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Comment on: Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-α antagonist therapy: An ultrasound study: Reply
No full textSonographic measurement of Achilles tendon thickness in seronegative spondyloarthropathies
No full textObjective: To define the best cut-off value for identifying Achilles tendon thickening using ultrasound (US) in patients with spondyloarthropathies
(SpA) and to assess its diagnostic utility in comparison with different cut-off values used in the literature.
Material and Methods: One-hundred and one subjects (55 SpA patients and 46 age and body mass index ((BMI)-matched healthy controls
(HC)) were investigated. US was performed using a MyLab70 US system (Esaote Biomedica, Genoa, Italy) with a linear probe (6-18 MHz). Three
images per Achilles enthesis were stored and the antero-posterior thickness of the enthesis was measured at the level of the Achilles tendon
deeper margin insertion into the calcaneal bone on the longitudinal median scan. The best cut-off value for each gender was determined by
ROC curve analysis and compared to the other cut-off values in the literature: 1) 5.29 mm for both genders, and 2) 5.5 mm for females and 6.2
mm for males. The number of measurements exceeding the cut-off values as well as sensitivity (SE), specificity (SP), positive (PPV ) and negative
(NPV ) predictive values were calculated.
Results: A significant difference was observed for Achilles enthesis thickness between genders (mean±SD: 4.6±0.7 mm in males vs. 4.0±0.8 mm
in females, p<0.00) and between SpA patients and HC (mean±SD: 4.4±0.8 mm in SpA patients vs. 4.0±0.8 mm in HC, p<0.001). The ROC curve
analysis revealed the best cut-off value to be 3.7 mm for females and 4.8 mm for males (SE: 43-70%, SP: 59-85%, PPV: 66-79%, NPV: 54-63%).
Previously reported cut-off values were found to have high SP (91-98%) but very low SE (2-11%).
Conclusion: Achilles tendon thickness differs between genders; thus, it is crucial to refer to normal values that are specific for gender. High cut-off
values, as previously suggested, showed very low SE in the current study. When Achilles enthesis thickening is used for the purpose of screening
enthesitis in SpA patients, a lower cut-off value has a higher SE with slightly worse SP, PPV and NPV
Predictive Factors for Work-Day Loss in a Multi-Center Study in Behcet's Disease: Indirect Costs for Healthcare
No full text
Mucocutaneous Activity Index As a Patient-Reported Outcome Measure in Behcet's Disease: A Multi-Center Study from Turkey
No full textQuantifying disease involvement in Takayasu's arteritis Scoring with colour-Doppler ultrasound
No full textMusculo-Skeletal and Vascular Involvement in Behcet's Disease
No full textAs a complex vasculitis of unknown etiology, both innate and adaptive immune systems are activated in Behcet's disease (BID), together with neutrophilic and lympho-histiocytic inflammation. With some features also resembling spondyloarthropathies, arthritis is one of the most frequent manifestations of BID and its prevalence ranges from 40-70%. The most frequently affected joint is knee. Patients generally present with non-erosive, recurrent, asymmetric mono or oligoarthritis. Enthesitis, spondylitis and sacroiilitis are seen less frequently. Non-steroidal anti-inflammatory drugs and intra-articular corticosteroids are the first choice of treatment. Although controlled-trials are lacking, most clinicians also use sulphasalazine and methotrexate in refractory cases. BID, with a prevalence of 25-30%, also involves vessels of all sizes, both arterial and venous. It most commonly affects young males as an important cause of mortality. Endothelial dysfunction is thought to be the major etiopathogenetic factor of vessel involvement. As the disease course continues with remission and relapses and disease activity abating in older ages, controlling inflammation and the prevention of complications at the early phases of the disease is the main aim of treatment. For major vessel involvement cyclophosphamide and high-dose corticosteroids are used, azathiopurine is recommended for small-vessel disease. (Turkderm 2009; 43 Suppl 2: 54-60
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