ObjectivesUltrasonography (US) is a fast, available and low-cost imaging tool used for detecting knee synovitis. Our aims were to assess the relationship between US and histology findings in ...appraising levels of inflammation and vascularity in the knee joint in subjects with inflammatory arthropathies; to determine whether differences exist in the appraisal between varying knee compartments and to compare US performances compared with gold standard histology for knee synovitis detection.MethodsSubjects with actively inflamed knee joint having crystal arthropathies, rheumatoid arthritis, psoriatic arthritis or ostoearthritis were prospectively recruited from rheumatology clinics after giving their written consent between May and October 2015. Study was approved by the institutional ethics committee. The knee was divided into three compartments (medial, lateral, superior). Patients had a knee US followed by a knee arthroscopy with biopsies retrieval from each compartment. Biopsies were blindly scored for lining layer hyperplasia, inflammation, vascularity, CD68 and factor VIII staining. Correlation was determined using the Spearman’s correlation test.Results26 patients with active arthritis in a knee joint and recent onset of disease were prospectively included. Strong correlations were observed between US synovitis grade and histological inflammation score (r=0.63; P=0.002), US Doppler grade and histological score for vascularity (r=0.68; P<0.001); US measured synovial thickness and lining layer hyperplasia (r=0.61; P=0.002). Moderate correlation was found between US synovitis grade and CD68 score (r=0.49; P=0.02).ConclusionUS findings correlate with histological inflammation and vascularity scores in actively inflamed knee joints. US accurately describes knee synovitis.
The synovium is the major target tissue of inflammatory arthritides such as rheumatoid arthritis. The study of synovial tissue has advanced considerably throughout the past few decades from ...arthroplasty and blind needle biopsy to the use of arthroscopic and ultrasonographic technologies that enable easier visualization and improve the reliability of synovial biopsies. Rapid progress has been made in using synovial tissue to study disease pathogenesis, to stratify patients, to discover biomarkers and novel targets, and to validate therapies, and this progress has been facilitated by increasingly diverse and sophisticated analytical and technological approaches. In this Review, we describe these approaches, and summarize how their use in synovial tissue research has improved our understanding of rheumatoid arthritis and identified candidate biomarkers that could be used in disease diagnosis and stratification, as well as in predicting disease course and treatment response.
ObjectivesTo gain insight into current methods and practices for the assessment of competences during rheumatology training, and to explore the underlying priorities and rationales for competence ...assessment.MethodsWe used a qualitative approach through online focus groups (FGs) of rheumatology trainers and trainees, separately. The study included five countries—Denmark, the Netherlands, Slovenia, Spain and the United Kingdom. A summary of current practices of assessment of competences was developed, modified and validated by the FGs based on an independent response to a questionnaire. A prioritising method (9 Diamond technique) was then used to identify and justify key assessment priorities.ResultsOverall, 26 participants (12 trainers, 14 trainees) participated in nine online FGs (2 per country, Slovenia 1 joint), totalling 12 hours of online discussion. Strong nationally (the Netherlands, UK) or institutionally (Spain, Slovenia, Denmark) standardised approaches were described. Most groups identified providing frequent formative feedback to trainees for developmental purposes as the highest priority. Most discussions identified a need for improvement, particularly in developing streamlined approaches to portfolios that remain close to clinical practice, protecting time for quality observation and feedback, and adopting systematic approaches to incorporating teamwork and professionalism into assessment systems.ConclusionThis paper presents a clearer picture of the current practice on the assessment of competences in rheumatology in five European countries and the underlying rationale of trainers’ and trainees’ priorities. This work will inform EULAR Points-to-Consider for the assessment of competences in rheumatology training across Europe.
Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, ...patients are rarely directly consulted and involved in the app development process.
This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps.
The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia.
The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7%), and 86.8% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53%), with 42% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9%) and disease activity (221/346, 63.9%) or communicate directly with their health care provider (200/346, 57.8%).
Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control.
Identifying and quantifying inflammatory disease activity in rheumatoid arthritis remains a challenge. Many studies have suggested that a large proportion of patients may have active inflammation, ...but normal inflammatory markers. Although various disease activity scores have been validated, most rely to a large degree on biomarkers such as CRP and ESR. In this study, we examine the utility and limitations of these biomarkers, as well as the DAS28-CRP in appraising disease activity in RA.
Two hundred and twenty three consecutive rheumatoid arthritis reporting knee arthralgia underwent synovial sampling of the affected knee via needle arthroscopy. The synovium was examined by microscopy with H+E staining as well as immunohistochemistry, and related to the ESR, CRP and DAS28-CRP on blood samples taken immediately before arthroscopy.
Although a statistically significant positive correlation was observed between CRP and the level of inflammation in the biopsy retrieved (
= 197, rho = 0.43, CI 0.30-0.54,
< 0.0001), there was histological evidence of inflammation in the synovium in 49.4% of the patients who had a normal CRP. A positive correlation was also observed between ESR and the level of inflammation in the biopsy retrieved (
= 188, rho = 0.29, CI 0.15-0.42
< 0.0001). A statistically significant but weak positive correlation was observed between the DAS28-CRP and synovial inflammation (
= 189, rho = 0.23, CI 0.09-0.37,
= 0.0011). Only the CD19 infiltrate in the synovium correlated with serum CRP (
= 70, rho = 0.32, CI 0.08-0.52,
= 0.0068).
CRP has a moderately strong relationship with disease activity, but there are significant pitfalls in the use of this biomarker in RA, and therefore a need interpret CRP results judiciously. The results of this study underline the heterogeneity of RA, and the need to develop improved panels of biomarkers, to better stratify RA, and to identify the cohort for whom inflammatory activity cannot be measured accurately with CRP.
Biopsies synoviales Najm, Aurélie; Le Goff, Benoît
Revue du rhumatisme monographies,
June 2020, 2020-06-00, Letnik:
87, Številka:
3
Journal Article
Recenzirano
Les techniques de biopsies synoviales ont évolué ces dernières années, notamment avec le développement des procédures échoguidées, permettant une implémentation rapide dans différents centres ...européens à visée de pratique clinique ou de recherche translationnelle. Cette monographie passe en revue les différentes techniques, applications cliniques et également les dernières avancées en termes de recherche translationnelle, ainsi que les challenges et perspectives actuels.
Synovial biopsy techniques have developed and widely expanded over the past few years, in particular due to the development of ultrasound-guided procedures. This article reviews the different techniques, clinical applications and also the latest advances in translational research, as well as current challenges and perspectives.
La gonarthrose est une maladie dégénérative courante qui représente un lourd fardeau économique et sanitaire. Les traitements symptomatiques médicaux actuels comprennent les infiltrations ...intra-articulaires (IA) de corticoïdes (CO), dont l’efficacité et le profil de sécurité ne font pas l’unanimité.
Nous avons réalisé une revue systématique de la littérature (RSL) et une méta-analyse d’essais comparatifs randomisés (ECR) évaluant les effets des infiltrations IA de CO dans la gonarthrose. Les effets des interventions sur la douleur et la capacité fonctionnelle ont été extraits des études individuelles et les différences moyennes standardisées (DMS) compilées ont été calculées.
Sur 520 études sélectionnées, 23 ont été incluses dans la RSL et 15 ont ensuite été prises en compte pour la méta-analyse. À court terme (≤6 semaines), nous avons observé une tendance à un effet supérieur des infiltrations IA de CO par rapport aux interventions témoins concernant la douleur (DMS −0,61 IC 95 % −1,25 à 0,03) et la capacité fonctionnelle (DMS −1,02 IC 95 % −2,14 à 0,10), tandis que l’analyse du suivi à long terme (≥24 semaines) montrait une tendance à la supériorité des traitements témoins (acide hyaluronique IA, anti-inflammatoires non stéroïdiens IA, physiothérapie) pour la douleur (DMS 0,68 IC 95 % −0,11 à 1,47) et la capacité fonctionnelle (DMS 0,88 IC 95 % −0,36 à 2,12). Aucune différence entre les interventions n’a été relevée à moyen terme (>6 semaines et <24 semaines).
Dans cette revue, les infiltrations IA de CO ont réduit la douleur et amélioré la capacité fonctionnelle peu de temps après l’administration (≤6 semaines) par rapport au placebo, mais ce résultat n’a pas atteint la significativité statistique pour d’autres comparateurs (acide hyaluronique IA ou physiothérapie). Il semble que d’autres interventions soient plus efficaces sur le long terme (≥24 semaines), mais cet effet est fortement influencé par des études individuelles ayant des ampleurs d’effet importantes.
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