axial spondyloarthritis (including ankylosing spondylitis - aSPA), peripheral spondyloarthritis (including reactive arthritis - pSpA), psoriatic arthritis (PsA), and osteoarthritis (ОА) established by a rheumatologist and meeting the relevant criteria, Three hours after the injection of pyrophosphate, labeled with Tc-99m, scintigraphy of the skeletal bones was carried out according to the “whole body” program. The joint / bone accumulation ratio (AR) was calculated as the ratios of counts in relevant areas. All AR were recalculated into T-score for each joint based on data from control group. The CHAID algorithm for classification trees constructing was used. The significance of the division in the nodes was estimated with Bonferroni adjustment.Results:266 patients were included in the study aged 46.6±14.3 years, men - 134 (50.4%). aSPA was diagnosed in 40 patients, pSpA in 87, RA in 45, ОА in 68, PsA in 26. 2279 joints were analyzed. A classification tree for differential diagnosis of arthropathies has been built (Pict.). Key indicators for identifying subgroups in the algorithm: AR in the wrist, knee and hip joints.At the first step of the classification tree, the sum of the T-scores of the wrist joints is determined. If this amount exceeds 7.76 (node 2), the most likely diagnosis is RA (58.5% of patients in the subgroup of this node). Patients with the sum of the T-scores in the wrist joints less than 7.76 (node 1), in turn, were divided depending on the sum of the T-scores of hip joints. Those with this value less than 3.25 (node 3), mainly suffered from OA (48.7%), less often in this subgroup were diagnosed pSpA (16.7%) and PsA (14.1%). Patients in whom the sum of the T-score in the hips was more than 3.245 (node 4) were further subdivided depending on the sum of the T-scores in the shoulder joints. If it was more than 4.21 (node 8), then pSpA was most likely (58.7%). If the sum of the T-scores of the shoulder joints was in the range from 2.05 to 4.21 (node 7), then these are mainly patients with spondyloarthritides (56.2% with aSPA and 31.2% with pSpA) and a small number of patients (10%) with PsA. In the subgroup with the sum of T-scores of the shoulder joints <2.05 (node 6), patients with PSA (40%) prevailed, with a significant proportion of persons with OA (27.5%). Thus, out of the final branches formed by the tree (node 2, 3, nodes 6-8), four correspond to certain diseases (node 2 - PA, node 3 - OA, node 7 - aSPA, node 8 - pSpA). Node 6 includes patients with various diseases with a predominance of PsA. The level of significance of differences between the formed groups at all branch points of the tree is p = 0.001 or less (Bonferroni adjusted). In the training sample, 51.5% of observations are correctly classified. According to cross-validation data, the expected rate of correct classifications in real application of the algorithm is 38.0%.Conclusion:An algorithm for the differential diagnosis of the most common inflammatory diseases of the joints has been developed, which makes it possible to use the data of quantitative osteoscintigraphy in the process of diagnosing arthritis.Acknowledgements:MD. PhD Constantin V. Kushnir, Main hospital of police.Disclosure of Interests:None declared

Capabilities of ultrasonography in the diagnosis of early rheumatoid arthritis and hand osteoarthritis

Objective: to compare results of ultrasound examination (US) of the wrist joints (WJ) and small joints of hands with the clinical signs in patients with early rheumatoid arthritis (eRA) and hand osteoarthriti (OAH).Patients and methods. The study included 42 patients with eRA (group 1) and 38 patients with OAH (group 2). The average age of patients with eRA was 48.60±14.86 years, the duration of clinical manifestations was 7.45±1.77 months, of patients with OAH – 54.97±12.45 years and 8.26±1.83 months, respectively. The ratio of men and women in both groups was approximately the same, the majority were women. All patients with eRA had clinical and instrumentally confirmed signs of OA: I, II, and III radiological stages of OA according to Kellgren–Lawrence were detected in 10 (23.80%), 23 (54.76%) and 9 (21.43%) patients respectively. In erosive OA II and III X-ray stage was diagnosed in 16 (42.10%) and 22 (57.90%) patients, respectively. All patients underwent ultrasound of the joints, as well as a general clinical examination, which included an assessment of the number of painful joints, the number of swollen joints, and a general assessment of pain intensity using a visual analogue scale (100 mm). RA activity was determined using the DAS28 index. We also studied laboratory parameters – the levels of CRP, rheumatoid factor and antibodies to cyclic citrullinated peptide in blood serum.Results and discussion. Comparison of the two groups of patients showed that ultrasound in B-mode and power Doppler mode with eRA and OAH showed more pronounced inflammatory and destructive changes in the wrist joints and small joints of the hands, with the exception of the distal interphalangeal joints (DIPJ). In addition, only in patients of the 1st group there was a close correlation between the enhancement of the Doppler signal and levels of inflammatory markers. Conclusion. eRA compared with OAH is characterized by more pronounced ultrasound signs of inflammatory and destructive changes in the wrist joins and small joints of the hands, with the exception of DIPJ.

The Effects of Initial Rehabilitation Exercise on Range of Motion, Muscular Strength, and Muscle Pain after Surgery for Osteochondritis Dissecans of the Humeral Capitellum in Middle and High School Baseball Players

Background: This study evaluated the effects of a 4-week initial rehabilitation program in middle and high school baseball players who underwent removal of a loose body from osteochondritis dissecans of the capitellum humerus. Methods: Middle and high school baseball players with osteochondritis dissecans of the capitellum humerus were enrolled in this study. Each had more than 3 yr of experience and had undergone arthroscopic removal of loose bodies from the same expert at Kim's Orthop Special Clinic in Seoul. The initial exercise rehabilitation program was based on a two-stage program. Body composition, range of motion of flexion and extension in the elbow and wrist joints, grip strength, and subjective pain scale were measured before and after rehabilitation. To assess the differences between groups, we used a two-way analysis of variance. Results: The range of motion for flexion and extension of the elbow and wrist joints, grip strength, and score on the visual analog scale each were significantly improved following the 4-week program (P<0.001), had an interactive effect in time × group (P<0.001), and had significance between groups (P<0.05). Conclusion: The 4-week initial rehabilitation exercise program might improve the overall range of motion of the elbow joint and has a positive therapeutic effect on grip strength and visual analog scores. However, future welldesigned studies with more subjects and multicentric research groups are necessary for verification.

Objective Accuracy Indicators of the Single-Joint Arm Movements Simultaneous Reproduction with Closed Eyes and under Visual Control in Patients with Hemiparesis and Healthy Test Subjects (a New Method for Proprioceptive Sensitivity Objective Assessment)

Aim. We have developed a method for objective assessment of proprioceptive sensitivity (PS) based on determining the accuracy of reproduction with the eyes closed of the tested arm passive single-joint movements by active movements of the other arm during their execution. It was shown that healthy test subjects reproduce the passive movements with high accuracy, while post-stroke patients with hemiparesis reproduce a large proportion of paretic arm test movements with gross qualitative and quantitative errors. To make sure that the reproduction errors are associated with the state of PS but not with the cognitive factor or the functional state of the conditionally healthy arm, it was necessary to find out how accurately these patients are able to reproduce the test-movements under visual control. Materials and Methods. In 11 patients with a lesion in the right and in 9 patients in the left hemispheres of the brain and a control group of 23 healthy subjects, the accuracy of reproduction of the 5 elementary hand movements was studied: flexion-extension in the shoulder, elbow and wrist joints and abduction–adduction in the shoulder and wrist joints. The test person was subjected to a series of passive cyclic movements of the test hand during which he had to copy them with active movements of the other hand. The reproduction procedure for each test movement was performed first under visual control and then with the eyes closed. The angles in the test join and the same joint of the other arm were recorded. Qualitative and quantitative indicators were used to assess the degree of similarity of active and passive movements and to reveal the correspondence of copying accuracy to the previously developed conditional criterion of the norm (CCN) of PS in healthy test subjects. Results. It was shown that in healthy test subjects the accuracy of all movements copying in tests with closed eyes and 98% of movements in tests with opened eyes met the requirements of the CCN. In the group of patients in tests with eyes closed, copying only 61% of movements met this criterion. 20.4% of movements were reproduced with qualitative gross errors, 18.4% were copied qualitatively correctly but differed from CCN in quantitative indicators. In tests with visual tracking of passive movements, reproduction of 98% of movements was qualitatively correct and 83% of movements corresponded to CCN. Conclusions. The vast majority of single-articular movements of the paretic arm are copied by patients with unilateral brain damage under visual control qualitatively correctly and accurately (meeting the CCN). It means that in the course of the study of PS by the proposed method, they, as a rule, understand the motor task and can reproduce the tested movements with their conditionally healthy arm. From this it follows that the main cause of these movements impaired copying in tests with closed eyes is proprioceptive deficit.