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Women and spondyloarthritis
Full text link: Spondyloarthritis is an umbrella term for a heterogeneous group of chronic inflammatory diseases affecting the spine and/or peripheral joints, often associated with extra-articular manifestations, such as psoriasis, uveitis, and inflammatory bowel disease..
Psoriatic arthritis. When the heterogeneity requires normality
No full textPsoriatic arthritis (PsA) is characteristically associated with a large spectrum of disorders, some of which are peculiars, such as enthesopathy, dactilytis, osteitis and axial involvement. Due to the heterogeneity of its expression, definition and classification of PsA have been unsatisfactory until recent years, with consequences on the reliability of epidemiological studies. Other confounding factors for diagnosis and classification of PsA are the radiological changes, sometimes found in asymptomatic patients with psoriasis, and the frequent normality of acute phase response indices, in particular erythrocyte sedimentation rate and C reactive protein. All these aspects are frequently neglected and probably account also for the unsatisfactory response of PsA to traditional drugs, such as NSAIDs, steroids and DMARDs. Furthermore, these drugs showed only a partial ability to influence radiographic progression and psoriasis. The anti-TNF agents have demonstrated to be able to influence all the multiple aspects of the PsA disease and indeed, to slow radiographic progression and to improve patients’ quality of life. This seems obtained with a convenient cost-effectiveness ratio
Editorial: Genetic Studies on Spondyloarthritis: From Disease Predictors to Therapeutic Targets
Full text linkUltrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy
No full textUltrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy Author(s): Salaffi, F (Salaffi, F.)1; Carotti, M (Carotti, M.)2; Iagnocco, A (Iagnocco, A.)3; Luccioli, F (Luccioli, F.)4; Ramonda, R (Ramonda, R.)5; Sabatini, E (Sabatini, E.)3; De Nicola, M (De Nicola, M.)6; Maggi, M (Maggi, M.)6; Priori, R (Priori, R.)3; Valesini, G (Valesini, G.)3; Gerli, R (Gerli, R.)4; Punzi, L (Punzi, L.)5; Giuseppetti, GM (Giuseppetti, G. M.)2; Salvolini, U (Salvolini, U.)6; Grassi, W (Grassi, W.)1 Source:
RHEUMATOLOGY Volume: 47 Issue: 8 Pages: 1244-1249
DOI: 0.1093/rheumatology/ken222 Published: AUG 2008 Times Cited: 10 (from Web of Science) Cited References: 40 [ view related records ] Citation Map Abstract: Objective. To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS).
Methods. The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening methods performance.
Results. Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 +/- 0.030), followed by sialography (AUC = 0.804 +/- 0.035) and by salivary gland scintigraphy (AUC = 0.783 +/- 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score 6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold 8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5).
Conclusions. Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease. Accession Number: WOS:000257787200026 Document Type: Article Language: English Author Keywords: Sjogren's syndrome; salivary glands; ultrasonography; sialography; salivary gland scintigraphy; diagnosis KeyWords Plus: COLOR DOPPLER SONOGRAPHY; PAROTID SIALOGRAPHY; CLASSIFICATION CRITERIA; DIAGNOSTIC-CRITERIA; SICCA SYNDROME; BIOPSY; ECHOGRAPHY Reprint Address: Salaffi, F (reprint author), Univ Politecn Marche, Cattedra Reumatol, Via Colli 52, Ancona, Italy Addresses:
1. Polytechn Univ Marche Reg, Dept Rheumatol, Ancona, Italy
2. Polytechn Univ Marche Reg, Dept Radiol, Ancona, Italy
3. Univ Rome, Rheumatol Unit Sapienza, Rome, Italy
4. Univ Perugia, Dept Clin & Expt Med, Rheumatol Unit, I-06100 Perugia, Italy
5. Univ Padua, Dept Clin & Expt Med, Rheumatol Unit, Padua, Italy
6. Polytechn Univ Marche Reg, Dept Neuroradiol, Ancona, Italy E-mail Address: [email protected] Publisher: OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND Web of Science Category: Rheumatology Subject Area: Rheumatology IDS Number: 328GU ISSN: 1462-032
Joint and bone assessment in hand osteoarthritis
No full textHand osteoarthritis (OA) is a common disease frequently affecting middle-aged women. Prevalence estimates for OA vary widely depending on the age and sex of the population studied, the assessment tools used, and the specific joint sites analyzed OA is characterized by the degradation of articular cartilage, subchondral bone changes and osteophyte formation at the joint margins leading to joint failure. The pathogenesis of the disease and its evolution are multifactorial involving biomechanical, metabolic, hormonal, and genetic factors. Moreover, the role of inflammation has recently been advanced as pivotal in OA onset and progression. In particular, an uncommon variant of hand OA, erosive hand OA, is characterized by inflammatory and degenerative interphalangeal proximal and distal joints. The diagnosis of different types of hand OA is centered on clinical and laboratory investigations which can distinguish the peculiar aspects of these forms. Joint and bone assessments in hand OA are widely studied but there is no agreement with regard to established parameters to make a definitive diagnosis. This report focuses on the laboratory and clinimetric assessments that can be used to distinguish hand OA subtypes and addresses the debatable association with low bone mineral density in osteoporosis
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