This study proposed to evaluate the value of diffusion-weighted MRI (DWI) to detect active inflammatory changes in the sacroiliac joints of patients with early axial spondyloarthritis (also spelled ...spondylarthritis).
Forty-two patients with chronic low back pain underwent clinical and MRI evaluation for axial spondyloarthritis or early ankylosing spondylitis. STIR, contrast-enhanced T1-weighted, fat-saturated T2-weighted, and diffusion-weighted (b values: 100, 600, 1,000 s/mm(2)) images were obtained. The presence of subchondral bone marrow edema, subchondral fatty marrow infiltration, or contrast enhancement in the sacroiliac joints or adjacent enthesitis sites was considered a marker for active inflammatory changes. All MRI sequences were evaluated for the presence of acute inflammatory changes and inter- and intrarater reliability of the sequences. Mean apparent diffusion coefficient (ADC) values of diffusion-weighted images were calculated from normal and involved iliac and sacral bones of sacroiliac joints.
ADC values measured from the lesions at b values of 1,000 and 600 s/mm(2) in patients with sacroiliitis (n = 13) were significantly higher than values measured from iliac and sacral bones in patients with low back pain of mechanical origin (n = 29). DWI showed sensitivity for detecting acute lesions in early sacroiliitis similar to that of T1-weighted gadolinium images (area under the curve, 0.843-0.971). Intra- and interrater reliability of DWI was acceptable.
DWI is a sensitive, fast sequence and does not require a contrast agent, which makes it a good and cost-effective alternative for imaging sacroiliac joints. DWI also offers the possibility of quantifying diffusion coefficients of the lesions, which helps to discriminate between normal and involved subchondral bone.
Objective: The aim of the study was to compare characteristics of pain in terms of neuropathic pain (NeP) and to assess the association between the neuropathic component and quality of life (QoL) in ...patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Subjects and Methods: Fifty-four patients (47 females, 7 males) with SSc and 53 patients (46 females, 7 males) with RA were assessed for outcome measures including disease activity, physical functions, mental condition and health-related QoL (HRQoL) measures (Short Form-36; Hospital Anxiety and Depression Scale), and pain. NeP was assessed by the Douleur Neuropathique 4 (DN4) and PainDetect questionnaires in this cross-sectional study. Results: The patients had similar education, smoking status, functioning, and HRQoL. However, the patients with RA declared a more severe visual analogue scale of pain and a higher BMI than those with SSc. The NeP component was detected in 42.6% (n = 23) of the SSc patients and in 45.3% (n = 24) of the RA patients (p > 0.05) according to DN4. On PainDetect, possible NeP was detected in 13.0% (n = 7) versus 15.1% (n = 8), whereas 16.7% (n = 9) versus 17.0% (n = 9) were likely to have NeP in SSc and RA, respectively (p > 0.05). Most of the NeP characteristics were similar in SSc and RA, except for numbness and painful cold, which were notably more common in patients with SSc. Having the NeP component (according to DN4) had no influence on functioning and HRQoL in SSc; however, the NeP component revealed a heavier burden of disease regarding functional status, HRQoL, and psychometric components in RA. Conclusion: The NeP component was similar between patients with SSc and RA. However, NeP was associated with a heavier burden of disease in patients with RA.
Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever, peritonitis/pleuritis, or arthritis attacks. Patients may have FMF-associated mutations of pyrin. ...The role of biologics such as anti-tumor necrosis factor (TNF) agents (infliximab, etanercept, adalimumab, golimumab) and anakinra, canakinumab, or rilonacept in the treatment of FMF needs to be clarified. Herein we present reports of three patients (all were positive for HLA B27) with typical spondylitis associated with FMF who were successfully managed with anti-TNF agents, along with a literature review. The patients were a 37-year-old man with concomitant Crohn's disease and amyloidosis who was treated with infliximab (INF, 5 mg/kg for 3 years) and switched to adalimumab (ADA), and two female patients (a 24-year-old and a 31-year-old) with FMF who developed severe spondylitis and who were also treated with ADA. Anti-TNF agents can control FMF attacks quite effectively and they reveal a promising role in the treatment of FMF-associated amyloidosis and spondylitis.
Colchicine is the mainstay treatment for Familial Mediterranean Fever (FMF). However 5% to 10% of the patients with FMF are unresponsive or intolerant to colchicine. Biologics are efficient in many ...rheumatic diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, cryopyrin-associated periodic syndromes. We performed a systematic review to analyze patients with FMF, including juvenile patients who received treatment with biologics.
A MEDLINE search, including articles published in English language between 1990 and May 2012, was performed. Patients who had Mediterranean fever variants but could not be classified as FMF according to Tel-Hashomer criteria were excluded.
There is no controlled trial on the efficacy and safety of biologics in FMF. Fifty-nine (32 female and 27 male) patients with FMF who had been treated with biologics (infliximab, etanercept, adalimumab, anakinra, and canakinumab) were reported in 24 single reports and 7 case series. There were 16 children and 43 adults (7- to 68-year olds). Five patients were reported to have colchicine intolerance or had adverse events related to colchicine use, and the rest 54 were unresponsive to colchicine treatment.
The current data are limited to case reports, and it is difficult to obtain a quantitative evaluation of response to biologic treatments. However, on the basis of reported cases, biologic agents seem to be an alternative treatment for patients with FMF who are unresponsive or intolerant to colchicine therapy and seem to be safe. Controlled studies are needed to better evaluate the safety and efficacy of biologics in the treatment of patients with FMF.
Ankylosing spondylitis is the prototype of inflammatory rheumatic diseases grouped under the term
spondyloarthritis
or
spondyloarthropathy
(SpA). New classification criteria for SpA have now been ...proposed; the patients are subgrouped into (1) a predominantly axial disease, termed
axial
SpA, which includes AS, and (2) peripheral SpA. There is an unacceptable delay in the diagnosis of axial SpA, and there are still no validated diagnostic criteria for SpA. An early diagnosis has now become increasingly important because effective therapies in the form of TNF antagonists have become available that are even more effective if used in early stages of the disease. Therefore, new strategies are being proposed that will assist in making an early diagnosis and will also help primary care physicians in screening for these patients so that they can be referred to rheumatologists when the disease is still in its early stages. These strategies may be less efficient for early referral of children and adolescents suffering from SpA, because their most important early manifestation is not inflammatory back pain but peripheral arthritis and enthesitis. There is, therefore, a need to develop a different strategy for children and adolescents with SpA through the use, preferably, of the ASAS/EULAR classification criteria for peripheral SpA, more so than the classification criteria for axSpA.
To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA).
Consecutively recruited patients were included and underwent clinical, radiological and laboratory ...evaluation by using standardized protocol and case report forms.
Women (n = 115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n = 72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis AS) were quite similar between men and women.
Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.
The aim of our study was to compare the magnetic resonance imaging (MRI)-defined cross-sectional area and semi-quantitative grading of fatty degeneration of lumbar paravertebral muscles in patients ...with non-radiographic axial spondyloarthritis (nr-axSpA) and established ankylosing spondylitis (AS).
Cross-sectional area (CSA) of lumbar paravertebral muscles, including the right and left multifidus (MF), erector spina (ES), psoas (PS), vertebral body and muscle:vertebra ratio (MVr), was measured. Fat infiltration of the paravertebral muscles was graded semi-quantitatively.
The CSA of the MF, ES and PS muscles and the MVr (at the L2, L3, L4 and L5 levels) were quite similar between patients with nr-axSpA (n = 14) and AS (n = 22). However, patients with AS had higher grades of fat infiltration than those with nr-axSpA (Right L4 grading of MF + ES muscles: 1.4 ± 0.73 vs. 0.51 ± 0.52, respectively, p = 0.001; left L4 grading: 1.36 ± 0.65 vs. 0.38 ± 0.50, respectively, p < 0.0001). This difference remained significant after adjusting for age and symptom duration. The inter-rater reliability was good (intraclass correlation coefficient 0.75 and 0.85).
This is first study demonstrating that MRI-defined fatty degeneration differs between patients with nr-axSpA and established AS. Semi-quantitative grading is reliable, and fatty degeneration of paravertebral muscles seems to be related to chronicity and spinal functions in patients with nr-axSpA and AS.
The aim of this study was to sonographically assess the presence and distribution of enthesopathy in systemic sclerosis (SSc).
Consecutive patients with SSc and age-matched healthy controls were ...included in this study. All of the patients met the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc. Six entheses sites were evaluated using gray scale and Doppler ultrasonographies (USs) with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI).
We evaluated 52 patients with SSc (46.10 ± 13.42 years) and 41 healthy controls (49.59 ± 9.35 years). Patients with SSc had significantly higher MASEI scores than the healthy controls. Except for plantar aponeurosis, the tendons and ligaments were thicker in the SSc group. In the SSc group, there were 25 (48.1%) diffuse cutaneous SScs and 22 (42.3%) limited cutaneous SScs. Variables such as age, BMI, disease duration, diagnostic delay and MASEI scores were similar in subgroups of SSc. There was a positive correlation between MASEI score and age, modified Rodnan's skin score and dyspnea grade, and a negative correlation with handgrip strength.
To the best of our knowledge, this is the first study showing the presence of enthesopathy in patients with SSc using US. Enthesopathy should be kept in mind in symptomatic patients with SSc; additionally, it can be easily identified with US.
Abstract Oxygen-derived free radicals have been implicated in the pathogenesis of skeletal muscle injury after ischemia–reperfusion. Caffeic acid phenethyl ester, an active component of propolis ...extract, exhibits antioxidant properties. The aim of this study was to assess the effects of caffeic acid phenethyl ester (CAPE) and α-tocopherol (vit E) on ischemia/reperfusion (I/R) injury in a rat hind limb ischemia/reperfusion model. For this purpose, ischemia was induced in anesthetized rats by unilateral (right) femoral artery clipping for 2 h followed by 2 h of reperfusion. Four groups were studied: sham, I/R, I/R + CAPE and I/R + vit E. Drugs were administered intraperitoneally after 1 h of ischemia and I/R rats received saline vehicle. After 2 h of reperfusion, venous blood was sampled and the right gastrocnemius muscle was harvested. Plasma and tissue were assayed for malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide (NO) metabolites. Tissue was also assayed for catalase (CAT) activity. Both tissue and plasma NO levels, MDA levels, SOD activities was significantly increased in I/R groups compared to control groups. The two treated groups showed decreased MDA and NO in both muscle and plasma compared to the I/R group. No differences were noted in muscle tissue SOD in three I/R groups, but SOD activity were increased in the plasma of I/R + CAPE and I/R + vit E groups compared with I/R group. Whereas tissue CAT activity was not changed among groups. Our results indicate that CAPE has antioxidant properties similar to those of vit E in this model and may attenuate the harmful effects of hind limb I/R in skeletal muscle.
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