1,721,201 research outputs found
Capillaroscopy abnormalities in relation to disease activity in juvenile systemic lupus erythematosus
No full textJuvenile-onset systemic lupus erythematosus (jSLE) has a more severe disease onset and clinical course in comparison with the adult SLE. The aims of this study were to investigate in jSLE the prevalence of capillaroscopic patterns, to assess any association between capillaroscopy and clinical parameters and, to monitor the capillaroscopy changes over time. A total of 62 SLE patients, 35 jSLE (mean age 13.2 years) and 27 adult-onset SLE (mean age 29.1 years) were studied. In this study non-specific capillary abnormalities were observed in the majority of jSLE patients and the severity of the overall capillaroscopic abnormalities seems to be related to disease activity. Moreover, this longitudinal study allowed the observation of the dynamic feature of capillaroscopic pattern in these patients. Particularly, the presence of a scleroderma-like capillaroscopic pattern should be considered a red flag for the potential development of clinical manifestations suggestive for scleroderma spectrum disorders. Capillaroscopy may be considered a useful examination in an overall clinical assessment and an additional help in the assessment of disease activity in these patients
How to select the most appropriate capillaroscopic device : pros and cons
No full textNailfold capillaroscopy is a noninvasive technique that allows direct observation of capillaries using a magnification lens for the two-dimensional projection of the three-dimensional capillary network. After application of a drop of immersion oil, capillaries can be observed with a magnification lens because they run parallel to the epidermis at the nailfold area.
A number of different instruments are available to perform the exam. They have different characteristics in terms of their cost, quality of images, magnifications, training period, software for image analysis and storage.
Some of these instruments can be used both in clinical and research settings such as the stereomicroscope and the videocapillaroscope. The stereomicroscope allows the widefield visualization of the nailfold with low magnifications, the training is relatively short, but the examination is difficult to perform in patients with digital contractures.
There appears to be consensus regarding the use of videocapillaroscopy that allows a detailed visualisation of capillary morphology using higher magnifications (100–300x). Contact probe with polarized light microscopy permits easier observation of the skin surface, and the training period is briefer. Specific softwares are available for images analysis, storage, and complete medical reports (text + images) can be produced.
By contrast, in a clinical setting, nailfold capillaries can generally be visualised using more simple but also efficient tools such as a dermatoscope, USB microscope, ophtamloscope or smartphone device. The quality of images can be quite good, although the lower magnification means that some details are unlikely to be seen, and they often lack the possibility of image storage and measurement
Rheumatoid nodules predating seroconversion and rheumatoid arthritis : an uncommon case report
No full textRheumatoid nodulosis is a benign condition associated with mild or no arthritis. Differently from classical
rheumatoid nodules, which are relatively common in patients with long-standing rheumatoid arthritis, particularly
in rheumatoid factor (RF)-positive patients, rheumatoid nodulosis may rarely precede arthritis onset and even
seroconversion. We describe the clinical course of a patient with isolated painful rheumatoid nodules, who
subsequently experienced RF and anti-citrullinated protein antibodies (ACPA) seroconversion and finally developed
overt rheumatoid arthritis. This case should raise clinical awareness to consider rheumatoid nodulosis as a possible
diagnosis even in the absence of arthritis and of RF positivity, whenever facing with isolated subcutaneous nodule
Assessment of hand involvement in systemic sclerosis by ultrasonography : comment on the article by Elhai et al
No full textA systematic overview on the use and relevance of capillaroscopy in systemic sclerosis
No full textCapillaroscopy is a non-invasive and safe technique that allows the detection and quantification of the early microvascular abnormalities that characterize secondary Raynaud's phenomenon. The well-established role of capillaroscopy for the early diagnosis of systemic sclerosis, its inclusion in the classification criteria, combined with its predictive value for clinical complications of the disease and its potential for monitoring disease progression and treatment response, makes nailfold capillaroscopy an important assessment in clinical practice and research. Capillaroscopy provides a unique window into the microcirculation and its application in diseases in which a microvascular component is suspected; it also may provide new insights into their pathophysiology and natural history
A systematic review of systemic sclerosis instruments for the eular outcome measures library : An evolutionary database of validated patient-reported instruments
Full text linkBackground: Over time, a patient-centered evaluation of health status has become more important for systemic sclerosis (SSc), both in research and clinical setting. Patient-reported outcomes (PROs) are being increasingly used to measure various domains of disease status relevant to patients and physicians. The EULAR Outcome Measures Library (OML) is a freely available website with structured access to a growing database of validated PROs [1], but currently there are no PROs available on SSc at the EULAR OML.
Objectives: To provide a comprehensive review of validated SSc-specific PROs and to critically appraise their validity.
Methods: A sensitive search was developed in Medline and Embase (08/2015) to identify all validation studies, cohort studies, reviews or metaanalyses in which the objective were the development or validation of PROs evaluating organ involvement, disease activity or damage in SSc. A reviewer screened title and abstracts, selected the studies, and collected data concerning validation using ad hoc forms based on the COSMIN checklist.
Results: From 13,140 articles captured, 74 met the predefined criteria. After excluding an instrument for the unavailability of an English version, the selected studies provided information on 6 SSc-specific PROs: the Scleroderma Assessment Questionnaire (SAQ), the scleroderma functional score (FS), the Raynaud's condition score (RCS), the Mouth Handicap in SSc (MHISS), the University of California Los Angeles-Scleroderma Clinical Trial Consortium Gastro-Intestinal tract (UCLA-SCTC-GIT 2.0), and the Skin Self-Assessment. The table summarizes the instruments and their measurement properties:
Table 1
SSc-specific PROs Domains No. of items and range Measurement properties
Reliability IC/TR/ME Validity Responsiveness Interpretability
SAQ Functional status (vascular, respiratory, GIT and musculoskeletal apparatus) Items: 23Range: 0–3 ICC 0.79–0.95 Total score higher in pts with systemic involvement Vascular z=0.92–2.97; Respiratory z=1.34–2.52; GIT z=−3.14–4.03; Musculoskeletal status z=0.68–3.16 –
FS Functional ability (upper limbs & muscle weakness) Items: 11Range: 0–33 Intra-observkw 0.19–0.6inter-observkw0.69–0.94 HAQ-DI r=0.90Skin score r=0.11 FS correlates with HAQ-DI 0.59, & Hand HAQ-DI 0.58 –
RCS Severity and impact of Raynaud's phenomenon Item: 1Range 0–10 ICC 0.70 Disease activity, Rp measures, digital ulcers, mood/tension 67% variance ES 0.6SRM 0.64 MID 14–15 points (0–100 VAS)PASS 34 points
MHISS Disability involving the mouth Items: 12Range: 0–48 ICC 0.96 HAQ r=0.33, CHFS r=0.37, mouth opening r=−0.34, MACTAR r=0.11, HADd r=0.26, HADa r=0.17 – –
UCLA SCTC GIT 2.0 GIT symptoms severity Items: 34Range: 0–3 Cronbach's α>0.70, constipation (α=0.67)ICC 0.71 Total GIT score r=0.60; Upper GIT r=0.52; Lower GIT r=0.60 rho 0.05–0.48 MID/improvement: 0.07–0.36;MID/worsening: 0.06 −0.21;Floor: noneCeiling: 4%
Skin self-assessment Skin thickening Items: 17Range: 0–51 ICC 0.5–0.61 Skin score r=0.435 No changes 1 yr follow-up – dcSScFloor 15%Ceiling n.a.
Conclusions: Six SSc-specific PROs have a minimum validation and will be included in the EULAR OML. In general, the level of validation attained could be improved. Further development in the area of disease-specific PROs in SSc is warranted.
References:
Castrejón I, Gossec L, Carmona L. Ann Rheum Dis. 2015;74(2):475–
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