power doppler signal
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2022 ◽  
Author(s):  
Orazio De Lucia ◽  
Teresa Giani ◽  
Roberto Caporali ◽  
Rolando Cimaz

In this systematic review we analyzed the published articles related to the predictive value for flare of subclinical synovitis assessed by ultrasound (US) in juvenile idiopathic arthritis (JIA). Medline, Embase and Cochrane databases were searched from 1990 to 2020 by two authors, using PICO methodology. The study is built and reported according to PRISMA guidelines. Searches identified four articles comprising a total of 187 JIA patients in clinical remission from at least 3 months. Two of the articles found US subclinical signs of synovitis to be predictive for flare, with a five times higher risk (with Power Doppler signal as an important feature), while in the other two baseline US abnormalities did not predict a clinical flare. The articles differed for protocols, definitions, and length of follow-up. US has an expanding role in pediatric rheumatology, with interest-ing applications especially during the follow-up, potentially identifying subclinical inflammatory signs predictive of flare. However, the few studies available do not allow definite conclusions at this time.


Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 524
Author(s):  
Daniela Šošo ◽  
Jure Aljinović ◽  
Sanja Lovrić Kojundžić ◽  
Ivanka Marinović ◽  
Esma Čečuk Jeličić ◽  
...  

Background: We aimed to investigate possible association between the HLA-B*35 allele and peripheral arthritis, tenosynovitis and enthesitis. Methods: Ultrasound of peripheral joints and tendons was performed in 72 HLA-B*35 positive patients with preliminary diagnosis of undifferentiated axial form of spondyloarthitis and joint and tendon pain. Patients with other known types of axial and peripheral spondyloarthritis were excluded as well as patients with other known types of arthritis. Results: Pathological changes were found in the joints of 33 (46%) patients and on the tendons in 13 (18%) patients. The most common ultrasound findings were joint effusion and synovial proliferation with positive power Doppler signal grade 1. The most common ultrasound finding in patients with painful tendons was tenosynovitis. A higher disease activity and an increased incidence of elevated CRP (≥5 mg/L) were more often observed in the group with positive ultrasound findings. Conclusion: In this study, we showed that the HLA-B*35 allele could be a potential risk factor for developing peripheral arthritis, but not for tenosynovits and enthesitis in patients with the undifferentiated axial form of spondyloarthritis. This result may influence the follow up of these patients, especially since it gives us an opportunity to consider the use of different types of DMARDs in the treatment of these patients.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1106.1-1106
Author(s):  
S. Bouden ◽  
B. D. Siwar ◽  
A. Ben Tekaya ◽  
O. Saidane ◽  
R. Tekaya ◽  
...  

Background:Ultrasound (US) is an accessible and non-invasive tool to assess joint involvement in rheumatoid arthritis (RA). It is used for diagnostic and prognosis purposes and for following of RA patients by evaluating the disease activity and therefore the response to treatment.Objectives:This study investigates agreement between US of hand and wrist findings and the clinical examination and biological inflammatory parameters in RA patients.Methods:We performed a cross sectional study including patients responding to the ACR/EULAR 2010 criteria for RA diagnosis. We collected US findings assessing synovitis and doppler signal in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) articulations, and concomitant clinical examination assessing synovitis and pain in the same joints along with C reactive protein (CRP) levels and disease activity score (DAS28). The power Doppler US score (PDUS) from 6 simplified synovial sites (wrists, bilateral second and third MCP joints) was calculated [1].Results:Forty-three patients were included with 91.7% of women. The mean age was 62±12.95 years old. The mean age at diagnosis was 52±14.79 years with a mean disease evolution of 8±8.57 years. Rheumatoid factor and anti-citrullinated antibodies were positive in respectively 78% and 83.9% of cases.The mean disease activity (DAS28) was 1,52 with levels ranging from 1.5 to 7.33.Right wrist was the articulation in which US synovitis was most frequently detected (60.5% of patients), followed by the left wrist (53.5%). Power doppler signal was detected as frequently in the right as in the left wrist articulations (41.9%). Subsequently, clinical synovitis was most frequently detected in right and left wrist with 39,5% and 41,5% respectively. These joints were the most frequently painful, in 51.2% and 48.8% at right and left respectively.US synovitis of the first interphalangeal joint was found in only 2.3% and 4.7% in the right and left hand respectively, with positive power doppler signal in 2.3% of the patients in the same articulations.The overall agreement between US and clinical examination in detecting synovitis of wrist, MCP and PIP joints was of 67.3%. It was of 71.4% in wrists, 54.7% in MCP joints and 87% in PIP joints. This suggests the presence of infra-clinical synovitis. All sites combined, US synovitis were correlated to clinical synovitis (p=0.03).A positive correlation was found between PDUS from 6 simplified joint sites and CRP levels (p value of 0.02). No correlation was found with disease activity score (DAS28).Conclusion:US of hands and wrist articulations is more performant than clinical examination in detecting synovitis. The most frequently involved joints with clinical and US synovitis, pain and positive power doppler signal were the wrist joints. CRP level is predictive of the presence of a high simplified power doppler score which is related to clinical activity of the disease as reported by Kawashiri et al. [1].References:[1]Kawashiri S, Kawakami A, Iwamoto N, Fujikawa K, Satoh K, Tamai M, et al. The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatology (Oxford). mai 2011;50(5):962-5.Disclosure of Interests:None declared


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 283.2-283
Author(s):  
C. Guillén-Astete ◽  
V. García García ◽  
N. García-Montes ◽  
Á. Andreu-Suárez

Background:Achilles enthesitis is the most accessible psoriatic arthritis hallmark to assess through ultrasound scan. Recently it has been demonstrated that continuous mechanical stress such as experimented by runners can drive to the development of physiological morphological changes that resembles those observed in psoriatic arthritis. In a subject with the suspicious diagnostic of psoriatic arthritis who practice any sports associated to continuous impact over the heels, the challenge to determine in what extent the morphological changes are linked to the exercise or to the disease, is remarkable.Objectives:To determine morphological differences between patients with psoriatic arthritis, trained runners and sedentary volunteers through ultrasound scan of the Achilles tendon.Methods:An ultrasound scan of the Achilles tendon was performed to the following subjects: Patients with diagnosis of psoriatic arthritis with a DAPSA score of low activity in at least six months and with history of heel pain in the past, volunteers runners with not less of 3-year sport activity at least three times a week and sedentary volunteers. In the group of patients, ultrasound scan was performed over the feet with history of heel pain. In the case of volunteers, the ultrasound scan was performed in the dominant feet. The selection of volunteers was not randomly-based in order to match their age and sex to the patients as much as possible. Besides demographic features, a comparison between tendon thickness at the level of the calcaneus bone border and the height of the retrocalcaneus bursae in the longitudinal axis were performed through ANOVA test. Power Doppler signal was scaned in all subjects before and after a controlled mechanical stress of the Achilles tendon by climbing stairs (100 steps, two times).Results:Female/male distribution of the group of patients, runners and sedentary people were: 12/10, 18/18 and 20/18, respectively. Achilles tendon mean thickness ± standard deviation was 6.61 ± 1.05, 5.91 ± 1.44 and 4.61 ± 2.1mm, respectively (P=0.01). Retrocalcaneus bursae height was 3.42 ± 0.21, 3.22 ± 0.27 and 2.21 ± 0.31 (P=0.01). Basal PD signal was present into the enthesis of 2/22, 1/36 and 0/38, respectively (P not significant). After exercise, PD signal was present in 8/22, 5/36 and 0/38, respectively (P<0.001).Conclusion:Power Doppler signal after exercise was identified as the most relevant ultrasound hallmark to distinguish a patient with psoriatic arthritis from a trained runner, even when psoriatic arthritis were considered as low activity. Post exercise ultrasound scan should be considered as a diagnosis tool in sportsmen with suspicious of psoriatic arthritis, until further studies confirm our findings.Disclosure of Interests:None declared


Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 669
Author(s):  
Sheryl Mascarenhas ◽  
Nina Couette

Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.


Rheumatology ◽  
2021 ◽  
Author(s):  
Mirko Di Ruscio ◽  
Ilaria Tinazzi ◽  
Angela Variola ◽  
Andrea Geccherle ◽  
Antonio Marchetta ◽  
...  

Abstract Background Some studies have reported the development of moderate and severe de novo SpA-associated disease under vedolizumab (VDZ) treatment for IBD. Herein, we report a case series who developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases. Methods In a single Italian IBD Unit in which 90 cases were on VDZ therapy, we identified 11 cases who developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, and outcomes (including therapy switches) was described. Results A total of 11 cases, including 8 prior anti-TNF failures, with new-onset entheseal pathology were identified: multifocal (n = 4), unifocal (n = 6), and enthesitis/synovitis/dactylitis (n = 1). The mean duration of symptoms was 46 weeks (range 6–119), the mean CRP was 5.1 mg/dl, and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and US showed severe enthesitis, including power Doppler change in 7 patients. All patients were initially treated with NSAIDs, and 5 patients underwent local steroid injections. At 12 months, 5/7 cases continued VDZ and 2 were switched to ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of power Doppler signal. In addition, 4/7 severe patients developed marked post-inflammatory entheseal calcifications Conclusions A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy.


2020 ◽  
Vol 94 ◽  
pp. 103254
Author(s):  
Silvia Rabba ◽  
Valentina Petrucci ◽  
Lucio Petrizzi ◽  
Dario Walter Giommi ◽  
Valeria Busoni

Rheumatology ◽  
2020 ◽  
Author(s):  
Julio Ramírez ◽  
Andrea Cuervo ◽  
Raquel Celis ◽  
Virginia Ruiz-Esquide ◽  
Raul Castellanos-Moreira ◽  
...  

Abstract Objective To identify biomarkers of treatment change and radiographic progression in patients with RA under remission. Patients and methods RA patients in remission (DAS28-ESR &lt;2.6) were selected and followed up for 5 years. An MRI of the dominant hand and an US assessment of knees/hands and serum levels of inflammation/angiogenesis biomarkers were performed at baseline and at 12th month. Synovial biopsies were obtained in patients with Power Doppler signal. Conventional radiographies of hands/feet were taken at baseline and after 5 years. Radiographic progression was defined as the change in the modified Sharp van der Heijde Score at 5 years &gt;10.47 (small detectable change). Results Sixty patients were included, 81.6% were ACPA+ and 45% were taking biological DMARDs. At baseline, 66.6% had Power Doppler signal. After 5 years, 73.3% of patients remained in remission. Change of therapy was performed in 20 patients (33.3%) and was associated with BMI [odds ratio (OR) 1.3, 95% CI: 1, 1.7], lack of biological DMARD therapy (OR 24.7, 95% CI: 2.3, 257.2), first-year progression of MRI erosions (OR 1.2, 95% CI: 1, 1.3) and calprotectin serum levels (OR 2.8, 95% CI: 1, 8.2). Radiographic progression occurred in six (10%) patients. These patients had higher first-year progression of MRI erosions (P =  0.03) and bone oedema (P = 0.04). Among 23 patients undergoing synovial biopsy, mast cell density was independently associated with clinical flares. Conclusions One-third of RA patients lost clinical remission and changed therapy throughout the 5 years of follow-up, which was independently associated with BMI, lack of biological DMARDs therapy and first-year progression of MRI erosion score and calprotectin serum levels. Significant radiographic progression was uncommon.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1393.2-1394
Author(s):  
R. Fakhfakh ◽  
N. El Amri ◽  
K. Baccouche ◽  
H. Zeglaoui ◽  
E. Bouajina

Background:Several studies have shown the greater sensitivity of ultrasound (US) to detect B-mode synovitis and synovial Doppler activity in a high percentage of rheumatoid Arthritis (RA) patients in clinical remission, assessed by different composite indices.Objectives:The aim of the study was to compare the accuracy of composite indices to detect remission in ultrasound B-mode and power Doppler (PD) in RA patients that are in remission according to the DAS28 ESR.Methods:Cross-sectional study including patients with RA in clinical remission defined by: DAS28ESR ≤ 2.6, without disease flare or changes in therapy in the previous 6 months. Each patient underwent B-mode and PD assessments of 36 joints and 20 tendons in the Rheumatology Department over a period of 6 month. B-mode and PD signal for synovitis and tenosynovitis were defined according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT). A global score for B-mode and a global score for PD signal were calculated for each patient. The DAS28, CDAI, SDAI and the Boolean 2010 ACR/EULAR remission criteria were compared.Results:Thirty two patients were enrolled, the mean age was 53.7±13.4 and the sex ratio M/F was 0.3. The mean disease duration was 15.0 years ± 8.8. According to the SDAI, 68.8% of patients were in remission. These were lower for the CDAI (62.5%) and the Boolean criteria (23.3%). Synovial hypertrophy and tenosynovitis in B mode was detected in 100% with the Boolean remission criteria, in 93.8% with a DAS28, in 90.9% with a SDAI ≤ 3.3 and in 90% with a CDAI ≤ 2.8 (p>0.05). The PD signal was detected in 62.5% with a DAS28, in 59.1% with a SDAI ≤ 3.3, in 57.1% with the Boolean remission criteria and in 55.1% with a CDAI≤ 2.8 (p>0.05). The mean B-mode global score was higher for the DAS28 ESR (8.2±6) and lower for the Boolean remission criteria (6.2 ±5.4). For a CDAI ≤ 2.8, the mean global score for B-mode was 7.6 ±5.9 and for a SDAI ≤ 3.3, it was 7.4±5.7. The median PD global score was similar for the DAS28, SDAI≤ 3.3 and Boolean remission criteria (1[0-12]). It was higher for a CDAI ≤ 2.8 (1.5 [0-12]). The global score for PD signal was correlated with DAS28 ESR (r: 0.42 p: 0.02). There were no significant correlations between the other indices and the mode B and PD global scores.Conclusion:The CDAI least detected subclinical synovitis and tenosynovitis in B mode and in power Doppler signal but it showed higher scores of power Doppler.References:[1]Merve Ozata Olmez, Esen Kasapoglu Gunal, Sibel Bakirci Ureyen and al. Comparison of composite indices with global synovitis score on ultrasound for detecting remission. Clinical Rheumatology 2017. doi.org/10.1007/s10067-017-3925-xDisclosure of Interests:None declared


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1408.2-1408
Author(s):  
T. Okano ◽  
K. Mamoto ◽  
Y. Yamada ◽  
K. Mandai ◽  
S. Anno ◽  
...  

Background:In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. On the other hand, the effects of biologics cannot be obtained satisfactorily in all patients, and there are some cases in which treatment is interrupted due to ineffective or adverse events. However, the useful predictive markers of the biologics have not been found in the early phase of treatment in RA. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.Objectives:In this study, we investigated whether continuation of biologics treatment can be predicted by ultrasonographic findings in the early phase.Methods:Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included. All the patients were performed clinical examination, blood tests and US examination of hand and foot at baseline, 4, 12, 24, 36 and 52 weeks. US examination was performed on MCP joints, PIP joints, wrist and MTP joints.Results:Among 54 cases, 42 cases were able to continue treatment until one year later, and the continuation rate was 80.8%. Of the 12 patients who discontinued first biologics treatment, 5 were changes to other biologics due to inadequate response, 4 were their wishes, and 3 were adverse events. Multiple regression analysis was performed with treatment continuation as the dependent variable and improvement of CRP, MMP-3, DAS28-CRP, grayscale score and power Doppler score in 4 weeks as explanatory variables. Only improvement of power Doppler score was extracted as a significant predictor (p = 0.045). In the continuation group, the improvement of the power Doppler signal at week 4 was 36% compared with the baseline, compared with 10% in the discontinuation group.Conclusion:The early improvement of power Doppler signal in 4 weeks could be a predictive factor for the continuation of 1-year biological treatment.References:[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.[2]Atzeni F, Talotta R, Masala IF, Bongiovanni S, Boccassini L, Sarzi-Puttini P. Biomarkers in Rheumatoid Arthritis. Isr Med Assoc J. 2017;19:512-6.Table 1.Multivariate regression analysis of predictive factors for continuation of biologics treatment in 1-year.Improvement ratio of 0 to 4 weeksbetaP valueCRP-0.1220.465MMP-30.2280.103DAS28 CRP0.2800.103Ultrasound grey scale score-0.3420.119Ultrasound power Doppler score0.4420.045Acknowledgments:We thank Emi Yamashita, Yuko Yoshida, Asami Fujii and Shingo Washida who performed ultrasound examination.Disclosure of Interests:Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.


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