The purpose of the SAJI website is to enhance the ability of users to identify joint inflammation using standardized joint assessment technique. Visit the SAJI. GlycA is a novel inflammatory biomarker measured using nuclear a novel inflammatory marker, GlycA, for assessment of rheumatoid arthritis. MRI can detect early joint inflammation with high sensitivity and without the use for the assessment of synovitis, bone oedema and bone erosion,10 that is, joint . at week 4, − ()/+ () at week 8 and − ()/− () at week
of 2.3 inflammation Assessment joint
The results of our study analysis had no impact on the clinical management of patients and their confidentiality was maintained. National Center for Biotechnology Information , U. Published online Jun Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Limited data are available about the ultrasound US -detected inflammatory features in patients with suspicion of inflammatory arthritis S-IA vs.
Inflammatory joint pains, Joint ultrasound, Prediction of power Doppler, Rheumatoid arthritis, Subclinical inflammation. Introduction Ultrasound US assessment of small joints is routinely used for the diagnosis of peripheral inflammatory arthritis IA and helps guiding therapeutic decisions in patients with established rheumatoid arthritis RA [ 1 ].
Methods Subjects We conducted a real-life, retrospective cohort study of patients seen to our US outpatient clinics in the order of their referral, between May and September Statistical analysis for the prediction model We proposed a regression model to assess the contribution of every outcome measure to the risk of having active joint inflammation as well as predict PD signal.
Results We collected data from consecutive patients referred to our rheumatologist-led US clinic to have a scan of their hand joints aiming to answer the clinician question about the presence of active inflammation in their joints.
Open in a separate window. Table 2 Comparison between RA patients with different levels of disease activity. Table 3 Comparison between S-IA patients with different levels of disease activity.
Disease activity RA vs. Table 5 Marginal effects of different variables on the number of joints with PD signal in patients with other arthropathies vs. Discussion The results of our comparative analysis between the two groups of patients reflected their selection: Compliance with ethical standards The data was collected as standard of practice.
Patil P, Dasgupta B. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis. The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ohrndorf S, Backhaus M. Advances in sonographic scoring of rheumatoid arthritis.
A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. Prediction of relapse after discontinuation of biologic agents by ultrasonographic assessment in patients with rheumatoid arthritis in clinical remission: Predicting persistent inflammatory arthritis amongst early arthritis clinic patients in the UK: Prediction of erosion progression using ultrasound in established rheumatoid arthritis: Musculoskeletal ultrasound including definitions for ultrasonographic pathology.
Construct validity and reliability of ultrasound disease activity score in assessing joint inflammation in RA: Rheumatology Oxford ; Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments.
Can remission be maintained with or without further drug therapy in rheumatoid arthritis? Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: Role of ultrasound in assessment of early rheumatoid arthritis. A diagnostic algorithm for persistence of very early inflammatory arthritis: Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy.
Utility of the ultrasound examination of the hand and wrist joints in the management of established rheumatoid arthritis. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: Validation of a prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: Support Center Support Center.
Unlike healthy synovium, inflamed synovium is hyperemic and can be semi quantitatively graded, most commonly on a 4-point scale of 0 to 3 for PDUS activity [ 5 ]. PDUS is reported to have higher sensitivity and be more reliable for synovitis evaluation than an examination of swollen joints [ 8 ] and is predictive of relapse and radiographic disease progression [ 9 ].
It may be beneficial to better define the type of RA patient and clinical scenario in which MSUS will have differential impact on therapeutic management especially given the push towards early and aggressive control of disease activity. This lack of measured response in obese RA patient could be due to a differential response to therapy, a measurement error in assessing disease activity, or a combination of both. Our objective in this study was to evaluate the joint specific association between synovitis measured by PDUS and the clinically swollen joint in overweight and obese RA patients.
Eligible RA patients met the following criteria: Patients were excluded if they were pregnant or breast feeding, or if they had arthroplasty of the joints examined by ultrasound. These patients were then divided into three groups based on their body mass index BMI: The total tender and swollen joint count was assessed by a single study investigator VKR prior to ultrasound.
Based on a prior publication by Backhaus et al [ 6 ], with the addition of 2 joints metacarpalphalangeal 4 and 5 , a total of 9 joints were scanned by MSUS on the most active side: The max score of the views obtained for each joint was computed and then was theses maximums were summed across all 9 joints to obtain total PDUS range 0—27 and GSUS range 0—27 scores.
The clinical assessor was blinded to the ultrasound data, and the ultrasonographer was blinded to the clinical assessments. Additionally, when scoring the archived images, the ultrasonographer was blinded to all clinical data.
Kruskal-Wallis Tests were used for these US and clinical measures because they exhibited skewed distributions in visual assessments. Agreement between clinical swollen joint assessments and PDUS assessments were evaluated for the full cohort and each BMI group in several ways. First, the overall percent of joints that were considered swollen and PDUS positive were calculated for the full cohort and each BMI group. Next, the percent of joint-specific pairwise agreement between swollen joint assessment and PDUS assessment was calculated.
To assess the predictive relationship of clinical swollen joints versus PDUS positivity reference standard , the sensitivity, specificity, positive predictive value PPV , and negative predictive value NPV of swollen joint assessment were calculated.
This model included terms for SJC, BMI group represented ordinally , age, sex, joint, as well as a random effect for subject to account for the clustering of joints within subjects. Within the logistic regression, BMI was represented as an ordinal variable by converting the 3 categories of BMI as follows: Lastly, we included a term in the model for specific joint to evaluate in which joints the differences between BMI groups were most pronounced. Demographic characteristics were similar among BMI groups.
There were no significant differences in these characteristics across the BMI categories. The overall median and interquartile ranges IQR: These disease activity as measures were not significantly different across the BMI groups. Kruskal-Wallis tests used to compare groups. The logistic regression model demonstrates that each BMI category increase is independently associated with lower odds of PDUS positivity with an odds ratio of 0.
The AUC of the logistic model was 0. Multivariate Logistic model for PDUS accounts for correlation among different joints in the same patient. Our study addresses the latter point. Other studies have suggested that RA patients with fibromyalgia were found to have elevated disease activity scores, however noted to have low or absent measures of clinical synovitis or MSUS synovitis [ 22 , 23 ].
The obese and overweight patients with RA pose a considerable management challenge. Studies report that obese and overweight patients with RA are less likely to attain disease remission [ 24 — 26 ] and are more likely to have limited therapeutic response [ 13 ] as compared to non-obese RA patients, even with weight-adjusted treatments [ 14 ]. Sandberg et al found a significant dose response relationship between a BMI and change in disease activity in a study of Swedish patients.
Obese RA patients also have higher rates of functional disability, cardiovascular risks, and decreased quality of life as compared to non-obese RA patients [ 27 , 28 ]. Interestingly, although overweight patients have a decreased chance of achieving good disease control as measured by DAS28, multiple studies have suggested that patients with higher BMIs may have less radiographic joint damage [ 29 ], in particular in ACPA positive obese patients [ 30 ]. Thus, the natural question that arises is whether there could be a potential measurement error of disease activity in obese RA.
Our study implies that clinically assessed swollen joints are less likely to represent true synovitis in obese RA patients. Therefore, in obese patients, RA disease activity can be overestimated by CDAI and DAS28 calculations which may help to explain the reports that obese and overweight patients with RA are less likely to attain remission and are more likely to have limited therapeutic response as compared to non-obese RA patients.
Persons with erosive OA reported more pain and disability than persons with symptomatic radiographic hand OA [adjusted mean difference 1. While erosive OA has a greater impact than symptomatic radiographic hand OA in the general population, it is not as severe in terms of hand pain and disability as inflammatory RA.
Erosive OA of the hand is thought to be a subset of hand OA [ 1 ] and was first described by Peter et al. The clinical features in erosive OA can appear as pain, swelling, redness, warmth and limited function of the interphalangeal joints IPJs , which can be absent in non-erosive OA [ 3 ].
However, it is only recently that research into the occurrence of erosive OA in large-scale epidemiological studies has become possible with the development and validation of standardized methods for scoring cardinal features of IPJs, central erosions and collapse of the subchondral bone plate on radiographs [ 4—6 ]. Shortly after this, the Framingham Study showed age-standardized prevalence estimates for erosive OA of 9. These, and other previous studies in clinical populations, have consistently found more severe symptoms and functional limitations among those with erosive OA than those with non-erosive OA [ 7—10 ], raising the concern that erosive OA may carry the same burden as seen in inflammatory arthritis.
This concern was mainly raised by studies performed in rheumatology practices in secondary and tertiary care comparing patients with hand OA with patients with RA [ 11 , 12 ]. In rheumatology practices, the proportion of patients with erosive OA is relatively high. In these studies the clinical burden was similar between patients with hand OA and RA.
However, a study comparing patient groups referred to a rheumatology outpatient clinic may lead to selection bias, since the high clinical burden in itself can be a reason for referral. The aims of this study were to confirm the prevalence of erosive OA in a general population sample in the UK, to explore the impact of erosive OA on clinical outcomes further and to investigate the clinical impact of erosive OA compared with inflammatory arthritis arising from a population-based UK cohort with hand symptoms.
The protocols of these studies are described elsewhere in detail [ 13 , 14 ]. This criterion was selected in order enable comparison of prevalences with the Rotterdam Study [ 7 ], where patients with hand pain during the past month were selected instead of using the selection of pain during the past year.
Plain radiographs were completed of each hand in a posteroanterior PA view [ 13 ]. Joints were scored for the presence and severity of OA with the KL score range 0—4 [ 15 ]. Both observers re-scored 50 pairs to calculate inter- and intra-observer reliability. Erosions were scored by a single reader W. The majority of hand radiographs were scored for erosions; exceptions were those radiographs that had no or very few OA features.
The assumption was that erosions are not present in subjects with almost normal radiographs. The population was divided in subgroups by the summation scores range 0— Three sources of information were used to identify potential cases of diagnosed systemic inflammatory arthritis—specifically RA, seronegative RA, PsA and scleroderma: All searches were conducted by a researcher abstracting information using a standard form and blinded to the study clinical assessments and, in the cases of the medical records reviews, the study radiographs.
The abstracted information on potential cases was reviewed by members of the research team, including a consultant rheumatologist, to determine which diagnosis was made. These persons were used in the analyses of the comparison of clinical burden between erosive OA and inflammatory arthritis and were therefore excluded in the group used for erosive OA analyses only.
General characteristics of age and gender were recorded in postal surveys and height and weight were measured at the research clinics held at a local rheumatology outpatient department. Self-reported pain was also assessed with the pain subscale of the Arthritis Impact Measurement Scales health status questionnaire AIMS-2; range 0—10 [ 18 ].
Higher scores indicate more pain or stiffness. Higher scores represent a greater limitation in hand function. The GAT consisted of three tasks putting a flexigrip stocking over the non-dominant hand, putting a paperclip on an envelope, pouring water from a jug into a cup that participants had to perform within 2—3 min [ 19 , 20 ]. Scores are based on the time to complete the three tasks; higher scores correspond to poorer hand function.
General health perceptions were measured by the Short Form 12 SF , a widely used generic health status questionnaire yielding summary component scores for physical health PCS; 0— and mental health MCS; 0— , where lower scores represent poorer perceived health and a population average is 50 [ 21 ].
The appearance of the hand was measured with the aesthetics subscale score of the Michigan Hand Outcomes Questionnaire MHQ; range 0— , which is composed of four questions for both hands [ 22 ]. The impact of hand symptoms was measured with the impact subscale of the AIMS-2 range 0— Higher scores represent more satisfaction with aesthetics of the hand and a greater impact.
The prevalence of erosive OA in the population with hand symptoms and in the symptomatic radiographic hand OA population was calculated by dividing the number of persons with erosive OA by the sample size. The true population prevalence of symptomatic erosive OA was calculated using a combined approach of multiple imputation and weighted logistic regression, calculated for CAS-HA participants only [ 23 ].
Linear regression analyses were used to investigate differences in clinical characteristics between participants with and without erosive OA and also those with erosive OA in comparison with those with inflammatory arthritis.
Data of participants with inflammatory arthritis were only used for the comparison of the clinical burden outcomes between participants with erosive OA and those with inflammatory arthritis of the hand and for estimates of overall population prevalence. The cohorts yielded a combined sample of potentially eligible participants. The 44 persons with inflammatory arthritis were used in the analysis of clinical burden between erosive OA and inflammatory arthritis. Twenty-three persons presented one or more E phase in their hands and 57 persons presented only R phases.
Of the 23 persons, 76 erosive or remodelled joints were present, whereas erosive or remodelled joints were present in the 57 persons with only R phase. The prevalence of erosive OA was examined by gender and it was found that estimates for women were at least double those for men Table 2. Subpopulation with hand pain: The power grip and pulp pinch strength tended to be lower in persons with erosive OA than those with symptomatic radiographic hand OA, after adjustment for age and sex, but not significantly different.
Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients
erosions, hand osteoarthritis, inflammatory arthritis, pain, function a clinical assessment in the CAS-K study if they reported knee pain (rather than hand pain or hand .. AIMS-2 pain subscale, (), (), (, ). RA is a chronic inflammatory disease predominantly affecting joints, with clinical synovitis, through the presence of joint swelling as part of a joint count assessment. .. Physician TJC, mean (s.d.), (), (), (). Musculoskeletal ultrasound (MSUS) with power Doppler (PDUS) has become an accepted modality to identify features of inflammatory arthritis.